Vol. 717 No. 2
13 Deputy Brian Hayes asked the Minister for Health and Children when urgent admissions to hospitals (details supplied) will cease due to inhumane conditions identified by the Mental Health Commission; if she will provide details on the locations at which more than 1,000 urgent psychiatric admissions will be accommodated; and if she will make a statement on the matter. [34744/10]
In June 2010, the Mental Health Commission attached conditions to the registration of St. Brendan's, St. Ita's and St. Senan's Hospitals which, inter alia, require that new acute admissions to St. Brendan’s cease in September 2010 and those to St. Ita’s and St. Senan’s cease in February 2011. I am glad to be able to report progress on this.
The HSE opened a second unit in the department of psychiatry at Connolly Hospital on 6 September last and all acute psychiatric admissions from the Cabra and Finglas areas were transferred to the new unit from that date. Acute admissions to St. Brendan's have now ceased — for the first time, it is worth noting, since 1815. The building of replacement long-stay mental health facilities, which was recently announced as part of the Grangegorman redevelopment project, is due to begin this year; the new 54-bed unit will be completed by mid-2012.
Three old-age psychiatric wards in St. Ita's Hospital are scheduled to close by the end of the year; these will be relocated to a newly refurbished purpose-built unit elsewhere on St. Ita's campus. It is also planned to discharge approximately ten patients to suitable nursing home or continuing care facilities. Plans for the transfer of acute inpatient admissions from St. Ita's to a new purpose-built unit on Beaumont Hospital campus are proceeding. Construction work is expected to begin in February 2011 and will take approximately 18 months. The HSE is considering alternatives to acute admission to St. Ita's that can be established pending full commissioning of the Beaumont facility.
With regard to St. Senan's, the HSE is committed to the closure of all old psychiatric facilities in the HSE south area. Significant steps have already been taken in Wexford, including a reduction in the number of beds from 170 in 2005 to 85 at present. Four capital development projects are under way which will enable the complete closure of all non-acute wards in the hospital by early 2012. There is sufficient capacity in Waterford Regional Hospital to serve the acute admission needs of the extended Waterford-Wexford catchment area, in line with the recommendations of A Vision for Change. However, before acute admissions can be transferred from St. Senan's, community-based services will need to be further developed in both Wexford and Waterford to provide alternative treatment options and reduce dependence on acute beds. Such developments include the provision of a day hospital service and crisis houses. The HSE expects to finalise an integrated development plan for the expanded catchment area shortly.
I thank the Minister of State for his reply, and acknowledge the fact that he was not in charge of this portfolio for much of the duration of the pain and suffering that people have had to endure in these institutions and acute psychiatric admission units. The Minister to his right, however, has persisted with the policy of co-located hospitals, particularly at Beaumont, which impinges on the site which had the original planning permission for a new unit to replace the one at St. Ita's. This unit, I remind the House, has an open ward with 23 men on one side and another open ward with 23 women on the other, with a bank of three toilets, one shower and a bath on each ward. This is no way to treat people in 2010.
Would the Minister of State not consider, given the abject failure of the co-located hospital policy, using the original site at Beaumont Hospital — for which planning permission was obtained at some considerable cost — and proceed without any further delay to build the unit as provided for under that planning permission?
I fully support everything the Minister has talked about in terms of co-location and, indeed, I support all our policies within the Department of Health and Children.
So do some of Deputy Reilly's colleagues, actually.
Commitments made last year for capital programmes are being adhered to — it is not as if we are talking about a project at some future date. The unit at Beaumont will begin construction this year, and the site in Clonmel is under construction. The acute psychiatric unit in Letterkenny is also under construction. Thankfully, there will be no further referrals to Letterkenny hospital. With regard to St. Ita's, in the Deputy's own constituency, I was out there yesterday morning giving a commitment that the unit in Knockamann would be fully open next month. All the commitments we have made on mental health are being adhered to, thanks to the €50 million capital commitment. I will announce details of further openings. By the way, I forgot to mention St. Loman's in Mullingar, where I turned the sod not long ago for a 100-bed unit. I consider this a work in progress.
