Dáil Éireann díospóireacht -
Tuesday, 15 Jun 2004

Vol. 587 No. 2

Adjournment Debate.

Hospital Services.

Mr. O’Dowd

On 2 June a group of 25 general practitioners in Drogheda wrote a letter to the Minister for Health and Children about their disquiet at the deterioration in the situation in Our Lady of Lourdes Hospital, Drogheda. The catchment area of the hospital has greatly expanded over the past few years due to a combination of circumstances including the increased population moving into the area, particularly as a result of rising house prices in Dublin; the transfer from other local hospitals in Dundalk, Cavan, Navan and Monaghan, of many of the services; the increase in workload with the arrival of asylum seekers; and the policy of increasing the range and number of specialist services on offer. Matters are at a crisis level in the hospital because of the basic lack of space and facilities to deal with the issues.

The doctors went on to say that these factors had increased the workload experienced by the hospital. Despite the heroic efforts of their consultant colleagues and all hospital staff, the situation is deteriorating year by year. The patients, consultants, hospital staff and general practitioners are totally frustrated at the inevitable chaos caused by the lack of planning. General practitioners are concerned that in the absence of a plan to either extend the hospital on its current site or to build a new hospital, lives are being put at risk.

They go on to state that the accident and emergency department is overcrowded and inadequate and dangerous when near full capacity. There is no space for proper X-ray facilities, not enough theatres to service the surgical teams and general practitioners do not have access to basic diagnostic and therapeutic tools such as physiotherapy. For example, urology appointments can take up to four years.

The doctors demand a commitment from the Department of Health and Children and I urge the Minister to respond to that demand. He should draw up a plan within the next six months outlining how this intolerable situation in our regional hospital will be addressed. The doctors need clear written proposals as to how the hospital will evolve over the next three years. They want hospital staff, consultants and general practitioners to work together to resolve the issue. The issue is clear. The Minister must act and support the demands of general practitioners.

Drogheda hospital is a centre of excellence and its staff are first class in every respect. The Minister and the health board have commissioned a survey on the issue. In response to a parliamentary question I asked today, the Minister replied that the North Eastern Health Board was appointing a design team to prepare a feasibility study for Our Lady of Lourdes Hospital, Drogheda, and that the purpose of the study was to identify the potential for future capital developments at the site.

I urge the Minister to ensure that the design team consults not just with the medical people but also with the local authority in Drogheda. Any extra land that needs to be rezoned to extend the hospital will be available. I spoke personally to the town clerk who informed me that the local authority is ready and willing to rezone whatever land is necessary to provide a regional facility, either adjacent to the existing site or within, adjacent to or around the borough of Drogheda.

The expansion of this hospital is important to the people of Drogheda and the region. It is also important that the hospital is not put on wheels and moved somewhere else. It is unsustainable that the hospital would move to a greenfield site in the middle of County Louth or County Meath. This would bring enormous pressure on road infrastructure and on the support services and supplies that would be needed. It is essential that the hospital expands, that it does so in south Louth and that the services so urgently needed are provided by the Government. If not, it will be at the Government's peril. I will make this an election issue for the next general election.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

The general election is some time away yet.

I make this reply on behalf of the Minister for Health and Children, Deputy Martin. I welcome the opportunity to clarify a number of issues relating to Our Lady of Lourdes Hospital, Drogheda. Responsibility for the provision of services at the hospital rests with the North Eastern Health Board. It is a matter for the board to determine the nature and level of service at the hospital, consistent with the board's commitment to the provision of a high-quality, efficient and cost-effective service.

The board has advised that its strategic objectives for the delivery of acute hospital services in the north-eastern region are derived from a number of regional and local policy initiatives including: a health strategy for the people of the north-east; the proposed development of specialist services in the NEHB from 2001 to 2006; the strategy for capital developments for the acute hospital services from 2001 to 2011; and the report of the regional maternity services review group of 2001.

