Matt Shanahan demands urgent action on hospitals and cardiac lab

I'd like to just note the very sad passing of Detective Colm Horkin and also families and victims of COVID-19. We send our condolences on behalf of the regional group. Ministers, we appear to be exiting this crisis. We may well be heading into another, I suspect. In this present respite, we have yet to address the expected winter surge and the possible re-emergence of COVID-19. We are mindful of the present reduction in bed capacity and procedures output due to increased infection control protocols. Portioncla Hospital in Galway, for instance, is seeing a 10% reduction in its bed numbers. We are seeing a significant increase in waiting lists as the result of lost months of elective activity due to COVID lockdown. Some of the recent deferment in patient procedures could have been avoided, in my opinion, if full-time private consultants in private hospitals were allowed to continue to treat both public and private patients in the recent private hospitals agreement. The imposition of a Type A contract during this agreement was rooted in Department of Health Ideology and not in the practicality of trying to treat as many patients as possible at every opportunity. We need a renewed sense of urgency brought to bear on our hospital services plan, Minister. We need clear targets to deal with the impending beds crisis. System rigidity with respect to existing custom and practice must be set aside. Collaborative, innovative thinking should be encouraged across all grades to decide new work practices. And most importantly, resources must be guaranteed to get the job done. Resources have proven not to be a problem when allocating €330 million for a three-month agreement that delivered a 40% bed occupancy. Similar financial resolve is needed to properly support our frontline healthcare workers in the battle ahead and to deliver additional measures. And among those, Minister, I would propose to you that you open up the recruitment of additional clinical posts, that you provide additional home care packages to free up the long-stay patient beds, that you ask hospital management to reserve surgical bed capacity pathways with supporting ICU and HDU bed assists, you provide mandatory testing and dedicated COVID patient management in assigned group hospitals, and also, Minister, after-hours diagnostic imaging sessions would seem to be something that we can easily contemplate. Flexible rosters to support public consultants providing activity in private theatres. I believe also, Minister, we need significant engagement in new contracts through the National Treatment Purchase Fund. Additional capacity in the private sector must be immediately negotiated through service-level agreements and contracted better procedures purchase through the NTPF. We must not see a repeat of employment conditions in public contracts designed to exclude full-time private practitioners, thereby reducing value to the public purse. Additionally, Minister, to match the latest scientific understanding, I am calling for mandatory temperature testing of all hospital workers, which is now commonplace in the industrial manufacturing sector. Referencing a new ethos, Minister, can I revisit the issues at our University Hospital Waterford's cardiac care centre? Despite your welcome and recent assurances to me that we should see no further slippage of the second cat lab development promised from September 2018, I can confirm to you now, Minister, that the construction timeline has now extended a further three months and construction may not begin until the spring of 2021. This extension of time, Minister, is wholly unacceptable. This is why we continue to operate in the South East 39 hours per week with just one single cat lab for the whole of the South East population and understanding that the mobile diagnostic cat lab facility, which was on site at University Hospital Waterford since 2018, was removed in recent weeks, as you know. In addition, Minister, the remodification of our existing cat lab we previously discussed has also been suspended now for many weeks. Despite the new lab equipment being in storage in UHW for a considerable period, engineers required to install and commission it will not travel from abroad because of our two-week travel isolation requirements. Such requirements, in my opinion, could have been dispensed with by means of a COVID test on site at UHW and a managed accommodation agreement. Where there is a will, Minister, there is a way. However, it appears to me that senior officials responsible to deliver this project could not demonstrate a single ounce of wish in order to consider how these delays could be advanced, how this vital work progressed. Every day that the Waterford Cardiac Service operates without two labs means that diagnostic tests that could prevent heart attack cannot be undertaken with obvious implications. It is a further source of thanks to me, Minister, that a commitment to future provision of a 24-7 cardiac care service for the South East is not contained in the present programme for government. As you well know, UHW is the only designated National Cardiac Centre not providing a 24-7 cardiac care service. I know for