I put it to the Minister of State that the percentage of the health budget dedicated to mental health services has gone down to 5.4%, which is an all-time low. Does he intend to increase the amount of money spent in this area, in the context of commitments in A Vision for Change?
Has a clinical lead been appointed for mental health? We received a list of clinical leads in all the different specialties and the only lead that had not yet been appointed was that of mental health. That may since have been rectified, but I would like clarity on it.
The original plan, when times were good in the building industry, was to sell off properties in order to raise capital funds for the provision of mental health facilities. Is the Minister of State satisfied that funding will be available for the various projects he outlined in his reply and for others that are needed in order to remove people from these Dickensian conditions?
I have never argued publicly against the fact that the mental health budget has fallen from 8% to 5.4% of the overall health budget. Nor do I give the standard answer that there is hidden investment in mental health through the primary care facilities and community supports. Given that €600 million less will go into health services in this year's budget, the onus is on me to prioritise funding for mental health within this, particularly in the area of early intervention. To allow us to deliver the recommendations in A Vision for Change over the next four years, I will be making the case for a reorganisation of funding within the health budget to prioritise mental health. I am saying this in public and I said it recently at a conference. It ties in with the commitments of A Vision for Change.
A Vision for Change sets out a ten-year programme, of which four years have been completed. We can meet the commitments we have made in regard to the scheduled closure of mental hospitals in the six years remaining. I will be honest with the Deputies. We had hoped to raise €50 million this year but due to the downturn in the economy, we have raised €10 million thus far. Much of the anticipated windfall was dependent on local authorities being in funds. We are negotiating with local authorities on funding our developments over a two to three-year period.
In a nutshell, the commitment I have made on closing the old hospitals within three years remains. In addition to the commitments I gave last year on this year's spending, I gave a commitment that on 1 March each year we would outline what we can do to work towards our goals. Regarding the clinical lead, no appointment has yet been made.
This is my first opportunity to follow up correspondence I sent to the Minister of State on 14 July regarding the outworking of the Government's policy on mental health inpatient units in the north east. I acknowledge the reply he issued to me on 19 August. Specific questions which I asked in my letter did not receive a response in the Minister of State's letter. Is it the Government's intention to close the admissions unit at St. Davnet's Hospital by the end of November and to discontinue new admissions to the unit from 1 November? I understand all new admissions are to be redirected to the inpatients unit at Cavan General Hospital. It is important that people know the precise situation. This has been suggested and we are weeks away from the prospective outworking of the matter. People within the service and across the community have not been advised of the factual position.
The Minister of State's reply of 19 August referred to an inpatient service planning group established in 2007 to plan for inpatient services not only for Cavan-Monaghan but also for the entire north east. The letter stated that the group recommended that a purpose-built acute admissions unit be provided and that a site on the campus of Cavan General Hospital had been identified. It went on to indicate that an interim measure would be put in place in terms of utilising the existing admissions unit at the hospital and that the numbers which heretofore passed through St. Davnet's would be directed there. I object strongly to the closure of the admissions unit at St. Davnet's Hospital which is in an ideal, long-established and beautiful location. People are now being directed to the basement area of a general hospital. I have visited this unit and felt discomfort upon entering it.
Allow the Minister of State to reply.
It is unsuitable for people with severe mental health issues.
The Deputy's point is well made.
Will the Minister of State clarify the matter and revisit the proposal in light of what I have said?
It is a pity that the defects rather the progress are always pointed out in regard to Cavan-Monaghan. Within one month of my appointment I had the privilege of visiting St. Davnet's where I met the consultant, Dr. Russell. Long before A Vision for Change was even considered, Dr. Russell was one of the first people in the area to promote the concept of community mental health services and support. What is happening is exactly in line with his vision of eight community mental health nurses for the region.
Unfortunately, interim measures are often required where resources are not immediately available. While the basement services are clearly not adequate or proper, I am considering interim measures for the hospital. It is not just a matter of ministerial diktat. All our discussions take place with the full support of the hospital management group. Whenever I have visited any of these hospitals, I have met consultants, doctors, users and providers to work out the best way of developing services in the region. That is what we are doing in Cavan-Monaghan.
