Dáil Éireann díospóireacht -
Thursday, 7 Feb 2008

Vol. 646 No. 3

Adjournment Debate.

Hospital Services.

Deputy Joe Costello

I wish to a raise an issue of considerable importance, namely, the death of a young woman of 39 in tragic circumstances in the accident and emergency unit of the Mater Hospital two weeks ago. The woman, Ms Seville-Doyle, arrived at the hospital, was assigned a chair and was put on a drip while awaiting medical assistance. At 6 a.m., 19 hours after she had arrived, she walked into a toilet unaccompanied where she was later found in a collapsed state by the nurses. Medics telephoned her family at 6.20 a.m. but, due to a lack of parking space in the hospital grounds, the family were not able to arrive before she had passed away.

Let me quote the statement of Mr. Colm Seville, the lady's brother, in the Irish Independent on 26 January:

"When we reached the hospital, they brought us through another route so that we wouldn't have to see the place where she died," Mr. Seville said. "But at one point we ended up in the middle of Accident and Emergency and I just said to a nurse: ‘Please tell me my sister wasn't here'. People were sitting on chairs and in corners. The doctors literally had to step over the patients. It was like something out of the Third World." Last night Mr. Seville said: "I felt sorry for the ordinary doctors and nurses on the ground, who are dealing with this on a daily basis."

I am well aware of these dreadful conditions because I go to the hospital every Saturday and spend an hour there between 1 p.m. and 2 p.m. I inspect the conditions almost on a weekly basis and note that they are dreadful. There is a prefabricated building which is totally unsuited to interaction between the patients and hospital staff. The nurses and doctors do their best but there are long waiting lists. The accident and emergency department is like a railway station or even a cattle mart. People are coming and going and patients are in chairs and on trolleys in passageways and every other nook and cranny. The situation deteriorates even further every winter. I have gone there almost every week for four and a half years and the situation has not improved substantially in that time.

The Minister speaks constantly about her ten-point plan and how community care services are being put in place. In this way, she assures us, all this so-called bed-blocking, that dreadful phrase she uses, will be dealt with. The reality, however, is that waiting lists persist and accident and emergency departments remain overcrowded. Hygiene standards are atrocious. It is simply not good enough that people who are seriously ill find themselves in the frightening situation of not knowing how long they must wait in such unacceptable conditions. The Minister has been sitting on her hands on this issue, making promises but delivering nothing. It is the most vulnerable section of the population, the elderly and seriously ill, who are most affected by the situation.

I received a letter on 26 November from Phil O'Neill, head of operations and clinical support in the Health Service Executive. It stated:

I am writing to express the hospital's concerns regarding your unauthorised contact with patients in the emergency department of the Mater Misericordiae University Hospital and respectfully request that you discontinue this practice.

I have been calling into the hospital for four and a half years but now it seems I am not authorised to do so. The letter continues:

Hospital staff members in the emergency department work in an extremely challenging and stressful environment and must be permitted to fulfil their responsibilities without additional disruption from unwarranted personnel.

There has been a failure of management and leadership at the highest level in the HSE and the Department of Health and Children to deal with the matter. I am not even sure whether the HSE is conducting an internal inquiry. Such an inquiry is inadequate in any case. There must be an independent external inquiry into the death of this young woman.

Minister of State at the Department of Community, Rural and Gaeltacht Affairs (Deputy Pat Carey)

I will take this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

I extend my sincere sympathies to the family of the deceased at this most difficult time. The Department of Health and Children has been in contact with the Health Service Executive about this case. The HSE has advised that when it became aware of the death of the person concerned, it sought and received an immediate briefing from the hospital on the circumstances of her death and the management of her care in the accident and emergency department. It is understood that she died while awaiting admission from the accident and emergency department.

The HSE has advised that the medical staff who attended to the deceased, along with the hospital's patient representative, met her next of kin to discuss the circumstances of her death. In accordance with the Coroners Act, the hospital reported the matter to the coroner whose findings are awaited. A coroner's post mortem was undertaken to establish the cause of death.

The Department is advised that the HSE and the hospital concerned will be guided by the coroner's deliberations and any recommendations made. This will inform the HSE's decision on any requirement for further action. In the interim, the hospital is carrying out a risk assessment in line with normal procedures. The hospital has assured the HSE it is anxious to provide whatever support the family considers appropriate in dealing with this difficult loss. The Deputy will appreciate it would be inappropriate to comment on the specific circumstances of the case at this time.

Deputy Fergus O’Dowd

I thank the Ceann Comhairle for allowing me to raise this issue which, like that raised by Deputy Costello, relates to the appalling conditions in which hospital staff must work, particularly in accident and emergency wards. A report in today's edition of The Irish Times states that patients on trolleys yesterday in Our Lady of Lourdes Hospital in Drogheda were asked to give up those trolleys to accommodate more seriously ill patients admitted following a traffic accident. Patients had no problem doing so but it is an indication of the appalling pressure on patients and staff. It is unacceptable and disgraceful.

