Seanad Éireann - Volume 171 - 18 February, 2003

Adjournment Matters. - Hospital Services.

  Mr. U. Burke: I thank the Cathaoirleach for allowing me to raise this matter on the Adjournment. I also thank the Minister of State for being present. Will he indicate his future plans for the retention and development of maternity services at Portiuncula Hospital, Ballinasloe?

  Following the leaking of the draft report of the national task force on medical manpower last weekend, there is concern and anger in Ballinasloe, County Galway, among the staff and those who have had contact with the hospital in the past. The terms of reference of the task force clearly indicate concern in that it has to co-ordinate the implementation of a new model of hospital service delivery. Effectively, what it means is the downgrading of Portiuncula Hospital to associate hospital status. That is unacceptable, given that it is only 12 months since [723]some Members here and the Western Health Board acquired the hospital from the Franciscan Sisters. It is also unacceptable that the chief executive officer of the Western Health Board, Dr. Sheelagh Ryan, and her senior officer, the regional manager for acute services, are both on this task force. It is unacceptable in any shape or form, including that of the dual mandate, that the chief executive officer charged with the delivery of the service on behalf of the Minister within the Western Health Board in which this hospital is located can comfortably sit on a task force whose remit is clearly to rationalise and downgrade the hospital.

  There is a conflict of interest here and I ask the Minister of State to request, as a matter or urgency, that particular person vacate—

  An Cathaoirleach: That is not fair to the person as she is not here to defend herself.

  Mr. U. Burke: I am speaking about an office. I ask that that officer vacate that particular position as a matter of urgency in order to avoid a conflict of interest and give a clear commitment as to the priorities of the delivery of service as a chief executive officer of a health board. It is important not to have such a conflict of interest. It suppresses the energies of that person to deliver the services she is charged with, on one hand, while, on the other, she is being charged with responsibility to undertake downgrading of the other offices.

  Portiuncula Hospital has an outstanding history of delivery of maternity and accident and emergency services. If it is downgraded, after a period of one year under the auspices of the Western Health Board, it will give a warning light to other hospitals that may be in a similar position to have nothing to do with health boards taking over and acquiring private hospitals with the intention of maintaining services into the future. It is of the utmost importance that the Minister of State indicates a firm commitment to develop and maintain maternity services and accident and emergency services in Portiuncula Hospital.

  There are 30 maternity beds in Portiuncula Hospital, at which there were 1,800 births last year. If, at the behest of a task force, a Minister can eliminate that service in a hospital that serves a catchment area extending from Longford, Westmeath, Athlone, Roscommon, Offaly to east Galway, we are toying with a situation where there will be a repeat of what happened in Monaghan. Will the Minister of State give a clear indication of the Government's intention regarding the continuation and development of maternity and accident and emergency services in Portiuncula Hospital, Ballinalsoe?

  Minister of State at the Department of Health and Children (Mr. Callely): The issue raised by the Senator was the subject of numerous recent newspaper articles. The articles refer to the national task force on medical staffing. The report has yet to be completed. The work of the task force is ongoing.

[724]  My record is quite good in relation to the retention of hospitals rather than their closure. Equally, that is the record of my colleague, the Minister for Health and Children, Deputy Martin. There are no plans to close maternity hospitals or general hospitals. I am concerned at what is clearly an unauthorised leak by somebody who seems to be irresponsible. The Senator mentioned the downgrading of Portiuncula Hospital and said the remit of the group was to rationalise and downgrade. That conclusion is totally wrong.

  Portiuncula Hospital, Ballinasloe, is providing high quality acute hospital care for the people in the area. The Minister has recently invested in the development of the hospital, including the provision of a new theatre and a stroke care unit. The hospital will continue to deliver acute public hospital services in the region and will grow with the development of health services in the region. That is the current plan. I am happy to have the opportunity to come before the House to put that on the record.

  I will now give some background to the task force so that we know where we are going in relation to the development of hospital services. Among the key developments required in the development of medical staffing in the coming years are: the provision of a consultant-provided, rather than a consultant-led service; the implementation of EU requirements that non-consultant hospital doctors should work no longer than an average of 48 hours per week by 2009; and the achievement of a range of improvements in medical training and education.

  In recent years a framework for addressing these needs has emerged: the report of the working group on non-consultant hospital doctors' working hours; the report of the medical manpower forum; implementation of the 1997 agreement on a 65 hour working week for non-consultant hospital doctors; implementation of the non-consultant hospital doctors' 2000 agreement on overtime, which is ongoing and includes the work of the medical manpower managers appointed under this agreement; and the work of the national task force on medical staffing, which is also ongoing.

  The Minister for Health and Children established the national task force on medical staffing to prepare and cost an implementation plan for a new approach to hospital services, based on appropriately trained doctors providing patients with the highest quality service. The task force is chaired by Mr. David Hanley. The key work of the task force is: to oversee the implementation of detailed strategies for reducing the working hours of non-consultant hospital doctors so that the 48 hour working week is achieved by 1 August 2009 and 58 hours by 1 August 2004; address the associated medical staffing needs of the hospital system; analyse the practicalities and estimate the costs that would arise if a consultant-provided, rather than a consultant-led, system was in place; and consider the medical education and training requirements arising from any changes to the current model of delivering services.

