Dáil Éireann díospóireacht -
Wednesday, 9 Jul 2008

Vol. 659 No. 2

Adjournment Debate.

Hospital Services.

Deputy Aengus Ó Snodaigh

Is maith an rud é go bhfuil deis agam an cheist rí-thábhachtach seo a ardú. Baineann an cheist le páistí atá faoi chúram Ospidéal Mhuire do Leanaí, Cromghlinn. The children we are discussing are at major risk of infection through Ireland's most common life-threatening inherited disease, namely, cystic fibrosis. These, more than many other children in hospital wards, are at major risk if their environment is contaminated. Everybody, from the medical to the lay person, will understand the need to ensure those who suffer from cystic fibrosis and who have had to be hospitalised have proper sterile environments so they can recover in a short time to allow them to carry on as normal a life as possible for as long as possible.

Moving children at 6 p.m. on Fridays from a sterile environment in St. Michael's ward, which is dedicated to treating those children who are unlucky enough to have cystic fibrosis, into St. Joseph's ward, which has children with other ailments, puts their lives at risk. It is not good enough to state, as has been stated, that housing these children in single rooms will suffice. That not true and it is a cop-out.

This is about cost-cutting and shaving a few euro off the HSE budget. I have not heard of Professor Drumm shaving money off his wages or his bonus. Despite the Trojan work of the staff of Crumlin children's hospital, the nurses and doctors must suffer not only this cut but also a number of others which occurred during recent months and which I have tried to raise in the House. Porters have been let go. The orthopaedic service now works part time from 2 p.m. to 5 p.m. Phones are left unmanned for entire days and, in one case, for almost two weeks because of HSE cost-cutting. The chaplaincy service has been reduced from a 24-hour service to 9 a.m. to 5 p.m. Dieticians have also suffered.

Cutbacks have occurred across the board at Crumlin children's hospital. This cutback has been aimed at the most vulnerable children, namely, those at risk of cross-infection. Consider the risk involved in these children going to hospital in the first place given the other infections we have heard so much about, such as MRSA, and this increases the chance they will not come out of hospital alive. That is not good enough.

Major steps must be taken to ensure that at least this cutback is reversed so that the advances we have made in Ireland and throughout the world to extend the life expectancy of people who have inherited this disease are not reversed for the sake of a few measly euro.

Those with cystic fibrosis suffer in terms of their lung capacity and digestive system. The result of this is that sufferers are prone to constant chest infections and malnutrition. Most try to live a normal life but they must regularly attend hospital to regain the ability to breathe by themselves. Putting their lives at risk by forcing two hospital wings to coalesce at weekends is not good enough. I have not heard of any cutback in the private health service and that alone says it all.

Minister of State at the Department of Health and Children (Deputy Mary Wallace)

I thank the Deputy for raising this issue. Each hospital funded by the HSE is required to deliver services within the financial allocation provided. The HSE is involved in ongoing discussions with hospital management regarding its 2008 financial allocation and service plan. The hospital has an overrun of €10 million from last year and a projected overrun of €14 million for this year.

As part of the discussions on the budgetary position, the HSE has made an agreement with the hospital, on a once-off basis, to deal with last year's overrun of €10 million and to provide a further €7 million this year. However, the additional funding arrangement is contingent on the hospital working within its budget, which will be amended from €137 million to €144 million for this year, up from €128 million in 2007. The hospital must achieve savings of €7 million from the projected overrun of €14 million for 2008.

The priority of the HSE and hospital management is to ensure that services for children at the hospital are maintained at an optimum level. The initial focus of the discussions on budgetary issues between hospital management and the HSE is on ensuring that all areas of non-pay expenditure are critically examined.

In this regard, the hospital made a recent decision to close St. Michael's ward, which treats a mix of medical patients, a proportion of whom are children with cystic fibrosis, at weekends and move them to an adjacent ward, St. Joseph's, which also treats a mix of patients, including orthopaedic patients. The hospital took this decision as the occupancy on both wards was approximately 50% at weekends. As a result, five to ten patients from St. Michael's ward, a small proportion of whom are cystic fibrosis patients, are transferred to an adjacent ward at weekends.

The infection control team in the hospital is satisfied that there is no additional risk to children as a result of this move. The very same standard of care is being delivered to these children. There is no change in the specialised doctors and nurses and medical team caring for the patients who are transferred. On transfer, the children with cystic fibrosis are nursed in single rooms. The medical care delivered to these children remains the same. All patients and families are contacted by the nursing staff before they are transferred and there is an opportunity for families' concerns to be addressed by the multidisciplinary team. The only change for these children and their families is the location and there is ongoing monitoring and assessment of the situation by the infection control team.

The Minister has been assured by the HSE that patient care has not been compromised at the hospital as a result of the weekend closures of this ward.

