Wednesday, 21 September 2011
Dáil Éireann Debate
Deputy Michael McNamara: I thank the Ceann Comhairle for providing me with an opportunity to address the House on the issue of health care at Raheen Hospital, County Clare. I regret that the Health Service Executive remains a bureaucracy which is completely out of control and utterly unaccountable to democratically elected representatives at all levels. I greatly commend the Minister for Health for his moves earlier this year to have the entire board of the HSE resign and then appoint a new board. However, this signal clearly has not permeated down to the HSE representatives in the mid-west region, as borne out by recent developments in County Clare and particularly in Raheen hospital.
On Saturday, 10 September, staff at Raheen hospital were informed by e-mail that the number of respite beds would be reduced from 28 to 23. There was no discussion in advance and no inquiries about the impact this might have on care. Furthermore, they were informed that this would take effect from the following Monday morning. Patients who thought they would have a bed on Monday morning learned on Monday morning that this was not the case. This is completely unacceptable. As somebody who lives near Raheen hospital, I was aware there were difficulties there because the staff had outlined these to me. I made numerous inquiries to the HSE about what was happening but I got no information. This is not about me; it displays a contempt for the people who voted for me and for those who voted for Deputies Carey, Dooley and Breen in Clare, because they also made inquiries and similarly received no information, as did local councillors, yet the HSE persists in the circus of organising meetings and bringing in all the elected representatives to their lovely boardroom in Limerick where they ply us with generalities but give us no specific information.
The HSE was set up by the previous Government and it has ballooned into a bureaucracy. It now falls upon this Government to deal with it, and I urge the Minister to do so. Furthermore, the HSE was set up to provide health care led by professionals rather than by politicians. This is simply not the case. Professionals are not being listened to in the HSE. Instead, it is being run by bureaucrats who display nothing but contempt for this House, the people who sit in it and local government.
This is borne out by what has happened to psychiatric services in Clare. I am greatly encouraged by the comments of the Minister of State, Deputy Lynch, at the weekend that money would hopefully be ring-fenced for psychiatric services, because the 200 psychiatric nurses who were working in County Clare three years ago have now been reduced to less than 150. There are now rumours that psychiatric units in Tipperary, particularly in Clonmel hospital, are due to close and that all north Tipperary patients will be sent to Ennis. Initially, staff in Ennis were informed they would receive 14 new nursing posts to cope with the demand; now they are expected to receive only five. The psychiatric day care centre in my town was closed on 26 August. It had been manned five days a week up to May 2011 and two days a week since then. Some of the patients who attended that day care centre were not even informed that it was to close. That is simply unacceptable in 2011. Some of those psychiatric patients showed up on the Monday morning at the day care centre to find it closed. A little bit of communication with elected representatives, or with the population, would go a long way.
Minister of State at the Department of Health (Deputy Kathleen Lynch): I agree with the Deputy on the issue of psychiatric services. To discontinue a service without informing the people who rely on it is not right and should not happen. I hope it will not happen under the new regime we are trying to establish. The days when psychiatric services were part and parcel of the overall Vote and budget for acute hospitals are coming to an end. I hope we will be able to disentangle the funding and establish a far more robust system of psychiatric services. I am aware there is major resistance to the closing of particular units — I am not talking about day centres — but we must move from the bedside to the fireside. People with mental health issues must be treated in the community in a humane and respectful fashion. They should not turn up at centres to find them closed. I agree with the Deputy in that regard.
The Deputy asked about Raheen hospital. The Government is committed to supporting people to live with dignity and independence in their own homes and communities for as long as possible. Where this not feasible, the health service supports access to high quality long-term residential care where this is appropriate. We continue to develop and improve health services in all regions of the country to meet this objective and to ensure quality and patient safety.
The HSE has sole operational responsibility for the delivery of health and social services, including those at facilities such as Raheen Community Nursing Unit in County Clare. The community nursing unit is located in a rural area in south-east Clare. The unit has a total capacity of 28 beds. It can accommodate 14 long-term residents, with 12 places allocated as short-term care or assessment beds and two places dedicated to palliative care.