The Minister was notified of the problems in the hospital last June. Dr. Finbar Lennon, a senior consultant in the region, wrote a letter to the Health Service Executive at that time, which I understand was forwarded to the Department of Health and Children, expressing his concerns about the "failure of the management authorities at all levels to appreciate the impact and consequences of the current workload and throughput of cases in Our Lady of Lourdes Hospital". Mr. Lennon went on to state that, in his opinion, the situation was "very unsafe" and that he had called for a "fundamental reappraisal of the current strategy being pursued by management".

It is a shameful situation. The patients to whom I have spoken are very appreciative of the excellent treatment they receive from consultants, nurses and other hospital staff. However, they cannot understand why adequate provision is not made to improve conditions. Why does the HSE not provide the necessary services in Dundalk, Navan, Cavan and Monaghan to relieve the pressure on Our Lady of Lourdes Hospital? The current conditions are unsustainable and unsafe. Mr. Lennon's statement, which was brought to the attention of the HSE and the Department last June, is quite serious.

What is the Government doing to improve this unacceptable situation? The hospital is in chaos in terms of finding space for sick people. A friend of mine attended the accident and emergency department last Monday and had to wait on a trolley for almost 36 hours. The problem at that stage, before yesterday's crisis, was that there was only one bed for 30 possible patients. This is an ongoing crisis. While I fully acknowledge that there is a substantial difficulty in coping with the winter vomiting bug, the HSE has made an entirely inadequate provision for the care of patients in the hospital.

How is the Minister accountable for this situation? The Government has allowed the HSE to function in such a way that public representatives do not have a forum in which to raise such issues. The Minister absolves herself of any responsibility and everything goes back to the HSE. There must be accountability to the House. The Minister must be able to answer our questions on certain urgent matters. It is a shame that the wonderful staff of our Our Lady of Lourdes Hospital and the sick patients who receive tremendous care from them must endure these appalling, disgraceful and shameful conditions.

Deputy Pat Carey

I will take this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

My understanding is that the issues raised by the clinician in question relate in the main to the capacity of Our Lady of Lourdes Hospital, Drogheda, to manage the regional emergency workload within existing resources. The issues raised were brought directly to the attention of the medical board of the hospital, the Health Service Executive and the Minister. The Department raised the issue with the National Hospitals Office of the HSE and asked that the matter be followed up as a matter of urgency with the HSE north east which has operational responsibility for the provision of hospital services in the region.

The number of patients reporting to the accident and emergency department of Our Lady of Lourdes Hospital has increased in recent days and this has placed additional pressure on its capacity. The HSE is working to ensure all possible measures are taken to alleviate the difficulty and to ensure the waiting time for patients is kept to a minimum. The measures being put in place include increased ward rounds by consultants, and liaison with other hospitals to effect transfers, where appropriate. Discussions are also taking place with a view to placing into more appropriate care settings patients whose acute phase of treatment has finished.

In line with a commitment to improve the overall capacity and resources at Our Lady of Lourdes Hospital, the HSE advises that construction of a new accident and emergency department and additional clinical facilities commenced at the end of January this year at a cost of more than €11 million. This project will provide for an accident and emergency unit on the ground floor encompassing some 1,300 sq. m of space with additional clinical facilities proposed for the upper floors. This project will result in an almost 300% increase in the existing space available for the Department. The HSE advises that the new emergency department is scheduled to be operational by the end of the year with 19 adult trolleys and six paediatric beds. The HSE is also working to ensure that the hospital has the required capacity in readiness for the overall reconfiguration in the north-east area.

The Teamwork Management Services Limited report entitled, Improving Safety and Achieving Better Standards, which was prepared for the HSE found that the present system in the north east, whereby five local hospitals deliver acute care to a relatively small population, is exposing patients to increased risks. The report recommended a three-strand action plan as follows: the development of a new regional acute hospital; the development of local services, with the existing five hospitals and primary and community care providers playing central roles; and the development of a series of clinical networks to bind local and regional services around the needs of patients, including networks for emergency care, surgery and critical care.

The hospital reconfiguration process is being overseen by the HSE steering group. Following a tendering process, the HSE appointed a firm of consultants to carry out an independent site location study for the new regional hospital. The Department has been advised by the HSE that it anticipates that the consultants' report will be completed in February. The report will then be considered by the board of the HSE.

The first priority in the development of a fully integrated regional health service is to ensure that the people of the north east have local access to both routine planned care and immediate life-saving emergency care. Over the next few years, in preparation for all acute emergency inpatient care and complex planned care being provided at a regional centre, the existing five hospitals will continue to provide services which meet the majority of health needs of the community.

