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Hospital Services.

Dáil Éireann Debate, Wednesday - 3 March 2004

Wednesday, 3 March 2004

Questions (15)

Liam Twomey

Question:

92 Dr. Twomey asked the Minister for Health and Children his views on a report compiled by the ERHA detailing the use of elective beds in acute hospitals by patients who were not resident within the region; and if he will focus his views on the SEHB region. [7123/04]

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Oral answers (12 contributions)

I presume the Deputy is referring to a report compiled by the Eastern Regional Health Authority and presented to its board last year. The report dealt with the extent of referrals of elective patients resident outside of the region to hospitals in the eastern region. The report concluded that protocols were required in the referral of patients from other health board areas for elective services in hospitals in the eastern region.

Analysis also carried out in 2003 by the South Eastern Health Board found that approximately 60% of elective patients from the south-east who are referred to the eastern region each year come from the counties of Wexford and Carlow. Such use of eastern region facilities may reflect individual choice or perhaps the traditional referral patterns of local GPs. The case mix analysis carried out by the South Eastern Health Board demonstrates that the complexity of the South Eastern Health Board residents receiving treatment in the east is of a higher complexity than those of the ERHA.

The proportion of South Eastern Health Board residents being admitted to hospitals in the eastern region has decreased in recent years. This has come about as a result of the development of specialist regional services. This development of regional services in the south-east is reflected in the 30% increase in consultant posts in the period 1999 to 2004.

Successive Governments have pursued a policy of regional self-sufficiency in the provision of hospital services to ensure that patients are in a better position to access services locally. The benefits of this policy are evident through a series of major infrastructural developments in hospitals around the country, which has resulted in the availability of more services and new specialities on a regional basis. However, for reasons of complexity, a number of specialised services are concentrated in the eastern region. The ERHA has acknowledged that the referral of patients from outside the region to avail of tertiary and super-regional services in the eastern region remains appropriate given the range and specialised nature of the services provided.

In this regard, my Department has been informed by the authority that it intends to have discussions with hospitals in the eastern region and other health boards during 2004 with a view to the implementation of protocols regarding referral of patients from outside the region. The intention is to secure greater transparency, agreement and understanding of the referral process for utilisation of services in the east. The South Eastern Health Board will, therefore, have the opportunity of discussing and agreeing protocols for referral of patients from the south-east to specialist services in the eastern region. Having regard to the potential service and budgetary implications of any change in traditional referral patterns, my Department has requested the ERHA to inform the Department before any revised protocols are implemented.

The Minister indicated he believed there is a natural inclination for patients to go to the hospitals in the ERHA region. In some respects this is because the services are still not available in the south-east. The number of in-patient beds in the ERHA region occupied by patients from the South Eastern Health Board region reduced from 15% to 11%. There has been no corresponding increase in the South Eastern Health Board budget to reflect that it is doing more work in the south-east and it remains the second lowest per capita budget in the country.

Why are more than half the consultants appointed to the ERHA? There is a deficit in the services that need to be provided in the south-east. While the Minister said the number of consultants appointed to the south-east has increased there are considerable deficits in the service.

The Minister mentioned that some patients still go to Dublin. In the south-east it takes five years to get regional services such as an ENT or orthopaedic out-patient appointment. The South Eastern Health Board has the perfect structure with a regional hospital and a number of local hospitals working around it. It is not working as efficiently as we would like because of insufficient funding. It is not a question of the Hanly report and all the silly recommendations coming from that. For instance, the Hanly report did not refer to the tertiary services offered by Dublin hospitals to any great extent, considering the cost involved.

Does the Minister not believe we should start to appoint consultants in the south-east to embed these services in the south eastern region so that we have some hope of providing the services for the 400,000 patients in the region? I would like a commitment from the Minister to increase the funding to the South Eastern Health Board region. The presentation to the Oireachtas Joint Committee on Health and Children last Friday made it clear that the South Eastern Health Board is very efficient in dealing with the money it receives. However, it is also aware that huge capital expenditure will be required because its buildings are becoming run down. In the Dublin region there are too many consultants and not enough beds. Outside that major region there is a deficiency of consultant numbers. That is the problem with the Hanly report. Unfortunately there seems to be a sense that the best way of complying with the European Working Time Directive is not to bother with the consultants' contracts but instead to withdraw services from hospitals, such as the hospital I support, Wexford General Hospital. There should be a way around the directive which does not require the radical closing of services proposed by Hanly.

This is not the time to go into this. I am much more interested in hearing the Minister's views on why the South Eastern Health Board, no matter what it does, still seems to receive a poor share of resources, despite all the talk of equality.

There are elements of contradictory commentary in terms of what should happen in the south-east. Much of what the Deputy has said is what the Hanly report is about, namely, regional self-sufficiency and a dramatic increase in the number of consultants in the region. I support that. The essence of the Hanly report is to move from a consultant-led to a consultant-provided service. In the mid-west, for example, it is estimated that the number of consultants will be doubled. The same will probably happen in the south-east although the region has not been examined yet. That is ultimately the way to take a number of services back to the east.

At one level there has been a decrease in the traffic going to Dublin from the south-east, especially since the appointment of consultants in oncology, rheumatology haematology, nathology and dermatology. More cardiologists will be coming on board. All that has succeeded in bringing many services back within the geographic areas of the south-east which perhaps heretofore were located in Dublin. There has been an improvement.

That said, there is still evidence of high rates of referral to the east for routine treatments which are available in local health board areas as a result of significant development of services. I could give some statistics regarding the numbers of patients who are still travelling. Some people are still travelling for routine treatments which are available within the south-east. However, in the areas to which I referred, especially oncology, there has been a significant reduction in traffic to the east because of the appointment of additional consultants. Since 1999 about 35 additional consultants have been appointed to the south-east.

We should engage. We are not interested in downgrading services in the south-east. Leaving elections out of the equation, the issue is how to make the region as self-sufficient as possible in terms of consultant manpower, which means additional specialties and strong critical mass in those specialties. This will ultimately mean that the majority of people will be treated in their own region. That is what I am about.

I agree with those sentiments.

We have exceeded the allotted time.

The best way to implement Hanly is to recruit consultants and provide services because patients drift towards where the quality service is available.

We are way over the time limit.

Our argument throughout the debate since I was elected to this House and since the Hanly report was published in September has always been about the report's approach towards acute services, not towards what we are talking about here on which we are in agreement.

It is related. There will be no diminution of acute services.

Of course there will be. That is rubbish. The Hanly report spells it out and the Minister accepted it. The Minister is misleading the House.

There will not.

Tell it to the marines.

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