Dáil Éireann 29th January 2013
Check against delivery
While the Minister for Health was trying to justify to the people of Roscommon why their A&E was to be closed, he was pushing through proposals to upgrade 2 other, local A&E departments, in Wexford & Kilkenny.
The argument is being made that the issues in Roscommon were different, that it was a matter of safety.
Yes HIQA, did raise concerns regarding the operation of an undifferentiated emergency service at Roscommon County Hospital. But these could have easily been addressed by effective by-pass protocols, changes to staff rotations between the Galway Hospitals and Roscommon; and investment key infrastructure.
Yet the HSE board remained silent on such proposals, contrary to clear commitments given a few short weeks earlier by the Taoiseach and Tánaiste, commitments that were given because of the unique geographic challenges faced by the communities throughout Co. Roscommon. A fact recognised by the establishment of the Air Ambulance service out of Custume Barracks in Athlone.
So upon what is this claim of a safety issue based?
Well, the Minister may remember in July 2011 when he told the Dáil that “a patient attending Galway University Hospital has a 5.8% mortality rate compared with a 21.3% mortality rate in Roscommon, which is four times greater”. A claim that was immediately contested by a consultant at the Hospital and Prof. John Crown who had reviewed the actual figures. The actual mortality rate in Roscommon was 4.92%.
So according to the Ministers own argument, this made Roscommon County Hospital a safer hospital than GUH where such patients are now being treated.
We were subsequently informed by Dr. Jennifer Martin of the Department of Health that the figures were based on a report compiled to “look at the quality of the data, not the care provided”, in acute hospitals.
Yet, despite the minister’s evidence being based on faulty figures, not faulty care, he has failed to correct the Dáil record (see attached correspondence); apologise to the staff at Roscommon County Hospital whose professionalism was undermined by the comments; or publish the report, which has been imminent for the last 18 months.
Another key question that I have is; what capital projects were delayed by the decision to fast track the upgrade of Kilkenny & Wexford’s A&E departments?
Reports are now circulating that the delay in delivering the new endoscopy suite, the Governments “replacement” for the closure of the A&E at Roscommon County Hospital, was due to a delay in funding, in order to deliver the new A&E’s in Kilkenny & Wexford.
In July 2011 Minister Reilly was committed to having this temporary endoscopy suite in place by September of that year, with a permanent facility under way by early 2012. Yet, 18 months later we are only now at the stage of seeking planning permission for the permanent facility at Roscommon Hospital, and we are told that a temporary endoscopy suite is ‘too expensive’.
Why was the long promised upgraded x-ray service at Roscommon Hospital, which would encourage the public to use the facilities at the Urgent Care Centre only delivered last September – a year later than promised.
I now fear that there may be other projects either at Roscommon Hospital or elsewhere, which would have had positive implications for the delivery of services to people locally, which were long fingered while these other A&E departments were upgraded.
Letter to Minister Reilly:
19th December 2011
Dear Minister Reilly,
I am writing to you to request that you come before Dáil Éireann and correct the record pertaining to your comments of the 5th July 2011 in Dáil Éireann and the Joint Oireachtas Committee on 21st July 2011 regarding the mortality rates at Roscommon County Hospital.
Regarding your comments of 5th July 2011 in Dáil Éireann that the mortality rate at Roscommon County Hospital as follows “One set of statistics shows that a patient attending Galway University Hospital has a 5.8% mortality rate compared with a 21.3% mortality rate in Roscommon, which is four times greater”, it is now clear from the evidence of Dr. Jennifer Martin at the Health Committee on 8th December, in your presence, that this is factually incorrect.
As you are aware I pointed out that “Dr. Martin has stated the assessment was related to the quality of data, not the care provided, but the contents of the report have been used in assessing the quality of care provided in Roscommon County Hospital, as the committee will be aware from the debates in the Dáil and here”. In response Dr. Martin said “While the report never aimed to do so, when a number came up in relation to Roscommon County Hospital, it would not have been in the interests of patient safety to ignore it and say, “Yes, we are convinced it is due to the quality of data.” Subsequent analysis and work undertaken by the hospital highlighted limitations in the quality of data and have been more reassuring on the quality of care provided”.
