Just like the Titantic HSE Teamwork Report will sink on it’s Maiden Voyage

January 27th, 2009 - Pat Breen

Speaking during the Dail Adjournment Debate on Wednesday, 28th January 2009, Deputy Breen said:

The engineers who designed the Titanic said it was unsinkable but it sank on its maiden voyage.  The Teamwork report will also sink on its maiden voyage because it is based on a perfect world and a perfect health service which do not exist.  The report makes no reference to funding.  In the current economic climate, nobody believes the Government has any intention of providing the necessary funding.

  If the Health Service Executive proceeds to implement this report without the full capital expenditure, people will die.  This is not scaremongering.  One life lost as a result of the implementation of this report without the provision of the necessary funding will be one life too many.  This report is not concerned with putting the patient first or reshaping local services in line with the needs of the local population.  Rather, it is concerned with cutting costs and removing services from Ennis and Nenagh hospitals.  No sooner was the ink dry on the report than the implementation team was put in place.  Another plan is being hatched as we speak to remove services from Ennis as soon as possible.

  Not one hand was raised in support of these proposals when GPs from Clare and Tipperary met yesterday.  These are the people who work at the coal face of the health service and who understand the issues.  The Minister, Deputy Harney, said yesterday in her response to a parliamentary question of mine that detailed plans are being formulated by the Health Service Executive in regard to emergency care, critical care and surgical services and that certain changes to current arrangements for the provision of some acute services will be made.

  The people of Clare want a 24-hour accident and emergency service to be retained at Ennis General Hospital.  There is genuine fear and concern among those living in west and north Clare that they will be further isolated from the provision of vital life-saving services.  If this report is implemented in full, Ennis General Hospital will become a minor injuries clinic.  A group of six advanced paramedics based in Ennis will be expected to deliver a 24-hour emergency care service throughout the county.  The existing ambulance service is already starved of resources.  If the Health Service Executive and the Minister are serious about providing funding, they must increase the number of proposed advanced paramedics and install them on a 24-7 basis at each of the ambulance stations at Kilrush, Ennistymon, Scariff and Ennis.

  My colleagues and I are elected to represent our constituents and we demand answers on their behalf.  The Minister, Deputy Harney, has the ultimate responsibility and she must come clean with the public.  If we cannot obtain answers in the Chamber tonight, we will persist in our efforts to oblige the Minister to debate this issue in the House.  I am disappointed she is not here for this debate.  She should be in attendance to answer our questions.  


Minister of State at the Department of Health and Children (Deputy John Moloney): I am responding to the Deputies on behalf of the Minister, Deputy Harney, who cannot be here this evening.

  The Government is committed to ensuring the delivery of the best quality health services possible, in an effective and efficient way, and ensuring patient safety is of paramount importance in order that people can have confidence in the services and the best possible patient outcomes can be achieved.

  There is significant international and national evidence that acute complex health care, particularly for emergency medicine, complex surgical services and critical care, should be provided in hospitals which are suitably staffed and equipped and which undertake sufficient volumes of such activity in order to maximise clinical outcomes and, more importantly, ensure safe services.  At the same time there is a significant range of less complex care which can continue to be provided safely in smaller hospitals.

  Reorganisation of services must occur in consultation with the key stakeholders and on an incremental basis.


   Deputy Seymour Crawford: That never happens.


   Deputy John Moloney: It does.  I  have seen it happen in the midlands and I am quite certain it also happens here.


   Deputy Joe Carey: The GPs were not consulted.


   Deputy John Moloney: I make the point that reorganisation will occur in consultation with all the stakeholders, which would include the GPs.  The Minister believes that it is important to work with health professionals and other interested parties to secure an increasing set of improvements over time.  She is confident this approach will produce the best outcome for patients.

  It is also important to note that the HSE has commissioned a number of reviews on how acute hospital services should be organised, including the Teamwork/Horwath report on the mid-west region, which the executive has recently published.

  The Teamwork/Horwath report on the mid-west highlights the need for changes to be made in the provision and organisation of acute hospital services across the region, particularly in regard to accident and emergency services, critical care, acute surgery and medicine.  It is also worth noting that the report found that the services are too fragmented, carry increased risks for patients and staff and are not sustainable in their current form.

