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 Header Item Hospital Services (Continued)
 Header Item Mental Health Commission Reports

Thursday, 2 June 2016

Dáil Éireann Debate
Vol. 911 No. 3

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  5 o’clock

(Speaker Continuing)

[Deputy Hildegarde Naughton: Information on Hildegarde Naughton Zoom on Hildegarde Naughton] GUH was a centre of excellence for bone densitometry with the only DEXA specialist radiographer in post in Ireland, Professor John Carey, who is the vice president of the ISCD. GUH also established one of the first DEXA centres in the country in 1999 and one of the first fracture liaison programmes. GUH was the first Irish site to gain recognition from the Capture the Fracture programme, which recognises centres of excellence around the world.

While I could continue to recite reasons for the necessity to make and keep this unit properly operational, I think the Minister would agree that any suggested closure is a highly retrograde step. There is enormous public anger building that such a service could be threatened with closure in the west, forcing people again to travel to Dublin for what is a reasonably basic service. I am told that the difficulty with the service appears to be the hiring and retention of qualified staff.

Osteoporosis is one of the most common diseases in the world today, affecting more than 200 million people worldwide. There are no symptoms or clinical features until a fracture occurs. One in two women and one in five men over 50 will experience a fracture related to osteoporosis in their lifetime. A postmenopausal woman's annual risk of fracture is greater than her combined risk of all cardiovascular disease and invasive breast cancer combined. Ireland has one of the highest incidences of osteoporosis and hip fracture in the world. One in three men and one in five women admitted to our hospitals with a hip fracture are dead within a year following the fracture. This is almost double many other countries and well above the UK and EU norms. Many others require lengthy hospital stays in nursing homes, for example.

The cost of treating osteoporosis-related fractures is close to €1 billion annually. Many fractures are preventable by identifying people at risk or diagnosing osteoporosis before a fracture occurs. DEXA scans play a critical role as they are the gold standard in testing to identify people with low bone mass, to diagnose osteoporosis before a fracture occurs and to monitor those on treatment. DEXA is cheap, very safe and very cost-effective. Identifying people early helps them to reduce their risk of fracture. Musculoskeletal diseases are among the commonest diseases in the world and the commonest cause of disability among men and women over 50 years of age in the developed world.

New staff were promised for the hospital's DEXA service in 2013 after a business plan was approved by the Saolta executive committee for a clinical specialist radiographer, a clinical nurse and a secretary. Only the radiographer post was finally approved for advertising nationally after two years. No one has applied for the position and neither a nurse nor a secretary was provided. It is, therefore, clear why there is a waiting list of 20 years.

The cut-off to the staff for musculoskeletal diseases since the implementation of the moratorium on new staff has had an impact on waiting lists and the welfare of patients. I urge the Minister to intervene directly in this case so this vital service is available for the people of the west and I would also like an assurance that the unit will not again be threatened with closure. It makes no sense ending this service for financial reasons or not staffing the unit properly when keeping it. Making it work effectively will save the taxpayer in the long term.

Deputy Helen McEntee: Information on Helen McEntee Zoom on Helen McEntee I thank the Deputy for raising this issue, which is obviously very important to her, her constituents and those in the west. Galway University Hospitals, comprising of University Hospital Galway and Merlin Park University Hospital, provide a comprehensive range of services to emergency and elective patients on an inpatient, outpatient and day care basis across the two sites.

An issue has arisen with respect to the operation of the DEXA scanner situated at Merlin Park Hospital. The Minister for Health has been advised by the Saolta University Health Care Group that the bone density scanning service has been impacted, as the Deputy has rightly pointed out, by a shortage of radiographers. As a result, a waiting list has been building up for some time now.