These strategies set out the vision for the future direction of acute services in the north-eastern region. This is designed to meet the needs of the population of the region by providing appropriate services at each hospital, which satisfy the necessary criteria relating to each specialty. In summary, this policy networks the five hospital sites into two hospital groups, Cavan-Monaghan and Louth-Meath, with clearly defined roles for each group and site. It aims at expanding the range of specialist services available with a view to attaining regional self-sufficiency for an increasing population.

The overriding objective of this policy is to provide a safe and sustainable acute hospital service. With regard to Our Lady of Lourdes Hospital, Drogheda, the health board has advised that increases in hospital activity, partly attributable to demographic changes, have posed challenges in recent years. However, it must be emphasised that there have been a number of significant service developments introduced to meet these challenges. These include the appointment of additional consultants in emergency medicine, anaesthetics, haematology, dermatology, cardiology, surgery, orthopaedics and radiology. MRI services have been developed and a new oncology day service has been introduced.

The health board has also advised that the regional unit for symptomatic breast services and palliative care services has been commissioned in recent weeks on the hospital site. In addition, the Department has approved four new consultant posts in paediatrics and in obstetrics-gynaecology. The board has advised that it is currently in the process of filling these posts.

With regard to capital and service developments, a project team comprising representatives of the Department, the North Eastern Health Board and the staff of the hospital has prepared a planning brief for the hospital. In April 2004, the Department approved the appointment of a design team to prepare a site feasibility study which will help to determine future development plans for the hospital. It is planned that this study will be progressed over the coming months and completed by the end of the year.

In tandem with this overall planning process, a number of interim capital projects are being progressed. A newly refurbished ICU-CCU department will be opened within the next two weeks at a capital cost of approximately €1.3 million. Plans are currently being formulated for the refurbishment of the accident and emergency department, including new radiology equipment, for an upgrade of the catering department and for the provision of a pilot midwifery-led unit at the hospital.

While the board accepts that there are some infrastructural deficiencies at the hospital, it is clear that progress is being made on a number of fronts. The North Eastern Health Board and my Department look forward to advancing the overall site feasibility study as well as the various interim capital projects relating to the hospital. The Minister is assured by the North Eastern Health Board of its continuing commitment to the further development of services at Our Lady of Lourdes Hospital, Drogheda, and to the provision of high-quality patient care to all of the people of the north-east.

Community Support Services.

Ms Burton

I wish to share my time with Deputy Costello.

Acting Chairman

Is that agreed? Agreed.

Ms Burton

The Centre for Independent Living, Carmichael House, is located in Brunswick Street. It is home to some 45 organisations, most of which work in the areas of health, social support and information. On account of the funding crisis which has engulfed the centre, it is threatened with imminent closure and 55 members of staff have been issued with redundancy notices.

I heard the Taoiseach boast again today about the riches of our resources and the economic success that every party which has served in Government has helped to create. It is shameful, therefore, that organisations such as the Centre for Independent Living, Parentline and organisations that specialise in providing advice on diseases such as Crohn's disease should be threatened with having their vital core activities cut back or stopped altogether because this Government refuses to provide core funding to the tune of an additional €150,000. Responsibility for this debacle lies somewhere between the Department of Health and Children and the Department of Craggy, whatever it is called. I like to call it Craggy Island; it seems to be headed by a Father Jack-style figure because the Minister does not seem to know what he is doing from one day to the other.

Mr. B. Lenihan

It is the Department of Community, Rural and Gaeltacht Affairs.

Ms Burton

These vital organisations are threatened with closure. I will cite one example for the Minister of State. For the past ten years, I have been involved in the building up and development of the Centre for Independent Living which is now an all-Ireland organisation offering support to people who have serious illnesses which involve them becoming dependent on wheelchairs. Most of these people are young. The Centre for Independent Living has developed the model of personal assistance which allows such young people — and nowadays, middle-aged and older people — to use a personal assistant and, because they have this vital support, they do not have to live in an institution. Why can this Government, which is rolling in money and which, it is reported today, received an extra €500 million from people who dodged tax, for the sake of €150,000 from the Department of the Minister, Deputy Ó Cuív, not address this crisis?

