St. Ita’s, October 2009

Speech by Dan Neville TD on the Rehabilitation unit at St., Ita’s Hospital, Newcastle West, Co Limerick – Adjournment of Dail Eireann on 7th October 2009

I welcome the opportunity to contribute to this debate. I fully agree that an excellent service is provided by the acute rehabilitation unit in St. Ita’s hospital. This service induces efficiency in the mid-west regional hospital by ensuring the level of beds available for the elderly in that hospital is accommodated by the service from the acute rehabilitation unit of St. Ita’s in Newcastle West. This is now under threat. A reduction in the number of senior house officers means a lack of medical facilities which creates a difficulty for the service and for Dr. David Clinch and his support team and for transferring patients to the acute rehabilitation unit.

It is wrong that somebody should have to sign a disclaimer in order to receive this excellent service in Newcastle West. It is also unacceptable that people in the hinterland of Newcastle West, which includes most of my constituency, will now not have the services of the rehabilitation unit available locally. I have personal experience of a member of my family being in that unit and of the excellent service it provided in allowing people return to their communities as a result of rehabilitation without which they would have had to go into long-term care.

The absence of the required medical cover will create a situation in the medium term where this facility will probably be discontinued. This is not acceptable to us. Not providing the cover is false accounting because closing the unit will cost the HSE more in resources than keeping it open. Patient treatment in the mid-west will also cost more. Some 350 patients are transferred to the unit each year. We want to retain this excellent service and call on the Minister and HSE to ensure we do.

Deputy Billy Kelleher: I apologise on behalf of the Minister for Health and Children, Deputy Mary Harney, who is unable to attend. I am taking the debate in her place. I thank Deputies Cregan and Neville for raising this issue. It provides me with an opportunity to update the House on this matter and to outline the background to the current situation and the action taken by the Health Service Executive.

As Deputies are aware, Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care, where this is appropriate. The Health Service Executive has operational responsibility for the delivery of health and social services, including facilities such as the rehabilitation unit at St. Ita’s community hospital.

St. Ita’s hospital was built in 1841 and certain developments have taken place there over the years, including the provision of the rehabilitation unit which opened in 1992. This was as an eight-bed inpatient unit which also provided day hospital services three days a week. The medical needs of the rehabilitation unit were provided for under the leadership of a consultant geriatrician. In 2001, in response to increasing needs, the service was expanded to include 14 acute rehabilitation beds. The outpatient services are provided through a day hospital, the medical clinic and therapy services.

Early in 2008, a number of perceived risks at St. Ita’s hospital were raised with the Department, including the question of 24-our medical cover. On foot of this approach, the Department requested a report from the Health Service Executive on the services provided at St. Ita’s. Consequently, an assessment of risks in St. Ita’s has been completed and a risk register is being prepared which will incorporate an implementation plan.

The Health Service Executive’s national service developments for older people, 2008, identified the need for four consultant-led community geriatrician teams, one team per HSE administrative area. The team for the HSE west is based in Limerick and will incorporate two medical posts, one consultant and one specialist registrar. The medical posts will allow for some additional medical cover to be provided to St. Ita’s hospital by the full medical team in the Mid-Western Regional Hospital. The Health Service Executive has advised that interviews for the community consultant geriatrician recently took place. Appointments will take place on a “joint appointment” basis to both the acute and primary, community and continuing care, PCCC, service. It is envisaged that strong clinical links between the hospital and community will continue to be developed and this will enable care to be streamlined to best meet the needs of the individual.

In addition, I understand that detailed discussions have taken place between relevant staff of the Health Service Executive and the hospital with regard to addressing the particular issue of service provision. The capacity of the executive to provide approved levels of services continues to be reviewed in the context of overall resources available. It is incumbent on each local health manager to ensure that services, including rehabilitation services such as at St. Ita’s, are delivered within allocated budgets. This includes any decision on prioritising and providing additional rehabilitation cover at this particular location. This requires a stringent ongoing review of the application of the resources.

The Government is committed to the development of comprehensive rehabilitation services across the country. As I have outlined to the House, the Department of Health and Children will continue to work with the Health Service Executive to advance this objective.

This includes any decision on prioritising and providing additional rehabilitation cover at this location. It requires a stringent ongoing review of the application of the resources.

The Government is clearly committed to the development of comprehensive rehabilitation services across the country and I have outlined to the House that the Department of Health and Children will continue to work with the HSE to advance this objective.