Wednesday, 11 February 2009
Dáil Eireann Debate
Deputy Mattie McGrath: I thank the Leas-Cheann Comhairle for allowing me to raise this serious matter. I believe a death notice for South Tipperary General Hospital has appeared in the form of an information document dated 29 January 2009 on the modernisation of acute services for the hospital group south-east. A short few years ago, St Joseph’s County Medical and Maternity Hospital, Clonmel was renamed South Tipperary General Hospital at great expense and inconvenience to take account of the amalgamation with Our Lady’s County Surgical Hospital, Cashel.
South Tipperary General Hospital under the new guise of modernisation of acute services will lose its identity and become part of a recognised, or possibly unrecognised, group — it will become a statistic in the HSE plan. Lest anyone forget or needs reminding, the HSE is about saving lives, not saving money. The situation in regard to South Tipperary General Hospital and the proposed reconfiguration of hospital services within the south-east, and its impact, is a matter of grave concern to the constituents of Tipperary South and to myself.
The implementation of the transformation programme as required by the national services plan will commence, we are told, in March 2009 with the development of a steering group for the modernisation of acute hospital services for the HSE group south-east. The steering group will have a membership initially comprised of four clinical directors — one from each hospital — and a hospital manager. The role of the steering group will be to supposedly agree and plan for a re-configuration model of acute hospital care for the hospital group south-east, make recommendations on service delivery issues and oversee the implementation of the modernisation programme. A project manager will support the planning and implementation phases of the programme and the planning phase will be completed by September 2009.
I am concerned that we have too many programme managers within the HSE and too few frontline staff. Under the HSE plan for the modernisation of services, the so-called aims of discussion are as follows: understanding and clarification of challenges, as if we did not know already; having a shared understanding of the need for change; a shared understanding of what we must do and how we should go about it; and timelines — all fancy jargon adopted by the HSE. However, what we have is no two-way dialogue, completely one-way traffic, a tunnel vision on behalf of the HSE and its management and no proper, meaningful consultations with the extremely hard-working and dedicated staff at Clonmel.
As I said, the death notice for South Tipperary General Hospital has appeared in the form of this information document, dated 29 January 2009, with its fancy title concerning the modernisation of acute services for the hospital group. I am totally opposed to these new plans to remove out-of-hours services or accident and emergency services after 7 p.m., as well as the removal of maternity services and all acute hospital services. This would mean that never again would a child be born in Tipperary, which is unacceptable, particularly when we have a top quality maternity service with large numbers of deliveries each year.
While I have no issue with centres of excellence, as with speakers on another debate today, I believe we must have centres of excellence in place before we attempt to remove services. A radical change in the direction of health care policy is needed in the Department of Health and Children and the Health Service Executive. Democratic accountability must return to the Minister and services must return to our local hospitals. There must be a health care system which truly places the patient first and which is capable of meeting the needs of our communities. I remain committed to fight might and main to keep all services in South Tipperary General Hospital.
Minister of State at the Department of Health and Children (Deputy Mary Wallace): I thank Deputy Mattie McGrath for raising this important issue. The Government is committed to ensuring the delivery of the best quality health services possible, in an effective and efficient way. Ensuring patient safety is of paramount importance, such that people can have confidence in the care they receive and can expect the best possible outcomes. Patient safety and quality must be prioritised and services organised and managed from that perspective. In addition, services should be available, as far as possible, close to where people live.
Currently, South Tipperary General Hospital provides acute services for a catchment population of some 135,000 people in South Tipperary and the bordering areas of North Tipperary and west County Waterford. Since acute hospital services in South Tipperary were amalgamated in South Tipperary General Hospital in January 2007, following the transfer of accident and emergency, general surgery and oncology services from Our Lady’s Hospital, Cashel, service delivery arrangements have been much enhanced and have proved beneficial for both patients and health service staff in the area.
We are all now familiar with the expert advice that, where the delivery of complex care is concerned, better outcomes for patients are achieved if this takes places where the necessary staff and equipment is all to hand and sufficient volumes of activity take place. The available evidence also emphasises the need to provide timely emergency care to patients in an appropriate setting and that this leads to lower rates of death, fewer complications and longer life.
It is important to appreciate that the nature of health service delivery is changing and that the direction of future development is towards an increased proportion of diagnosis and treatment taking place on a day or outpatient basis. For example, much computerised tomography, CT, scanning and endoscopy work can be undertaken in local hospitals. This is a good deal more convenient for patients and their families, as well as being much more cost-effective.
The HSE’s national service plan for 2009 contains a commitment to develop in the south east an overall framework for reconfiguration of all services in the hospital network. The HSE is at present developing its plans to advance this work. This task is at a relatively early stage. The Government is committed to a process of change which is incremental, involving appropriate consultation and discussion with health professionals, service users and other interests.
I assure Deputy Mattie McGrath and the House that any proposed changes emerging from the process in the south east will be the subject of consultation. The HSE has already prepared the information document to which Deputy McGrath referred dealing with the modernisation of acute services in the region which will be a helpful input to the work ahead.
Whatever configuration of services is ultimately decided upon, the Minister is confident that South Tipperary General Hospital and each of the other acute hospitals in the region will continue to play a valuable and significant role in the delivery of an integrated regional health service. I thank Deputy Mattie McGrath for raising this important issue.
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