  The HSE has also indicated that certain changes to the current arrangements for the provision of some acute services, including accident and emergency services, must be made, in the interests of patient safety and also to make best use of the clinical resources available within the mid-west region.  The HSE has been engaged in a consultation process with key stakeholders as it formulates detailed plans in regard to emergency care, critical care and surgical services in the region.

  The HSE plans will involve the reconfiguration of acute hospital services into a network and their better integration with primary care services across the region, with a regional centre at Limerick Regional Hospital that will deal with complex and specialist cases.  The plans will also provide for the development of significant and effective local hospital and community services.  These will include important roles for Nenagh General Hospital and Ennis General Hospital which, for example, will involve the expansion of day surgery and diagnostic activity.


   Deputy Joe Carey: The Government is closing them.


   Deputy John Moloney: If the Deputy follows the script, he will note the position is otherwise.  The Minister emphasises and confirms that there will be important roles for Nenagh and Ennis.


   Deputy Noel J. Coonan: There are like the centre of excellence in Portlaoise in the Minister of State’s constituency, the Government did not invest the necessary funding in it.


   Deputy John Moloney: No, the Deputy is wrong about that.  I supported the then Minister who selected Tullamore.  The funding is in place and the service is up and running.


   Deputy Noel J. Coonan: Portlaoise was appointed as a centre of excellence.


   Deputy John Moloney: In regard to Accident and Emergency services, it is important to appreciate that, although these departments are staffed on a 24-hour basis, the number of attendances in Ennis and Nenagh between 8 p.m. and 8 a.m. is low.


   Deputy Joe Carey: Some 21,000 people attended the accident and emergency department in Ennis.


   Deputy John Moloney: That does not stack up with the facts I have here.  In Nenagh the average number of attendances in this period is 7.6, while the corresponding number in Ennis is 9.2.  Most of these cases would be more appropriately dealt with by GP out of hours services.


   Deputy Noel J. Coonan: Some 19,000 people attended the accident and emergency department in Nenagh.


   Deputy John Moloney: The HSE plan will reorganise the arrangements in Ennis and Nenagh so that these hospitals will provide an urgent care service for 12 to 14 hours a day as part of a regional accident and emergency structure.  These hospitals will also continue to admit appropriate medical cases.  The HSE has identified the enhancement of emergency ambulance services as an essential element of the new service delivery arrangements for the mid-west.


   Deputy Noel J. Coonan: Where are they?


   Deputy John Moloney: Agreement has been reached with the ambulance service that all trauma, paediatric and obstetric emergencies will not be brought to the local hospital but will go directly to the major tertiary centre, which includes the regional maternity unit.

  Plans are under way to introduce a 24-hour advanced paramedic service in Clare and north Tipperary.


   Deputy Pat Breen: There are only two such paramedics on duty at any stage.  How can two cover an area?


   Deputy John Moloney: Plans are under way to introduce a 24-hour advanced paramedic service in Clare and north Tipperary.


   Deputy Pat Breen: Six are assigned for the entire county, but how can that number cover the county if one of them is out ill?


   Deputy John Moloney: Advanced paramedics are trained to a standard that equips them to provide more complex pre-hospital care than ordinary paramedics.  This includes the administration of a wider range of drugs and the urgent assessment and resuscitation of patients.


   Deputy Pat Breen: The Minister of State should tell that to someone from Kilbaha or Carrigaholt.


   Deputy John Moloney: The strategy is all about providing the best care for patients. 


   Deputy Paul Connaughton: It is all about money.


   Deputy John Moloney: In regard to capital development, the Minister has asked the HSE, in the context of the development of its capital plan, to consider the requirements of the mid-west arising from the planned reconfiguration of services in the region.


   A Deputy: What about patients who died when they had to pass Monaghan—–


   Deputy John Moloney: Deputies will also be more than satisfied to realise that discussions on the HSE draft capital plan are ongoing between the executive and the Department.  The Minister is satisfied that the measures being taken by the HSE are necessary and appropriate in order to ensure the provision of safe and effective health services to the people of the mid-west region.


   Deputy Pat Breen: We believe she is wrong.