Deputy Pat Breen

I am delighted to be a voice for cystic fibrosis sufferers and to highlight the issue on their behalf. There are approximately 1,100 sufferers in the State and life can be difficult for them. I wish to raise the issue of facilities for cystic fibrosis sufferers in the mid-west region. Cystic fibrosis is Ireland's most common life-threatening inherited disease, with one in 19 people carriers of the CF gene. CF affects the glands and damages many organs, including the lungs and the digestive system, and sufferers are prone to constant chest infections and malnutrition. Many advances have been made in recent years but more remains to be done.

There are approximately 1,100 CF sufferers in Ireland and we all hear stories of how sick they are and how they are afraid to enter hospital in case they pick up an infection, such as MRSA or C. difficile. The situation is more acute for CF patients because many of them are afraid they will die. They cannot mix with other patients and going through an accident and emergency department is not an option. I recently witnessed a case of a 19 year old who was afraid to go to an accident and emergency department because he thought he would pick up an infection and die and we had to try to bypass the department to have him admitted to hospital.

Approximately 30 CF patients from County Clare attend for treatment at the Mid-Western Regional Hospital in Limerick. The current CF service at the hospital is provided by two consultant respiratory physicians providing inpatient and outpatient services in addition to their normal work. A full-time consultant with a speciality in CF is required. The present consultant is due to retire and when the position is advertised, a consultant with a speciality in CF should be appointed. The provision of a dedicated adult outpatient unit is also essential. Such a unit is available for children but adults cannot avail of same.

Progress has been made in some areas and funding was allocated in 2006 and 2007 to put in place a full medical multidisciplinary team, following an audit by the HSE in 2005 of the staffing levels at the hospital. However, while a number of positions have been filled, there is serious concern regarding the position of two CF nurse specialist positions, which have not been advertised, even though funding has been allocated. When will these positions be advertised and filled?

There are also other issues. For example, Internet access is not available in the CF area of the hospital for immobilised patients and no television remote controls are available. I recently met representatives of the Clare branch of the Cystic Fibrosis Association of Ireland and they outlined the stories of the battles they fight every day for services. I met a woman whose son died six weeks ago aged 23 and I admire her courage in playing a part with the association to highlight the plight of other sufferers. I was amazed by her strength in speaking about her son's plight. She wants to do something for other CF sufferers in County Clare. I hope that news of cutbacks will not affect progress on this matter. CF patients and their families cannot wait and I urge the Minister of State to put in place the facilities in Limerick regional hospital because they deserve a better quality of life.

Deputy Mary Wallace

I thank the Deputy for raising the issue. The need to improve services for persons with cystic fibrosis has been identified by the Minister for Health and Children as a priority in the Estimates process in recent years. Since 2006, additional revenue funding of €6.78 million has been allocated to the HSE to develop services for CF patients. The executive has advised that 44 additional staff dealing with cystic fibrosis have been appointed to date in Limerick regional hospital and eight other hospitals. The necessary funding is available to facilitate the recruitment of a further 37 staff nationally, including staff for the mid-western region.

With regard to the specific issues raised by the Deputy, the HSE has advised that the current adult CF service for the mid-west region is provided in Limerick regional hospital by two consultant respiratory physicians providing inpatient and outpatient services for adult patients. The CF service for children is provided by a consultant paediatrician providing inpatient and outpatient services. Two nurse specialists currently cover both the paediatric and adult CF services. Both services are supported by a dedicated team, which includes a social worker, a dietician, a physiotherapist and a pharmacist.

An audit of CF staffing at the Mid-Western Regional Hospital was carried out in 2005. The HSE has since earmarked funding for the creation of 8.5 additional posts to enhance both the adult and paediatric CF service. The additional staff include a consultant respiratory physician with a special interest in cystic fibrosis and a consultant paediatrician with a special interest in respiratory medicine, supported by specialist nurses, a physiotherapist, a dietician, a social worker, a pharmacist and a medical scientist post. The HSE has advised that the dietician, the social worker and 0.5 of the physiotherapist post have been filled, the consultant posts are under consideration and it is in the process of recruiting the remaining posts.

The Mid-Western Regional Hospital, Limerick, has provided three dedicated rooms, which are ring-fenced for adult CF patients. These rooms may be used for other patients if not required for CF patients. Paediatric CF patients are accommodated in the paediatric unit. The Minister is confident that these developments will significantly enhance the service provided for persons with cystic fibrosis.

Deputy Joan Burton

I am delighted the Minister of State is present because, like myself, she has long-standing connections with Connolly Hospital in Blanchardstown and she will be aware of the excellence of the staff, how hard they work and the service they provide to people in Dublin 15 and County Meath.

