Tuesday, 18 October 2005
Dáil Eireann Debate
Mr. Kenny: I am sure the House will agree that we should express our condolences and sincere sympathies with the family of the late Pat Joe Walsh who died in Monaghan General Hospital on Friday last. Mr. Walsh’s death was the latest in a number of tragic incidents in the north-eastern health area. Difficulties with health and hospital services are not new. The Taoiseach will be aware in recent years of the tragic case of Bronagh Livingstone and Benny McCullagh. It seems clear that the decision to withdraw permission to medical staff in Monaghan General Hospital to carry out surgical procedures after 5 p.m. was a critical feature in this latest tragic case.
One year ago this party tabled a Private Members’ motion expressing concern over issues of quality in the health service in this area. Earlier this year I raised this matter with the Taoiseach on leaders’ questions. Despite these political warnings nothing has changed. In the last two days both he and the Tánaiste have sought to distance themselves from any political responsibility for this tragedy and are now desperately trying to point a finger at the Health Service Executive. Today, in an article under a headline entitled “You would not let an animal die the way he died”, the Tánaiste says that all questions relating to services and facilities available at different hospitals are now a matter for the HSE to determine. On Monday the Taoiseach is quoted as urging the HSE to look at hospital services in the Monaghan region and resolve the issues. He is further quoted as saying he hoped the HSE would resolve this situation.
The people are outraged at this latest tragedy. It is incomprehensible how a man can be allowed to die and his life’s blood to flow away when the personnel, skills and theatre facilities were available in Monaghan General Hospital to carry out a life saving procedure. It is utterly astonishing the Government continues to wash its hands of political responsibility for the chaotic state of the health services.
Under section 10 of the Health Act 2004, the Minister for Health and Children can issue a written directive to the HSE. Will she now issue such a directive that in similar circumstances no administrative procedure will prevent surgical teams from carrying out life saving operations on any patient? Will the Taoiseach explain to the House and to the people how the circumstances surrounding the death of this man in Monaghan General Hospital are a matter for the HSE, but if the executive wants to buy a single computer, it is a matter for the Department of Health and Children? Arising out of this latest tragedy will the Taoiseach now see to it that Monaghan General Hospital is put back on call?
The Taoiseach: I join Deputy Kenny and the Tánaiste when she raised the matter earlier in extending my sincere sympathies to the family and friends of Patrick Walsh of Carrickmacross who died at Monaghan General Hospital last Friday, 14 October. The circumstances surrounding the death of Mr. Walsh will, as we heard from the Tánaiste earlier, be the subject of an independent review to be undertaken on behalf of the Health Service Executive by Mr. Patrick Declan Carey, a consultant surgeon at Belfast City Hospital and an honorary senior lecturer at Queen’s University Belfast City Hospital. That review is to be completed and a report issued within the timeframe outlined by the Tánaiste. The terms of reference for the review are being finalised, but it will cover the period commencing with the admission of Mr. Walsh to Our Lady of Lourdes Hospital in Drogheda on 21 September until Mr. Walsh’s death in Monaghan on 14 October. The report will be furnished to the director of the national hospitals’ office of the Health Service Executive who will make recommendations as he sees fit. The HSE in the north-east area has contacted the family of Mr. Walsh and a meeting will take place today. The Tánaiste and Minister for Health and Children, Deputy Harney, has also offered to meet the family if they so wish.
Earlier today the Tánaiste outlined the circumstances of the incident. This is clearly a tragic event. It is difficult for people to explain. I do not attempt to explain it. The patient had been in hospital since 21 September, was released on 13 October and came back in the following day. The medical records and those who were dealing clinically with the patient were in the hospital in Drogheda, but he was brought to Monaghan hospital when there was a bed in Cavan hospital. I do not understand why this happened.
I know difficulties have existed in the area for some time, but I will not use the tragic and regrettable death of Mr. Walsh to get into those arguments. I met the Hospital Alliance last Friday night when I first heard of this case some hours after the death of Mr. Walsh. The Hospital Alliance outlined the case explaining to me that Mr. Walsh could not have an operation in the hospital because of protocols set out. As the Tánaiste outlined those protocols were from the recommendations of the steering group which were unanimously approved by members of the group in the interests of patient safety.
