Dáil Éireann díospóireacht -
Wednesday, 11 Nov 1998

Vol. 496 No. 4

Adjournment Debate. - Orthopaedic Services.

Mr. Alyward

; I thank the Minister of State for coming into the House to reply to this matter. I thank the Minister, Deputy Cowen, also for sending representatives to meet members of the South Eastern Health Board at my request.

When rumours first circulated regarding the imminent closure of the orthopaedic hospital in Kilcreene, my immediate concern was for the patients and staff of the hospital. Some time ago the South Eastern Health Board decided on a three year programme under which the orthopaedic hospital in Kilcreene would be closed down, elective surgery would be transferred to Waterford Regional Hospital and trauma services would be carried out in St. Luke's General Hospital, Kilkenny.

The staff of the hospital met with the chief executive officer on Friday, 5 December 1997 to discuss the proposals for Kilcreene Hospital, that is, the sale of the hospital and the transfer of services. He reassured the staff that contracts of employment would not change; equal status would be given to posts in Kilkenny city applying to both temporary and permanent staff; theatre staff would be accommodated at St. Luke's Hospital in Kilkenny; redeployment of staff would not take place until the new unit was ready at St. Luke's Hospital and refresher courses and training would be provided for staff. Unfortunately, following a recent visit by senior management of the South Eastern Health Board, it was indicated that this programme had changed.

I am concerned that there should be any consideration to close the orthopaedic hospital in Kilcreene which is located on a beautiful site. The hospital has an excellent record of achievement. Compared to similar hospitals in a stand alone situation like Cappagh, the orthopaedic hospital in Kilcreene could be just as good if it had the same medical back-up.

When one considers the improvements carried out in the orthopaedic hospital in Kilcreene in recent years, the question must be asked if we are getting value for money. I am aware that major works have been carried out in the orthopaedic hospital over recent years. The kitchen has been fully outfitted, a new pharmacy and elaborate computer centre were provided, a clinic has been refurbished at a cost of £250,000 and the canteen has been reconstructed. That money was spent at a time when people were deciding that the future of the hospital was no longer viable and that it would close.

I attended a public function with the then Minister for Health, Deputy Noonan, who came to Kilkenny to open the orthopaedic clean air theatre at St. Luke's Hospital, which cost in excess of £1 million. That theatre remains locked up today and there are questions to be asked in that regard.

I want to pose some other questions in relation to the orthopaedic hospital. A total of £100,000 of maintenance money was allocated earlier this year which has not been spent. That money should have been spent during the month of August when most of the ward closures occurred. It has not been spent and that is a deliberate attempt to run down the hospital.

I ask the Minister to investigate the questions I have raised and ensure that answers are provided. Furthermore, will the Minister of State indicate the number of operations that have been carried out in the hospital since 1 September? How many public and private operations were carried out by the seven consultants attached to this regional hospital? How many patients are on the waiting lists? Are we getting value for money? I hope some of these questions will be answered in detail and that the Minister will send his representatives again to investigate the future viability of the orthopaedic hospital in Kilcreene. On behalf of the staff and patients I invite the Minister to visit the hospital because I am not satisfied it has got a fair deal in the proposals that have been put forward.

Minister of State at the Department of Health and Children (Dr. Moffatt)

I welcome the opportunity provided by Deputy Aylward to address the House this evening on future proposals for the Lourdes Orthopaedic Hospital at Kilcreene, Kilkenny, and acknowledge the Deputy's interest in this issue. As the Deputy is aware, the provision of orthopaedic services is a matter for the South Eastern Health Board in the first instance. In this context, the House will be aware that in September 1997 the board unanimously adopted a plan for the Kilkenny Hospital system that involved the rationalisation of all hospital services in Kilkenny city onto the St. Luke's Hospital site. This plan involved the development of existing services in St. Luke's; the addition of new specialities of acute psychiatry, paediatrics and geriatrics, including a long-stay unit; the further development of community services and the provision of a community hospital to support the acute hospital.

A central element of this plan for the development of an integrated hospital service for Counties Kilkenny and Carlow involves the transfer of elective orthopaedics from Kilcreene to Waterford Regional Hospital. This is in line with the conclusions of a major review of orthopaedic services in the region completed in 1992 by a joint Department of Health-Comhairle na nOspidéal expert review group. The review group concluded that:

"in the best interests of patient care, elective orthopaedics in the South Eastern Health Board region should be centralised in Waterford Regional Hospital, which is being developed as the flagship hospital and tertiary referral centre for the health board area. . . the review group is convinced that an opportunity now exists to dramatically improve the orthopaedic service to the people of the South East by centralising both the trauma and elective services at Waterford Regional Hospital.

I note that Deputy Aylward disagreed with some of the findings and this may give us an opportunity to review the situation in light of what he has been saying about the operation of the orthopaedic unit in Kilcreene.

The full implementation of the Kilkenny Hospital Plan will require progress on a number of fronts. Central among these is the need to provide suitable accommodation at Waterford Regional Hospital for the transfer of elective orthopaedic services there. In view of the complexities inherent in co-ordinating the implementation of the plan, a planning group, involving officials, medical and nursing staff of the South Eastern Health Board and officials of my Department, has now been established to draw up an implementation timetable, a priority list for the developments and to work on costings. I understand this group will meet on 24 November and it is hoped it will have completed its work by early 1999 with a view to establishing a project team or teams by May 1999.

In tandem with this, I understand that a joint management-unions group has also been established to develop career options and provide career guidance, advice and training, as necessary, for nurses and other staff at Kilcreene who will be affected by the impending changes. In the meantime, elective orthopaedic procedures will continue to be performed at the hospital while this process of phased implementation, in consultation with all relevant interests, is under way. As the Deputy said, this may provide an opportunity for us to consider the cost effectiveness of the operation.

In this context, the South Eastern Health Board is conscious of the short-term infrastructural needs of the hospital pending the full transfer of services under the Kilkenny plan.

I understand the board approved the expenditure of a sum of £100,000 on ongoing maintenance works at the hospital at its June 1998 meeting and the board is now progressing these much needed works with the appointment of a contractor this week.

Ultimately, the overriding aim is to ensure that the transfer of services from Kilcreene is achieved in a structured and workable manner that best serves the interests of both patients and staff.

The Minister is confident that the planning work now under way can achieve this to the benefit of health providers and users in the south eastern region. As I have said, in view of the strong representations made by Deputy Aylward on the financial viability of both hospitals, we will look again at this problem.