Mr. Costello

I thank Deputy Burton for sharing her time with me. The Carmichael Centre is in my constituency in North Brunswick Street. I have watched this centre grow in size in terms of the services it provides, the number of organisations represented there and its physical size. Only last month, the Taoiseach opened a renovation of the building costing €1.3 million. The main building is a marvellous period building. That seemed to indicate that the Government was prepared to fund the service being provided there. There are 45 voluntary groups working in the centre, as Deputy Burton stated. There are also 350 other groups being serviced by the centre. It provides a significant benefit to the city. The staff have been served with redundancy notices to expire on 9 July and if the centre were to go under, it would be a great loss to the area. It is not possible to contemplate how serious this would be for the variety of organisations which would lose the roof over their heads and would not have the support services provided.

The sum of €825,000 as core funding is required to keep the house running on an annual basis. The Department of Health and Children has made some contribution but it is the Department of Community, Rural and Gaeltacht Affairs that needs to make the commitment. Will the Minister provide the core funding to ensure that the centre can go forward in the years to come and with this insecurity lifted from the heads of both the staff and the organisations represented and serviced by the centre?

Mr. B. Lenihan

I am replying on behalf of the Minister for Health and Children, Deputy Martin. I am pleased to take this opportunity to clarify some matters relating to the provision of funding for the Carmichael Centre, North Brunswick Street, Dublin. Like the Deputies opposite, I am well aware of the important work which is conducted at this centre by many different organisations.

The provision of health-related services for people with disabilities, physical, sensory or intellectual, and for those with autism is a matter of the Eastern Regional Health Authority and the health boards in the first instance. Since 1997, the Department has allocated significant levels of funding across the disability sector which has resulted in substantial advances in the quality and quantity of the health-related services which are being provided to people with disabilities.

The Carmichael Centre is Ireland's largest centre for voluntary organisations, providing accommodation for 43 small voluntary organisations working in the area of health, social services, community and art. By small I do not mean small in the scope of their contribution to our life. The centre provides a large range of services enabling voluntary organisations to achieve their objectives in a cost-efficient manner.

Approximately €100 million in additional ongoing revenue has been provided for the maintenance and development of services to people with physical and sensory disabilities. Such services include residential, respite, home support, personal assistance, therapy and day care services. An additional €25 million in current expenditure was made available by the Minister for Finance in the 2004 budget for services for people with disabilities.

The sum of €250,000 was allocated in 2002 by the Department of Health and Children for the refurbishment of the Carmichael Centre. This grant was made in recognition of the fact that the centre includes among its clients a number of organisations active in the health field. I understand that my colleague, the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, also has a role in supporting this centre.

The Department of Health and Children has been in contact with the management of the Carmichael Centre in recent days to confirm that it will allocate funding to help the centre to continue to provide an excellent service.

Ms Burton

Will it be given any money?

Mr. B. Lenihan

The Deputy should read the last sentence.

Mr. Costello

The other Minister has not given anything. He has reneged.

Accident and Emergency Services.

Mr. Crowe

I have tabled this question because there is great concern in Tallaght about the situation in Tallaght hospital. At one stage there were 45 people on trolleys and chairs in the hospital. I do not believe that the staff, local politicians and local residents know what is happening there. The first sight in the accident and emergency department is people on trolleys and the number is unacceptably high.

A friend of mine has a congenital heart problem. He was brought to the hospital which at that time had 18 people accommodated in the corridor. He saw an elderly woman surrounded by her family. I do not know if the woman died or not but people were very upset. Children attending the hospital's accident and emergency department must pass by. My friend, who was wired up to an ECG machine, left his bed to use the toilet. When he returned, his bed was gone. I hear these stories from people.

