Dáil Éireann díospóireacht -
Wednesday, 27 Jan 2010

Vol. 700 No. 2

Adjournment Debate.

Hospital Services.

Deputy Tom Sheahan

The PET scanner I shall refer to has nothing to do with pets. It is a positron emission tomography, PET, scanner which shows how an organ works or how a damaged heart, for example, is functioning. It shows blood flows through the brain and can indicate potential tumours. It is used in areas of cardiology, urology and oncology.

Last May I asked why the HSE had not employed an operator for the PET scanner at Cork University Hospital, as people had to go to Dublin to have this scan. The reply was to the effect that the completion date for the building works was June 2009, and that there would be an equipment installation period. I am sure when that reply came, from the HSE last May, it did not envisage a nine month installation period for the equipment.

This equipment cost €3.8 million and is sitting idle because the HSE cannot afford to put a person in place to operate it. Hence people in the south are being sent either to the Mater Hospital or St. James's Hospital in Dublin for this scan, at their own expense. In 2008, some 108 PET scans were referred from the HSE south area. We do not know the figure for 2009, but the 108 PET scans in 2008 cost the HSE south €250,000, despite having €3.8 million worth of equipment lying idle because there was no operator.

The HSE has described the PET scanner as being crucial in the management of cancer patients as it allows more accurate diagnoses. It allows more accurate diagnosis of cancer. In addition, the PET scanner will augment the delivery of cancer services in the HSE south region.

When cancer services were withdrawn at Kerry General Hospital, we were promised that we would have a centre of excellence for such services at Cork University Hospital. A vital component of that would be the PET scanner which has been purchased. In addition, the building has been constructed. In May 2009, I asked the question and was told that the completion period would be in September. However, here we are, six months later, and the PET scanner is not yet up and running. This is causing a lot of distress to people. For anyone suffering from cancer, the idea of having to travel to Dublin for such treatment is unthinkable. Those suffering from cancer will not make a big issue of the cost of going to Dublin for this treatment, but it is inconvenient. When people are sick the last thing they want is to have to take the road to Dublin for a PET scan. The equipment is in Cork University Hospital at a cost of €3.8 million, but it is not operational because there is no staff member there to run it. I ask the Minister of State to get that PET scanner up and running in Cork University Hospital as soon as possible for the benefit of those patients who need it.

Minister of State at the Department of Health and Children (Deputy John Moloney)

I am responding to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney, who unfortunately cannot be here this evening.

I thank the Deputy for raising this matter. PET-CT scanning is one of a number of sophisticated diagnostic tools used in the acute hospital setting in the diagnosis and management of disease. In 2006, the HSE decided to procure a PET-CT scanner for Cork University Hospital. Construction of the new facility and installation of the scanner was completed in 2009.

In order to implement savings on public service numbers, the Government decided that, from March 2009 to the end of 2010, no public sector post may be filled by recruitment, promotion or payment of a higher duties allowance. A HSE circular gives effect to the Government decision and other specific aspects of the employment control framework for the health services.

While the Government decision applies to all permanent and temporary staff, including nursing staff, there are specific exemptions. For the health service, the employment control framework specifically exempts the following front line grades from the moratorium: medical consultants, speech and language therapists, occupational therapists, physiotherapists, clinical psychologists, behaviour therapists, counsellors, social workers and emergency medical technicians.

The framework allows for growth in numbers in those posts within the overall approved employment ceiling for the health sector. In addition, special provisions apply in relation to certain specialist grades under the national cancer control programme. The Government decision was modulated to ensure that key services are maintained as far as possible in the health service, particularly in relation to children at risk, older people and people with disabilities.

Health employment levels are monitored by the joint employment control monitoring committee, which comprises officials from the Department of Health and Children, the Department of Finance and the HSE. This committee also reviews implementation of the moratorium and any issues arising. A process is in place to fill critical vacancies and formal approval is required for non-exempted posts. Where approval is granted, recruitment then takes place.

