Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 27 May 2010

Vol. 710 No. 3

Adjournment Debate

Hospital Services

I thank the Ceann Comhairle for giving me an opportunity to raise this important issue this evening. A statement issued by the HSE on 12 May last, in which plans for a reduction in non-consultant hospital doctors were announced, will have consequences for services in Roscommon, Portiuncula and Mullingar hospitals. It is clear from discussions with health management and professionals that a perfect storm is being allowed to develop by the HSE, in order to facilitate the implementation of the Hanly report by means of a hatchet. The HSE is referring to this as "reconfiguration". It involves the transfer, over time, of accident and emergency and surgery services from Roscommon and Portiuncula hospitals to the University College Hospital in Galway. It will also involve the closure of the local maternity unit in Ballinasloe, which is the only maternity unit in the country to be accredited as a "baby-friendly" hospital.

The HSE is using the shortage of non-consultant hospital doctors and the introduction of the EU working time directive as a means of downgrading services at Portiuncula and Roscommon hospitals. This staffing issue is threatening the operation of the accident and emergency departments at both hospitals, which currently operate 24 hours a day, seven days a week. The overnight downgrading of these hospital services, without planning, will result in loss of life locally. Foreign non-consultant hospital doctors are not coming to Ireland for a number of reasons. Red tape and the short duration of visas represent a major part of the problem. This is not something that has happened overnight. It is only now, at the 11th hour, that the Government has started to discuss the issue and to try to resolve the problem. It did not become a priority for the Government until it started to realise not only that it will affect the smaller hospitals, as secretly planned, but also that it will threaten the operation of the major regional centres. This is a deliberate act of national sabotage.

The management of the HSE claims that it will provide a better and safer service and that non-emergency work will be transferred from the regional centres, such as the University College Hospital Galway, UCHG, to the local hospitals. While some people in the Ballinasloe area may be naive enough to believe this, the people of Roscommon have seen the HSE renege on previous commitments. The HSE claimed all surgeons appointed to the amalgamated departments of surgery at Portiuncula and Roscommon would be joint appointments. We now find out that the Roscommon hospital has been air-brushed from these surgical contracts and the posts will be shared between University College Hospital Galway, and Portiuncula. Eventually, these particular surgeons will be relocated to Galway city.

The people of Roscommon were told by the Minister of State, Deputy Michael Finneran, that they either use or lose their hospital, yet no funds have been provided to upgrade the sterilisation facilities to ensure additional procedures could be performed in the hospital. In the past four years not one patient has been put through Roscommon County Hospital under the National Treatment Purchase Fund even though the hospital has the capacity and no waiting lists.

Roscommon was promised additional out-patient clinics. Instead, the HSE has reduced the number of clinics that take place at the hospital. On 23 April, at a meeting with local public representatives in Portiuncula Hospital, HSE management informed them the super-manager would not be appointed until the end of the year at the earliest. Yet, less than a month later, the HSE made an announcement of an appointment without any notice. I understand the individual in question is a consultant radiologist, Mr. David O'Keeffe, based in UCHG. His appointment will cover six acute hospitals, community services and long-stay hospitals in an area that takes three hours to travel across, more than it takes to travel from Dublin to Cork.

While I have no doubt that Mr. O'Keeffe is a fine individual, with all due respect to him, we do not need another Brendan Drumm Óg to do the Government's dirty work in implementing the Hanly report.

Will the Minister of State clarify what will happen to accident and emergency services in Portiuncula and Roscommon hospitals? What is the secret intention behind the establishment of this new super-manager and the reneging on previous commitments regarding future services?

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

The Government is committed to ensuring the delivery and maintenance of the best quality health service possible and providing the highest standard of patient care in an effective and efficient way within the resources allocated. Roscommon and Portiuncula hospitals play an important part in the HSE West network of acute hospitals and provide a range of acute, diagnostic and support services to both adults and children in their catchment areas, which include east Galway, Roscommon, north Tipperary, Offaly and Westmeath.

The HSE has been working in recent years to enhance collaboration between UCHG, Portiuncula and Roscommon hospitals in the provision of services. This is occurring, for example, in the reconfiguration of the surgical and anaesthetic departments of Portiuncula and Roscommon hospitals into a joint department of surgery and anaesthesia. In addition, the HSE, in line with the commitment in its national service plan for 2010, has commenced the process of preparing a plan for the future configuration of acute hospital services in the HSE West as a whole. A process of dialogue with the hospitals, staff and other interests has begun and will continue to be conducted on a consultative and inclusive basis in the interests of ensuring safe, effective and sustainable services in the years ahead.

The HSE plans to recruit a manager with responsibility for UCHG, Portiuncula Hospital and Roscommon County Hospital. This initiative involves the expansion of the current post of manager at Galway and is designed to promote good co-ordination of service delivery. The purpose of this is simply to improve management processes and thereby improve services for patients. This planned appointment is also in line with the approach on the governance of acute hospitals recommended in the Health Information and Quality Authority's 2009 report on quality and safety of services at the mid-western regional hospital Ennis. This report identified integrated governance across hospital networks as an important factor in ensuring higher quality services for patients.

The current position on this matter is that the public competition conducted by the Public Appointments Service did not result in the selection of a successful candidate. The HSE is, therefore, considering further options in order to provide for this key appointment and hopes to be in a position to make an announcement presently.

The Minister is satisfied the plan to recruit a manager with responsibility for the hospitals will enhance the capacity for collaboration in service provision, provide a more strategic approach to the management of the hospitals concerned and ensure the provision of better and safer services to the people of the region. Both Roscommon and Portiuncula hospitals will continue to play key roles in the provision of hospital services to the population of the west.