The son of another friend of mine had meningitis. He recognised the signs, rang the hospital and was told by an administrator to bring the person to the hospital immediately. He asked whether he should bring his son to the local doctor but he was told to go to the hospital. That patient was waiting to be treated for between four and five hours. As it happened, the type of meningitis was not contagious, but this incident highlights the situation in the hospital.

I do not know if the Minister of State is working from a script. I have a script with me but I am not working from it. People want to know if it is a case of a lack of investment in the hospital or a lack of staff and they want to know what the problems are. It is becoming worse. The Irish Nurses' Organisation says it has never been so bad and the same applies in other hospitals in Dublin. People need answers. If it is a problem with money or a lack of investment, we are in a time of plenty and there are reports today of receipts of €500 million. People do not understand.

Tallaght hospital was created by an amalgamation of a number of hospitals. It was a stop-start hospital and many sods were turned before it was built. People had great expectations that this hospital would fulfil all the local needs, not only of Tallaght but of the surrounding areas, but it has not done so.

A woman told me of her child who has severe arthritis. The child was two weeks in hospital waiting to be seen by a rheumatologist because the hospital does not have a consultant rheumatologist. The main problem seems to be a blockage in the system. I do not know if it is due to the lack of step-down beds. There are many reasons but people in the area need to know what is happening in the accident and emergency department. Sometimes there may be four patients and two nurses in the observation ward with perhaps 80 people on chairs, trolleys or beds. It is beyond belief.

My friend was in the hospital on a week night. One would expect an increase in attendance at the weekend but the problem also occurs during the week. I am not criticising staff at the hospital who I accept are doing their best. People are asking whether the problem lies with the administration and management of the hospital or the lack of funding. We do not know the answer and I ask the Minister of State to provide one. I do not want to hear the script.

Mr. B. Lenihan

I make this reply on behalf of the Minister for Health and Children, Deputy Martin. Deputy Crowe will be aware that services at the Adelaide and Meath Hospital, incorporating the National Children's Hospital, Tallaght, are provided under an arrangement with the Eastern Regional Health Authority. The authority has advised the Minister that the emergency department at Tallaght Hospital has been experiencing pressure on its services which has resulted in delays for patients awaiting admission to hospital. That is acknowledged.

Activity in the hospital is driven predominantly by emergency admissions as 74% of all admissions are through the emergency department. While there was a peak of 45 patients awaiting admission in the emergency department on 8 June, which was the figure to which the Deputy referred, the position has improved on a daily basis since then. The authority has reported that ten patients were awaiting admission in the emergency department yesterday.

The authority has been liaising closely with the hospital regarding the ongoing pressures in the emergency department. Well-developed procedures are in place in the hospital to manage beds as efficiently as possible. Daily bed management meetings are held with key stake holders to deal with all issues relating to admissions and discharges of patients in the hospital.

A contributing factor to the delays being experienced by patients awaiting admission is the number of patients who have completed the acute phase of their treatment and continue to occupy an acute bed. The authority has reported that on 6 June, 38 elderly patients and 18 young chronically ill patients in the hospital had been deemed fit for discharge but continued to occupy an acute bed. To address the problem, an €8.8 million package was provided by the Minister for Health and Children to the authority to facilitate the discharge of patients from acute hospitals to a more appropriate setting, thus freeing up acute beds. To date, more than 40 patients in Tallaght Hospital have benefited from this initiative and arrangements are being made for further discharges in the weeks ahead.

In addition, the authority commissioned a joint initiative in 2003 between the South Western Area Health Board and the hospital to implement a multi-disciplinary programme designed to provide individual programmes of care, which would enable patients to be discharged with appropriate support to the community. To date, 17 patients have been discharged under this scheme.