The HSE has given an assurance that in progressing the implementation of the Teamwork report, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.

Site Acquisitions.

Deputy Michael D’Arcy

While the issue I raise may not be as vitally important as the life and death ones my colleagues who spoke before me raised, the biggest issue in my area is the lack of schools. A public private partnership for a site for schools was announced in 2005. I believe that Wexford County Council has done a deal with the Department of Education and Science on the purchase of an 18-acre site in Gorey. However, I am trying to find out what stage we are at in regard to the building of the schools on the site. We are three years further down the line and there seems to be a dearth of information in this regard. Nobody seems to know what is happening and whether there is to be one school or two schools.

I tabled parliamentary questions to the Minister for Education and Science asking when something will happen, to which the response was "shortly", which is like asking "How long is a piece of string?" I hope we will be given much more detailed answers to fair and valid questions. When will planning permission be sought? I believe there was an advertisement in the newspaper. I have been told these are almost pre-packed, pre-built schools which will be constructed on site. What sporting amenities will be available, which will be used by the general community as well as the school? Perhaps the most important question is who will be the patrons of the school or schools.

The last answer I got to a parliamentary question asking whether there would be one primary school or two primary schools on the site was that it had not been decided but, amazingly, a couple of weeks later there was a planning permission application for two schools. I am not here to badger anybody but the lack of information and the manner in which I, as a representative from the area, have been treated are not good enough. That decision had been made when I tabled that question because planning permission was applied for within a couple of weeks. I got a short, terse reply that a decision had not been made. That is not good enough and I hope the Minister will shed more light on the matter.

The same questions apply in respect of the new second level school on that site. When will planning permission be submitted? What type of school will be built? Who will be the patrons?

Deputy Pat Carey

I am taking this matter for the Minister for Education and Science, Deputy Mary Hanafin, who wishes to thank the Deputy for raising this matter. I will outline the Government's strategy for capital investment in education projects and the current position in regard to the purchase of a site in Gorey, County Wexford.

At the outset, modernising facilities in our 3,200 primary and 731 post-primary schools is not an easy task given the legacy of decades of underinvestment in this area as well as the need to respond to emerging needs in areas of rapid population growth. Nonetheless, since taking office the Government has shown a consistent determination to improve the condition of our school buildings and to ensure that the appropriate facilities are in place to enable the implementation of a broad and balanced curriculum.

The Government has dramatically increased investment in the school building programme to almost €600 million this year. Under the lifetime of the national development plan almost €4.5 billion will be invested in schools. This is an unprecedented level of capital investment which reflects the commitment of the Government to continue its programme of sustained investment in primary and post-primary schools.

It will underpin a particular emphasis on the delivery of additional school places in rapidly developing areas while continuing to develop on the Government's commitment to delivering improvements in the quality of existing primary and post-primary accommodation throughout the country. It will also enable the purchase of sites to facilitate the smooth delivery of the school building programme, again with the focus being on site requirements in rapidly developing areas.

Turning to the specific matter raised by Deputy D'Arcy, the site in question of about 18 acres in Gorey is in the process of transfer to the Department from Wexford County Council. As the Minister announced on 1 February last, it is planned to provide for two primary schools consisting of eight classrooms each in 2008. It is expected that, in time, in each of these schools the number of classrooms will be increased to 16 with a special needs unit. The Department also plans, in time, to provide a post-primary school on the site and this will form part of the master plan for the site.

I thank the Deputy again for affording me the opportunity to outline to the House the current position in regard to the purchase of a site in Gorey.

Deputy Michael D’Arcy

I finished a little early so——

Acting Chairman

I am sorry I cannot allow the Deputy to come back in.

Deputy Michael D’Arcy

I did not get answers to the questions I asked.

Acting Chairman

The Deputy cannot come back in as Standing Orders do not allow that.

Special Educational Needs.

Deputy Terence Flanagan

I thank the Ceann Comhairle for the opportunity to raise this serious issue. Achieve ABA school in Donaghmede was established to provide education for autistic children. It was founded by a group of parents whose children's needs were not being catered for by the Department of Education and Science. The Minister for Education and Science provides a home tuition allowance to the parents of the children attending this school. However, the allowance only covers 50% of the costs and as a result parents must come up with the other 50%, which is placing an enormous financial strain on them. To make matters worse, the Minister now only provides the home tuition allowance on a monthly basis. Meanwhile, parents are left not knowing whether they will receive this allowance. This is a national disgrace. The school is unable to plan for the future and cannot give tutors a guarantee that they will be paid.

