Government is not a 'bystander' in deciding the future of Portlaoise hospital claims Minister

Sinn Féin TD Brian Stanley tells Dáil progress on coming up with a plan has not "moved one jot further forward"

Conor Ganly

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Conor Ganly

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A Minister of State at the Department of Health has insisted that the Government is not a 'bystander' in deciding the future of Portlaoise hospital.

Minister Marcella Corcoran Kennedy was responding to Laois Deputy Brian Stanley, Sinn Féin, who demanded a timeline for a publication of a HSE / Dublin Midlands Hospital Group plan for the future of the hospital.

"It is a stretch too far to suggest that the Government is acting as a bystander in this matter. That is especially the case when one acknowledges the improvements that have been prioritised in the hospital," said the Fine Gael Offaly TD.

Deputy Stanley rejected that progress had been made toward coming up with a plan.

"We have not moved one jot further forward. The plan was to be published in September 2015 but we have not seen it to date. A delay of one month or even three months is reasonable but the plan is 15 months late at this stage. Meanwhile, we hear the argument that we do not have the clinical staff required at the hospital. As I set out in my introductory comments, one needs to have the clinical staff in place, but there must be some certainty for the future of the hospital," he said.

The following is the full text of the debate in the Dáil on Portlaoise hospital on Wednesday November 2 raised by Brian Stanley TD.

Deputy Brian Stanley: I welcome the opportunity to raise this very important issue. It is the most important issue in Laois the and surrounding counties. It is the issue of the hospital services. There has been a threat hanging over key services at Midlands Regional Hospital Portlaoise for years. We have had leak after leak. One leak came out in early summer 2015 that indicated that the emergency services were to be removed. The Department of Health and the HSE then commissioned a report in response to the campaigning of local people under the tutelage of Dr. Susan O'Reilly. That report was to be published in September 2015. We are now in the month of November in the year of our Lord 2016 and heading for Christmas, yet we still have not seen that report.

In the interim, there have been more leaks and spin around the issue. One leak was regarding a recommendation that the emergency services be removed. It is time for the HSE, the Department and the Government to tell us what is planned for Portlaoise hospital. The emergency department is one of the busiest outside Dublin, busier than Mullingar and Tullamore. The absence of full consultant cover is often cited as a reason to downgrade the unit. The strategy of the Department and the HSE seems to be to keep the unit under constant threat of closure and consultants will not apply for the job as long as that is the case. In that way, the Department and the HSE get the outcome they want.

Resources are the issue in Portlaoise. That has always and ever been the case. A positive story from the point of view of the Government, the Department and the HSE has shown this in the last year. When the staff allocation was granted for the maternity unit, there were improvements. There has been a huge increase in the number of staff. They were operating with little over half the staff that was needed. We have seen the improvements in outcomes at the maternity unit. It can be held up as a good example. There were deficiencies there and the staff was operating under huge pressure. That has been improved. In a reply to a question of mine from 18 October, the Minister, Deputy Harris, acknowledged that there are far better outcomes now.

It is a busy but excellent service.

There is also a busy paediatric unit at the hospital. If any of the key services in Portlaoise is closed, there is nowhere to send people. I do not need to tell the Minister of State, Deputy Corcoran Kennedy, that one cannot send accident and emergency patients or those requiring paediatric services to Tullamore. The maternity services for Offaly are based in Portlaoise. Has the Minister read the important set of proposals issued in the summer by GPs and senior medical and clinical staff at Portlaoise hospital? These highlight the interdependent nature of the main services at the hospital in Portlaoise and the fact that if the emergency department were removed, other services would go with it because they are dependent on having a functioning emergency department. I refer to maternity and paediatric services in particular and the concerned professionals who manage, operate, staff and look after primary care and hospital care services in the midlands. They acknowledge the benefits of networking with the larger Dublin hospitals. Staffing is one of the issues affecting the maternity unit. The fact that it is now networking with the Coombe hospital is another benefit. The staff say that approach should be used as a template for the other services at the hospital.

There are people in the Gallery from County Laois. Jackie Cuddihy is one of them. As she has said publicly, she would not be here today but for the fact that we have an accident and emergency unit at Portlaoise hospital. That is an indication of the importance of the service.

Minister of State at the Department of Health (Deputy Marcella Corcoran Kennedy):     I thank Deputy Stanley for bringing this important matter to the attention of the Minister for Health, who sends his sincere apologies that he cannot be here and has asked me to respond on his behalf. This is a good opportunity to update the Deputy and the House on the future of services at the Midland Regional Hospital in Portlaoise. I acknowledge the presence in the Gallery of the people from the constituency to whom Deputy Stanley referred. Sadly, the constituency is no longer part of my constituency but I suppose what I have lost, others have gained and vice versa. The situation might revert at some point.