With all due respect to the Minister of State, that reply was a load of rubbish.

Health Services

I thank the Ceann Comhairle for allowing me to raise this matter on the future of the HSE in the light of recent developments.

We are all aware, and I certainly acknowledge, individual staff members in the HSE are conscientious, diligent and public-spirited, but time and again the HSE as an organisation has proven to be disturbingly dysfunctional and unfit for purpose. Sadly, in recent days we learned the failures of this organisation have had lethal consequences for some of the vulnerable people with whose care it was entrusted.

These past weeks have given us proof of the dysfunctional nature and cataclysmic failures of an organisation entrusted by the Dáil with the care of vulnerable children. We learned of the troubled life and sad death of Daniel McAnaspie, a young man in need of a caring environment, in need of a support structure, in need of help. He was a member of a family which had to face a number of serious crises and traumas in their young lives. His was a family failed by the State care system and Daniel, a young man, was allowed to fall through the cracks. His life is now over — a young man whose needs were well documented yet ignored.

It is not only the vulnerable young who have been let down by the HSE. We also heard the heartbreaking stories raised in this week's excellent "Prime Time Investigates" programme on the lack of support, the lack of services and the lack of a strategy to help those affected by Alzheimer's disease and dementia. In the programme, we saw older people and their families fighting for services to which they are entitled, including respite care, home help, day-care facilities, residential care facilities of an appropriate standard and counselling for the women and men struck down by this insidious disease and their families. The evidence of this programme should not be forgotten, such as the tears of frustration of grown men caring for their mothers, doing the job of the State and struggling to make up for the failures of the HSE.

We are witnessing the gradual shutting down of HSE-run nursing homes, very often without proper consideration being given to the option of upgrading those local facilities. Instead, the elderly and frail patients of these public facilities are being bundled out the doors into private nursing homes without any serious consideration for their feelings, their former friendships or their sense of belonging. Sadly, many of these people have died shortly after being moved and nobody in authority seems to care.

I could go into detail about the number of separated children or unaccompanied minors missing from State care. HSE data from 2007 show 41 children went missing from care. In all, between 2000 and 2007, 441 separated children were recorded as missing from their care placemen,t and of these only 53 were accounted for. What is that if not an admission of abject failure?

We are only now getting a glimpse of the outrageous power struggle being played out in the corridors of power in the past few days. The organisation tasked with responsibility for the health of our nation at first refused to provide to the elected Government and Dáil information on the number of children who have died in its care. Only after a contentious meeting with the Taoiseach, as reported in today's The Irish Times, did the organisation backtrack on that stance. This is simply outrageous. It raises the question who governs this country — the Government or the HSE, the Taoiseach, Deputy Brian Cowen, or Brendan Drumm?

Members should now join forces to demand an end to this monstrous bureaucratic experiment called the HSE. It is dysfunctional, dangerous and defeated. I believe it no longer commands the confidence of this House or the people we represent and it should be brought to an end.

It is high time for us to hold a mature discussion about what we can do to replace this dysfunctional organisation with a health care system in which we can have confidence to look after the care needs of the entire population.

I thank the Deputy for raising this issue and I welcome the opportunity on behalf of my colleague, the Minister for Health and Children, to reaffirm the Government's commitment to the principles underpinning the establishment of the Health Service Executive as a single, national authority with responsibility for the management and delivery of health and personal social services. While I understand the Deputy's concern in respect of some of the issues raised by him, this should not detract from the significant progress that the HSE has achieved on several fronts in the reform of our health and social care services since its establishment five years ago.

The strategic reasons for abolishing the health boards and certain other agencies and replacing them with a single national authority remain as valid as ever. Reform of our health system was driven by the need to bring about improvements in services to patients and other users through the organisation and delivery of consistent national services, based on objective standards and implemented in a uniform manner throughout the country which made the most beneficial, effective and efficient use of taxpayers' money.

The vital work that is now well under way to implement a national cancer control strategy was made possible by the unified HSE structure. Similarly, the implementation of national standards for nursing homes throughout the country has also been greatly facilitated by a single structure, as has the introduction of the Fair Deal nursing home scheme. The implementation of critical primary care and chronic illness strategies also require a single, national management structure. Over time, these strategies will deliver real and tangible benefits that would not have been possible to achieve under the previously fragmented system.

The HSE has recognised that its own internal structures must be reorganised to improve the delivery of health and personal social services on an integrated basis and to improve accountability at all levels of the organisation. That is why it has moved to put in place an administrative regional structure, within the national structure, to drive operational performance and accountability on the ground.

The sheer scale and complexity of the health service reform programme cannot be underestimated. It is the biggest reform project ever undertaken in the country and change of this magnitude can only be successfully achieved over a timeframe of several years. It is inevitable that deficiencies will come to light as the reform programme evolves and it is imperative that the HSE takes the necessary corrective action to address these as they arise.

However, as I stated earlier, the policy objectives behind the establishment of the HSE are as valid today as they were seven years ago when the Government took the strategic decision to establish a single national authority to replace the seven regional health boards, the Eastern Regional Health Authority, the three area health boards and several other agencies. Improving the range and quality of services to patients, clients and other users of our health and personal social services is at the heart of the reform programme and the Minister for Health and Children remains steadfast in her view that this can best be achieved through a unified national structure as the progressive implementation of the national cancer control programme has clearly demonstrated.