The people of Clare have heard enough rumours and spin Deputy Breen warns during Dail Adj Debate on the future of A&E Services at Ennis General Hospital

December 18th, 2008 - Pat Breen

   Deputy Pat Breen: I wish the Acting Chairman, the Ceann Comhairle, the Leas-Cheann Comhairle season’s greetings and thank them for facilitating Members in raising matters on the Adjournment during this session.

  It is a sad indictment of the Minister for Health and Children and the Government that the HSE ‘s national service plan for 2009 was leaked to the media and that the matter was not debated in the House prior to Christmas.  The House should have debated this important plan because a real emergency exists in respect of our health services. 

  If we read between the lines of the HSE ‘s plan for 2009, it is obvious that we face a catastrophe.  The plan is already obsolete.  It emerged in recent days that some €900 million in cuts will be required and not the €500 million to which the plan refers.  The Taoiseach stated yesterday that the purpose behind driving the efficiencies required is to maintain rather than reduce services.  If €900 million in cuts are going to be necessary in respect of the HSE , I do not know how it might be suggested that services, particularly those of a front-line nature, will be reduced.

  According to the plan, a reconfiguration of the accident and emergency services is envisaged in respect of several hospitals, including Ennis General Hospital in my constituency.  The provision of 24-hour accident and emergency services at Ennis is again in the spotlight and under threat.  In recent days, Clare GPs have spoken out about this matter and stated that 24-hour accident and emergency surgical services are to be withdrawn at Ennis from 1 April 2009 .  This will result in the loss of on-call anaesthesia services, intensive care and coronary care services and the discontinuation of all inpatient admissions and casualty services.

  How does the Minister for Health and Children expect accident and emergency services to continue to be provided at Ennis General Hospital if surgical services are to be transferred?  I appeal to her – I have done so on many occasions – to publish the Teamwork report.  My sources inform me that this unpublished report is already in place and being implemented by a project manager.

  Who is going to pay the price for the cutbacks in the health service?  The answer is that patients in the system will suffer.  Long before the publication of the plan, patients were finding it difficult to access health services.  Despite commitments given by the Minister for Health and Children, not only are hospital facilities under-resourced but patients and their families in County Clare face long waiting times in respect of critical appointments and older people are unable to remain at home and cannot find places in nursing homes.  For those who wish to continue to live in their own homes, the primary care facilities are grossly underfunded.  Each day I speak with patients and their families in respect of the stress they are obliged to endure.

  The number of people on trolleys in our hospitals during the week was unbelievable. It is almost 40% higher than it was in 2006 when the Minister first said we had a national emergency.  Last Tuesday, there were 390 people on trolleys in accident and emergency departments throughout the country.  According to the Irish Nurses Organisation, there were 30 patients on trolleys in the Mid-West Regional Hospital in Limerick last Monday.  The situation at that hospital has been chronic during the past few weeks.

  By end December 21,038 will have passed through the doors of accident and emergency at Ennis General Hospital, 4,586 of whom were classed as emergency admissions.  How is Limerick Regional Hospital to cope with the additional influx of patients from Clare if accident and emergency services at Ennis General Hospital are contained?  Also, it will have to cope with additional patients from Nenagh General Hospital and St. John’s Hospital in Limerick , the services of which are also to be axed.

  I want answers this evening.  I am tired of hearing promises such as that the hospital development plan will shortly be announced.  In an update I received recently from the Minister in regard to the progress in terms of implementation of the recommendations of the HSE following the incidence of C.difficle at the hospital, I was advised that the project to improve ward accommodation is progressing and is expected to go to tender early in 2009. 

  We want to know the current position.  People are extremely worried.  I note that the only reference in the plan to the capital programme for the hospital is a capital injection of €0.4 million for 2009 for completion of the radiology department and in respect of an upgrade of CT scanner services.  We are awaiting publication of the report of the Health Information and Quality Authority into the tragic cases of misdiagnosis.  My fear is that the report, rather than dealing with the real concerns of the families involved, will be used as a smoke screen to downgrade accident and emergency services at the hospital.

