21 June 2010

Senator Fitzgeralds Speech on HSE Debate in Seanad Eireann, June 2010

I welcome the Minister to the House. I agree with the Leader's comment about the time she gives to the House and I thank her for that. She listens to the contributions we make and takes up the issues we highlight. She gives a response in so far as she can on the day on the issues we raise.

She referred to improved life expectancy as one of the factors that proves we have a better service. However, the overall social and economic context is a huge factor and not just the direct experience of the health service. We know that internationally that as the social and economic circumstances of a population improve, the health outcomes improve dramatically. That is one of the reasons good health policy means a focus on prevention as much as possible. I agree with the Minister that we have not focused on this enough and there is great scope to focus more on prevention of a range of diseases and illnesses to save money and to ensure better health outcomes, which is important.



She stated the health service is moving to evidence-based quality services with high clinical leadership and a monitoring of outcomes. She is correct and I support her move to specialties and excellence, the benefits of which can clearly be seen in breast cancer services. However, there has been slow progress overall in the move to cancer screening. Many counties had to wait a long time for the breast cancer service. I acknowledge we are there now but I would hate to think that when it comes to rolling out screening for colon cancer, cervical cancer or prostate cancer, it could take the time it did to deliver the breast cancer screening service nationwide. That was not acceptable because the political will and vision was there but the implementation of the programme was unbelievably slow. It was incredible that it took ten to 15 years from start to finish, which was too long. That issue must be taken on board.



The Minister mentioned reducing infection control, which is also important. The criteria she listed were evidence-based, patient safety, a quality service, high clinical excellence and monitoring outcomes. I can only focus on a number of areas but serious questions have been raised about each criterion even in the past few weeks. It is one thing for the Minister to say she wants quality patient outcomes, patient safety, clinical excellence and so on and I totally respect that is the model she is operating on, but questions arise about each criterion.



The Minister will acknowledge that is still a real issue. For example, maternity services were in the public arena recently. The very least a woman expects if she has had a miscarriage and goes for a scan is that it would be accurate. I had two miscarriages and like every woman in the country when this scandal emerged, my mind flashed back to the experience I had and I went through what happened to me. The Minister and I do not create panic because miscarriage is common. However, the very least one would expect when attending a hospital for a scan is standard routine procedures, clinical excellence and proper monitoring with information from around the country about the service available.



The Minister should compare what she said in her introduction with the experience of patients. The women concerned were intuitive but it is difficult to be that intuitive when one is dealing with a medical issue because one feels one should trust the medical information. I became involved in public life because of my concerns about maternity hospitals and the lack of voices women had. It sparked my interested in policy issues. The Minister must explain why, for example, when the HSE had the experience of an incorrect diagnosis of a miscarriage in UCHG in 2006 and set down a standard operating procedure following a review, that was not rolled out throughout the country.



Why did the HSE not learn from that? This is one example, but there could be many more. Why did the HSE not move to the type of model the Minister is talking about, in that most recent example, which is quite extraordinary? It is a good example when putting it to the Minister that although she has the model and the approach, what about the implementation? We are talking about the delivery of services by the HSE. Obviously, the country is extremely concerned about the management issues that arise in relation to the HSE.



Take the child care issue and the lack of a death mechanism review. Again the Minister talks about the importance of having statistics. If one takes the social aspect and the child care area it is clear that monitoring, consistency and feedback were missing. What was also missing was having child care at an appropriate level within the HSE, in terms of reporting, management and budgetary levels. The Minister might confirm whether it is true that only very recently has child care been on the agenda of the board of the HSE.



If something like child care services is not an agenda item for discussion by the board of the HSE, that tells us all we need to know about why we have had the sort of problems we have seen. I have limited time, but I would like the Minister to inform the public on what the plans exist in relation to prioritising child care issues so they are dealt with at the right management level, with appropriate budgets within the HSE. There is so much criticism of the HSE structure not delivering that she has to address this issue. The minute I say this we come up against a problem, because the whole question of the Minister's relationship to the HSE and the political accountability her office takes in that regard is one that seems very fluid. Again, I ask Deputy Harney as an experienced Minister for Health and Children, to outline how she sees that relationship. How can she be certain that she has the political accountability to ensure that what she said in her introductory words to this House, for example, happens in relation to child care or maternity services?



