Crumlin Cuts 2009

Dail Eireann – Private Member’s Debate on Cutbacks at Our Lady’s Hospital For Sick Children, Crumlin, Dublin – 24th June 2009

Deputy Dan Neville

I welcome the opportunity to speak on this motion and I commend Deputy Reilly on tabling it. It has raised the profile of this very serious issue. I was with the delegation from the Joint Oireachtas Committee on Health and Children which visited the Crumlin hospital yesterday. I compliment the board and management on the time they spent with us, the openness of the information provided and on their deep concern for the hospital and its patients. I found the approach of those I met very humane and they expressed a great concern that the service they provide will be affected by the proposed changes.

A Government Deputy welcomed the fact that the planned closure did not take place. However, the reason it did not take place was the approach, that is, to seek volunteers for unpaid leave. It sought people to leave voluntarily but could not achieve the appropriate mix. In other words, the response was either all from nurses with no doctors or vice versa. The resulting mix was not right and it was not feasible to implement the planned closure. Those I met made this point very clearly. The intended cutbacks must now take place elsewhere, which, they have indicated, will affect patient services and the treatment of patients.

The hospital management made the point that the hospital, built in 1956, is a voluntary hospital and its operation and that of all voluntary hospitals is derived from public funding. It goes against the whole approach to suggest private funding should be involved. Any voluntary funding is used for research and capital development. These are the reasons such money is collected and why the organisations carry out such fund-raising. To switch such funding for use in the day-to-day running of the hospital is wrong and deceitful.

Deputy James Reilly

Hear, hear.

Deputy Dan Neville

That is not the reason the money was collected nor is it the intention of the board of management that the money should be spent in that way. It is the duty of the Government to fund voluntary hospitals and to fund Crumlin hospital.

Crumlin serviced 135,000 patients last year, including 80,000 outpatients, 30,000 emergencies and 24,500 in-patients, rather than the figure of 10,000 suggested by the Government side. The issue of Birmingham hospital was raised. It was suggested we were not comparing like with like. However, the figures for Birmingham are based on inpatients and outpatients and the calculation for Crumlin hospital is for inpatients only. When one compares the same figures for both hospitals, the result is the same. The inefficiency suggested by some people in respect of Crumlin hospital is false. It has seven theatres, six of which are open, as previously mentioned. One theatre and some 25 beds have been closed because of the lack of finance.

It was made clear to the visiting delegation that Crumlin hospital provides a national service of interventions, some of which are exclusive to it such as oncology, haematology, cardiac, thoracic surgery, burns and medical genetics. It is also the national centre for cystic fibrosis. It is a key hospital in ensuring these services are provided.

It was pointed out to us on the wards that in any given ward there are people from all parts of Ireland, including the west, the south and the north. The hospital provides a service to the nation. It was also pointed out to us that at 13.6% of the total spend, management and administration costs are the lowest of any hospital in Ireland. Efficiencies exist in the management and administration of the hospital, an area often finger-pointed by people as inefficient. However this is not the case with Crumlin hospital.

I refer to the proposed cuts. The approach of the Government is crude and determined on an historical basis. Much has changed in Crumlin hospital since the ballpark figures suggested by the Government. The board of management of Crumlin hospital seeks a complete analysis of what is required given the changed circumstances. It has no hesitation in welcoming an evaluation of its performance in the delivery of services. Any such evaluation would find areas are under-resourced rather than otherwise. Recent studies show an under-resourcing in intensive care. The Minister of State has made comparisons with 2004 but I remind her that the number of outpatients has increased by 23% since then, the number of theatre procedures has increased by 34% and the number of ICU beds has increased by 21%. The whole areas of service delivery has improved in numbers and because of improved medical developments.

Some 25% of the increase that has occurred in costs is a result of payments to staff on the basis of agreements. Therefore, there is no return for 25% of any increase and it must be paid in any event. The non-pay element is only 3% and the balance of 13% is related to increases in volume and complexity of interventions to save the lives of children, as already outlined. Prior to the time for which the Minister of State has made comparisons, cases of cardiac surgery were sent abroad at a substantial cost. Now, no cases of cardiac surgery are sent abroad and all such procedures are completed in Crumlin.

They wish to develop other innovations such as national share-care programmes to keep more children at home. It was explained to us that when children are discharged programmes or personnel such as dietitians are not available to ensure those children have a healthy diet and that it complements the surgical intervention or treatment in Crumlin hospital. This service is not available on a nationwide basis. There are no nurses or nutritionists.

The social consequences are worse for children than for adults because if the surgery is not carried out, children grow with the problem which then causes difficulties. They cannot give an assurance that no emergency case will not be dealt with. They said that emergency cases may not be dealt with, that if the cuts continue we are going to fall further behind international norms for proper of children. They are regarded as some of the leaders in Europe. Much concern was expressed that the international norm of proper treatment for children would be dropped in Crumlin.