  There will be chaos at Ennis General Hospital if these cuts go ahead.  There will be chaos in County Clare and lives will be lost.  A person in Kilbaha who has the misfortune to suffer a heart attack – we must recognise in this regard international best practise in terms of the golden hour rule – will have to be taken directly to Limerick Regional Hospital , a journey of 117 kilometres. 

The spatial analysis study of ambulance resources for the hospital and mid-west area has not yet been published.  The ambulance service is already over-dependent on on-call services.  How is this service, without adequate resources, to cope with transferring many more patients out of the county?

  The people of Clare have heard enough rumours and spin.  I want to know this evening if 24 hour services will continue at Ennis General Hospital; when the redevelopment project will go to tender, when additional resources will be made available for Clare ambulance services and, when the Teamwork report will be published?  We deserve answers.  It is time the Minister stopped running.  It is time for leadership, accountability and answers.

  Minister of State at the Department of Education and Science (Deputy Seán Haughey): I am responding to the Deputy on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

  The Government is committed to ensuring the delivery of the best possible quality health service in an effective and efficient way.   Patient safety is of paramount importance in ensuring people have confidence in the services and that the best possible patient outcomes are achieved.  It is essential that patient safety and quality are prioritised and that services are organised and managed accordingly.

  In February 2007, the Health Service Executive commissioned Horwath Consultants in association with Teamwork Management Services to examine the arrangements for the provision of acute hospital services at Ennis and other hospitals in the mid-west with a view to identifying the best configuration of such services in the region, including arrangements for accident and emergency, critical care, acute medicine and surgery together with diagnostic services so that the highest quality of care can be delivered to the population of the region.

  The work of the consultants will act as inputs to decisions on how best to reconfigure acute services in the mid-west region. The Government and Executive are committed to ensuring that the approach to reorganisation of services is carried out in consultation with the key stakeholders and that each element is progressed incrementally.  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.  This approach will, she is confident, produce the best outcome for patients.

  Recent reports in regard to patient safety have raised concerns about the capacity of smaller hospitals such as Ennis General Hospital to deliver consistent high quality care for patients who present with complex care needs at accident and emergency.  Smaller hospitals treating low numbers of complex cases means that medical and nursing staff often have difficulty in maintaining skills in specialised areas and delivering safe care to such patients.  Concerns have also been raised in respect of the capacity to recruit permanent consultants in such hospitals with the inevitable reliance on long term locum appointments.

  Currently, the accident and emergency department at Ennis is staffed primarily by sub-consultant emergency care physicians who deal with all emergencies that present and then refer patients to the appropriate specialty or service based on their clinical assessment.  The HSE in the mid-west is currently working on a detailed plan to address the future configuration of emergency services in the region so that they will be in line with best practice.  This plan which will consist of an emergency care network under which designated services will be assigned to individual hospitals and service delivery will be based on clear protocols under the direction of a regional department of emergency medicine.  Many of the services currently provided in local hospitals will continue under the new arrangements but in a more structured manner and with patient safety and quality of care as the determining criteria.

  In regard to capital developments at Ennis, the Minister understands that installation of a CT scanner and radiology upgrade is underway and is expected to be completed in 2009.  On the particular issue raised by the Deputy, the HSE has been asked to prioritise and accelerate the Ennis capital development project along with other key capital projects in the mid-west in order to support the delivery of a modernised and improved service for this area.

  I assure the Deputy, on behalf of the Minister, that Ennis General Hospital will continue to play a significant part in the delivery of health care in the region.


   Acting Chairman: I wish Deputy Breen a happy Christmas.


   Deputy Pat Breen: I wish the Acting Chairman, Deputy O’Connor and the Minister of State, Depu ty Seán Haughey, a happy Christmas.