Tuesday, 12 April 2011

Questions (15, 16, 17, 18, 19, 20, 21)

Denis Naughten


36 Deputy Denis Naughten asked the Minister for Health and Children the position regarding his review of the Health Service Executive reconfiguration process for acute hospitals; and if he will make a statement on the matter. [7392/11]

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Caoimhghín Ó Caoláin


47 Deputy Caoimhghín Ó Caoláin asked the Minister for Health and Children if he will bring forward new plans for hospital configuration in the north-east region and in other regions. [7531/11]

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Seamus Healy


54 Deputy Seamus Healy asked the Minister for Health and Children further to his announcement of a review of the general hospital reconfiguration process, the nature of the proposed review; its terms of reference; the persons who will carry out the review; the involvement of all stakeholders including staff, patients, service users and the public; the timescale involved; and if he will make a statement on the matter. [7495/11]

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Peadar Tóibín


66 Deputy Peadar Tóibín asked the Minister for Health and Children his plans to restore any or all of the services cut from Our Lady’s Hospital, Navan, County Meath; and if he will make a statement on the matter. [7535/11]

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Gerry Adams


71 Deputy Gerry Adams asked the Minister for Health and Children his plans to restore any or all of the services cut from Louth County Hospital, Dundalk; and if he will make a statement on the matter. [7533/11]

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Michael Colreavy


76 Deputy Michael Colreavy asked the Minister for Health and Children if he will restore any or all of the services cut from Sligo General Hospital; and if he will make a statement on the matter. [7553/11]

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Jerry Buttimer


376 Deputy Jerry Buttimer asked the Minister for Health and Children the timeframe surrounding the reconfiguration process that is intended to take place in Health Service Executive south. [7430/11]

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Oral answers (18 contributions) (Question to Minister for Health)

I propose to take Questions Nos. 36, 47, 54, 66, 71, 76 and 376 together.

I am committed to ensuring that acute hospital services at national, regional and local level are provided in a clinically appropriate and efficient manner. In particular, I wish to ensure that as many services as possible can be provided safely in smaller, local hospitals. To fully consider the issues involved, I am being briefed by my Department and the Health Service Executive, HSE, on the organisation of acute services in each region and on the important clinical programmes being developed by the HSE. These inter-related programmes aim to improve service quality, effectiveness and patient access and to ensure that patient care is provided in the service setting most appropriate to individuals' needs. The aim is to ensure that patients receive treatment in the most timely, cost-effective fashion that is safe and as close to home as possible.

I am very impressed with the work done by Dr. Barry White and his colleagues in developing these programmes. I have already had several discussions with him about how best to ensure that they are implemented. I have also made it clear that patient safety must be the overriding priority. I want patients to be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible.

I also want to be briefed by the HSE before any further services are withdrawn from individual hospitals. The Secretary General of my Department has written to the CEO of the HSE asking him to make the necessary arrangements.

I congratulate the Minister on his appointment and wish him well in his new role. He has an understanding of the issues affecting small local hospitals.

Patient safety must be the main priority. Does the Minister not agree that transporting patients for hours from small local hospitals that could treat them to regional super-centres, as have been proposed to date, is not necessarily the best approach in that it puts lives at risk? Will the Minister clarify the direction that has been given to the HSE on the roll-out of the reconfiguration process and the implications it will have for small hospitals from 1 July, bearing in mind the appointment of non-consultant hospital doctors in the new rotation and, specifically, the non-training posts? This issue should be addressed immediately with reference to the regional structure rather than leaving hospitals in a dire predicament from 1 July.

I certainly agree with my colleague Deputy Naughten in regard to transportation or forcing people to travel without providing transport. It is not wise or cost effective to transport patients to have treatments that could and should be available in the local hospitals. This is certainly an area we are examining very closely. As I said to Deputy Ó Caoláin in respect of Monaghan hospital, many more facilities and treatments could be provided at the hospitals in question; they are being under-utilised. They not only could, but will, be a key part of our drive to address the waiting times many citizens must endure before obtaining the treatment they have been recommended.

I congratulate the Minister on his appointment and wish him well.

Will the Minister confirm that the hospital reconfiguration programme is parked and that an instruction to this effect has been accepted by the HSE officials? I was disappointed that the Minister did not set out in his reply the detail of the process. When does he envisage that the review process will commence? How will it be carried out and by whom? Will all stakeholders be involved?

I thank Deputy Healy. The review will be carried out by officials in my Department. I certainly want to be made aware of any withdrawal of service because I want the impact of any such withdrawal to be assessed fully. I do not want a recurrence of circumstances in which services are withdrawn on the promise that they will be replaced by new ones at a regional centre, only to have that promise not met. I have requested that there be no further withdrawal.

To say reconfiguration has ceased is untrue because it has not. Some parts of the reconfiguration process do not entail the withdrawal of services. I have no issue with these proceeding although we are reviewing the very nature of what we are trying to achieve. The health service is taking a new direction and we have made that very clear. I am very pleased with the appetite for change, both in the Department of Health and the Health Services Executive.

I want to refer to the Minister's earlier reply. In the hope of having an accurate record, will he revisit his statement that he is an advocate of co-location? I know he was only referring to the National Children's Hospital in regard to the Mater site, for example; I do not believe he has made a volte-face in regard to co-location. He should clarify this for the record in case some scribe picks up on it such that it will be the story we read tomorrow.