We must move on. We have used more than double our allotted time for this question.
I am not at present in a position to say anything more to the Deputy but I will try to revert to him in the next week or two regarding the November date.
May I ask a supplementary question?
We are over time. I do not want to cut the Deputy short on his next question.
I will take the cut on my next question because this is terribly important.
It is extremely important. That is why we spent double our allotted time on it.
The Minister of State said we are not discussing plans for the future and that he has done X, Y and Z. The reality is that the patients of St. Ita's still do not know when they will be accommodated by a psychiatric admissions unit in Dublin north. We have not been told when the unit will be built. Will it be done sometime in the future when planning permission is received? In the meantime, we have been told by the Mental Health Commission that the unit should close by February 2011. Where will the patients who are being admitted or who will need admission next year be accommodated?
The position is clear. Last year we did not have the money but now we are committing the money. We are working with the commission to develop interim measures. I have four specific ideas in mind. I do not intend sharing them with the House at present because it is clear that by doing so I would give rise to concerns about the transfer of patients. I am not looking at the easy option of extending the time period but investigating how adequate and proper facilities can be provided.
14 Deputy James Reilly asked the Minister for Health and Children if the Hayes group report investigating the non-reporting of nearly 58,000 X-rays and the failure to process thousands of general practitioner referral letters at Tallaght Hospital, Dublin, has completed its work; and if she will make a statement on the matter. [34780/10]
The HSE has recently received the report of the independent review undertaken by Dr Maurice Hayes. The review deals with the delay in reporting radiological examinations and the management of GP referral letters at Tallaght Hospital. It is hoped that the findings of the review will be published in the coming weeks. Prior to the separate clinical review of 57,921 X-rays carried out in Tallaght Hospital, two cases of delayed diagnosis emerged. No further cases were identified during this clinical review which was completed in April 2010.
All the GP letters have been opened and examined. It was found that 2,328 related to the period 2002 to 2008, of which 1,269 no longer required appointments. The relevant GPs were informed. Of the remaining cases, 1,059 patients were allocated appropriate orthopaedic and physiotherapy appointments. Additional clinics were held at the hospital to deal with the remainder of cases identified. All outstanding appointments will be completed by the end of next month.
I will be brief, to save time.
I am much obliged.
The Minister promised that the review would be ready in June but it was since delayed to September. Today she informs us that it will be published at some point in the future. That is not acceptable to the people of Tallaght who want a definite date by which they will be made aware of the contents of the report. Will the Minister set out a firm date on which the report will be made available?
The Health Information and Quality Authority, HIQA, was supposed to produce a report on how letters should be dealt with in future. What is the status of that report? I have been requested by Dignity 4 Patients to inquire into the standing of the report promised to that organisation last year.
This is not my report and it was not in my hands. Dr. Hayes was appointed on 18 March and he has completed and submitted his report. It is being examined by Dr. White and others at the HSE because certain legal issues arise. I have not seen the report nor have I been briefed on it. I hope to see it as soon as the legal position allows. I assure the Deputy that the report will be published at the earliest opportunity.
I wish to raise with the Minister policy issues pertaining to people who undergo X-rays and other investigative procedures. We want to have proper procedures in place to ensure this does not happen again to other patients. Will the Minister clarify the procedures being followed in our hospitals to ensure X-rays are appropriately read?
I also want to ask her about the 1,059 patients who needed appointments. The Minister has said that they have since got appointments. Does she know how long some of those patients have been waiting and how much pain they might have been suffering while their letters were unopened? Will any policy lessons be learned from this and will procedures be put in place to ensure that GP referral letters are appropriately dealt with in all hospitals?
The college of radiology was involved in making recommendations on the reading of X-rays and we can make that information available to the Deputy. The letters related to a period between 2002 and 2008 and of course the situation is unacceptable. It is not a policy issue. I think it is a management and operational issue. When we see the report we will be able to determine the management and operational issues that led to that situation. Clearly, it is completely unacceptable that a general practitioner's letter was left lying on a desk and the appropriate procedure was not followed to make an appointment for the patient.
