Martin Daly: Patient transfer failure exposes system dysfunction

Secretary General Tierney and to CEO Miss Anne O'Connor, I wish you the very best in your roles, tough positions but I know that you have the capabilities of dealing with them. You know we get reports and I welcome your statements and I've read through them a few times but really it comes down to the individual patient experience. So I'm going to just bring you to this and I'll let you draw your own conclusions because this isn't always about resources, it's about communication and it's about organisation. So Veronica Curley was a 39 year old mother of two who suffered a hemorrhagic stroke outside the gym in Athlone on the 27th of December, this is on the record of the Dáil, I worked with Deputy Michael Fitzmaurice on this case. She was airlifted and received exemplary treatment in Beaumont Hospital, the National Surgical Unit. She was there for over two months. She obviously wanted to get back to her children locally in South Roscommon, Four Roads. They had insurance, they tried to get into the National Rehab, there was going to be a 12 month wait list for a 39 year old woman who'd had a stroke. She then tried to get private care, there isn't private care in this area available and the insurance company were playing, making an issue of it. But this is the crucial point, we made representation to the Stroke Rehab Unit in Merlin Park Hospital in Galway to get someone who's from the west of Ireland, from Dublin, to the west of Ireland who has two small children in the new year. And we were told that she could not be admitted directly to a Stroke Rehab Unit from the National Neurosurgical Unit in Beaumont Hospital, even with the assessment of a neurologist and a report to accompany her. We had to either admit her to Roscommon University Hospital or Banlaisloe, Port Yonkley University Hospital in order to make that transfer to the Stroke Rehab Unit. That's all on correspondence, that is a matter of fact. So she was admitted after a phone call to the manager in Port Yonkley University Hospital by a politician, this shouldn't be happening. This should be clinician to clinician to clinician, hospital manager to hospital manager to hospital manager. And he very kindly admitted her, arranged her admission for three days to allow that transfer to a Stroke Rehab Unit in Merlin Park Hospital in her own area, HSE West North West. Now that is simply not about resources, that is about lack of communication, it's about goal keeping, it's not proactive, it's silo, all the words, fragmentation, a simple phone call, a simple transfer for a mother of 39 with two small children. Is there any reflection on that? Because I haven't gotten a satisfactory answer yet from HSE West North West and I'm going to move on, I may leave it with you because, but I think it's, if that's emblematic of the dysfunction within our service, we have a problem. No matter how much money we throw at it, that's a cultural issue. So clearly I don't know the details of the case, I'll have to look into it, but I mean I think in terms of how we deliver our care, my own view is that we have to make that as streamlined as possible, so what you've described to me seems to fall far short of that in terms of a coordinated integrated care pathway. Would you say it's acceptable? Well I don't know the details of it, so it doesn't sound acceptable. I can assure you on the public record that those details are great, in my view it's simply unacceptable. I just want to move on because I'm on the clock, there's real concern about the regionalisation of our health services and I suppose this goes to both the department, really I suppose the department mainly, Secretary General, there's a real concern that our national strategies which have been so effective over the last 20 years, a national cancer strategy, a national cardiovascular strategy, a national stroke, that with regionalisation that we're going to lose that national focus in a small country the size of Ireland, most especially in cancer care, we're beginning to drop off on some of the indices in terms of our access to cancer diagnostics, the time of diagnosis to the point time to be treatment, especially in the west of Ireland, we have some worrying trends there. Could I ask you, is that commitment there that we will have a national focus which is so important with clinical networks, research and networks with the European Union which we should be using, could I just get your comment on that please? First I'd say the introduction of the health regions, we all recognise they do represent a significant structural reform agenda and with the current position reflecting government's agreed approach to organising services on a more population health based, regional needs basis, I do hear those concerns expressed myself and in establishing the regions the whole purpose was to give regional autonomy but also be supported by a strong centre, particularly in the context of clinical programmes, in context of planning and designing services, performance and insurance, so I think the challenge is to understand how we achieve that balance between that national health service delivery through clinical programmes and ultimately service delivery and that's something I think that's at the front of our mind as we face into a revision to the cancer strategy, maternity strategy, so we have work to do in that space. I think it will require really strong leadership in order to ensure that we don't get a fragmentation of everything, there was huge political capital expended on coalescing services 20 years ago, people lost their seats in this eructus because of it, because they made the right decisions to centralise care and to get specialised care, so I would hope that that doesn't slip. I move on to a favourite topic of mine which is digitalisation. I'm still looking at these charts, the 2024 e-government benchmark, the digital decade indicator, showing Ireland not just in last place but off the chart in terms of digitalisation and I'm on a tight time frame here. Can I get assurance, I've spoken to the Minister for Health about this, I've spoken to Minister Deaper and Minister Jack Chambers, I've emphasised that if we do not digitalise our health service, we can throw as much money as we like at the system, we will not get the commensurate productivity. I might respond in the first instance and I'll hand it over to Damien on the HSE side who's leading out in digital reform. This department is fully committed to delivering on the digital agenda, we recognised that almost three years ago, since then we've developed a strategy and vision, so we're not lacking on vision or ambition, we fought hard to secure a funding line in the NDP to support that and we've done that in two ways, to harden our infrastructure and to deliver on our digital programmes and we've now rolled out our app, we're in the middle of rolling out a sharecare record and we're close to shortlisting vendors for our national digital electronic health programme. So I want to give this committee confidence that I'm fully committed, it is a passion of mine, I'm going to be relentless on it and Damien understands what relentless means when I'm engaging with him. Could I ask Damien, I'm sorry I'm on tight because I want to get one last question in. Very briefly, there are 10 major programmes, the electronic health record is one of those, that's a big programme, I was up in Northern Ireland again yesterday just talking to them in terms of our team, making sure we learn from some of the things they've done. As Derek said, we're now in the procurement stage, we've under 100 people working on that, that's huge in scale, that's the system if you like that our staff will use in the system, but in parallel with that the HSE app is live, we believe that's a mechanism perhaps to reduce postage costs to allow that money to be reinvested in services. Our shared record is live in the South East and we have a range of other initiatives. I take your reassurance that I just want to get one last thing in because I visited Roscommon University Hospital with a number of deputies yesterday to the plastic surgery unit. It is unbelievable that there is only one plastic surgeon serving Donegal, Mayo, Leitrim, Sligo into Roscommon. There are 8,000 referrals a year, 6,000 actively treated, one plastic surgeon now joined by a second plastic surgeon on a part-time basis from Galway, 8 advanced nurse practitioners doing outstanding work in the area of skin cancers and on the see and treat model of care. They have only got two procedure rooms and they seem to have hit a stone wall. I really do think that if you're looking for productivity, if you're looking go to Ms Deirdre Jones, go to the plastic surgery unit in Roscommon University Hospital, that's productivity, that's the way the service should be run. There are people coming from Donegal, from the far breaches of Donegal to Roscommon to have their skin cancers removed.