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Estimates for Public Services 2016 (Resumed) (Continued)

Thursday, 16 June 2016

Dáil Éireann Debate
Vol. 913 No. 3

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(Speaker Continuing)

[Deputy Michael Harty: Information on Michael Harty Zoom on Michael Harty]  The Minister has had to depart, but I will make a suggestion to the Ministers of State. In 1985 an educationist and psychologist by the name of Dr. Edward de Bono developed the six hats system for analysing problems and finding solutions. One put on a hat to teach in one way, a hat of a different colour to teach in another and so on. I would love to give the Ministers of State the reference for this system which they could use in analysing and planning change in the health service.

Deputy Michael Collins: Information on Michael Collins Zoom on Michael Collins According to the study of the impact of reconfiguration on emergency and urgent care networks, SIREN, the farther one lives from a centre of excellence, the poorer the outcome in the event of a serious emergency. The SIREN report found that, while survival rates in Dublin were the best in the country, those in the south - counties Cork and Kerry - were the worst. This is in stark contrast with the aim of the reconfiguration programme, namely, to achieve the best possible health outcomes for the people it served. The people of west Cork have not been well served by the programme. Many find themselves having to travel up to 100 miles at night by ambulance to Cork University Hospital, CUH, a journey that could take three hours. They may then have to wait for several more hours before receiving medical attention. The appointment of a night-time casualty officer would mean the extension of the Bantry General Hospital emergency department's night-time service. More patients could be treated without needing to be transferred to CUH, resulting in more ambulances being freed for other emergencies and a reduction in the numbers presenting at and overcrowding in CUH's emergency department.

Recent figures released show that 50,000 patients per year are walking out of emergency departments because of long waiting times and overcrowding. Some leave without being seen by a nurse, which is further evidence of the failure of the reconfiguration of acute hospitals.

Home help and home care packages are a major issue throughout the country, particularly in west Cork. An underlying cause of overcrowding and bed blocking in hospitals is the fact that many elderly patients cannot return home owing to a shortage of home helps and a lack of investment in home care packages. I call on the Minister for Health to invest in this area immediately. In doing so, he would automatically reduce overcrowding and free hospital beds for those in need of more urgent medical care. When I spoke to the Taoiseach about this issue last week, he directed me to the Minister. I will take up that opportunity in the days ahead, but we need to consider the question of home help services as recipients are being treated poorly.

According to the Lightfoot report, CUH takes the longest time in Ireland to clear an ambulance from the time it arrives at the emergency department until it is available for its next deployment. The report recommends further investment in ambulances and related vehicles.

I wish to address the issue of waiting times for the assessment and delivery of services for children with special needs. I have been informed that some children are waiting a year and a half or more for initial assessments and a further six for the service to be delivered. Under the Disability Act, children have a statutory entitlement to an assessment of their needs within a six-month period if they were born after 2002. The Government is failing in its duty to these children under the Act.

I wish to address the cuts to disability services, specifically the €1 million cut in funding for CoAction in west Cork. With growing numbers availing of CoAction's disability services and supports, the organisation has been put under severe financial strain. Complying with the Health Information and Quality Authority, HIQA, standards has taken more than €350,000 out of its stretched budget. No additional funding has been made available for the residential, respite care or transport service in the past eight years. Many parents of adults with intellectual disabilities are ageing and finding it increasingly difficult to care for their adult children without the support of respite and residential care services. They are also under increasing stress to provide for the future care of their children owing to the decrease in the number of places available in full-time residential services. I call on the Minister to reverse the savage cuts to a service that is vital for more than 600 children and 140 adults across west Cork.

Acting Chairman (Deputy Alan Farrell): Information on Alan Farrell Zoom on Alan Farrell Deputies Stephen S. Donnelly and Eamon Ryan are sharing a 15-minute slot. Is that agreed? Agreed.

Deputy Stephen S. Donnelly: Information on Stephen Donnelly Zoom on Stephen Donnelly We are debating whether to sign off on an additional €500 million for the health budget, an issue I will address alongside the lack of an analysis provided for the Dáil on same. While we are discussing health services that need more funding urgently, I wish to raise a particular matter, that of Cappagh National Orthopaedic Hospital, about which a constituent of mine contacted me in recent weeks. She needs a hip replacement and is in severe pain and her condition is deteriorating. She is on her way to being in a wheelchair, something I have had confirmed by her surgeon. She was told that she would have to wait 15 months.

When I looked further into what was happening at Cappagh hospital, what I discovered was disturbing. If a general practitioner, GP, believes someone in the greater Dublin area needs orthopaedic surgery, or if anyone in the country needs complex orthopaedic surgery, it will take 15 months to see a consultant. It will take a further 15 months to get into an operating theatre. As such, it takes two and a half years to get from a GP to the operating theatre. In the United Kingdom it takes four months and in New Zealand, three.

I have spoken to surgeons in this field. To say they are demoralised, frustrated and angry would be a gross understatement. Anyone who attends a GP and needs orthopaedic work, be it on a hip or a knee, is typically already in serious pain. In the two and a half years someone will wait for surgery, the pain will escalate, the person's condition will deteriorate and the complexity, cost and recovery time of the operation will move in the wrong direction, as will the clinical outcomes.

I will explain what is happening in Cappagh hospital and why people in Ireland are waiting two and a half years for a hip operation. By the way, if someone needs the other hip or knee to be operated on, he or she must go back to the start of the list. Compare this with the figure of 12 weeks in New Zealand and 16 across the water in the United Kingdom. In 2014 Cappagh hospital suffered a serious cut in Government funding, which meant that it needed to reduce the number of procedures it could carry out that year by 700. It let staff go and scaled down. In 2015 the situation was so bad that the Government increased its funding. Last year Cappagh hospital started to scale up again, but it incurred higher costs by hiring agency staff because it did not want to have to fire anyone again. At the start of this year the HSE could not tell the hospital how much money it would be given for the year. For the first three months it operated on the understanding that it would have the same budget as last year. After the first quarter, however, it discovered that it would suffer a further cut in funding. It must let staff go and scale back again.

There are six operating theatres in Cappagh hospital, only three of which are being used. Typically, an orthopaedic surgeon can perform five procedures in an operating theatre on a given day. The surgeons in Cappagh hospital have been instructed to stop after three. The State is paying all of the hospital's fixed costs - for the six operating theatres, the wards, the beds that are not being used, the theatre staff and the surgeons - but the hospital no longer has money for implants, which typically cost between €1,500 and €3,000 each. For a complex operation, it might cost up to €6,000 and, obviously, the cost increases. I told the patients that, were my relative affected, I would borrow the money to buy an implant on eBay and bring it to the hospital, but when I asked them about doing this, they said they were not allowed to do so. When I asked the surgeons what they did after performing the three procedures, they told me that they went home or into private practice where they could actually treat patients.

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