As you are aware this is a clear admission that the data rather than the care at Roscommon County Hospital was flawed, a fact that was both to you attention in Seanad Éireann by Dr. John Crown and again in your presence on a number of occasions at the Joint Oireachtas Committee meeting of 21 July 2011 where it was pointed out that the average, mortality rate between 2009 and 2011 was 4.92%, making Roscommon, based on that statistic, a safer hospital than Galway.
The error in these figures have now been brought to your direct attention on the public record on more than one occasion, an error which has done irreparable damage to the reputation of the hospital and as a result its staff, and in order to restore the good name of all involved, I would be most grateful if you could immediately ensure that you correct the Dáil record on the first available opportunity, which is 11th January next.
While, I am sure that you initial remarks were given with the best intentions, the fact that this error has been brought publically to your attention, and I’m sure privately by your own officials, I do now hope that you will correct the record without any further delay.
Denis Naughten TD
JOINT COMMITTEE ON HEALTH AND CHILDREN
Thursday, 08 December 2011
….Deputy Denis Naughten: At the time of the last review on 24 November the Minister said he would ask Dr. Devlin to respond on the matter I had raised concerning the report on coronary death rates at Roscommon County Hospital and other accident and emergency departments across the country. Unfortunately, there was no opportunity to give a response on that day. Can this issue be dealt with today?…….
…….Deputy James Reilly: There are a number of other issues. Dr. Martin will deal with the mortality rate issue raised in the report to which Deputy Naughten referred with reference to Dr. Devlin.
The roll-out of the helicopter emergency medical service which I first mooted in June-July has been under consideration since. I will ask Mr. Gilroy to update the committee on the matter.
Dr. Jennifer Martin: I thank the committee for giving me the opportunity to comment on the report. I might clarify that the report we are finalising looks at quality indicators or the potential for using the high data system or the biggest data system in the country that collects information from all hospitals. While one of the indicators at which we are looking is mortality rates after a heart attack, the aim of the report is to look at the quality of the data, not the care provided.
On the timing of the report, the reason it has been somewhat delayed is that when we went to a number of hospitals in which a good deal of work was done in looking at the data which add a great deal of information and learning to the report, there were some unforeseen time delays which we are still working through with the HSE and hospitals. We hope to have the report finalised shortly.
Deputy Denis Naughten: Will it be finalised very shortly?
Dr. Jennifer Martin: It will be finalised as soon as we can clarify the issues involved with the HSE and hospitals.
Deputy Denis Naughten: The reason I ask is that in July we were told the report would be available “very shortly”. Will it be another six months?
Dr. Jennifer Martin: When we went to hospitals they had done much of the work themselves which accounts for an entire second aspect of the report which people will appreciate really adds learning to it. We are much closer and I hope the report will be available very shortly.
Deputy Denis Naughten: To clarify—–
Deputy Denis Naughten: —–Dr. Martin has stated the assessment was related to the quality of data, not the care provided, but the contents of the report have been used in assessing the quality of care provided in Roscommon County Hospital, as the committee will be aware from the debates in the Dáil and here.
Dr. Jennifer Martin: While the report never aimed to do so, when a number came up in relation to Roscommon County Hospital, it would not have been in the interests of patient safety to ignore it and say, “Yes, we are convinced it is due to the quality of data.” Subsequent analysis and work undertaken by the hospital highlighted limitations in the quality of data and have been more reassuring on the quality of care provided.
Deputy Denis Naughten: That is an important point. Does that mean we will have an opportunity to correct the Dáil record as regards the data provided? I am sure the Minister did it in good faith; I am not questioning that aspect. The data were related to the quality of care and what Dr. Martin is telling the committee is that following their reassessment, particularly the data for Roscommon County Hospital, in terms of the question marks over it and the scale of the issue of quality of care, the impression given will not match what will be in the report. That is a serious matter regarding the information given in the Dáil at the time on the closure of the accident and emergency department at Roscommon County Hospital. I seek clarity in that regard, as it was such a fundamental issue in the public debate on the matter.
Dr. Jennifer Martin: The report will show that the information input by hospitals into the HIPE system was reported on in the Dáil. The same numbers are in the report.