The Taoiseach: It is, but those were the circumstances and the Tánaiste outlined them in great detail. The death of a person is regrettable, but it is important that the examination and recommendations with regard to what is now necessary are quickly dealt with. I am not here to answer for medical or clinical decisions as to why Mr. Walsh was treated in one hospital and sent to another when an intensive care bed was available in yet another.
Mr. Kenny: The late Mr. Walsh was not released from the hospital in Drogheda, he was transferred to Monaghan Hospital. The Tánaiste’s revelation that an intensive care bed existed in Cavan Hospital makes this even worse. The Taoiseach should make a public statement on why this intensive care bed in Cavan was not used, as the public has an interest.
Political responsibility for the chaotic services within the health system rests with the Government. After nine years and record amounts of money being spent, this is the situation. In November 2004, at a meeting of the PD constituencies, the Tánaiste stated, “if we put money in but it flows away, gets diverted and loses its force before it delivers results for the public, we have a big problem”. This was not a case of money flowing away but a man’s blood flowing away. That man is now dead.
Despite all the promises made, there was no room at the inn for Pat Joe Walsh. When Monaghan Hospital inquired, there was no room at Cavan, Drogheda, or Beaumont Hospital. The Taoiseach is shifting political responsibility for this incident to the HSE. We were also promised trained paramedics on all ambulances but this has not happened. The family of the late Pat Joe Walsh and the public in general deserve to know what happened, and the Taoiseach should make a public statement on the bed in Cavan Hospital not being used. He should confirm that the report of the public inquiry will be published in full so that people will know the full tragic consequences for Pat Joe Walsh and his family of a Government that is unable to cope with the realities of life.
The Taoiseach: The death of Mr. Walsh is a tragedy and I will not bring that into arguments about other circumstances. The Deputy posed the question as to why Mr. Walsh was transferred when he was in a hospital since 21 September and when there was a bed in Cavan. Why did this happen? Why did they check with Beaumont Hospital? Did they check with Beaumont? To inquire into these and all the related questions the Tánaiste has given the investigative task to an eminent consultant surgeon.
There is a separate question over the 106,000 people working and saving many people’s lives in top-class operations and services. It is not correct to indicate that they are not doing immense work every day, or that they are not being properly resourced and managed every day.
The Taoiseach: We have tragic circumstances here that will be investigated. The report will be published as we will all have an interest in it. I will not accept that there should be political accountability every time a person dies anywhere in our health service.
Mr. Rabbitte: On behalf of the Labour Party I join the Taoiseach and Deputy Kenny in extending condolences on this terrible but avoidable tragedy. Reading the graphic description in the newspapers this morning on the way this man died one is reluctant to focus on the matter at all. It must cause additional grief to the family. Mr. Walsh’s sister is quoted this morning saying that an animal would not be let die in the way that her brother died. Nevertheless, the family and people in general will expect us in Dáil Éireann, the national parliament of the people, to raise this question. How can it happen in a civilised country in 2005 that a man should die in a fashion that I will not repeat from the newspapers this morning because it makes such unbearable reading?
When one considers policy in health services at the moment one must come to the conclusion that the service is in free fall. Nothing competes with this tragic example in highlighting the extent of the acute crisis in critical aspects of the management of the health services. The Tánaiste, when she came into office, published a ten-point programme to deal with this situation. Almost none of the ten points has been implemented. I could not believe it when I heard her state earlier that there has been a 22% reduction in patients on trolleys between April and September. The period between April and September is in high summer. That is the kind of sleight of hand that she would be the first to condemn out of the mouth of any other Member of this House. We are not even in winter, but the Tánaiste adduces figures about what happened in the summer. She may as well state that there has been a reduction in the winter vomiting bug between April and September, such is the relevance of what she said.
What is the position on beds inappropriately occupied? Is it true, as The Irish Times reported yesterday, that 378 beds are inappropriately occupied in the acute hospitals in Dublin alone? How many such beds have been freed up as a result of the Tánaiste’s ten-point plan? Could we have some answers to these questions rather than some sleight of hand about what happened in the height of the best summer enjoyed since the rainbow Government in 1995?