Galway University Hospitals are actively working to recruit radiographers in order to fill a number of vacancies. One successful candidate will commence work in early July. An additional five individuals have been offered posts and are currently in the process of appointment. Recruitment to three further posts is ongoing. As I mentioned to another Deputy earlier today, recruitment of staff within the whole health sector is a big challenge that we need to overcome and a lot of changes need to happen in that regard. Saolta has advised that GUH plans to treat all patients booked into the bone density scanner service until the end of June 2016. In the interim they are reviewing options to manage the waiting lists after June, and that includes the employment of the agency staff.

The Saolta Group and the HSE are working to put the necessary arrangements in place to ensure the continuity of services from July. In the interim period until the newly recruited radiographers have taken up their posts, the hospital group is progressing a range of options, including staff overtime and outsourcing in order to ensure service continuity for patients. As the Deputy would also know, a number of facilities in Galway can also carry out DEXA scans, including Portiuncula and Sligo University Hospitals, and there are private facilities in the Galway area that also offer DEXA scans. That is her area, so she needs to ensure that the service remains within the hospital.

It is also important to note that major developments are ongoing and planned for Galway University Hospitals. The programme for a partnership Government has committed to progressing a new emergency department facility. Construction work is also ongoing on the new 75-bed ward block as well as a new acute mental health department at the hospital. There will be much focus on making sure that those positions are filled and that the situation is tenable into the future.

Mental Health Commission Reports

Deputy James Browne: Information on James Browne Zoom on James Browne I raise the issue of the Mental Health Commission approved centre inspection reports that were published on 26 May 2016, in which 11 units across the country were assessed. As the Minister of State will know, every approved centre registered by the Mental Health Commission must, under law, be inspected at least once a year and during each inspection, the approved centre is assessed against all regulations, rules and codes of practice and section 4 of the Mental Health Act 2001.

These reports have highlighted a number of high-risk practices taking place in a number of psychiatric units throughout the country. For example, the acute psychiatric unit in Cavan General Hospital was found to have been non-compliant in its maintenance of records and had practised the use of physical restraint on high-risk patients. In St. Stephen's Hospital, risk management procedures were found to be at high risk while in the Aislinn Centre, staffing issues were found to be at high risk. In Letterkenny General Hospital, individual care plans and therapeutic services were again found to be high-risk issues while at Le Brun House-Whitethorn House in Clonskeagh, the premises and safety issues were found to be at high risk.

I want to focus, in particular, on the department of psychiatry in St. Luke's Hospital in Kilkenny. The premises was found to be of high risk and, extremely disconcertingly, the admission of children and the relevant code of practice was found to be a high-risk factor. The report states that "the approved centre was deemed non-compliant as there was no evidence of required Children First training or any other relevant training [of] staff [in this area]". The approved centre "was not suitable for the admission of children". The admission of children to adult psychiatric units is an ongoing issue. It is a wholly unacceptable practice and I ask the Minister of State what her proposals are in this regard and when it will stop. The previous Government promised to end this during its lifetime and that pledge was made in 2011 when it had come to power. It can only contribute to the mental health problems of these children by putting them into adult psychiatric units. While the staff will do their best, they cannot be given the full supports these children need, in particular early intervention supports, and many of these children are simply put on suicide watch.

The parents gave their consent to the children being admitted on most occasions to these units out of simple desperation and under a sense of duress as they feel they have no other options for their children who need psychiatric care. This is, of course, also a breach of the UN Convention on the Rights of the Child. There are many issues surrounding mental health - 24/7 care, in particular, is a key issue - but I ask the Minister of State to make this issue the No. 1 priority during her tenure to bring an end to this practice of putting children into wholly unsuitable and unsafe places, namely, adult psychiatric units.

Deputy Helen McEntee: Information on Helen McEntee Zoom on Helen McEntee I thank Deputy Browne for his question. The Mental Health Commission is charged with visiting and inspecting every approved mental health centre at least once a year. The commission, as the Deputy has rightly pointed out, has now published its report on St. Luke's Hospital in Kilkenny, Cavan General Hospital, Naas General Hospital and Clonskeagh hospital.


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