you, Minister, the South East 24-7 cardiac care issue may be soon in your rearview mirror. But I would highlight to you, your party colleagues, and those that sit on the other benches in this house, that this service refusal remains a stain on Department of Health and HSE national planning with respect to acute clinical care. All eyes matter, Minister, including those of us who live in the South East. And we will not continue to be treated like such in our own land. The timelines proposed to deliver these two urgent CATLAB projects must be given the highest priority in your Department, Minister. And the ground loss must be recovered. The sad reality to date, Minister, is that the urgency of NEFET has not been extended to the lives or clinical needs of cardiac patients living in the South East. In summation, Minister, this debate tonight mirrors the challenges facing the next government. The problems are known and widely flagged. Solutions are possible, but questions remain. What action will those in leadership in the next government take to address these issues, Minister? Will the commitments they espouse be forthcoming and brought to bear? And will resources be equally distributed across this country in the future? Thank you. Thank you very much, Deputy Shannon. So firstly, maybe just to deal with the issue of cardiac care in the South East, and I know you've raised it, indeed, the Cahirlach, Deputy Butler, who was also in touch with me on it earlier today. I know this is a very important issue in the South East. It's an issue which I accept we're not yet where we want to be in relation to it. I do accept that. But I also acknowledge that there has been a huge focus on trying to improve the outcome. So we've obviously had the mobile unit for a significant period of time, the sanction that we gave for the second cath lab. You can't provide 24-7 without a second cath lab, and also the national review. Because there is in any country, as you know, there isn't any country a limit to the number of services you can provide 24-7. The question is, is there a fair distribution? And I think the people in the South East make a very strong argument that there isn't. But we need that national clinical review to determine how we best distribute that in a safe, appropriate, fair and equitable way across the country. We know the chair of that review is Professor Philip Nolan, who's become very well known to all of us now through his work on NEFET. But I take your point, and this is an issue, regardless of whatever role I may or may not be in, that I will continue to give my attention. I would suggest we got a lot done in the last Oireachtas by the Oireachtas members from the South East coming together, regular meetings. I think we should do that again. And what I'll also do is send a transcript of this exchange to the CEO of the HSE and ask that he update particularly on the important issue you make about slippage in relation to construction delay timelines as well. In the time available to me, I just want to comment on some of the other issues. Look, in relation to the use of private hospitals, I would make the point, in my view, there wasn't an ideology involved here. There was actually a pragmatism that we needed to get every bit of extra capacity that we could for a massive surge that thankfully, due to the incredible efforts of the Irish people, didn't come to pass in the way that it could have. I have got figures here, though, that show 11,531 patients benefited, public patients, from inpatient procedures, and 46,298 public patients benefited from day case procedures, 71,967 patients benefited from diagnostic procedures, and 44,865 public patients benefited from outpatient appointments. So that's many, many, many thousands, tens of thousands of public patients who did utilise hospital. And bizarrely, I'm also pleased that there was vacant capacity in the private hospitals. In other words, that it was an insurance policy we didn't need. Was it ideal? No. Are there lessons to be learned? Yes. And do we need now to have a better deal going forward? Absolutely. And I think we should be honest and humble enough to admit that. Your point, Deputy Sianhan, about extra posts, I think is really well made. And I think I've dealt with that already. I welcome the comments of the HSE CEO in that regard today. There is a once-in-a-generation opportunity to try and ensure that we provide the additional posts so those who came back to Ireland to help and those who didn't leave Ireland because of the travel restrictions can work in the Irish Public Health Service. We very much need them. I also agree with your point in relation to the need for new contracts for consultants, building on the GP contracts, but also for pharmacists. And whoever is Minister for Health in a new government has a lot of work to do on contractual reform if we're to deliver the health service that we envisage and want under Solange Care. Oh, sorry, and temperature testing, my apologies. I know a number of hospitals are now beginning to do temperature testing. I don't believe it's yet mandatory, but what I will do is I will contact the HPSC and just get some clinical guidance on that which I will write you on. Thank you. Thank you. Thank you.