Dáil Éireann - Volume 637 - 04 July, 2007
Adjournment Debate. - Hospital Services.
Deputy Pat Breen Deputy Pat Breen
 Deputy Pat Breen: I propose to share one minute of my time with my colleague from County Clare, Deputy Joe Carey. I am pleased to have the opportunity to raise this urgent issue. I was shocked to learn yesterday morning that the HSE had made a decision not to recommission the mammography unit at Ennis General Hospital following its closure last October. I am reliably informed that unit was fully installed and ready to be recommissioned. The problem with the service is simply that there was no consultant radiologist employed at the hospital who could and was willing to interpret and report on the mammograms.
Prior to the refurbishment, this work was carried out by the HSE in Limerick Regional Hospital, but the service was discontinued. Why was the HSE not up-front with the people of Clare before the election? Can the Minister of State, Deputy Gallagher, explain why this decision was made five weeks after the election? This is another example of the HSE policy of centralising health services with the approval of the Fianna Fáil-Progressive Democrats-Green Party Government.
In its press statement yesterday, the HSE said this decision would cause inconvenience for the women of Clare but that those in north Clare could avail of services in Galway rather than make the long journey to Limerick. Did the HSE give any consideration to the women of west Clare, who will have to travel up to 100 miles to avail of the new service? This morning I had a telephone call from a woman in Kilbaha in the west Clare peninsula who asked what she and others like her had done to deserve this. People elected this Government because its candidates told people before the election that there would be no downgrading of services at Ennis General Hospital. We have been conned.
I know of several women who have had to avail of a mammogram in the last year. A relative of mine who had a lump detected in her breast waited 12 months for an appointment after being sent for a mammogram by her GP. The stress that woman and her family had to endure for four weeks as they waited for the results was unbelievable. She is one of hundreds of women who must endure this agony each year.
 Does the Minister of State realise that centralised health services lead to the creation of more queues, greater inconvenience and increased pain and stress for patients who must endure longer waiting lists? The lack of maternity and mammography services for women in Clare is a sign of what is to come from this new Fianna Fáil Government. It is an indication that other essential services at Ennis General Hospital must now be in doubt as we wait for another HSE review. These include the provision of a six-slice CAT scanner, although consultants say a 16-slice scanner is required, and, above all else, the future of 24-hour consultant-led accident and emergency services. There is no doubt that the Hanly proposals are alive and well and that the people of Clare are its first victims.
I ask the Minister of State not to turn his back on the people of Clare. I ask him to go back to the Minister, Deputy Harney, who holds the purse strings. She can reverse this decision of the HSE and restore the basic essential services to which we are entitled.
Deputy Joe Carey Deputy Joe Carey
Deputy Joe Carey: I join my colleagues in raising this important matter for County Clare. The mammography service in Ennis General Hospital has been available to the women of the county since 1985. The money to put the service in place was raised by volunteers. I was appalled yesterday to learn that it was announced at a press conference that we are to lose this service. No consultation took place before this decision was made.
The mammography unit has provided service to the people of County Clare for the last 22 years. It is totally unacceptable that it is to be removed from Ennis General Hospital. I and other public representatives have been misled on this issue in recent months. We were told the service would be recommissioned once the unit was refurbished. That did not happen. As Deputy Pat Breen observed, this decision was made without any debate after the general election. It was not even raised at the western health forum.
This centralisation of services represents a black day for County Clare. I appeal to the Minister for Health and Children to reinstate the mammography unit at Ennis General Hospital as a matter of urgency.
Deputy Timmy Dooley Deputy Timmy Dooley
Deputy Timmy Dooley: I welcome the opportunity to address this serious matter. It is unfortunate that my maiden speech in this House must relate to an issue of such negativity and devastating impact on the lives of the women of County Clare. I am deeply unhappy at the decision of the HSE to end the mammography service at Ennis General Hospital. We must have far more information from the HSE and I welcome any information the Department may be able to provide through the Minister of State, Deputy Gallagher.
 The genesis of this service was based on the efforts of a local group of women who raised funds to put the equipment in place. Without consultation, however, the HSE proposes to end the service. This shows a great lack of understanding of the voluntary sector and an arrogance on the part of the HSE that is not befitting a public agency charged with the responsibility of delivering a health service to the people of County Clare and the rest of the State.
I object in the strongest possible terms to the decision, without notice or consultation, to propose to end this service. There has been no consultation with the stakeholders. As public representatives, we have been provided with no information. We too had to depend on journalistic colleagues to provide us with the information they received in advance of yesterday’s press conference. That is no way for a State agency to do business. It does not allow for the type of accountability we expect and shows a scant regard for those of us with an electoral mandate.
I am not a medical expert but I believe there is some merit in the idea of a centre of excellence. However, the HSE has not put forward a credible service plan to cater for the women of Clare in Limerick and Galway. A previous speaker made an exceptionally good point regarding the west Clare peninsula, which is 100 miles from the location identified for mammographies. As public representatives, we should have been provided with the information in advance and discussions should have been held on finding an open and transparent solution through the health forum which was to have been established for the people of the locality. This decision has caused concern for women because it gives rise to the belief that further delays will ensue in getting access to mammography services.
A women who has had a preliminary examination by a general practitioner only to be told she will have to wait a number of weeks before having a mammogram faces further anxiety and pressure. That is not acceptable and should not be allowed to continue. Given the proposal to further roll out BreastCheck services, I cannot understand why Ennis does not have the numbers to sustain a centre for excellence, particularly with the population expansion taking place throughout the county.