Can the Minister confirm that the Hayes report addressed the unopened referrals issue and not just the X-ray situation at Tallaght Hospital? This is not clear from her response.
Aside from the processing of the individual letters concerned, what steps have been taken to ensure that there will be no recurrence? Has there been any investigation on whether a similar backlog of referrals has taken place at any other hospital across the State? Can the Minister assure the House that this is not the case? Vacancies are not being filled due to the current recruitment embargo and there is a growing strain on clerical supports at a number of hospitals. Clerical administration is suffering as a consequence.
The terms of reference for Dr. Hayes included the GP referral issue. The HSE carried out an audit of all hospitals following the emergence of the Tallaght issue. The college of radiology was also asked to make recommendations and the HSE intends to publish that report.
There seems to be an assumption that all management and administrative staff are in some HSE office, but the vast bulk of them are at hospital level. There are around 400 people working in administration and management at Tallaght hospital alone. There may be some isolated cases involving problems with administrative support, but our hospitals generally have a fair amount of administrative support. The health service, like the rest of the public service, is still very dependent on manual supports. While technology is being put in place, we still have some years to go before we have the technology backup to allow for the efficient processing of correspondence and more complex issues like patient safety——
I want to know whether we will avoid a recurrence of what we have witnessed this year.
When will the HIQA report on how letters should be dealt with be made available to us? When can we expect the report on Michael Shine as requested by Dignity 4 Patients?
I do not have the information on the HIQA report to hand, but I will revert to the Deputies when the authority makes its report. The purpose of appointing Dr. Hayes was to see what recommendations he would make, having done a thorough job and including a GP, a patient advocate and so on. Following the Tallaght issue, the HSE made contact with every single hospital in the country and their clinical directors.
The Dignity 4 Patients report cannot be made public at this time.
When will we see it?
We will not see it for the foreseeable future. The judge has recommended that it should not be made public because there are possible criminal proceedings on the matter.
15 Deputy Dan Neville asked the Minister for Health and Children her views on the fact that more than 46,000 patients are on hospital waiting lists here; if she will provide a breakdown of the number of patients on waiting lists per hospital; and if she will make a statement on the matter. [34759/10]
17 Deputy Brian O’Shea asked the Minister for Health and Children the number of patients treated under the National Treatment Purchase Fund between 2009 and 2010; the cost to date spent on administering this fund; and if she will make a statement on the matter. [34685/10]
I propose to take Questions Nos. 15 and 17 together.
Since its establishment in 2002, the National Treatment Purchase Fund has provided over 200,000 public patients with inpatient treatment, diagnostic procedures and outpatient appointments. The median waiting time for medical and surgical patients is now 2.6 months. This is a very significant reduction from an average of between two and five years when the fund was established in 2002. The cumulative amount allocated to the fund from 2002 to 2010 is almost €598 million. Of this amount, €30.7 million has been allocated to costs related to administration of the fund. This is approximately 5% of the NTPF's total funding in that period.
In 2009, the NTPF facilitated almost 29,000 patients — 20,000 for elective surgery, 2,500 MRIs and 6,400 outpatient appointment — at a cost of €90 million, including administrative costs of €4 million. The fund's allocation for 2010 is €90.092 million. The activity targets agreed involve facilitating 31,000 patients, consisting of 20,000 inpatients, providing 3,000 MRIs and 8,000 outpatient appointments. The NTPF anticipates meeting these targets. I have emphasised to the fund the need for maximum cost-effectiveness, consistent with safe and effective care. I have asked it to seek even better value from private hospitals and the fund has successfully negotiated price reductions for certain high-volume procedures. In addition, it will not purchase services where the price is not acceptable.
The NTPF is responsible for the collation and reporting of national waiting list data and patients are placed on the national list only after they have been waiting three months. This is because many people receive their treatment within three months and, in some cases, with little or no waiting. It is not appropriate to classify these patients as "awaiting treatment" in the same way as those who have been waiting for several months. It is not, therefore, correct to conclude that there are over 46,000 patients on waiting lists.