With regard to Cork specifically, and staff required for the PET-CT scanner, the HSE has identified posts required to operate the scanner and has begun the application process for approval to fill non-exempt posts. Until the PET-CT in Cork University Hospital becomes operational, patients will continue to travel to St. James's Hospital or the Mater Hospital in Dublin, with whom the HSE has service level agreements for the provision of PET-CT services. In 2009, a total of 108 patients from the Cork and Kerry region were referred to St. James's and the Mater hospitals in Dublin, in line with service level agreements in place.

The HSE is working to bring this project into operation as soon as possible to ensure that the people of Cork and Kerry have easy access to the most advanced diagnostics available, thus ensuring that better outcomes are achieved for patients.

Accident and Emergency Services.

Deputy Joe Costello

This day last week we had the largest recorded number of patients sitting on chairs and lying on trolleys, waiting to be admitted to beds and receive treatment in accident and emergency units throughout the country. The previous occasion on which numbers were close to that was in 2006. Last Wednesday, the numbers reached 500 and four years ago it was 495. On that occasion, the Minister for Health declared a national emergency, but she did not declare any emergency last Wednesday. On umpteen occasions the Minister has declared that she would sort out the accident and emergency problems, but clearly she has not done so. These are not just statistics — they are ordinary citizens, generally elderly people. They are all sick, having suffered in one way or another and are awaiting emergency treatment. They should not be sitting in such appalling conditions, waiting for long periods — very often overnight or two nights in a row — without any changing or proper toilet facilities. It is appalling in this day and age. It is not good enough that this situation should be continuing now, without any alleviation over the past ten years. We are raising the issue to impress upon the Minister that accident and emergency is the interface between the patient and hospital services. Unless this is improved we are subjecting our most vulnerable citizens to the most appalling treatment facilities. They receive excellent treatment when they get into the hospital proper, but the interface stage is absolutely atrocious. I do not know what it means for the Minister to declare a national emergency, but she should take this matter seriously. During the last floods, a section of the accident and emergency unit in my own local hospital, the Mater, fell down and is now in an even worse condition than it was before.

Deputy Jan O’Sullivan

If it was an emergency in 2006 with fewer people on trolleys, I challenge the Minister to say why it is not an emergency today. Why is the Government not addressing this issue? Some 365 people were on trolleys today, of which the largest number, 41, was in the constituency of my colleague, Deputy Ciarán Lynch, in Cork University Hospital. The second largest number, 33, was in the Mid-West Regional Hospital, which is in my own constituency. Coming in third, was Tallaght Hospital which is in the Acting Chairman, Deputy O'Connor's, constituency. This situation simply cannot be tolerated any longer. I have been talking to people on the telephone who are on trolleys in corridors. In the Mid-West Regional Hospital, which has a very small accident and emergency department, the trolleys are now in wards, corridors and almost out into the hospital's reception area. We are talking about sick people who need attention. They have a right to acute care, as well as respect and privacy. It is simply unacceptable that they are on trolleys awaiting medical attention in public areas. I urge the Minister to intervene.

In effect, people who are far away from accident and emergency departments are saying that they are focusing on community care and step-down beds. The reality, however, is that those resources are not in the community, including step-down, rehab and long-term beds. They cannot discharge people from our acute hospitals. Almost 900 beds are closed at the moment and 1,000 more are scheduled to be closed this year because of cutbacks in the HSE. The system cannot take it because the resources, which I know the Minister of State would support, have not been put into the community. They are not there. We cannot pretend the problem does not exist and act like the three monkeys and see, hear and speak no evil. Unfortunately, the people who pontificate on these issues are far removed from the problem of the people who are lying on trolleys in our hospitals today. I urge the Government and the Minister of State, Deputy Moloney, to ensure there is a response to this situation and to ensure it is treated as the emergency it is.

Deputy John Moloney

I thank Deputies Costello and O'Sullivan for raising this issue and apologise that the Minister cannot be here.

The HSE accepts that emergency departments have experienced significant increases in the numbers attending to date in January. The work to rule currently in operation by staff at the HSE has led to a disruption in the HSE's normal data collection on activity in emergency departments. As a result data is limited with effect from 25 January.

