Seanad Éireann debate -
Thursday, 8 Jul 2010

Vol. 204 No. 3

Health Services

Senator Jerry Buttimer

I thank the Cathaoirleach for allowing me to raise this Adjournment matter regarding the reconfiguration process in the HSE South area. This concerns the region's acute hospital service. As the Minister of State will know well, a process is under way under the stewardship of Professor John Higgins. It is my view that the HSE is not communicating or making information available, although clarification is required on a number of topics, including the status of the accident and emergency departments in the Mercy University Hospital, the South Infirmary-Victoria Hospital, the transfer of services, the issue of community hospitals and the role of St Mary's Orthopaedic Hospital.

There has been a profound impact on acute hospital services in the Cork-Kerry region. The reconfiguration process must be carried out in an open and transparent manner and it is for that reason I tabled this matter. As I understand it, a special and secret committee is being established in an advisory capacity. Its terms of reference are not clear and were not published when the committee was established. I stress I do not question the composition or membership of the committee and in no way do I wish to impugn the integrity of the members. However, the board is comprised of developers and medics. There was no public notification or ratification process and, to my knowledge, no selection or interview procedure for the membership. In many ways it could be viewed as self-nominating. Is there a conflict of interest? I stress again I do not question the bona fides of the members of the committee.

A number of other fundamental questions arise. What process was put in place to ensure there was no conflict of interest? Was the Minister for Health and Children aware of the establishment of this advisory board? Why were the terms of reference not set out until March 2010 when the board was established in September 2009? In addition, the board has a gender imbalance in that there is no female member. Although I am not a spokesperson for County Kerry there is no representative of the county on the board. There is no patient advocacy representative and no public representative although there is a HSE southern forum comprising councillors of all political parties and none. Ironically, the board has access to the highest level up to and including the chief executive officer but there are a dozen or so committees under the reconfiguration process which do not have the same level of access.

I ask the Minister of State in his reply to clarify the points I raised. I hope there will be increased representation on the board to take on board the groups I mentioned and that there will be a more open and transparent process regarding this. I reiterate I do not question in any way the integrity or the personnel but the presentation of the board on the part of the HSE and the Department needs to be more honest.

Deputy Dara Calleary

I am taking this Adjournment matter on behalf of the Minister for Health and Children, Deputy Harney. As the House is aware, patient safety is central to the delivery of health services. Ensuring patient safety is of paramount importance so people can have confidence in the care they receive and achieve the best possible health outcomes. The overwhelming consensus among clinical experts is that demonstrably better outcomes, as seen in cancer care, are achieved for patients if delivery of complex care takes places where the necessary staff and equipment are available and where there are sufficient volumes of activity. To achieve better outcomes for patients, the acute hospital system needs to change fundamentally the types of service it delivers to our communities and how those services are delivered. The reconfiguration of services in counties Cork and Kerry, when implemented, will produce an improved service, with clinical benefits for patients and treatment of the highest standard. The HSE's work on the reconfiguration of acute hospital services in counties Cork and Kerry is informed by the principles enunciated in the Teamwork review of services in the region as well as by an extensive consultation process with stakeholder interests.

In early 2009 a group of individuals from the business, education and health care fields expressed to the HSE an interest in supporting the executive's work in regard to the delivery of acute hospital services in the region. Arising from this and after discussions between the parties, a non-executive advisory board was established in September 2009. This board has 17 members and includes persons from academia, professional practice and non-HSE hospitals. Its purpose is to support and advise the HSE, as appropriate, in regard to the reconfiguration of acute hospital services in the region and to bring practical experience to bear from outside the health field. The advisory board members receive no remuneration for their participation and give of their time and advice voluntarily. The board is purely advisory and has no executive or decision-making functions. The Minister for Health and Children very much welcomes the fact that senior people from a range of disciplines are willing to offer a fresh perspective on important issues in health care and on how the challenges that reconfiguration poses might be addressed.

The reconfiguration process in counties Cork and Kerry is informed by a wide-ranging and comprehensive consultation process. This includes a regional reconfiguration forum which brings together clinical directors and health service managers as well as 40 clinical subgroups, with input from patient advocates, nursing, service staff, general practice, primary, community and continuing care and from University College Cork. The regional director of reconfiguration has also met public representatives regularly and has reported to the regional health forum. Specific initiatives, such as the introduction of advanced paramedics to west Cork, have been supported by a public information campaign that included direct interaction with community groups and public meetings. Nonetheless, in the light of a number of representations which it has received, the HSE is at present considering the possible extension of the membership of the advisory board to include additional representation of patients and the public.

The Minister looks forward to the continued engagement of the advisory board and all the other stakeholders in the development of arrangements which will ensure the provision of safe and sustainable hospital services for the people of Cork and Kerry into the future. I shall forward the Deputy's concerns about the gender make-up of the board directly to the Minister.

Senator Jerry Buttimer

I thank the Minister of State for his reply.

The Seanad adjourned at 8.10 p.m. until noon on Tuesday, 13 July 2010.