The hospital is being forced to wait again for at least three more years for vital diagnostic and imaging equipment, including an MRI scanner, because the HSE has taken a decision in principle to wait until after a proposed new private hospital is built and opened on the hospital grounds under the Minister for Health and Children's controversial private hospital co-location scheme. The preferred bidder for the private hospital is the Mount Carmel group and the HSE is considering its bid. However, the difficulty is the private group is insisting it should have the exclusive rights to imaging, particularly as it pertains to MRI scanners, in order that the public hospital cannot acquire such a facility. The public hospital will, therefore, have to pay for the services provided by the private hospital. Not only will the private hospital receive all the tax breaks and other lucrative incentives from Government, it will be provided with an income stream from the sale of services to the public hospital.

HSE management and its predecessors promised updated MRI scanning, imaging and radiological equipment for Blanchardstown hospital nine years ago. It was due to be installed at the conclusion of phase 1 of the new hospital building. It was then deferred to the beginning of phase 2, which is nearing completion, but now it has been long-fingered until the private hospital is built.

The Minister of State may enlighten the House as to whether the HSE has agreed to proceed with the private hospital. Once approval has been given, the private hospital will go to planning and tendering, be built and commissioned and finally opened, all of which will take three years. In the meantime, the thousands of patients in Connolly Hospital, many of whom come from the Minister of State's constituency in County Meath, will be ferried by ambulance or taxi and accompanied by ambulance and nursing staff to Beaumont Hospital, the Mater Hospital, the new private hospital in Hermitage or the Bon Secours to have necessary imaging undertaken. The cost to Connolly Hospital will outweigh the capital cost of buying and using a scanner and facilitating the hospital's teams by providing full diagnostic equipment. There is imaging equipment in relatively small hospitals in European countries that have not experienced the Celtic tiger, such as rural areas in France or the Czech Republic, and one would not be carted off in an ambulance or taxi with accompanying hospital staff to undergo diagnostics.

The situation in question is an extraordinary feature of life at Connolly Hospital and is inefficient and cruel to many of its patients. It is also costly. On ideological grounds, the Government appears to have decided that public patients at Connolly Hospital who have paid their taxes cannot have vital services because the private hospital wants a lucrative element of private medicine. Given the downgrading of Navan hospital in County Meath and the population on the western side of Dublin West, Dunboyne, Clonee and Navan, it is extraordinary that the Government should allow a blinkered ideology that seems to favour private medicine even though taxpayers, including those insured by VHI, pay for public medicine. It is also extraordinary that we in Blanchardstown and County Meath must wait a minimum of three years before people can access services locally. It is ideology gone mad and I hope that the Minister of State will tell the House that she may have been able to persuade her colleague, the Minister for Health and Children, Deputy Harney, to see some sense in respect of the Connolly Hospital situation and to provide the facility.

Deputy Mary Wallace

I thank Deputy Burton for raising this important matter and I concur with her comments on the excellence and hard work of staff at Connolly Hospital. As a former staff member of the hospital, there is no doubt about the wonderful work that occurs therein.

The prioritisation of capital requirements is a matter for individual hospitals, including Connolly Hospital in Blanchardstown. A hospital must indicate to the HSE the priority attaching to each development with regard to other competing needs within the hospital. When Connolly Hospital identified its capital requirements for 2008-09 to the executive, an MRI scanner was not among the hospital's immediate capital priorities. This was on the basis of the current numbers of patients presenting at the hospital for the service and the clinical requirement to treat large volumes of patients so as to ensure consistent quality service provision. The HSE has indicated that there is no waiting list for MRI services at Connolly Hospital. The clinical requirements of the hospital's patients for MRI services are currently being met through Beaumont Hospital or via the purchase of private capacity.

The potential for developing an MRI service at Connolly Hospital was identified in the context of the development of a co-located private hospital on the campus and associated increased patient volumes. I understand that the executive will take a decision on this matter in the context of proposals for developing a co-located private hospital at the Connolly Hospital site. This is in the context of the co-location initiative allowing for new ways for the public and private sectors to work together on a single campus.

The HSE is aware that Connolly Hospital has experienced increased activity levels for diagnostics and will continue to monitor these on an ongoing basis with a view to developing increased capacity, if required.

School Accommodation.

Deputy Brian Hayes

I thank the Acting Chairman and the Ceann Comhairle's office for giving me the opportunity to raise this important matter for Dublin South-West. I appreciate the attendance of the Minister of State, Deputy Wallace, at this late hour.

In my constituency, Templeogue in particular, there is a considerable degree of disappointment concerning the manner in which the Department of Education and Science has dealt with this issue for some time. Our Lady's school in Templeogue serves a student population of approximately 730. A substantial number of communities in the area — Knocklyon, Terenure, Walkinstown, Greenhills, Firhouse and Tallaght — send young women to that distinguished school, which has waited patiently for a green light from the Department in respect of a proposed extension. The proposal has been on the desk of the Minister for Education and Science for the past eight years. The school was given a firm indication that a decision to allow it to commence extension work would be made in June. Unfortunately, the decision has been stalled and placed to one side.