The ABA model is viewed worldwide as the best way to educate autistic children. While it does not work for every autistic child, it has achieved outstanding results among many children. Only last week, we witnessed the Ó Cuanacháin family being dragged through the courts as they fought to obtain education for their child, Seán. They now face a massive legal bill. It is one of the great scandals of this Republic that the parents of autistic children still have to go through the courts as a means of getting justice for their children because the education system has failed them so disgracefully over a period of prolonged prosperity. There are 12 Government-funded ABA schools in operation on a pilot scheme. The Minister for Education and Science stated recently in the Dáil that no more ABA schools will be built or funded and that all autistic children will be taught in mainstream schools. All other ABA schools are now at risk because of the Department's intended position that these children will attend mainstream schools, whether they can manage or not. However, students are attending ABA schools because mainstream schools are not providing for their needs.

I urge the Minister to recognise Achieve ABA school in Donaghmede and to allocate funding annually to the school. I invite her to visit Achieve ABA and witness at first hand the excellent work it is conducting in educating autistic children. By visiting this school, the Minister will realise she is wrong to deny it a place on her pilot programme. Allocating funding to 12 ABA schools in Ireland and ignoring the other ABA schools is grossly unjust. All autistic children have the right to access the same standard of education. The Minister's policy of not providing funding for additional ABA schools means that many autistic children are missing out on the best chance of leading a normal and productive life. International research for the past 40 years has shown that up to half of children who engage in ABA as their primary method of preschool intervention go on to mainstream education without additional supports.

The Minister's approach, which provides a range of educational approaches, is not working for lower functioning children. It is obvious that both ABA local schools for autistic children and mainstream places are needed. The Government's approach is useless to a large percentage of lower functioning children who need ABA schools. The Minister should concentrate on developing a model to meet the teaching needs of all children with autism. She should cherish all the children of the nation equally and not treat autistic children in Ireland as second class citizens.

Deputy Pat Carey

I am taking this matter on behalf of the Minister for Education and Science, Deputy Mary Hanafin. I thank the Deputy for raising this matter as it provides me with the opportunity to clarify the current situation on Achieve ABA.

The home tuition scheme was established to provide funding to parents for the education at home of children who, for a number of reasons such as chronic illness, are unable to attend school. The scheme was extended in recent years to facilitate tuition for children awaiting a suitable educational placement.

While the Department does not fund Achieve ABA directly, parents have been using the funding provided through the home tuition scheme to give this tuition in a group setting at the centre. Home tuition funding cannot be provided indefinitely in respect of children who have school placements available to them. A suitable school place is available for each of the children attending this centre. Officials in the Department of Education and Science have written to the parents of the children attending the centre in question regarding the home tuition scheme. The Government is committed to ensuring all children can have access to an education appropriate to their needs and abilities.

The Government believes that as each child with autism is unique, each child should have access to a range of different approaches to meet individual needs. This view is informed by advice received from international experts on autism, the National Educational Psychological Service and the inspectorate. An analysis of research, including the report of the Irish task force on autism, also supports this approach while autism societies in other countries also caution against relying on just one method. By enabling children in special classes to have access to a range of methods, including ABA, we are doing what we are advised is in the best interests of such children.

The Department of Education and Science has supported the use of ABA for many years and training is provided for teachers in its use. However, the Department does not accept, based on research, advice and best practice, that it should be the only method used. While ABA can address certain needs, in particular behaviour other methods such as TEACCH and PECS are just as important, especially in developing children's communication and speech skills. It is important that children have access to a range of methods so that their broader needs can be met.

Hundreds of children with autism are integrated into mainstream schools and hundreds more are in autism-specific classes. More than 275 autism-specific classes have been approved throughout the country while more are being set up all the time. A testament to the scale of progress being made in this area is the fact that the number of such classes has increased by more than 40% in the past year alone. There are a maximum of six children in each special class with a teacher and at least two special needs assistants. Extra assistants are provided where the children need them. A child can have his or her own SNA if needed. Children in special classes have the benefit of fully qualified teachers who are trained in educating and developing children generally and who have access to additional training in autism-specific approaches, including ABA. The level of such training available to teachers has improved dramatically in recent years and is a major priority for the Government. Children in special classes also have the option, where possible and appropriate, of full or partial integration into mainstream classes and of interaction with other pupils.

The Department of Education and Science and the National Council for Special Education have been working hard to ensure all children with autism have access to a range of approaches in special classes. A number of years ago, before this extensive network was in place, some centres were approved for funding under an ABA pilot programme. The Government is committed to long-term funding for these pilots subject to agreement on certain standards, such as appropriate qualifications for staff and the type of educational programme available to the children. Discussions have taken place with Irish Autism Action with a view to advancing this commitment as soon as possible.

Other centres, including the one to which the Deputy refers, are seeking funding under the pilot scheme. Now that a national network of special classes is available, however, new centres will not be brought into the pilot programme. We are determined instead to ensure each child has access to the autism-specific education being made available to schools throughout the country. Appropriate placements are available in local schools for the children attending the centre in question. I hope this clarifies the position for the Deputy and I thank him once again for raising the matter.

The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Tuesday, 12 February 2008.