Deputy Jan O’Sullivan

We can get the data for the Minister of State, if he requires it.

Deputy John Moloney

That might be helpful. I am explaining why the Department does not have it to hand. Hospitals which experienced particular challenges last week included Cork University Hospital, Beaumont, the Mater, St. Vincent's, Tallaght, St Columcille's, Galway and Clonmel.

Deputy Jan O’Sullivan

The Minister of State has omitted Limerick.

Deputy John Moloney

The facts have not come up from there yet.

Deputy Jan O’Sullivan

There were 33 people on trolleys today.

Deputy John Moloney

Figures reported by the HSE this morning at 8 a.m. indicate that Beaumont, the Mater and Cork University hospitals continue to have patients waiting for unacceptably long periods for admission, although it has informed the Minister that the situation has improved from last week and that it is continuing its efforts to improve waiting times in all hospitals, particularly these three hospitals.

Seasonal factors such as the swine flu, winter vomiting and the extremely inclement weather conditions have placed additional demands on emergency departments in recent weeks.

Deputy Ciarán Lynch

Those are annual factors rather than seasonal ones.

Deputy John Moloney

The Minister has been monitoring the situation in emergency departments very closely. This afternoon she met the CEO and members of the HSE management team to review progress and to ensure that all possible steps are being taken to minimise the waiting time for patients awaiting admission, including to the Mater. The Minister has also asked the HSE to streamline the administrative processes for dealing with applications under the fair deal, so that the discharge of patients to a suitable long-stay facility is not delayed unnecessarily.

Following a meeting earlier this week, the HSE has put several actions in train. These include escalating plans to enable patients to be moved to wards; providing for additional ward rounds to take place daily to help earlier discharges from hospitals; the cancellation of some elective surgery and the deployment of day wards to accommodate patients; providing for measures to be put in place to improve transfer arrangements to other hospitals; the better use of discharge lounges, medical assessment units and chest pain clinics to steer patients away from emergency departments; ensuring access to additional diagnostic facilities such as imaging to allow earlier decisions about admission or discharge; providing additional support to day units to avoid unnecessary admission to hospital; improving ambulance and transport stand-by arrangements; and liaison with community units, community nursing and GPs is being reviewed to promote community based interventions.

Escalation plans have been activated again this morning around the country. Day wards are being freed for in-patient accommodation and additional temporary beds have been opened in St. Vincent's and St. Columcille's hospitals. Hospitals have been requested to ensure that all escalation measures are implemented and reviewed as necessary and appropriate liaison arrangements with primary community services are in place to deal with the current pressure. The HSE is also introducing, with effect from 1 January, the hospital award 2010 which is aimed at encouraging good performance in a number of areas, including emergency department waiting times. Non-performing hospitals will be subject to review by the director for quality and clinical care in conjunction with clinical directors. The directorate is liaising with local clinical directors and providing clinical input and support as necessary.

The Minister is confident that the roll-out of the above measures, actively driven and reviewed by HSE senior management on an ongoing basis, will deliver a timely and effective service to patients attending our emergency departments.

Deputy Joe Costello

I am glad the Minister is confident.

Deputy Jan O’Sullivan

I hope the Minister of State will convey our views to the Minister.

Deputy John Moloney

I certainly will.

Hospital Visiting Regulations.

Deputy Thomas Byrne

This may not be the most important issue facing the country today, but it is an issue that impacts on a number of fathers who wish to attend scans or other antenatal appointments or at the labour ward during delivery with their wives. I attended the birth of my two children and Deputy Mattie McGrath has informed me he attended the births of his eight children. Attendance at the birth of children is much more in vogue now than when I was born.