  I assure the Deputy that the Minister, Deputy Harris, is committed to securing and further developing the role of Portlaoise hospital as a constituent hospital within the Dublin Midlands hospital group. The most important issue in relation to any changes at Portlaoise hospital is that patient safety and outcomes must come first.

  As the Deputy acknowledged in his contribution, there have been a number of reports on the Midland Regional Hospital, Portlaoise in recent years. The reports have pointed to the need for reconfiguration of some services to ensure that patients are treated in the most appropriate setting by specialist staff that can safely meet their needs. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies, and incorporating the hospital into the governance structures within the Dublin Midlands hospital group. Significant work has been undertaken to strengthen and stabilise current arrangements for services at the hospital to ensure they are safety-assured and adequately resourced. Governance and management arrangements in Portlaoise hospital have been strengthened, additional clinical staff have been appointed, and staff training and communications have improved.

  The Dublin Midlands hospital group recently produced a draft plan which sets out a proposed service design for a new model of clinical service delivery at Portlaoise hospital. The draft plan has been discussed with the Department of Health and is currently the subject of further work and consideration within the HSE in advance of further necessary consultations with stakeholders, including GPs and consultants. No decisions have been made in respect of Portlaoise hospital but any changes, once approved, 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.

  I again assure the House and Deputy Stanley that this work is being done to strengthen services at Portlaoise from a patient safety and quality point of view. I am confident that the changes will improve services for patients at Portlaoise hospital. Patients are at the centre of everything we do in the Department of Health and within the Health Service Executive. Their needs must be prioritised, which is exactly the standpoint from which we are coming.

Deputy Brian Stanley:  While it is acknowledged in the reply that there are significant concerns, we now have a draft plan but GPs locally say there has not been meaningful consultation with them. There has not been any consultation with local Deputies. When will we see the draft plan? With all due respect to the Minister of State, we are going around in circles. Today's response is the same as we received months ago. We have not moved one jot further forward. The plan was to be published in September 2015 but we have not seen it to date. A delay of one month or even three months is reasonable but the plan is 15 months late at this stage. Meanwhile, we hear the argument that we do not have the clinical staff required at the hospital. As I set out in my introductory comments, one needs to have the clinical staff in place, but there must be some certainty for the future of the hospital.

Senior HSE managers and bureaucrats will come and go but we must be able to see a clear way forward. Surely the people of Laois and the surrounding counties are entitled to that at this stage? HSE management might make decisions but the Government is not a bystander. The Minister of State in the Department of Health, Deputy Corcoran Kennedy, is not a bystander. We need certainty on the matter. Is it Government policy not to have busy regional hospitals strategically located? One could not but argue that Portlaoise hospital is strategically located. Is it Government policy to act on a wing and a prayer and not to secure the future of such hospitals? The Minister needs to make a policy decision to resource and staff the hospital.

Despite the fact that Portlaoise hospital is busier than either of the hospitals in Mullingar or Tullamore, its funding is €30 million less than that which is provided for Tullamore hospital. I do not argue to reduce the funding for Tullamore hospital but I just highlight the fact. It is miraculous what the staff in Portlaoise hospital have done with little resources. They have performed great tasks. It is now up to the Government to clearly set out a plan to secure the future of Portlaoise hospital.

Deputy Marcella Corcoran Kennedy:   It is a stretch too far to suggest that the Government is acting as a bystander in this matter. That is especially the case when one acknowledges the improvements that have been prioritised in the hospital. For example, additional consultant posts have been created in anaesthetics, surgery, emergency medicine, paediatrics and obstetrics in addition to physician and midwifery posts. An additional 76 posts have been created since 2014, and a further 38 were converted from agency posts. One must accept that is very positive. Nobody could argue that it is a negative action to have taken.

I understand Deputy Stanley's anxiety about having an input into the draft plan. The plan has been discussed with the Department and it is subject to further work and consideration by the Health Service Executive. When that process is finished, the parties concerned will consult with the GPs and consultants.

Deputy Brian Stanley: Is there a timeline?

Deputy Marcella Corcoran Kennedy: I cannot give it to Deputy Stanley but I will try to find out.

Deputy Brian Stanley: Will it be before Christmas?

Deputy Marcella Corcoran Kennedy: I am keen to see the plan as soon as possible, but it is important that adequate consultation is carried out and that those who wish to submit ideas will be given every opportunity to do so.

It might be helpful for Deputy Stanley to hear that a plan - The Future of Acute Services in the Midlands Regional Hospital, Portlaoise: The Local Stakeholder Perspective - was submitted to the HSE and the Department by Laois GPs and senior medical staff at Portlaoise hospital in September. That is another positive for the Deputy to take from today's discussion. I assure him that services at Portlaoise hospital are a priority for the Department, the Government and the Health Service Executive.