These are the key issues. It is about the relationship between the two. The Minister has the model and says she wants to see it delivered and yet, again and again on the ground, there are examples of where there are problems. Tallaght hospital X-rays is such a problem area, as is not knowing the number of children who died. The colonoscopy area is another example. I ask the Minister to update us on Tallaght, to reassure the House that those letters have now been read, systems are in place, we understand why this happened and that the lessons learned from that review will be spread to the other hospitals where the same thing could happen, and indeed, where there were reports to this effect. These are the key questions about delivery and the patient experience.



The Minister rightly says that what is important is the quality of the patient's experience, and I totally agree. However, the examples I am giving impact on and are at the core of patient safety. The statistics are still incredibly worrying. They are about the numbers still on trolleys and the loss of patient beds. I would like the Minister to return to the bed issue. On 23 May we were told that 333 beds were closed in hospitals around the country, owing to cost savings, infection control or refurbishment. The Minister is apparently planning also more than 1,000 closures, while originally she had promised 3,000 extra beds. Could she comment on that? If 300 people are on trolleys on a daily basis, 900 operations were cancelled in the first half of last year and more than 270,000 bed days were lost due to delayed discharges, what is the plan in relation to beds, and what is the Minister's estimate of the number of beds necessary to give people the services they need? Co-location was the Minister's plan, but clearly that is not being developed as she intended.





I want to move to the area of primary care. The Government programme is

way behind in the delivery of primary care centres. Again, in the current economic climate what is the response to those who wish to develop primary care units? What state of progress is the Minister at in relation to the development of further primary care systems? A quick glance at the statistics will show that the rhetoric and the theory indicate that while we want to move towards the development of primary care, there is nothing on the ground to show we have anything like the level of units needed. If the Minister is going to close the beds and move away from a hospital admissions regime as much as possible, which is the right thing to do, obviously people must have a service locally. They must be able to avail of it in terms of primary care.



There is a problem as regards moving to specialist centres before the services are developed in the specialist hospitals. This will result in the same problem we saw as regards maternity services, namely, registrars, senior house officers and consultants who are so rushed and pressurised because of pressure from outlying hospitals being closed that they are not able to respond to the woman, for example, who needs to be given sufficient time if her scan is to be read properly. This is very problematic and I do not want to pretend that running our health services is easy since it is enormously complex.



Nonetheless, we are investing €20 billion a year, €16 billion of which is in the public health system. Fine Gael has looked at other countries. Ireland is investing an enormous amount of money in health, but it is not getting value in terms of the outcomes, despite the improvements the Minister has referred to in terms of extension of life etc. We are not getting the quality levels we should be, given the amount of money going into the health services, and everybody knows that. I do not, for a minute, want to criticise frontline staff. I absolutely acknowledge the pressure that nurses, doctors and hospital staff are under and the efforts they make, but I would like the Minister to speak about the way the hospitals are being administered and the interaction between the HSE and herself.



The Minister commented on today's report on mental health and the closure of the hospitals. I too acknowledge the personal efforts of the Minister of State, Deputy Moloney, but where are the people whom the Mental Health Commission says cannot now be admitted to St. Ita's, St. Brendan's or St. Senan's, from January, going to get a mental health service, if the mental health teams are not at the levels that are needed? Is the Minister planning some emergency response for beds for individuals with mental health difficulties, because it seems to me there is going to be a crisis? Again, given that this is such a vulnerable group, and people with mental health problems can be so easily marginalised, it is absolutely critical that if those three hospitals are going to be closed and not being allowed to admit patients, we need to know that the plans are in this regard.



There are quite a number of other areas I should like to touch on, but I shall go back to the question of colonoscopies. Will the Minister inform the House as regards the waiting times, because this is an area in which she has taken an interest? She wants to see patients who need colonoscopies getting them in a speedy manner.