The Taoiseach: The Tánaiste referred to the 378 beds earlier in her answer to a question on the issue. She also pointed out the range of issues of the ten-point plan on accident and emergency departments that are being implemented. A number of them have been implemented while others are on the way. The acute units are being extended in hospital accident and emergency departments to help in the assistance. Most staffing issues are also being dealt with. There are still problems in some of the accident and emergency departments, although not in all of them, which are being resolved.
We are trying to find alternative locations for long-stay patients in acute hospitals so that such patients do not hold back those hospitals but have adequate medical care in other locations. The figures have already been given for those who have been accommodated in recent weeks. A significant number of patients in hospitals in Dublin and elsewhere have been accommodated in private nursing homes and in alternative care. These are satisfactory arrangements and have allowed the beds in acute hospitals to be used for those who come in through accident and emergency departments or for treatment.
We will continue to try to improve the throughput and to free more beds, so that accident and emergency departments do not have the problems that they currently experience and people can be dealt with. As the Tánaiste also pointed out, we are trying to provide home care packages and arrangements where people who do not want to be in hospital can be cared for in the home.
Mr. Rabbitte: This is the eighth year of the Taoiseach’s leadership and he keeps reeling off these figures like they represent some kind of improvement. The Tánaiste had promised significant improvement by this autumn. From what she said today, we know that such is not the case. I do not know whether the Taoiseach is right in saying that the Tánaiste had already given out the figures I quoted, but they were in The Irish Times this morning. They highlighted the lack of progress made.
I must ask the question again. How many acute beds have become available as a result of the implementation of the ten-point programme? Now that the HSE is established, will there be a pattern of a washing of hands, avoiding political accountability and political responsibility? When asked about this in the Irish Examiner, the Taoiseach responded:
What does that mean if it is not a passing of the buck by the Taoiseach, the Tánaiste and the Government to the HSE? Meanwhile, Professor Drumm has been announcing policy initiatives, which I thought was the responsibility of the Minister.
No one knows where they stand in the north east, with all the chopping and changing that has gone on over 20 years. If the Tánaiste and Minister for Health and Children insists, as a matter of protocol, that no emergency surgical procedures be available before or after 5 p.m. in Monaghan General Hospital, surely it is imperative that such a facility be available nearby. How is it that the adjacent hospitals can refuse a patient? I point out to the Minister for Foreign Affairs that it is not a matter for smiling.
Mr. Rabbitte: How can a patient be refused in such circumstances in extemis? It is beyond belief that he could be turned away in circumstances like these. The people expect the Head of Government to answer that question in this House.
The Taoiseach: That is precisely what I would like the inquiry to find out. We have five hospitals in Cavan, Monaghan, Drogheda, Dundalk and Navan with considerable resources. They should be able to work together to try to deal with the issue. The Deputy said there were no resources.
The Taoiseach: When I spoke the other night to the members of the group from Monaghan, who were very responsible and put their case to me even though the tragedy had happened hours earlier, they told me that to have the additional facility, they would need two extra nurses as they had the infrastructure and the medical personnel. We spent €12.4 billion, so I do not think it is a question of resources.
The Taoiseach: I am sorry, I should not have responded. Deputy Rabbitte asked about the three categories of bed to which the Tánaiste referred. Of those in high dependency beds, 48 with more demanding needs have been contacted by private nursing homes. A total of 318 patients have been discharged in 95 intermediate care beds for six-day week stays since contracts with private providers began in May. Additional home care packages and enhanced subventions have facilitated the discharge of 246 patients and 94 patients, respectively, from hospitals in the Dublin area. In total, around 700 patients have been removed from the hospital system this year.
The Taoiseach: The policy approach in respect of the surgical services for the Cavan-Monaghan hospital group was set out in 2004 in a report of the steering group established by the former North Eastern Health Board. That group was representative of all the stakeholders and included consultant representation from both hospital sites in surgery, medicine and radiology. The recommendations of the report were unanimously approved by the numbers of the group. The steering group recommended that major and emergency services should be carried out in Cavan General Hospital and that Monaghan General Hospital should provide selective elective surgery. The report’s recommendations reflected what the Royal College of Surgeons in Ireland stated. I know that people would like to think that these are political decisions, but that is not so.