The HSE in the mid-west had spent €20 million more than its allocated budget at the end of June 2011. One of the measures implemented to deal with this issue is a reduction in the use of agency staff and overtime across all health and hospital facilities and services in the mid-west. This has had an impact on the number of residents that can be safely accommodated. Consequently, the HSE has reduced the number of beds in Limerick, County Clare and north Tipperary by 65. The reductions, mainly in short-stay beds, are as follows: 15 beds at St. Camillus Hospital, Limerick; 17 beds at St. Ita’s Hospital, Newcastlewest; 22 beds at the Community Hospital of the Assumption, Thurles; six beds at Dean Maxwell Home, Roscrea; and five beds at Raheen CNU. It must be noted that 23 of these beds are currently vacant. A reduction of nine beds had originally been envisaged in County Clare; however, through a successful redeployment of nursing staff, this figure was reduced to five beds at Raheen. The reduction will be managed with minimum disruption to residents. I accept the Deputy’s point about the planning that goes into respite and long-stay beds. Clearly, this is a cause of major disruption.
The Deputies will appreciate that all developments must be addressed in the light of current economic and budgetary pressures. Any decisions taken by the HSE must have regard to this and to the current moratorium on the recruitment of nursing and non-nursing staff.
The HSE has been asked to make a rigorous examination of how existing funding might be reallocated to ensure maximum service provision. In particular, we need to ensure that the highest standard of care will continue to be provided to all residents in a safe and secure environment. The employment control framework gives effect to Government priorities on employment policy in the public sector and provides that there will be a net reduction in employment of approximately 1,500 annually to 2014. The framework is designed to maintain tight control on the cost of providing public services while at the same time allowing the service flexibility to manage staffing resources so as to protect front-line services as far as possible. The framework also provides for adaptation to changing service needs. It allows for some growth in certain grades and posts which are exempt from the moratorium on recruitment in order to deliver on key priority services. These exemptions include certain therapy grades, medical consultants and a limited number of nursing posts. The Croke Park agreement also allows the HSE to redeploy staff based on service need. In July 2011, the HSE introduced a recruitment pause to assist it in addressing its serious budgetary overrun. Notwithstanding this pause, exceptions are still being made where this is deemed necessary to address critical service risks.
The Department of Health is currently reviewing the provision of public residential care in the light of the need to meet national standards and regulations, local demographic pressures and the differential between public and private provision. The review will serve as a platform for discussion and will inform the development of an overall strategy on how the HSE should continue to provide this service in future in view of current budgetary and other pressures. The review must be also seen in the light of the wider health reform programme to which the Government is committed and the position of social care services in a future health service. I should make it clear, however, that, the HSE must maintain appropriate staffing levels to meet the needs of residents. Providing high quality and safe care will have to remain at the heart of any considerations.
Deputy Michael McNamara: I am somewhat encouraged to hear that it had been envisaged that the number of beds in County Clare would be reduced by nine and that this was changed to five. However, I am reliably informed by the professional nursing staff at Raheen hospital that they are now a couple of nurses short of the number required to deal safely with the 23 beds that remain, yet other health facilities in County Clare remain over-staffed, and the HSE, in its infinite bureaucracy, does not seem to be able to move nurses from one hospital to another. The problem of a lack of information is not confined to Raheen. The Friends of Ennistymon Hospital group has €500,000 ready to invest in the hospital, but Senator Conway, a former Fine Gael councillor, has been unable to obtain information from the HSE about its long-term plans for the hospital. We have exactly what we want on a political level — public private partnership — but people who are willing to put their money where their mouths are and invest in local care are being stymied by a secretive bureaucracy. The only information I received about Raheen hospital was a message on my voicemail to say that a press release would be going out that night but the contents could not be shared with me. I cannot think of a greater example of contempt — not for me, but for the people who vote for me or bother to vote at all.
I call upon the Minister of State to address this issue. I for one have lost confidence in the ability of the HSE to manage our hospitals. I note the programme for Government provides that the ownership and management of hospitals will be transferred to boards whose members are selected from among local people with an interest in and genuine commitment to the area. It seems the bureaucrats of the HSE do not have a commitment to anything other than pushing pens. If I sound frustrated, it is because I am. This is not something I suffer from alone; it is shared by all Deputies from County Clare and, I suspect, the great majority of Deputies in the House. I urge the Minister of State, therefore, to move ahead as speedily as possible with the transfer of the running of hospitals from the HSE to boards, as provided for in the programme for Government.
Deputy Kathleen Lynch: The frustration is very obvious. The movement of the organisation to a board type structure and the running of different community-based units and smaller hospitals may ensure budgets are adhered to and priorities are dealt with at that level. However, shortage of staff in one area and an excess in others will not be dealt with by boards. That is clearly a matter which must be managed centrally. That is what the Croke Park agreement is about. We see this not only in County Clare but in many areas of the country. We see a disproportionate number of staff in certain allocated areas and must get down to dealing with that task.
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