Hospital Services

Mark Daly (Fianna Fail)

I thank the Minister of State, Deputy O’Dowd, for coming to the House.

I raise this matter to clarify the number of paediatric tracheotomy patients in Ireland and the number of registered nurses who are able to perform the procedure, how many of those are in the hospitals around the country and also how many are able to show parents how to perform the procedure.

Unfortunately, there have been some tragic cases in the past while where, because of the parents’ inability to perform the procedure, children have died. In some cases when looking for assistance from nursing staff who have not been properly trained in the procedure, tragedies have occurred.

I ask the Minister to outline to the House what the Government is doing to ensure that as many of the health care professionals throughout the State as possible are properly trained and qualified and that procedures are in place to ensure that tragedies, such as those that occurred in Kilkenny and in Cork, do not happen in the future.

Fergus O’Dowd (Louth, Fine Gael)

I thank Senator Daly for bringing this matter before the Seanad. I would assure him that I will bring it to the attention of the Minister of State at the Department of Health, Deputy Kathleen Lynch.

In answer to the Senators specific questions in relation to the number of paediatric tracheotomies and nursing care, I will put the following on the record of the Seanad.

Information available from the hospital inpatient inquiry database would indicate that the number of children between zero and 16 years who have had this procedure and have been discharged from hospital is relatively small. Of the 74 such discharges between 2010 and 2012, the majority have been from Crumlin children’s hospital, 41 discharges, and the Children’s University Hospital, Temple Street, 21 discharges. However, it is not possible to say how many of those children were discharged with the tracheostomies still in place.

The active register of the Nursing and Midwifery Board of Ireland has a total of 4,274 individuals holding a children’s paediatric qualification. This does not mean that all of these are actively practising in this discipline. Individuals may hold more than one qualification and as such may be practising in another division of the register. It is also possible that individuals may not be practising at all, but still pay annual retention fees to maintain their names on the register. Under new requirements set out in the Nurses and Midwives Act 2011, future registration will capture more defined information on current employment. This will allow for more accurate analysis of the active register, including numbers of practising paediatric nurses.

The HSE established a working group to examine the discharge of infants or children with complex health care needs from the acute paediatric hospitals in Dublin mid-Leinster in July 2012. The group comprised representatives from the paediatric hospitals, HSE primary care, nursing agencies, Jack & Jill Foundation, LauraLynn House and University College Dublin.

The group is finalising its report and will submit it to the national director for quality and patient safety. Findings indicate the following needs: establish a clinical governance model for children discharged into the community; ensure that all staff providing care to children with complex needs are fully trained; and develop a support package for parents.

It is proposed that these recommendations will apply throughout the HSE. A key recommendation concerns the need for a detailed paediatric home care package to be agreed prior to the child’s discharge from hospital, with a detailed specification outlining the care requirement for each child and family. A paediatric home care package needs to include a key worker to advise everyone within the family on all aspects of the child’s care and trained nursing-care staff.

The provision of safe home care for children who are well enough to leave hospital, such as these children, is a priority for the Minister for Health. He has highlighted care at home for children who have had to undergo tracheotomies as a priority service area for the HSE in planning its services in 2014. The Minister is meeting the advocacy group tomorrow. The HSE has informed the Minister that, following publication of the national service plan for 2014, officials will meet in early December to discuss future steps to deliver on the working group’s recommendations in 2014.

Denis O’Donovan (Fianna Fail)

An bhfuil an Seanadoír sásta? Is the Senator happy?

Mark Daly (Fianna Fail)

I do not know.

Denis O’Donovan (Fianna Fail)

The Senator can ask a brief supplementary.

Mark Daly (Fianna Fail)

I thank the Minister of State, Deputy O’Dowd. I note this is not his specific area. I wish that the Minister for Health would come into the House.

I asked the Minister to clarify the number of paediatric tracheotomy patients and to clarify the number of nurses who are competent to carry out and train in the tracheotomy procedure. In brief, the answer to the first question was it is not possible to say how many children were discharged with tracheostomies in place. The other answer, in a page and a half, was basically that the Department does not know how many nurses are trained to do this.

Perhaps the Minister of State will indicate whether I have got the wrong end of the stick. I must inform him, however, that the question I posed was not answered in the two pages of script he read into the record. It said a lot but it also said very little. I am not criticising the Minister of State; rather, I am stating that the two-page reply supplied by officials from the Department of Health to a matter raised on the Adjournment by a Member of the Oireachtas contains only one line in reference to that matter, namely, “it is not possible to say how many of those children were discharged with the tracheostomies still in place”. The fact that the information I am seeking could not be supplied is a cause for concern. In addition, the Department does not know the exact position with regard to the qualifications of nurses.

Instead of insisting on the Minister of State reading out the reply in the House, the officials to whom I refer should have been honest and stated that they do not have a clue. That would have been the best answer they could provide. I ask the Minister of State to return to those officials and state that it is not acceptable that a public representative be provided with a reply as disgraceful as that which has been read into the record of the House. I do not blame the Minister for Health or the Minister of State in respect of this matter.

Denis O’Donovan (Fianna Fail)

The Senator’s lack of pleasure with the reply is noted. However, the Minister of State is not the line Minister. If he wants to make a brief comment—–

Mark Daly (Fianna Fail)

Absolutely, and I do not—–

Fergus O’Dowd (Louth, Fine Gael)

It is very important that the views of all Oireachtas Members – including those of Senator Daly – should be brought to the attention of the Minister. The Minister stands over the reply because it comes from him. Notwithstanding what the Senator stated, the most important aspect to note is that there will be a meeting with representatives from the advocacy group tomorrow. In other words, the people involved, who have deep, abiding and very real concerns, will be met and the issues outlined by the Senator – who also has concerns – will be dealt with tomorrow and will be the subject of direct answers from the Minister.

Another important point is that the existing requirements did not allow for the capture of the data which the Senator, quite rightly, is seeking. Under the new requirements, future registration will capture more defined information in respect of those who are working and practising in this specific area. I am satisfied that the solution to this problem is contained in the relevant legislation, which was passed in 2011. In other words, the lacuna in our knowledge is being filled. Information on the counties from which the patients come is not provided but statistics are supplied with regard to the hospitals at which they presented and had procedures carried out. The data gap is quite small and really relates to patients’ point of origin. We are aware of the number involved and the hospitals where they were treated. However, we do not know if patients had tracheostomies in place when they were discharged. These are all important matters. I am assured that no one was allowed to leave the hospital without the proper discharge protocols being observed and adequate and proper care policies being in place.

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