Léim ar aghaidh chuig an bpríomhábhar
Gnáthamharc

Dáil Éireann díospóireacht -
Wednesday, 28 Feb 2001

Vol. 531 No. 4

Other Questions. - Hospital Services.

Ruairí Quinn

Ceist:

26 Mr. Quinn asked the Minister for Health and Children if his attention has been drawn to a report from the Eastern Regional Health Authority showing that as much as 22% of theatre time in hospitals in that region is not being used, largely as a result of staff shortages; the steps being taken to ensure the optimum use of all theatre facilities; and if he will make a statement on the matter. [5972/01]

I am advised by the Eastern Regional Health Authority, ERHA, that the report referred to by the Deputy was completed in April 2000. Actual theatre utilisation was compared with that achievable if theatres were operated for five full days per week.

The main reason cited for lost theatre time was the shortage of trained personnel, particularly theatre nurses. Other factors which can give rise to under-utilisation of theatres include seasonal pressures which may lead to an increase in acute medical admissions at the expense of elective surgery and capacity constraints in other areas of the hospital, for example, ward accommodation and intensive care unit, ICU, facilities, leading to the unavailability of beds where patients can be transferred post – operatively. It should be recognised, however, that a number of hospitals have in recent years achieved significant productivity gains in the utilisation of available theatres.

The theatre utilisation survey formed an important element of the wider analysis undertaken by the ERHA of capacity constraints within acute hospitals. Underpinning this analysis has been a whole system approach which recognises the fact that service pressures in certain parts of the acute and non-acute sectors can give rise to difficulties in appropriately utilising existing capacity. This approach is essential in tar geting investment in order to achieve maximum patient benefit and efficiency throughout the continuum of health and social care. This system analysis has been set out by the ERHA in its recently completed bed capacity review. This review will inform the national review of bed capacity which will be completed shortly.

In co-operation with hospitals throughout the region the ERHA is addressing the management of how theatre time is planned, allocated and utilised by different specialities. The shortage of key hospital staff is being tackled on a number of fronts, including the operation, with good effect, of international recruitment campaigns. The ERHA is continuing to work closely with hospitals and other agencies to retain and recruit key staff. Recent figures available to my Department indicate that the shortages in Beaumont Hospital have reduced to ten from 110 in September 2000. Overall, 750 nurses have been recruited since the commencement of the international recruitment drive. I am informed by the ERHA that the wider factors impacting on theatre utilisation such as the management of acute medical admissions, early discharge planning and improved access to appropriate facilities are also being addressed within the region.

Is the Minister aware that a senior consultant recently stated that surgeons are banging on the doors of theatres out of frustration at not being able to use them and that there is a serious problem as to their use? The report was completed in April 2000. Rather than give us a wide-ranging and not very informative report, will the Minister recognise that it is a clear indictment of the failure of the Government to address the problems in our hospitals? Does he accept that staffing shortages have not been addressed and that blood shortages have, in part, led to the closure of operating theatres? I can cite two hospitals in Galway as examples.

I will outline the up-to-date position for the Deputy.

The surgical and gynaecological theatres have been closed in certain hospitals leading to the deferral of 39 procedures in one hospital. This is a record.

The Deputy is engaging in polemic rather than asking questions. It is unfair to suggest that no effort has been made to tackle the the issue of staff shortages.

It is not working.

It is working. Huge efforts have been made to recruit nurses in particular.

If the Minister addresses his remarks through the Chair he might not invite interruptions.

Enormous efforts have been made in the past 12 months to tackle the issue of nurse shortages through international recruitment, the record increase in the number of placements for trainee nurses, the retention and education initiatives, particularly for theatre nurses in terms of the payment of fees and salary while undergoing courses and so on. If anyone can come up with an idea which we have not tried or pursued in partnership with the Nursing Alliance and others, I would like to hear it. We have left no stone unturned in our efforts to recruit the extra nurses needed due to the decision taken in the early 1990s to reduce the number of nurse training places. It is a problem I inherited and one I have moved to solve. I have also taken unprecedented steps to resolve the junior doctors issue.

Is the Minister aware that earlier this week a consultant at St. James's hospital resigned from the board of the hospital because he could no longer stand over the mess that was the accident and emergency department? Does he agree that this, taken with the shortage of theatres over which he has presided, is a clear indication that if Mr. Cromien was asked to inquire into his leadership at the Department of Health and Children, he would make the same finding that he made in respect of the Department of Education and Science of incompetent administration? What does the Minister have to say about this unprecedented crisis where theatres remain unused and consultants resign from boards at a time when there are unprecedented amounts of taxpayers' money available?

Is the Minister conceding that the initiatives taken in the past 12 months are not working? We listen to doctors and patients daily. I was contacted this morning by a patient from Mayo who had to be sent home from Galway as there was nobody available to deal with him. This is outrageous.

Will the Minister acknowledge that he is misleading the House? Is he aware that there is more than an adequate supply of registered nurses and that it is his failure to retain nurses within the health service and to ensure nurses are attracted back by favourable conditions has led to the crisis? Does he accept that this is cold comfort to somebody whose operation has been cancelled, even though a theatre is available, due to the failure of the Government to deal with the problems in our hospitals?

I reject the strong party political element of the attacks which bear no relation to the facts and are completely inaccurate. Given that retention has correctly been identified as a key issue, I was the first Minister, in the autumn of last year, to develop new flexible arrangements and a comprehensive back-to-nursing initiative for those on the register to enable them to return to nursing. We have introduced the concept of permanent part-time nursing where after a period of eight hours a nurse becomes entitled to superannuation and so forth. No other Government ever attempted to do this. Working with the Nursing Alliance, I have been keen to introduce family-friendly policies for nurses and provide funding for the implementation of measures to enable nurses follow career paths—

What about patients?

We need nurses for patients.

(Interruptions.)

Why is the position so bad?

I have had to listen to four Members. I am entitled to have them listen to me.

It is the same old PR, with no action.

The said emergency consultant approached us some time back. The hospital also approached us in relation to its accident and emergency department and put forward an innovative programme. We took it on board immediately and provided £5 million for it. I cannot go out there and build the bricks in four or six months.

It is the Dáil which provides the money; the Minister provides the service.

Everyone knows it will take two years to provide that modern accident and emergency department.

The Dáil provides the money—

Deputy Mitchell, please allow the Minister to conclude.

In addition, 70 extra beds are due to be provided in the hospital.

The entire service has changed.

The man resigned because of the mess.

He did not write to the board; he wrote to me. He is entitled to do this but he should have written formally to the chairman who could then have approached me. This would have been the proper procedure.

He said it is a mess.

When I visited the accident and emergency department I was struck by the degree of lethargy in terms of the unenthusiastic embrac ing of the proposal and the resources I made available for it.

The consultant is correct – the Minister has made a mess of the medical service.

I call Question No. 27.

How many consultants have been appointed?

If Deputy McManus stops interrupting, I will take one supplementary question from her on Question 27.

On a point of order, will we not be allowed to ask a supplementary?

I am obliged at 4.15 p.m to move on to a Private Notice Question on foot and mouth disease.

Barr
Roinn