Dáil Éireann Debate, Thursday - 9 July 2015
11. Deputy Sean Fleming asked the Minister for Health if he will ensure that the emergency department at the Midland Regional Hospital in Portlaoise, County Laois continues to provide a 24-hour service; and if he will make a statement on the matter. [27571/15]
View answerWill the Minister ensure that the emergency department in the Midland Regional Hospital in Portlaoise continues to provide a 24-hour service?
I am committed to securing and further developing the role of Portlaoise hospital as a constituent hospital within the Dublin Midlands Hospital Group, which also includes St. James's, Tallaght, Tullamore, Naas and the Coombe hospitals.
The hospital group and the HSE acute hospitals division are examining the scope of services in Portlaoise, and other hospitals in the group, subsequent to the recent Health Information and Quality Authority, HIQA, report on the hospital. The important point here is that work is being undertaken to strengthen services in Portlaoise hospital from a patient safety and quality perspective and also to ensure that services that are viable are safety assured and appropriately resourced and that services that are not viable or cannot be made safe are discontinued.
Detailed planning is under way for staff to develop the best clinical services for all patients. Consultation is ongoing this month with the national clinical leads for medicine, surgery, critical care, patient transport, emergency medicine, obstetrics and paediatrics, as well as the national ambulance service. Further consultation with local general practitioners, GPs, is expected to begin this month and other stakeholders will also be engaged.
Decisions will be made on the basis of ensuring patient safety and getting best outcomes for patients, not financial or political considerations. Any change to services at Portlaoise, including emergency department services, will be undertaken in a planned and orderly manner and will take account of existing patient flows, demands in other hospitals and the need to develop particular services at Portlaoise in the context of overall service reorganisation within the hospital group.
I thank the Minister for that general reply. A number of public representatives met him in his office a few weeks ago and I thank him for meeting a bigger group that he may have thought would arrive on that occasion. He indicated then that he expected to have a report from the HSE within three or four weeks. Can he advise when he expects to receive it? He referred to planning, negotiations and consultations in his reply and that sounds as if it is a long way off yet and will not happen in the immediate future. He might indicate the timescale he envisages for this.
As the Minister said, consultation is taking place with the GPs. He will know that they issued a letter publicly on this issue in recent days and it is important that it be taken into account. We all agree that patient safety is the first and foremost issue and that quality of service and outcome for patients is the most important issue. The Minister spoke about the demands in other hospitals in the context of his consideration of the accident and emergency department in Portlaoise hospital. He must know that the accident and emergency departments in Naas and Tallaght hospitals are totally overcrowded, all the more reason to maintain the 24-hour service in Portlaoise hospital. We need adequate cover for that.
I am told now that a report will probably not be ready until sometime in September. That is down to the fact that so much consultation has to take place with everyone who is affected, not only the staff in the hospital but GPs in the area and, as the Deputy rightly pointed out, the impacts that this may have on other hospitals such as those in Naas, Tallaght and Tullamore. I am told it could be September before a plan of action will be ready. I have seen the letter from the Laois GPs. I was pleased to note they called for the HIQA report to be implemented but of course reports have to be implemented in full, not only the parts of them that one likes while leaving out the parts that one does not like.
Part of the under-six contract was that we made it a stipulation that anyone getting such a contract would have to be a member of a specialist register for general practitioners because we do not think it is acceptable that somebody who is not on the specialist register should work as a GP and treat children for their ailments. Yet we do see it as acceptable in Ireland that we can staff emergency departments with people who are not on the specialist register for emergency medicine. It is an issue up and down the country that we allow so many of our centres not to be staffed with specialists. The reality is that there may not be sufficient specialists available to staff them all with specialists. Therefore, are we willing to accept an inferior level of care?
I understand and appreciate the issues and we all acknowledge the HIQA report. I believe the Minister accepts that people locally welcome the improvements in the maternity services that have flown from the HIQA report. Essentially, we want the same level of determination to be shown to make the accident and emergency service safe. If the HSE and HIQA cannot stand over it being safe, the issue is to make it safe; the issue is not to close it, or close it for half of the day or half of the 24 hour period. The Minister will be aware that between 25% and one third of admissions to the accident and emergency department are paediatric cases as a result of the large paediatric unit, and the maternity services, in the hospital. To ensure that the hospital works fully, it is essential that it has permanent consultant cover. I do not believe there is a permanent consultant covering the accident and emergency department in Portlaoise and that is a central issue that must be addressed.
I had tabled a similar question. The key issue is consultant cover. Having met the Minister and discussed that issue with him, and I thank him for the meeting with the public representatives from the County Laois area, he will be aware of that. Portlaoise hospital has only 24 hours per week temporary, part-time consultant cover. That is not satisfactory, and the GPs have gone to great lengths to explain that. In terms of throughput over the years, Portlaoise hospital had 38,000 attendances through its emergency department while Tullamore hospital had, on average, about two thirds of that figure. The general practitioners have outlined clearly the interdependency of the other important parts of the hospital, including the maternity and paediatric services, on the emergency department. Its paediatric unit is very busy and is one of the top eight in the country. I ask the Minister to take that into consideration in his deliberations.
Thank you, Deputy. We are over time.
I hope that the GPs' letter and the report will be given favourable consideration.
We all need to consider this one carefully because we have to ask ourselves what consultant cover actually means. We have very large emergency departments in this country with four and five emergency department consultants who are not in the departments after 6 o'clock or 8 o'clock at night. They are on-call from home or, in some cases, they will not cover weekends. Even with four or five consultants, either because of unwillingness or too onerous a rota, we do not have 24-7 consultant cover. I am not sure we have that in any emergency department in Ireland; they are probably on-call from home.
We have only a limited number of specialists, and we have to consider the level of patient safety risks we are willing to accept. If it is not possible to recruit people to cover a special service 24-7, or if there are not enough patients for them to keep up their skills in which case they cease to become specialists, we have to decide if we are unwilling to accept an inferior and non-specialist service just because it is local, and that is not particular to Portlaoise as it also applies elsewhere. One of the big struggles that will happen in Portlaoise is hiring the additional consultants for obstetrics and paediatrics. We need those additional consultants in obstetrics and paediatrics to ensure there is senior cover in that unit, but what if we cannot recruit them? We have serious difficulties recruiting people. The Rotunda hospital advertised two jobs not that long ago and did not get any applicants. We need to have a very serious conversation with the public as to what we do if it is not possible to staff units with specialists. Are we willing to accept an inferior service on that basis?
