Health Services.

Wednesday, 6 February 2008

Seanad Éireann Debate
Vol. 188 No. 9

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Senator Déirdre de Búrca: Information on Déirdre de Búrca Zoom on Déirdre de Búrca I ask the Minister for Health and Children to outline her intentions on the implementation of the recommendations of the Pollock report. This report was commissioned by the Cystic Fibrosis Association of Ireland and was published on 7 February 2005. Its author is Dr. Ron Pollock and the title of the report is, An Independent Review of Cystic Fibrosis Services in Ireland. The report stated that at the time, 1,143 patients were under care in the State, with 45% being adults and 55% being children. It also pointed out that Ireland has the highest incidence of cystic fibrosis in the EU, with on average one in every 1,600 persons suffering from cystic fibrosis. A disturbing finding was that the outcomes for cystic fibrosis patients in Ireland are worse than in other EU member states. The report contended there was a higher number of cystic fibrosis-related deaths in Ireland than in England, Wales or Northern Ireland.

The report’s recommendations provide an important blueprint for the future care of people with cystic fibrosis in this country. I ask for an immediate implementation of these recommendations. I raise this matter on the Adjournment of the House as a means of establishing the Minister’s intentions in this matter. The main findings of the report were that staffing levels in cystic fibrosis services were seriously inadequate. The report refers to a striking absence of specialist registrars and an inadequate number of cystic fibrosis nurses, physiotherapists, dieticians and psychologists. The report also highlighted the lack of segregation and isolation facilities and it particularly highlighted those in the Dublin area which were felt to fall well below accepted standards. Unfortunately, the most well known hospital to provide cystic fibrosis services in the Dublin area, St. Vincent’s Hospital, was mentioned in the report as being in particular need of investment and upgrading. It was stated that because of the lack of these segregation and isolation facilities for cystic fibrosis patients the risk of cross-infection was high with virulent organisms such as MRSA and hepatitis C.

The report also highlighted that as a small discipline, cystic fibrosis was particularly vulnerable to the vagaries of funding and was looking for more secure and stable funding into the future. The report recommended that urgent action was needed to address staffing problems in cystic fibrosis services; that a small number of highly staffed and fully supported cystic fibrosis centres should be created around the country with good geographical access for different parts of the country; that the links between the adult and children’s units should be strengthened; that the adult provision outside Dublin should be developed urgently to create balanced services and to reduce the burden on St. Vincent’s [696]Hospital in Dublin; that all beds for cystic fibrosis patients should be in single rooms with en-suite toilet facilities to prevent transmission of dangerous organisms; that a microbiology reference library should be established in Dublin to champion advances in knowledge and treatment in the area of cystic fibrosis; that a new funding methodology, possibly based on banded packages of care should be developed to create the stability required in the funding system; and that the cystic fibrosis registry of Ireland should be maintained and developed.

They strike me as good and sound recommendations. Obviously they have funding implications and I am interested in hearing the Minister for Health and Children’s intentions in regard to the implementation of some of these recommendations.

Minister of State at the Department of Health and Children (Deputy Pat The Cope Gallagher): Information on Pat the Cope Gallagher Zoom on Pat the Cope Gallagher I apologise on behalf of the Minister for Health and Children, Deputy Harney, who is abroad on official business. Consequently, I am taking the adjournment on her behalf. The Minister acknowledges the need to improve services to persons with cystic fibrosis. The negative experience recounted recently by some patients is a matter of much concern.

The Cystic Fibrosis Association of Ireland commissioned Dr. Ronnie Pollock to review the existing hospital services for cystic fibrosis in the context of accepted international standards. The Pollock report identified inadequate staffing levels and a lack of adequate infrastructure, particularly in the provision of care for adults with cystic fibrosis. Following publication of the Pollock report in 2005, the Health Service Executive established a working group to undertake a detailed review of cystic fibrosis services. The group, which was multidisciplinary in its composition and included representation from the Department, was asked to review the current configuration and delivery of services to persons with cystic fibrosis. The group identified a range of service improvements required for persons with cystic fibrosis, including the need to increase the level of clinical, nursing and allied health professional staffing in cystic fibrosis units around the country.

Arising from the Pollock report and the emerging recommendations of the working group, the Minister identified the development of cystic fibrosis services as a policy priority in the Estimates process. In 2006 and 2007, additional revenue funding of €6.78 million was provided to the Health Service Executive to develop services. The Health Service Executive has advised that 44 additional staff, covering both adult and paediatric services, have been appointed across a number of hospitals, including St. Vincent’s, Beaumont, Temple Street, Crumlin, Tallaght, Cork University Hospital, Galway, Limerick and Waterford. The necessary funding is available to [697]facilitate the recruitment of a further 37 staff nationally.

The Health Service Executive was asked to place particular focus on the development of services at the national adult tertiary referral centre at St. Vincent’s Hospital. A number of capital projects have been recently completed at the hospital and have helped to improve facilities. These include a new ambulatory care centre, the refurbishment of St. Camillus’s ward, and a new accident and emergency department which includes single room accommodation. However, these developments do not fully address the immediate needs of patients.

The Health Service Executive has been working intensively with the hospital and with representatives of the Cystic Fibrosis Association of Ireland to progress options for further interim improvements. The Health Service Executive is fast-tracking the redevelopment of a ward which is adjacent to the main cystic fibrosis treatment area. The project is to commence in the next few weeks and will provide six single rooms. On completion, additional work will begin to provide a further eight single rooms. The Health Service Executive advises that this will result in a total of 14 single rooms for cystic fibrosis patients by the end of the summer.

In the longer term, a new ward block is to be built and will include 120 replacement beds in single en-suite accommodation. The new facility will accommodate cystic fibrosis patients and will include appropriate isolation facilities. The Department has been advised that planning permission has been obtained, financial provision has been included in the HSE capital plan and the contract is to be awarded by the end of this year. It will be a condition of the contract that the design-build period is to be not more than 24 months from the date of contract award.

Beaumont Hospital operates as a regional centre in providing services to adults with cystic fibrosis. In the 2008 budget a special allocation of €2.5 million capital funding was provided to enable Beaumont Hospital to provide outpatient facilities for cystic fibrosis patients. The developments which I have outlined will significantly enhance the level of service provided for persons with cystic fibrosis.

I thank Senator de Búrca for raising the issue.


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