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 Header Item Hospital Services (Continued)
 Header Item Hospital Services

Thursday, 2 June 2016

Dáil Éireann Debate
Vol. 911 No. 3

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(Speaker Continuing)

[Deputy Simon Harris: Information on Simon Harris Zoom on Simon Harris] I hope I will be able to provide clarity to Deputy O'Reilly in this regard at that stage. I hope the decision to commence the winter initiative now, at the end of May or start of June, is seen as a signal of my intention and that of the HSE to try to prepare for this in advance and to look at next year as well. As this is a crisis that happens year on year, we need to plan ahead for it.

The Deputy spoke about the closed beds figure and asked where the 65 beds went. As I outlined in my initial response, there have been staff recruitment difficulties in some hospitals and some areas. One cannot open beds without staff. However, some 366 new or reopened beds that were not available in the system are now available in the system. The bed capacity review has to be different this time. I have no interest in carrying out a bed capacity review for acute hospitals only. We cannot keep seeing the acute hospital as the beginning and the end of every conversation. We must look at capacity in the community as well. I refer to nursing homes, long-term stay beds and community hospitals. The bed capacity review must look at the whole continuum of care and beds. I will come back to the Deputy with details of the timeframe. I would like it to take place as quickly as possible, particularly because I am conscious of the review of capital plans that is due to take place next year. I need to know the data so I can deliver in that regard. On the question of how I will have funding to deliver all of these things, the Estimates will be in the House in the next fortnight, as I have said.

Deputy Louise O'Reilly: Information on Louise O'Reilly Zoom on Louise O'Reilly We need to know who will conduct the review. I welcome the Minister's statement that it will encompass all beds because there is a serious need for that to be examined. The Minister may already be aware that according to the OECD, the number of beds we have per 1,000 people is below the EU average. We already have a deficit. I am disappointed that the figure for the winter initiative, which the Minister is right to start early, is not being shared with us. As the winter approaches, the pressure on our accident and emergency departments will increase. It used to get particularly bad when there were spikes, but now a level of difficulty is being maintained. I am familiar with this from my previous job. When one talks to the staff one is told that there used to be quieter times, but there are no lulls anymore. The sooner the bed capacity review is undertaken the better, because I believe this will result in all the beds that have been identified being opened. According to our figures, we are still 65 beds short, notwithstanding the other beds.

Deputy Simon Harris: Information on Simon Harris Zoom on Simon Harris This is my first outing here, so I do not want to disappoint the Deputy at this early stage of our exchanges. The Deputy will know the figure within the next fortnight. In fact, she will know when I know. Obviously, we have to look at what did and did not work last year and what we did not look at last year that we should look at this year. That is the message I delivered to the emergency department task force on Monday of this week. The important message for the HSE is that the solution to this problem is not one that solely rests in the acute hospitals. It has to involve the primary care divisions of the HSE, social care and the home care packages that were discussed by the Minister of State, Deputy McEntee, with Deputy Kelleher earlier. We will have clarity on this matter for Deputy O'Reilly in the next fortnight or so. I largely agree with what she has said about bed capacity. I stress that we need to identify exactly where the beds are needed. We intend to work with everybody on this. As I have said, we also need to look at delayed discharges because the infrastructure in the community is sometimes inadequate.

Hospital Services

 9. Deputy Sean Fleming Information on Seán Fleming Zoom on Seán Fleming asked the Minister for Health Information on Simon Harris Zoom on Simon Harris his plans to recast the Midland Regional Hospital in Portlaoise, County Laois, as a model 2 hospital; and if he will make a statement on the matter.  [13755/16]

Deputy Simon Harris: Information on Simon Harris Zoom on Simon Harris I thank Deputy Fleming for this question. I am committed to securing and further developing the role of the Midland Regional Hospital in Portlaoise as a constituent hospital within the Dublin midlands hospital group. Patient safety and outcomes must come first. As Deputy Fleming knows, a number of reports on the hospital in Portlaoise have been published in recent years. These reports pointed to the need for reconfiguration of some services to ensure patients are treated in the most appropriate setting by specialist staff who can safely meet their needs. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, on implementing the changes needed to address clinical service deficiencies and on incorporating the hospital into the governance structures of the Dublin midlands hospital group. Governance and management arrangements in Portlaoise have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved.