This matter is of significant concern in the local community and the school's catchment area. By raising this issue, I wish to highlight the community's deep frustration with the fact that a project that has been a matter for the Department for nearly a decade is still waiting to proceed to full construction stage. We want an early decision to ensure that we can proceed. Approximately €500,000 has been spent by the school in consultancy fees, planning fees and so on to bring the proposal to fruition. It is an example of a school that has waited for the Department's green light for too long.

What is involved in the proposal? The extension comprises four general classrooms, two lecture rooms, one learning support room, two science laboratories and preparatory areas, two arts and crafts rooms, two home economics rooms, one technological room, one woodwork, machining and preparatory room, one deputy principal's office, six pastoral offices, etc. It is not an add-on. Rather, it is the essential infrastructure expected of any school the size of Our Lady's school in 2008 and 2009.

It is a matter of deep frustration for the school authorities and parents that the decision to proceed to construction in June has been stalled under the school building and modernisation programme. Last week, the Minister for Education and Science told the House he expects to make a decision on the next phase of the schools building programme in September. I urge the Minister of State and her Department to ensure that Our Lady's school in Templeogue is a central part of that announcement so the school authorities can be allowed to proceed with their plans which are not extensive but are plans that deliberately aimed at providing the kind of modern, updated school infrastructure one would expect of a school of this size. I await the Minister's reply and I speak on behalf of the 730 students in the school and their families who expect their Government to respond to this issue.

Deputy Mary Wallace

I thank the Deputy for providing us with the opportunity to outline to the House the position of the Department of Education and Science regarding the proposed building project for Our Lady's school in Templeogue Road, Dublin.

This school is an all-girls' post-primary school with a current enrolment of 708 pupils. The Department intends to refurbish the school and to extend it to cater for a long-term projected enrolment of 800 pupils.

As the Minister for Education and Science has explained to the House previously, all applications for large scale capital funding are assessed in the Department against published prioritisation criteria. Each project is assigned a band rating under these criteria which reflects the type of works required and the urgency attaching to them. A band rating of 2.4 has been assigned to the project for Our Lady's school which reflects the fact that the building needs refurbishment and that while it has an accommodation deficit this is not as substantial as higher band-rated projects.

The project for Our Lady's school was listed on the 2007 school building programme to proceed to tender and construction. It is currently at stage 4-5 of architectural planning which means that planning permission has been granted and tender documents have been prepared. The next stage would be to allow the project to proceed to tender.

Unfortunately the Minister is not in a position to give the go-ahead for any more school building projects, including that for Our Lady's school, at the present time. Indeed, as he has previously said, he will not be making any decision on further capital expenditure until he has completed a review of the Department's spending plans for 2008. This process is currently under way and the Minister expects it will take a number of months to complete.

The Minister understands that some schools will be disappointed that their projects will not be proceeding as quickly as they might have hoped but, it would be disingenuous to create an impression to the contrary.

The Deputy will appreciate that the Minister has to manage his Department's capital budget in a responsible manner and in so doing must ensure that funding is targeted at the schools most in need. This is the reason the Department introduced prioritisation criteria for large-scale building projects, which were formulated following consultation with the education partners.

Thousands of building projects were carried out under the last national development plan, providing new and modernised educational infrastructure and thousands more will be carried out under the new NDP. However, there has to be an order as to how this happens and a realisation that not all building projects can proceed at the same time.

The extent of the demand on the capital budget is enormous providing as it does, accommodation for new communities together with accommodation for the unprecedented number of extra teachers which the Government has put into the system. The Department has also carried out substantial and major improvement works to hundreds of schools throughout the country, in an effort to address the historic under-investment in school buildings and this process will continue.

This cannot be achieved overnight——

Deputy Brian Hayes

That is certainly the case.

Deputy Mary Wallace

——but we have made significant inroads and we will continue to build on the success achieved under the last NDP when we delivered over 7,800 building projects. This must be done in an orderly and planned manner and on the basis of the most pressing needs. Projects will be advanced incrementally over time, consistent with the priority attaching to them. This approach is critical to ensuring that schools know that their individual projects will be allowed to proceed, in order of priority, as and when the funding situation allows. This approach will apply to the building project for Our Lady's school under the Department's school building and modernisation programme.

I thank Deputy Hayes for giving us the opportunity to outline the current position and to reassure the House of the Minister's commitment to this project.

The Dáil adjourned at 11.35 p.m. until 10.30 a.m. on Thursday, 10 July 2008.