I wish to pay tribute to all the staff in Our Lady of Lourdes Hospital, which is the hospital of choice for parents in my constituency of Meath East. The staff there do tremendous work and there is a massive throughput of patients through the hospital. I have spoken about the maternity unit there on previous occasions here. A number of fathers and mothers are upset that currently they cannot attend together the various appointments required during pregnancy. I understand that fathers are not being admitted during scans or for antenatal appointments and that they are only admitted for part of the labour. This issue was raised with me by constituents and has been confirmed to be the case. I understand there can be issues of hygiene and am aware there was an issue in Our Lady of Lourdes Hospital recently with regard to clostridium difficile. However, the HSE should be able to work out arrangements whereby a father can attend all appointments and admittances of the mother of his child. The advice to us regarded this as important and I found it an important experience.

I ask the HSE to reconsider this issue bearing in mind the hygiene requirements and the need to prevent the spread of disease. It should come to some compromise arrangements in this regard.

Deputy John Moloney

I am taking this Adjournment matter on behalf of the Minister, Deputy Mary Harney. I thank the Deputy for raising this important issue.

The HSE issued national guidelines on visiting policy to hospitals in September 2006. These guidelines reflect a balance between the needs of patients, their visitors, hospital staff and hospital procedures which allow for the most effective delivery of safe healthcare services. The guidelines state that the welfare of patients must always be considered in determining the approach taken. The potential for the spread of infection must also be taken into account.

With regard to the issue raised by the Deputy, the HSE has informed the Department that in line with preventative infection control procedures, visiting restrictions are in place generally in Our Lady of Lourdes Hospital, Drogheda, including the maternity unit. The HSE is advising women that they should be accompanied by one birth partner only when in the labour ward. Women are also requested to attend for antenatal scan alone. However, in certain circumstances a partner may be admitted following discussion with the relevant ward manager. Furthermore, all women with appointments are advised by the HSE that children should not attend the hospital with them. These procedures have been put in place because of recent outbreaks of hospital acquired infections in the hospital. They form a central part of eliminating and preventing recurrence of such infections.

Tackling all healthcare associated infections, HCAIs, continues to be a priority for the Government and the HSE. While it is not possible to completely prevent outbreaks due to these infections, simple interventions can minimise their effects. In 2007, the HSE launched a national infection control action plan. An infection control steering group within the HSE is responsible for overseeing the implementation of this plan. Over the period of the plan, the HSE aims to reduce HCAIs by 20%.

The Health Information and Quality Authority, HIQA, since its establishment in 2007, has also taken significant steps in the area of infection control. A core function of the authority is to set standards on safety and quality of health services and to monitor enforcement of those standards in an open and transparent way. In 2007, HIQA developed national hygiene standards and commenced a programme of audit against these standards. In May 2009, HIQA published its national standards for the prevention and control of health care associated infections to provide an overall framework for health and social care providers to prevent or minimise the occurrence of such infections. The HSE is in discussion with HIQA on the implementation of the standards. Patient safety is of paramount importance and I am satisfied that significant steps are being taken to reduce the rates of health care associated infections generally and to treat them promptly when they occur.

Schools Building Projects.

Deputy Ciarán Lynch

I thank the Ceann Comhairle for the opportunity to raise this important matter, which concerns Ballygarvan national school and the steps being taken by the Minister and his Department to ensure that work on the new school can commence as soon as possible. Will it be completed in September when the new school year begins? Can the Minister of State, Deputy John Moloney, confirm that the acquisition of the site has been completed by the school patron? I want to refer to the planning permission request lodged with Cork County Council by the Department of Education and Science and raise concerns I have regarding difficulties that will arise if the school is not built by September.

Ballygarvan national school has a student population of 285 and has applications from approximately 60 new pupils for next September. Eight of the existing classrooms are in prefabricated buildings and the remaining two are in a building constructed in the 1800s. Each new prefab has eaten into the playground space, which presents health and safety hazards and requires careful scheduling of play time. The school is sited on a narrow country road, with consequent traffic chaos at delivery and collection times, namely, 9 a.m. and 2.30 p.m. At these times, there is a bottleneck. It is but one example of many nationally. There was improper planning as housing estate after housing estate was built, resulting in daily gridlock as parents drive to school to pick up their children safely.