The most recent figures relate to September 2010 and indicate that the number of patients waiting for over three months was 19,865. I would emphasise that it is more relevant to measure waiting times rather than the numbers of patients involved and, as I have already indicated, significant progress has been made in recent years in reducing average waiting times. There remains a relatively small number of patients who have been waiting for longer than 12 months for treatment and I have emphasised to both the HSE and the NTPF that they must continue to work together to ensure that these patients are afforded treatment without further delay. The detailed data on individual hospitals requested by the Deputy will be circulated in the Official Report.
|
Hospital |
Patients |
|
AMNCH (Tallaght) |
1,181 |
|
Bantry General Hospital |
0 |
|
Beaumont Hospital |
1,374 |
|
Cappagh Orthopaedic Hospital |
302 |
|
Cavan General Hospital |
26 |
|
Children's University Hospital, Temple Street |
433 |
|
Connolly (Blanchardstown) |
101 |
|
Cork University Hospital |
970 |
|
Kerry General Hospital |
9 |
|
Kilcreene Orthopaedic |
138 |
|
Letterkenny General Hospital |
644 |
|
Louth County Hospital |
71 |
|
Mallow General Hospital |
0 |
|
Mater Misericordiae Hospital |
2,173 |
|
Mayo General Hospital |
131 |
|
Mercy University Hospital |
593 |
|
Merlin Park Hospital Galway |
518 |
|
Midland Regional at Mullingar |
215 |
|
Midland Regional at Portlaoise |
85 |
|
Midland Regional at Tullamore |
969 |
|
Mid-Western Regional Hospital, Croom |
54 |
|
Mid-Western Regional Hospital, Dooradoyle |
985 |
|
Mid-Western Regional Hospital, Ennis |
0 |
|
Mid-Western Regional Hospital, Nenagh |
0 |
|
Monaghan General Hospital |
67 |
|
Naas General Hospital |
17 |
|
Our Lady of Lourdes Hospital, Drogheda |
319 |
|
Our Lady's Hospital for Sick Children Crumlin |
1,094 |
|
Our Lady’s Hospital Navan |
143 |
|
Portiuncula General Hospital |
0 |
|
Roscommon County Hospital |
0 |
|
Royal Victoria Eye and Ear |
437 |
|
Sligo General Hospital |
556 |
|
South Infirmary — Victoria University Hospital |
149 |
|
South Tipperary General |
8 |
|
St. Colmcille's Loughlinstown |
0 |
|
St. James’s Hospital |
627 |
|
St. John’s Hospital Limerick |
196 |
|
St. Luke's Hospital, Kilkenny |
310 |
|
St. Michael's, Dún Laoighaire |
0 |
|
St. Vincent's University Hospital |
414 |
|
University College Hospital Galway |
3,720 |
|
Waterford Regional Hospital |
826 |
|
Wexford General Hospital |
10 |
|
Grand Total |
19,865 |
It may be all well in the Minister's mind to say that we will only talk about those waiting more than three months, but the reality is that there are 46,000 people waiting for treatment. The NTPF figures are extremely misleading because they do not include those people waiting up to three months. Many people are now finding that they are not getting onto the NTPF waiting list until they have been waiting six months.
How many people are believed to be on outpatient waiting lists? Does the Minister have any system to measure the number of patients and the length of time from the day a patient is referred from primary care to a hospital? Following our discussion on what happened at Tallaght, surely this is an issue of serious concern.
We never measured the lists in that manner, so we must compare like with like. When the NTPF was established a few years ago, there were over 30,000 people waiting over three months and now that list is below 20,000.
Clinical leads have recently been appointed by Dr. White to devise appropriate clinical pathways for patients, particularly in respect of access to appropriate outpatient appointments. Many of these patients end up being admitted to hospital through accident and emergency more ill than they otherwise might be, due to delays or inappropriate referrals. A great deal of work — I understand the Deputy has been briefed on many of these initiatives — has been under way in the HSE over recent months. Some highly respected clinical leaders have been appointed and they are making substantial progress. I expect to see the fruits of their new work early next year in regard to waiting times for outpatient and other appointments.