On Question No. 47, specifically with regard to HSE Dublin North East, with which the Minister is very familiar, can he indicate whether there are new plans for hospital reconfiguration in the north east against the backdrop of his knowledge of and exposure to the inadequacies and failures of the approach employed by a series of three Fianna Fáil-led Administrations since 1997? His substantive reply did not indicate this.

To confirm for the House and any scribe who might be interested, when I referred to my support for co-location I was referring to the location of a children's hospital next to an adult hospital, not to what might have been construed as a co-location policy of placing private hospitals on the grounds of public hospitals.

I am protecting the Minister's back already.

I really do appreciate that.

With regard to new plans for reconfiguration, we will reconsider the overall picture in terms of re-structuring the health service to deliver for patients in a timely fashion as near to their homes as possible, and also in a far more sensible fashion for us. The idea that somebody would go to a tertiary hospital such as Beaumont or the Mater for treatment for varicose veins, gall bladder surgery or hernia repair is akin to taking a ten-year-old Volkswagen to the Ferrari testing centre for a service. The latter would surely do a wonderful job but it would not comprise an appropriate use of resources. If people avail of the services of the county hospitals for the procedures in question, not alone will they be very pleased with the outcome, they will find their overall experience far more pleasant in that they will be away from the hustle and bustle and chaotic atmospheres of the larger hospitals. We will seek to address the latter issue because, in fairness to the larger hospitals, they are trying to do the impossible, very often with limited resources. I have no problem putting that on the record and seeking further rationalisation of our resources in respect of the sorts of conditions we treat. I refer to the number of people who end up in hospitals for treatment that could possibly take place in a primary care environment.

In the context of reconfiguration, the Minister has requested a review of the transfer of orthopaedic services from St. Mary's Orthopaedic Hospital to the South Infirmary Victoria University Hospital in Cork. Why has work not ceased on the construction of theatres in the latter hospital and on the transfer of services thereto while the review is being carried out? If the review recommends that the services remain where they are, what will be the position on the two theatres built in the South Infirmary Victoria University Hospital? Was the commitment just a commitment by a deputy leader so as to appear slightly enthusiastic during the election campaign?

On the same matter, will the Minister confirm whether the orthopaedic services review has started? If it has, how long will it take? When can a decision be made on whether the services will be transferred?

The review is ongoing. My understanding is that the transfer of services is not continuing and has ceased. The building may well be in the process of being built but it may be put to many different uses. The fact that building is continuing and a contract has been entered into does not indicate the end use will be as first proposed. I am not saying the proposed use may not be the end use but this does not mean it will be either. I am not in a position to give a timeline for the review. It will only be a matter of months; it will not take a year. The Deputy need not worry in that regard.

That is like saying we will build a house and not use it as a house.

With regard to reconfiguration and acute hospitals, there is in Tallaght an adult and children's accident and emergency unit. The unit in Tallaght is probably the busiest in the country and I believe it had 77,000 admissions last year. One of the problems with adult accident and emergency departments is a lack of beds and this is causing many of the bottlenecks in the hospital system. With regard to the service for children, current policy means that on the south side of Dublin we will be left with no beds for sick children. Will this be part of the review process? It is daft that sick children will not have overnight beds on the south side of Dublin.

To answer the latter question first, the review relates to the provision of the new hospital at the Mater Hospital. I do not think it will include the present situation at Tallaght Hospital. With regard to adult services, I am loth to give an answer to the question without having studied the situation. There may be a bed capacity issue, however there are also managerial issues at Tallaght Hospital which must be addressed and this is what is being examined at present. As in several of our major hospitals, issues arise on how discharges happen, how patients are assessed, how long patients are in hospital before their procedures are carried out and how long they remain in hospital after the procedure has been carried out. There is a host of issues around this. I will leave the door open on this as I do not have the answer for the Deputy on whether the problem in Tallaght Hospital has to do with bed capacity or use of the beds, or issues to do with management, as I know issues arise with regard to this.

I congratulate the Minister on his appointment. With regard to configuration, in advance of the general election the people of Roscommon and south Leitrim were made promises on the future of Roscommon and Portiuncula hospitals. It was stated that services existing at the time of the election would be maintained and enhanced. Given that a few promises made to people in my constituency have been broken in recent days I wonder whether the Minister will stick by this one.

With regard to services at Portiuncula and Roscommon hospitals and based on the Minister's previous response, will he clarify that existing services will be maintained and that we will examine providing additional services at both hospitals? In this context, I wish to bring to the Minister's attention an issue that needs to be addressed, namely, the situation regarding non-consultant hospital doctors at Roscommon County Hospital. The hospital has a projected spend on agency staff of approximately €4 million by the end of year, which is more than one quarter of the hospital's budget. Will the Minister assure us he will investigate this issue?

The issue of non-consultant hospital doctor numbers in our hospitals is one that creates a major difficulty for us and is being addressed in a fairly aggressive fashion at present through recruitment from abroad to make up the shortfall. There is every reason to believe this will be successful. Part of the problem with regard to non-consultant hospital doctors is with regard to their training. Sometimes they prefer to see on their curriculum vitae the names of large regional hospitals rather than smaller hospitals. One of the methods of dealing with this is an initiative undertaken by Dr. John Higgins in Cork. Rather than joining a CUH surgery team, one joins a Cork, Kerry and south surgery team which allows people to be placed throughout the system and rotate through smaller hospitals as well as gain experience at bigger hospitals. Participants are always under the one training team of surgeons who also rotate through the hospitals. If this model were to be repeated in Roscommon it would go a long way to solving the problems we have.

Written Answers follow Adjournment Debate.