In accordance with the recommendations of the steering group, a full surgical team based in Cavan would provide the services at Monaghan General Hospital in the form of selective elective surgery from Monday to Friday. Also in accordance with the steering group’s recommendations, the hospital returned to 24 hour, seven day medical cover ten months ago, in January. A third consultant position has been in place since this time last year and five new anaesthetic non-consultant hospital doctors have been recruited to facilitate the return of the hospital to being on-call. These decisions were thought out, whether rightly or wrongly, in the interests of patients and were set out in the report last year.
Caoimhghín Ó Caoláin: On my behalf and on behalf of the Sinn Féin Party, I extend our sincere sympathy to the siblings, nephews, nieces and extended family of the deceased, Patrick Walsh. Go ndéanfaidh Dia trócaire ar a anam dílis.
Last Friday, the Taoiseach visited County Monaghan. I welcome his meeting with the community alliance which has been campaigning for years against the cuts in services at Monaghan General Hospital. Nevertheless, it is important to note that I am extremely disappointed that he refused to meet the members of Monaghan County Council, the democratically elected members and representatives of the people of that county, on the same issue. That is not acceptable.
As the Taoiseach carried out official engagements in County Monaghan, a 70 year old man, Patrick Walsh, lay in Monaghan General Hospital suffering from a bleeding ulcer. It is important to make this point. The staff at Monaghan General Hospital did all they were allowed to do for him. However, because of the embargo on emergency surgery in the hospital, they could not operate on Mr. Walsh. That is the bottom line. Our Lady of Lourdes Hospital, Drogheda, Cavan General Hospital and Beaumont Hospital in Dublin could not or would not accept him. A detailed account of the facts which is not an exercise in scapegoating is now eagerly awaited. However, one cannot escape the fact that even if Mr. Walsh could not be transferred or moved, the surgeons in the hospital in which he lay, who have an excellent record, excellent support staff and a state-of-the-art theatre, could not operate on him because of protocols. They could not operate because of a policy that the Taoiseach and his Government have imposed on the health services in this State.
Caoimhghín Ó Caoláin: It is his Government’s implementation of the Hanly report that led directly to the death of Patrick Walsh. This policy was already in operation before Mr. Hanly reported at all. Make no mistake about it, up to 16 unnecessary and avoidable deaths have occurred in Monaghan General Hospital over the period since the tragic loss of baby Bronagh Livingstone.
Does the Taoiseach not accept that ongoing adherence to this policy is nothing less than criminal? When will the Taoiseach and the Tánaiste listen to the public, to the patients, to the health care professionals at Cavan and Monaghan and a variety of other professional opinion already expressed? When will they restore the life-saving services that have been taken from our hospital and community?
Is the Taoiseach aware that last month, the consultant surgeons at Cavan and Monaghan hospitals signed a joint appeal to the Health Service Executive and indeed to the Tánaiste to allow Monaghan General Hospital to go back on call for acute surgical emergencies——
Caoimhghín Ó Caoláin: ——and that the Health Service Executive should provide the resources to allow that to happen? Nothing has happened since. We have had the death of Patrick Walsh. How many more unnecessary avoidable deaths must be witnessed at Monaghan or allied to the situation in Monaghan before the Taoiseach and the Tánaiste listen and heed the cry of a people who are not second class citizens and are not prepared to accept a second class health service?
The Taoiseach: In reply to Deputy Ó Caoláin, it is not a question of an embargo. Protocols were set down following an examination of these matters last year, when a professional steering group that was not composed of politicians or people wishing to make political points, looked at these issues. When the group examined the surgical, medical and radiological facilities in the hospitals, it came to an agreement on protocols. It was unanimously approved and has been followed as a matter of policy since then.
The Taoiseach: I am answering Deputy Ó Caoláin. As Deputy Ó Caoláin is aware, I have met the group — the people at the coalface, the medics, the GPs and the consultants — twice. I am sorry that Deputy Ó Caoláin feels that the local public representatives might have known more than the consultants and other staff. I agreed to meet the group which I thought would best know how the hospital should be run, rather than acceding to a late request which I received from some public representatives.
