Wednesday, 20 July 2011
Seanad Éireann Debate
Senator Thomas Byrne: I am grateful for the opportunity to raise this matter. Apparently, as I was the only Member to give notice of raising a matter on the Adjournment, its selection was a fait accompli. This is an important function of the Seanad and I encourage Senators to use it. If we do not use it, we might lose it.
I welcome the Minister, Deputy Frances Fitzgerald. She is one of the better and more informed Ministers in terms of her brief. She is also a caring Minister, which is particularly important for her job given the need to show empathy and sympathy. Unfortunately, she is being detained in the House tonight because the Minister for Health, Deputy James Reilly, has not appeared before the Seanad to answer our questions. We have sought numerous debates on health policy and local hospital services but the Minister has not seen fit to come to the House. He came to the House for debates on non-controversial, cross-party issues and was happy to discuss them, but not issues such as this. This Minister would not be here tonight if the Minister for Health had come to the Seanad; therefore, I am sorry for detaining her.
The issue of local hospitals is very emotive but it is an issue that must be discussed at the highest levels in Parliament because it is being discussed at kitchen tables in counties Meath, Louth and Roscommon. There is confusion surrounding the status of Our Lady’s Hospital, Navan. Last year, certain surgery services were removed or suspended. I supported that at the time because we received confidential information from Dr. O’Brannigan of the HSE. I am happy to stand over that support as I believe it was based on sound medical practice, according to what was described to me.
However, there are various rumours, stories and allegations about the retention of accident and emergency and orthopaedic services at the hospital. In one case, a local group was apparently told that the accident and emergency service would remain open for at least six months. That is no way to run a health service, telling people it will be given six months and that it might close afterwards. In addition, the hospital in Navan is something of a centre of excellence for orthopaedic services, providing a service not only for the local catchment area but also for the entire north east and for north-east Dublin. We have been told that, for the first time ever, the orthopaedic service is to be closed if and when Cappagh Hospital gets extra capacity.
Any threat to accident and emergency services in Our Lady’s Hospital, Navan, will be vigorously opposed by the residents of County Meath. Throughout my party’s time in government it was consistently accused of attempting to close the hospital, but the situation with the accident and emergency service was always very clear — the hours of the service would be reduced but only when there was sufficient capacity available elsewhere to cope with the expected demand. That capacity is simply not available in either Our Lady of Lourdes Hospital, Drogheda, or in Blanchardstown hospital. Safety is the first priority and it has not been shown that patients would be safer going to hospitals in Drogheda or Blanchardstown.
The removal of orthopaedic services from Our Lady’s Hospital in Navan would be a travesty and a scandal. Its services are second to none and some of the finest surgeons and medical practitioners in this area of medicine operate from this hospital. It is the regional centre for orthopaedic services. Removing this important facility is surely only a stepping stone to the downgrading of the hospital to a glorified nursing home. In terms of the future of small hospitals, which the previous Government and the HSE were committed to, the idea was to accept that there would not be a general hospital in every area but there would be an effort to provide certain specialised services in particular hospitals. Navan has fulfilled this function very well in terms of orthopaedic services.
With regard to accident and emergency services, the facilities are not in place. It is most unfair of the Government to release information through leaks and, perhaps, briefings to Fine Gael Deputies and hospital committees. There are various stories emerging from those meetings as to what might or might not happen. It is time for clarity. It is also time for the Fine Gael Party to implement the commitments it made in the general election campaign. It made many varied commitments but it appears to be rowing back from them quite extraordinarily. If the removal of orthopaedic services had been raised when we were in government, there would have been holy war from the Fine Gael Party.
I am flagging that issue now and seeking clarity. With no disrespect to this Minister, who is very busy with her brief and doing an excellent job, I believe the Minister, Deputy James Reilly, should appear before the Seanad to discuss this and other issues.
Navan hospital is an integral part of the Louth-Meath hospital group and the Minister is determined that it will continue to play an important role in the delivery of clinical services in the Louth-Meath area and to patients in other parts of the north-east region. At present, Navan hospital continues to provide a 24-hour emergency department. The Minister has stated that any changes to the operation of the emergency department can only be carried out after significant improvement in the performance of the emergency department at Drogheda. To fully consider the issues involved, the Minister will take account of the current organisation of acute services in the region and the important clinical programmes being developed by the HSE. The Minister acknowledges the need for communication with the local community at this time and understands that the HSE is available to meet community representatives, as he is himself.
In this regard, the Minister met the consultants in Navan hospital and with the Save Navan Hospital Alliance last week. At that meeting, the Minister set out the position with regard to the emergency department at Navan hospital. The Minister is absolutely clear that due to need to ensure the safe delivery of services and the best outcomes for patients, changes need to take place at the emergency department. However, he has been equally clear that such changes need to be carried out in a planned way and that there will be full consultation on any changes. The Minister estimates that it will be at least six months before any changes to the emergency department in Navan can be effected.
The hospital continues to be the regional centre for elective orthopaedic surgery, including complex joint replacement surgery. This surgery is a combined service with Our Lady of Lourdes Hospital, Drogheda.
The debate over smaller hospitals has been dominated for far too long by what they cannot do. We need to move the debate on and focus on those things that they can do safely and efficiently, thereby ensuring the best outcomes for patients.
The Minister has repeatedly emphasised the extremely important role that smaller hospitals have to play in services for their local community. He believes that such hospitals can and should provide as wide as possible a range of services close to the local community. They should be the cornerstone of locally based services and should have strong links to the local community-based services and to the larger hospitals in their region. As the Minister previously stated, too often we have focused on what we are taking away rather than what we can add to services there.
All of this will be done with full regard to the safety issues highlighted by HIQA in its reports on Ennis and Mallow hospitals. When this framework is implemented, smaller hospitals will have a vibrant role, doing more work, not less, and meeting as many as possible of the needs of their local community while delivering safe health services with better patient outcomes. That is the goal.
Senator Thomas Byrne: I thank the Minister for her reply on behalf of the Minister for Health. There seems to be some watering down of the requirement that there would be capacity elsewhere to deal with patients who would otherwise be in Navan. The Minister’s reply referred to a significant improvement in the performance of the emergency department in Drogheda and estimated that it would be at least six months before any changes could be effected. I do not believe that is in line with the HIQA report, which talks about the extra capacity, nor is it very fair for the Minister to repeat this statement that there is at least six months left for the accident and emergency department. I agree the focus should be on what hospitals can do and I am glad the reply contained no express threat to the orthopaedic services.
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