The Dublin Midlands Hospital Group recently produced a draft plan for clinical service delivery at the Midland Regional Hospital in Portlaoise. I want to stress that the draft plan, which has been discussed with officials in the Department of Health, is currently the subject of further work and consideration by the HSE. Any change to services at the hospital, including any plans for service reconfiguration, will be undertaken in a planned and orderly manner and will take account of current use of services, demands in other hospitals and the need to develop particular services at Portlaoise in the context of overall service reconfiguration in the Dublin midlands hospital group. It is important to note that this work is being done to strengthen services in Portlaoise from a patient safety and quality perspective and to ensure the services currently provided by the hospital that are not viable are discontinued and the services that are viable are safe, adequately resourced and developed on the basis of health needs. I am confident that any changes will improve services for patients at the Midland Regional Hospital in Portlaoise. I have to emphasise at this stage that no decisions have been made. There is quite a body of work to be done in this regard.

Deputy Sean Fleming: Information on Seán Fleming Zoom on Seán Fleming I welcome the Minister and congratulate him on his new position as Minister for Health. I wish him every success in the interests of the people of this country, who depend on our health service. Essentially, I am calling today on the Minister to reverse the plans for the downgrading of the Midland Regional Hospital in Portlaoise that are being considered by the HSE regional manager. She has produced a plan to reduce the services provided at Portlaoise to the level associated with a model 2 or category 2 hospital. Such an approach, as set out in the draft plan referred to by the Minister, would mean that a full accident and emergency service would not be available at Portlaoise into the future. If that were to happen, we would not have a proper paediatric or maternity unit in the hospital because such units require the presence of a full-time accident and emergency department. As the Minister knows, the hospital in Portlaoise has one of the busiest accident and emergency departments outside the major cities of this country. Up to 35,000 people attend it every year. People who need urgent treatment might not be able to make the journey to Dublin, Naas or Tullamore. This will put lives at risk. Patient safety must come first. Everybody knows that the accident and emergency unit in Portlaoise is overcrowded and that additional staff are required to deal with this situation. The HSE's approach, which involves trying to curtail services rather than upgrading them, is a dangerous one.

Deputy Simon Harris: Information on Simon Harris Zoom on Simon Harris I thank Deputy Fleming for his good wishes. I emphasise that no decision has been made on Portlaoise or on the services mentioned by the Deputy. Officials in the Department of Health have been liaising with the HSE on the significant body of work that needs to be done in relation to the draft report that has been drawn up by the HSE. This work will answer some of the significant questions that have been asked here by Deputy Fleming. I want to make it crystal clear that nothing will be done to compromise patient safety and everything will be done to address patient concern. I cannot be clearer than that. Any decisions taken will have to be based on clinical evidence. Decisions about the provision of health services should be made by clinicians and not by Ministers for Health. There is a body of work to be done in that regard. I have read the media commentary. I know there has been some commentary in local newspapers and in national media outlets. I say respectfully to everybody that there is a body of work ongoing here. No decision has been made. Any decision that is made will be based on an assessment of the issues that have been outlined by Deputy Fleming and the other Deputies from the Laois constituency. I refer to issues like service provision and the capability of other hospitals. Consideration will be given to what should be provided in Portlaoise and what could be provided elsewhere. As I have said, there is quite a way to go in this regard. I will certainly keep the Deputy informed.

Deputy Sean Fleming: Information on Seán Fleming Zoom on Seán Fleming I am pleased that the Minister has an open mind on this matter. A great deal of further discussion will be required. I will set out the essential problem that has arisen in Portlaoise. As the Minister has mentioned, a number of reports have previously been published. The maternity unit has had a troubled history. It was under-staffed for several years. Twenty additional staff have been provided in Portlaoise over the past year or so. As a result, a first-class maternity service is now available in the region under the direct supervision and management of the Coombe hospital. The accident and emergency department at the hospital needs a similar staff upgrade. A lazy approach should not be taken just because there is a difficulty. I understand that HIQA officials are in the hospital this week. They are carrying out a number of inspections as we speak. These reports should be used to improve services. They should not be employed as a lazy excuse to downgrade services. This issue has arisen since the new regional manager arrived. She announced last autumn that she wanted to curtail the accident and emergency department by providing a daytime-service only, but she was told she could not do that. She was sent away to draft a report to back her original preconceptions. That report is now in front of the Minister. I am saying to the Minister that we need to keep the accident and emergency department in Portlaoise. As we all know, the triage service at the hospital currently sends some patients to the stroke unit in Naas. If there is a major car crash, injured people are sent to the trauma unit in Tullamore. That is fine but the facility in Portlaoise, which is used by 30,000 people every year, needs to be maintained in the interests of patient safety.

Deputy Simon Harris: Information on Simon Harris Zoom on Simon Harris The Deputy is right to acknowledge the additional staffing that has been provided at the hospital in recent years. According to the information that is available to me, an additional 65 posts have been filled at Portlaoise Hospital since 2014, comprising 17 medical posts, ten nursing posts, five allied health professionals, 24 patient and client care staff and nine administrative staff. I have a more detailed list here, but I probably do not have time to go through it.

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