Many of the difficulties and delays experienced in emergency medicine or accident and emergency departments reflect system wide issues. I will outline some of the key actions the Minister for Health and Children has taken in that regard. I have already spoken about the number of patients in acute hospital beds who have completed their acute phase of treatment and are ready for discharge to a more appropriate setting. I have been informed by the Eastern Regional Health Authority that some 250 patients have been discharged from acute hospitals in the region as a direct result of the funding provided by the Minister.

The Minister has also provided additional funding for recruitment of additional emergency medicine consultants and consultant anaesthetists. To date, 20 additional emergency medicine consultants have been recruited. Further appointments are being progressed by the health boards and the ERHA. The availability of senior medical staff in emergency medicine departments should facilitate rapid clinical decision making and enhanced management, diagnosis and treatment of patients.

Emergency medicine departments sometimes have to deal with injuries and conditions more appropriate to a primary care setting. Government support for the development of general practitioner out of hours co-operatives nationally for the period 1997 to 2003 amounted to €46.5 million. In time, these co-operatives can be developed to provide a much wider range of services to ensure that communities enjoy appropriate access to primary care services, irrespective of size and distance from major urban centres.

I understand the authority is continuing to actively monitor the situation and is working with hospitals and the area health boards to ensure every effort is made to minimise waiting time for patients being admitted through emergency departments of acute hospitals in the region.

Rural Transport Services.

Mr. Perry

Slightly more than a year ago, the Minister for Transport, Deputy Brennan, launched the west Sligo rural transport initiative in Dromore West. The project has grown from strength to strength with a total of 14 scheduled services in the rural electoral area of west Sligo and the south Sligo areas of Gurteen, Ballymote, Banada, Tourlestrane and Tubbercurry.

The working group is very proud of its achievements. The service now carries more than 800 passengers a month and more than 5,700 passengers availed of the service in 2003. It is alarming that the service is due to be cancelled as a result of the decision to reduce the allocation of €88,000 secured in 2003. The service is facing a deficit of €36,000 in funding for 2004.

Millions of euros went into the coffers today as a result of massive tax returns. This rural transport service, launched by the Minister and carrying 800 passengers per month, is regarded as a godsend by hundreds of elderly people in remote parts of County Sligo. It is the first time they have been able to use their free travel passes. There is no point giving out free passes if the people concerned cannot avail of public transport. Under this scheme, people are picked up, taken to the adjacent town and returned to their doors twice each week. This has had a considerable impact on their quality of life. According to one user of the service, the service is personal, 100% accessible and not only benefits the passenger but gives respite to carers.

Just €36,000 would fund a service availed of by 800 passengers a month but the refusal to provide the additional funds will lead to the service being cancelled. Something is wrong if this can happen in an economy which received an additional €500 million in its coffers today. I am aware, from my role as Chairman of the Committee of Public Accounts, of the many ways in which taxpayers money is spent. This service provides extraordinary value for money.

I received a letter today from the Secretary General of the Department of Transport, Ms Julie O'Neill, which stated: "I regret to say that in the current year the Department has no additional funds for the scheme." I do not accept that reply. I hope the Minister of State will give me some indication as to how the €36,000 required will be found. I call on Dr. Tony Crooks, chief executive officer of ADM, which is responsible for the distribution of funding secured from the Department for rural transport, to ensure, with the Minister, that the required sum is found. There is no way the service can be allowed to finish at the end of June.

Just this time last year, the Minister visited Sligo and had his photograph taken in a bus to launch the service. We need integrity in public office. I attended a public meeting attended by up to 100 people in support of this service. This service is of major benefit and offers opportunities to elderly people, the most disadvantaged in society who avail of the free travel pass. What has gone wrong that we cannot find €36,000?