Ballygarvan was first promised a new school almost 12 years ago by the then Minister for Education, Deputy Micheál Martin. The community has grown quite significantly since then and the demands of 12 years ago have increased significantly in the interim. There have been frequent commitments since the new school was promised, particularly at election times. These have culminated in a series of announcements. Last February, the Minister for Education and Science, Deputy Batt O'Keeffe, said Ballygarvan had at last been included in the list of schools that would be constructed. An application for planning permission was submitted in August 2009 to Cork County Council and it is under consideration. Furthermore, there have been two recent requests for information from the planning authorities. If this information is not provided within six months, the planning application could fall. This would have serious implications for the scheduling and project management of the development and construction of the school. Any delay in the granting of planning permission, or in construction, will have very serious social and financial consequences. If the new school is not ready for occupation by September 2010, the parents of existing and aspiring pupils will need to be notified in the very near future.

Decisions that have to be taken in the next six to eight weeks have implications. Should the school provide for one, or more, additional classes given the number of applications it will receive and how it will deal with them? Is an additional class to be housed in a prefab at a cost of approximately €100,000? Will it be placed on top of an existing prefab? Should rental contracts for four prefabs that are due to terminate this year be renewed? Given the rental of €120,000 per year on the other six prefabs on site, should the contracts be renewed in 2010 and 2011? If an additional class or two is enrolled, will the Department of Education and Science meet the cost of the additional yard space and play area required?

It is understood that construction work will begin by mid-April. Is it guaranteed that the school will be ready by September? In light of the fact that the Minister's construction budget was not all spent in 2009, will the Minister of State confirm that the funding for this much-needed project has been ring-fenced and that his Department is making every effort to facilitate the completion of this project to meet the educational needs of the Ballygarvan community?

Deputy John Moloney

I am responding on behalf of my colleague, the Minister for Education and Science, Deputy Batt O'Keeffe. I thank the Deputy for raising this matter as it provides me with the opportunity to outline to the House the strategy for capital investment in education projects and the current position on Ballygarvan national school.

The allocation of funding for school buildings in 2010 is just under €579 million, including the carryover of €72 million deferred from 2009. This represents a significant investment in the schools building and modernisation programme. This amount of funding, at a time of great pressure on public finances, is a sign of the Government's commitment to investing in school infrastructure and will permit the continuation of the Department's programme of sustained investment in primary and post-primary schools.

With regard to Ballygarvan national school, the proposed project, to construct a new school building, was one of 25 that the Minister announced would commence architectural planning in February 2009. Since then, officials have prepared detailed drawings and the local authority facilitated a number of preplanning meetings prior to the lodgement of a planning application. Following the preplanning meetings, the Department addressed the issues raised by the local authority and submitted a planning application for the new school. The local authority subsequently issued an additional information request, which raised some new issues. The Department responded to the additional information request in full. I understand the local authority has recently issued a further additional information request raising further issues. Officials are currently preparing a response to this second additional information request.

With regard to the acquisition of the site, the Deputy may be aware that the proposed site consists of three separate pieces of land in the ownership of the Catholic diocesan authority, Cork County Council and a private landowner. The Bishop of Cork and Ross, as patron of the school, has agreed to acquire the land in the ownership of Cork County Council and the private landowner to facilitate the proposed building project.

Any decision to progress this project is contingent, among other things, on the receipt of the necessary statutory approvals and the completion by the school patron of the acquisition of the site for the proposed new school building.

A reply to the further request for information will be prepared by the Department and submitted as soon as possible. When a decision regarding planning permission is made, the Department will examine the implications for the project. The progression of the project to construction will be given further consideration at that point. The Department will continue to liaise with the patron and the school authorities regarding the proposed project.

Deputy Ciarán Lynch

Is the money safely ring-fenced?

Deputy John Moloney

I do not want to mislead the Deputy and could not really answer that question. I will take it up with the Minister for Education and Science directly and revert to the Deputy within a week. I thank the Deputy again for giving me the opportunity to outline to the House the current position on the school building project for Ballygarvan national school.

The Dáil adjourned at 9.20 p.m. until 10.30 a.m. on Thursday, 28 January 2010.