The Taoiseach: He was discharged to another hospital. I would rather wait to ascertain why that was so because he had been in Drogheda for some considerable time. I also want to wait to find out why, if it was a question of an ICU bed, one in Cavan was not used or why he did not return to where he had been the previous day. However, I will wait for the report. I will not make a political point about it but will accept the findings of an eminent consultant.
The Taoiseach: Deputy Ó Caoláin knows the group I met a few nights ago and I believe he would respect and accept its views. The group told me that in its view, given the facilities available and the arrangements and consultants in place, the service could be run with just two extra nurses.
The Taoiseach: The group itself stated that it is not a question of resources, it is an issue of patient safety. An independent group of people who know far more than either the Deputy or myself, namely, the medical and surgical staff, with the Royal College of Surgeons, decided they did not believe, in the circumstances, that it was safe. I know that is disputed. The Deputy would rightly say to me that I would be entirely irresponsible to take action, ignoring the professional views of the Royal College of Surgeons, medics and medical and surgical consultants.
The Taoiseach: If it was a question of only two nurses the resolution would be easy. However, an examination of the region led to these conclusions. Deputy Rabbitte is correct. I find it difficult to know what the groups I listen to are at, but I will wait for the report. If it is as simple a matter as the people in Monaghan tell me, I cannot understand why the Royal College of Surgeons made its decision. I will await that report with interest but will not pre-empt it, nor should the Deputy.
Caoimhghín Ó Caoláin: I find it incredulous that the people the Taoiseach has met who are not working in the hospital system but are well informed about its needs would have said that two nurses would be the panacea for all the difficulties that have arisen in Monaghan General Hospital as a result of his Government’s policy of the diminution of its services over many years.
Caoimhghín Ó Caoláin: The Taoiseach should not seek to apportion blame outside his shared responsibility. Instead, he must undertake in conjunction with the Tánaiste to listen to a set of professionals and not to always use the crutch of the Royal College of Surgeons or any other expert group. To say it has a monopoly on wisdom on this or any other issue is ridiculous. It is plain to the people of County Monaghan, whether we have professional expertise, what is required in order to ensure the safe delivery of acute hospital services at Monaghan General Hospital. The Taoiseach must require the HSE to act.
Caoimhghín Ó Caoláin: ——about what has been a very important contributory fact, the inquiry must include an examination of the disastrous policies that directly contributed to the death of Mr. Patrick Walsh and so many others. Will the Taoiseach instruct the Tánaiste at this late stage, as Minister with responsibility for health, to in turn instruct the HSE to put Monaghan General Hospital back on emergency surgical call? We need the restoration of what we and most reasonable people throughout this country view as a fundamental service and an expectation of any citizen of what should be available at a local general hospital. It is still a general hospital in name at least. Surgical services, including accident and emergency, are a key component of that delivery mechanism.
I ask the Taoiseach to ensure this is the legacy of the tragic death of Mr. Patrick Walsh and many more and not to have a situation arise where I and my colleague Deputies from counties Cavan and Monaghan and other concerned voices throughout the country must confront him with yet another tragedy within our community.
The Taoiseach: Since September, I have met people including medics and not just the people involved in the alliance. I have also met the surgical consultants in Monaghan General Hospital, who gave me their views. I have seen the letter signed by the counties Cavan and Monaghan consultants. The Tánaiste and I have discussed the issue but the decisions on these matters will be made by the Health Service Executive.
The Taoiseach: It is not a matter of the Royal College of Surgeons dictating anything. The college is the professional body that reflects advice. Its recommendations to the steering group were given in the interests of patients’ safety.
The Taoiseach: The Deputy knows this is the system that works. We will wait on this matter. The Deputy knows that €4.4 million has been spent in upgrading parts of the hospital. Some of the facilities are available and ready to open, which I hope happens. Other developments are taking place in some of the wards concerned. However, they are separate issues that are being dealt with by the HSE and I hope they will be resolved.
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