While I am not casting any aspersions on the Minister of State, Deputy Brian Lenihan, I am very disappointed the Minister for Transport is not present. It is unfair of him to send the Minister of State to the House. I hope he has not been given a dud reply. I ask him to return to the Minister and ask him to contact Dr. Tony Crooks, empowering him to give the necessary funds to Mr. Michael Quigley of the west Sligo rural transport initiative to continue the service. The money must be found. If I have to bring people from west and south Sligo to the gates of Leinster House next week to get the money, I will do so. If the Minister of State does not have an adequate reply this evening, the Minister of Transport will be given a clear message next week when I come to Leinster House that the €36,000 required to continue the transport service provided in the areas of Ballymote, Banada, Tourlestrane and Tubbercurry, Dromore West and Enniscrone must be found. I will not take "No" for an answer on this issue.

Mr. B. Lenihan

I am making this reply on behalf of the Minister for Transport, Deputy Brennan. I fear I may meet the Deputy at the gates of Leinster House.

Area Development Management Limited is managing the pilot rural transport initiative, RTI, on behalf of the Department of Transport. The RTI provides funding on a pilot basis for 34 community organisations and community partnerships around the country to address the transport needs of their areas by the provision of transport services. A sum of €3 million was provided annually by the Department of Transport for the initiative in the two year period ending December 2003 and further funding of €3 million is being provided in 2004. This €9 million commitment compares with €4.4 million earmarked for the RTI in the national development plan. The RTI is operational in virtually all counties with 2,500 transport services being provided on approximately 380 new rural routes established under the initiative. A total of 20,000 people are using the RTI transport services every month.

ADM Limited advises that for a variety of reasons very few of the RTI pilot projects were able to commence transport operations in 2002. While funding of €3 million was made available that year, expenditure on the RTI in 2002 was slow. However, the position changed considerably in 2003 as the projects began transport services. By the end of the year all 34 RTI groups, including the west Sligo rural transport initiative, had become operational and many of the projects had expanded their services significantly from those originally proposed for the 2003 funding allocations. In addition, the free travel scheme of the Department of Social and Family Affairs was extended to the RTI in 2003 and €400,000 was provided for that purpose in that year. In contrast to 2002, practically all of the available funding for the RTI in 2003 was expended during that year.

It is understood from ADM Limited that the annualised RTI funding allocation for the years 2002 and 2003 for the west Sligo rural transport initiative was €40,000 in addition to a once-off grant of €6,349 to facilitate some pre-development work. However, only a minimal amount of this funding was expended in 2002 because the project was not in a position to roll out its services in that year. This resulted in a disproportionate amount of the funding, €80,000, being concentrated on one year, 2003. In addition, the company also received €6,880 from the allocation for the free travel scheme in 2003.

ADM Limited advises that, while the original 2004 RTI allocation for the west Sligo rural transport initiative was €49,594, this was supplemented by a further allocation of €2,920 in April this year arising from the distribution of a small amount of RTI funds which had been withheld by ADM Limited at the beginning of the year to cater for unexpected occurrences. It is understood that the west Sligo rural transport initiative will also benefit this year from funding being provided by the Department of Social and Family Affairs arising from application of the free travel scheme to the RTI. The project might also acquire funding from other sources. It is understood that, in some cases, RTI schemes have been able to generate additional funds from statutory bodies such as health boards.

While the Department of Transport provides the overall funding for the RTI, ADM Limited is responsible for the specific allocations to individual project groups. The Department has been in contact with ADM Limited with regard to the current difficulties of the west Sligo rural transport initiative. ADM Limited advises that its chief executive officer is in contact with the chief executive officer of the west Sligo rural transport initiative with regard to the project's financial position.

There is every indication that the rural transport initiative has, so far, been an excellent success and ADM Limited is concluding a comprehensive appraisal of the effectiveness of the overall scheme. When this is completed, the Minister for Transport will then consider the rural transport position and the funding of rural transport projects generally in the light of findings of the appraisal. However, he regrets that in the current year his Department has no additional funds for the RTI other than the €3 million provided.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 16 June 2004.