A recent case involving the misdiagnosis of a local women has created great anxiety among the people of County Clare. The woman underwent a mammogram in Limerick but was not informed that she had breast cancer. I understand the individual concerned has met the Minister for Health and Children but the result has been a lack of confidence in the services available in Limerick. The Health Service Executive has done nothing to provide reassurances that a centre of excellence will be established to avoid this kind of misdiagnosis, which further adds to the suffering of  people who are already in very vulnerable situations.
I ask that the contributions made in this debate be raised with the Minister so that discussions can be arranged with the chief executive of the HSE at the earliest possible opportunity with a view to revoking the order to transfer services to Limerick until such time as credible services plans are in place that meet the needs of all the women of County Clare.
Deputy Pat The Cope Gallagher Deputy Pat The Cope Gallagher
Deputy Pat The Cope Gallagher: I welcome the opportunity to address the issues raised by the Deputies from County Clare and to set out the current position regarding mammography services at Ennis General Hospital and breast cancer services nationally. The specific issue raised by the Deputies concerns the organisation and management of the health services and, as such, is a matter for the Health Service Executive under the Health Act 2004.
The HSE has informed the Department that following consultation with experts in the field of cancer care, it has decided to concentrate all mammography services for the mid-west at the regional specialist breast unit in the Mid-Western Regional Hospital in Limerick for reasons of patient safety. The HSE in the mid-west has informed the Department that the decision to discontinue mammography in Ennis is driven by the need to provide the best possible clinical practice. Centres where fewer than 1,000 mammograms are done in a year do not provide the volume of work necessary for the maintenance of the required level of professional skills. County Clare patients requiring mammograms between now and September will continue to be referred to Galway, after which date they will be referred to the specialist breast unit at the Mid-Western Regional Hospital. A total of 402 County Clare patients have had mammograms in Galway since October 2006.
The benefits of this change are the people of County Clare can be assured the services provided to the women of the county are in line with international best practice and subject to all the checks and balances that ensure units fulfil their remit. The HSE appreciates the move will cause inconvenience to some County Clare women but has stressed this must be set against the improvements that will ensue, including greater peace of mind for women undergoing mammograms. I understand clinicians practising in Ennis Hospital have been fully involved in the review and have accepted the need for change.
The new dedicated regional specialist breast unit will be sited adjacent to the outpatient department at the Mid-Western Regional Hospital, Limerick, and will provide dedicated facilities for the symptomatic, reconstruction, review and breast prosthesis and fitting clinics, as well as for nurse counselling sessions. Support  services such as X-rays, pathology and physiotherapy will be accommodated in the main departments of the hospital. Work on the detailed design and planning application is well advanced and the project is expected to go to tender before the end of 2007 and be fully commissioned in 2008. The capital cost estimate is €2.6 million, including design fees, equipping and construction.
A national breast screening programme is the most efficient population approach to preventing and controlling breast cancer. BreastCheck, the national breast screening programme, is available free of charge to eligible women in 15 counties in the eastern, north-eastern, midlands and parts of the south-eastern and western regions. This Government is committed to ensuring the BreastCheck service is rolled out to the remaining regions in the country as quickly as possible, and screening commenced in the west last May. Additional revenue funding of €8 million has been allocated for this year to meet the additional costs involved for roll-out, and the full complement of 111 staff has been approved. BreastCheck appointed the clinical directors for the south and west last November and has recently appointed three consultant radiologists, two consultant surgeons and two consultant histopathologists, all with a special interest in breast disease. The recruitment of radiographers and other staff is under way.
The Minister has also made available an additional €26.7 million in capital funding for the construction of two new clinical units and the provision of five additional mobile units and state-of-the-art digital equipment. The static unit at University College Hospital, Galway, is on track for late autumn.
The majority of women with breast cancer are diagnosed and treated outside the BreastCheck programme. It is therefore necessary that we support the symptomatic breast disease services as well as the screening services to ensure comprehensive breast cancer services are available for all women.
Breast cancer is the individual site specific cancer which has received the most investment in recent years and more than €60 million has been made available for development of the symptomatic services since 2000. The Minister for Health and Children recently formally approved quality standards for symptomatic breast disease services, which were prepared by a multidisciplinary expert group and submitted to the Minister by the Health Information and Quality Authority. The implementation of the standards is an essential element of the quality agenda set out in the national cancer control strategy. The response to the standards must be to ensure that every woman in Ireland who develops breast cancer has an equal opportunity to be managed in a centre which is capable of delivering the best possible results. The Department has requested  the HSE to prepare a plan to implement the standards for submission to the HIQA. The HSE has agreed that the plan will involve the evaluation of current provision of services and provision for the performance management of specialist centres. A two to three-year timeframe for implementation of the standards is envisaged by the HIQA.
Planned developments for Ennis General Hospital will cost in the region of €40 million and include the upgrading of wards, accident and emergency, radiology and outpatients departments, the intensive care unit and general infrastructural upgrades. I understand an application has been made for planning permission and these developments will be especially beneficial to people in County Clare and the surrounding areas.
Deputy Pat Breen Deputy Pat Breen
Deputy Pat Breen: Not at the rate they are taking away our services.
Deputy Pat The Cope Gallagher Deputy Pat The Cope Gallagher
Deputy Pat The Cope Gallagher: Aligned with the roll-out of BreastCheck nationally and the further development of symptomatic breast disease services, the developments at Ennis General Hospital will ensure we continue to deliver quality assured multidisciplinary breast cancer care to women nationally, including women in the mid-western region. I will raise the issue with the Minister and the HSE and note what Deputies have said regarding the communication of this decision to national politicians through the media.
Dáil Éireann 637 Adjournment Debate. Hospital Services.