I, too, would like to refer back to the previous question in the context of this one because that is what I meant when I said it was a policy issue in regard to the GP referral letters. As the Minister said, pathways of care are crucial to ensure we have proper relationships between the primary care system and the acute hospitals.
I would like to know when we will get information, and I do not believe the Minister answered that in response to Deputy Reilly's question. I gather it is planned to have information on the number of people with referrals from GPs and who await outpatient appointments. From my experience, more people are waiting a very long time before they even get to the outpatient department and on to the waiting lists. Will the Minister clarify when that information will be made available?
My second question relates to orthopaedics, which would be one of the large specialties in the work of the National Treatment Purchase Fund. Orthopaedic beds and orthopaedic theatres in a number of hospitals, in particular in the western area, are being closed. As a result, highly specialised orthopaedic surgeons cannot do the full quantum of work they used to be able to do. Will the Minister examine this in the context of value for money and the fact that many patients are going on to longer waiting lists and to the National Treatment Purchase Fund list? Public hospitals cannot do the work because beds and theatres are being closed and people are being sent to private hospitals, in some cases far from their homes, to have the work done.
For next year, we are examining the strong possibility of procuring, for example, orthopaedics from the hospitals because there is a substantial variation between the cost of procedures from one hospital to another.
Is that from public hospitals?
Yes. In other words, we will ring-fence the money for orthopaedics, because it is very measurable, and procure that service based on value for money. Clearly, there is a substantial variation throughout the country in the context of what one can receive for a specific amount of money. That is evident from the case mix. The money taxpayers make available must be used as productively as possible. I am having discussions with the National Treatment Purchase Fund and the HSE on the procurement of that service for 2011. As Deputy Jan O'Sullivan acknowledged, the resource group recommended that we would move in this direction in the future and it might be good to start along this road during 2011 in order that we are clear what we can get and that we can make appropriate use of our public capacity.
The Minister may or may not be aware that the number of patients on trolleys and chairs in hospitals today is 420. That figure was only 290 on the same date in 2005 when she committed to doing away with it entirely. Between August 2009 and August 2010 there has been an increase of 1,000 in the number of patients waiting more than three months for inpatient and day care treatments. Over the same period, there has been an increase of 5,000 patients waiting for up to three months for similar procedures. These statistics are shocking but they translate into real people.
How do I deal with a parent whose young child has constant issues requiring a tonsillectomy, which she has been told is not likely be performed for up to four years? That is the situation with which we are dealing. That is the advice being given by hospital sites to patients presenting today. It is not acceptable.
There are hundreds of people on the waiting lists for elective surgery in Our Lady's Hospital, Navan. They now have to go into the system. Where will they get their operations? Will that not add to the Minister's woes and increase these waiting lists? There is, effectively, a full surgical unit which could operate on people but cannot do so because it has been closed. The waiting lists will increase and people will be left waiting. We are talking about hundreds of people.
All hospitals, including Our Lady's Hospital, Navan, and all regions of the HSE must live within their budgets. No additional money can be made available. There is much scope within hospitals for greater efficiency. University College Hospital, Galway is in the news currently. It has an absentee rate of 7%.
I am telling Deputies the measures hospitals must take and we are working to ensure they take them. The Croke Park agreement has a crucial role to play in this regard. University College Hospital, Galway loses 25,500 hours per month through absenteeism. It is being asked to reduce it by 28,000 hours per month. All the problem does not rest with the HSE nationally or with the Department. There must be a greater emphasis on efficiency and effectiveness in each hospital to reduce absenteeism rates.
In response to Deputy Ó Caoláin, there is no suggestion that anyone would have to wait four years for that procedure. The National Treatment Purchase Fund is there in the event of a person having to wait three months. If it is an emergency procedure, it will be done immediately.
That is not what the hospitals are saying.
Will Deputy Ó Caoláin please give me the details? When I look for the details, I never get them.
I always give them.
Written Answers follow Adjournment Debate.