  To make recommendations on how to achieve [725]a 48 hour working week and a consultant provided service, the task force has had to look considerably beyond the services provided by consultants and the NCHDs alone. It has been considering the delivery of services throughout the hospital system with full regard to the interactions with primary care and long-term care services. It has, therefore, met not only consultants and NCHDs but also other health professionals, including nurses, management, other clinical disciplines, general practitioners and other primary care providers. Over the last year it has had over 300 consultative meetings; received 60 written responses from pilot regions; been engaged in detailed analysis of material from detailed questionnaires issued to each department of each hospital in the pilot regions, and analysed detailed material from management questionnaires.

  A key element of the work of the task force is the study of a number of pilot sites to assess the nature and practical implications of the changes required. It was decided that it would be necessary to examine the staffing and functioning of a large general teaching hospital in its capacity as the regional centre for a health board area with a population of 300,000. In this context, two sites were selected, the East Coast Area Health Board and the Mid-Western Health Board and the hospitals located in their two health board areas.

  The task force report will make recommendations regarding the number of consultants and NCHDs required to achieve a consultant provided service and a 48 hour working week for NCHDs. The national task force on medical staffing is completing its report which the Minister will consider in detail when he receives it and then bring proposals to Government.

  There are no plans to close maternity hospitals or general hospitals at present.

  Mr. U. Burke: At present.

  Mr. Callely: They will be an integral part of the development of hospital services.

  Mr. Leyden: I thank you, a Chathaoirligh, for allowing me to raise this matter on the Adjournment and the Minister of State, Deputy Callely, for coming into the House to reply. Unlike Senator Ulick Burke, I am not in a position to raise the matter at the health board. I can confirm that I signed the contract to purchase Portiuncula Hospital on behalf of the Western Health Board and the Government in the autumn of 2001. We did not spend £11 million to, in any way, downgrade it. Therefore, I do not understand the Senator's concerns.

  An Cathaoirleach: We are dealing with a different matter.

  Mr. Leyden: The two are interlinked. I could not resist adding to the debate on the previous matter.

  An Cathaoirleach: The Senator should speak on the matter he wishes to raise.

[726]  Mr. Leyden: I wish to raise the condition of St. Coman's ward, a medical ward, in Roscommon County Hospital, an issue I raised in the autumn of 2002 because the contract for the refurbishment of and improvements to the ward had been submitted to the Department in June 2002. A further submission was made on 9 August 2002. It is time for the Department to approve the acceptance of the contract by the Western Health Board.

  I am grateful to the former Minister for Health and Children, Deputy Cowen, for approving major developments at the hospital in 1998. I am equally grateful to the Minister for Health and Children, Deputy Martin, for his continued commitment to the hospital which allowed me, as chairman of the Western Health Board, on 16 May 2002, the day before the general election, to sign the contract worth about €5.5 million for a new accident and emergency department which will be a state-of-the-art facility. Work is well under way by the contractor, Tommy Connolly and Sons, and the building will be completed later this year or in early 2004. This is a major development which will be a hospital within a hospital with nine beds and all the required facilities. It is vital that an accident and emergency consultant is appointed when the building is completed.

  I also signed a contract on 27 June – I finished work on 30 June – worth €1.1 million for the refurbishment of the theatres. This work is now completed and provides excellent accommodation for surgery to continue at the hospital with two excellent surgeons. We have also provided new screening rooms and other facilities and upgraded the surgical wards. In 1995, 24 rehabilitation beds with links to the hospital were commissioned in the Sacred Heart Hospital. In 1997 educational seminar and conference facilities were provided and in December 1998 new surgical facilities opened at the hospital at a capital cost of €760,000. This provided additional beds. In May 2000 approval was given to upgrade the hospital drainage system, which work has been carried out. All in all, these were welcome developments.

  The condition of St. Coman's ward is far below the standard required in a modern hospital. It is extremely difficult for consultant physicians and nursing staff to work in such conditions. More importantly, it is totally unsuitable for patients being treated in the hospital. It is of a standard which I know the Minister of State, Deputy Callely, and the Minister, Deputy Martin, would not accept. I intend to raise the matter as often as I am allowed on the basis that it is of fundamental importance that this facility is upgraded bearing in mind that we have carried out and continue to carry out wonderful work at the hospital which will ensure its continued use as an acute general hospital providing medical, surgical and psychiatric facilities to the highest possible standard.

  The hospital is a fine building, on which my father worked as a stone mason and which was built in the 1940s. St. Coman's ward has not been refurbished since. It is certainly substandard. The Health and Safety Authority would have serious reservations about its continued use as a medical [727]ward. Work has been completed in the theatres and is under way on the accident and emergency department. Therefore, this is a timely opportunity for the Department to allow the Western Health Board to accept tenders for the contract to allow the work to proceed. I guarantee the Minister of State that we would then have a top class hospital. As a Member of the Seanad and former chairman of the Western Health Board, I would be delighted to ensure the work would be carried out as quickly as possible.

  Mr. Callely: As outlined in November 2002, my Department and I fully appreciate and are aware of the service Roscommon County Hospital provides for the people of County Roscommon. I was not aware the Senator's father was one of the stone masons who worked on the building. The Senator has been very much involved in the delivery, enhancement and improvement of services at the hospital since his father put the first stones in place. The Senator and the people of County Roscommon are aware that the hospital has served the community well in providing health services in surgery, medicine, geriatric assessment and psychiatry as well as casualty and out-patient services. The Senator was involved in ensuring the budget for the hospital increased to €14 million this year, more than double the level in 1997.

  Mainly arising from a number of representations made by the Senator, the hospital has benefited from a number of developments during the years. In December 1991 St. Teresa's ward was opened providing 16 additional beds. In February 1992 a new acute psychiatric unit was opened while in 1993 a consultant with an interest in the elderly was appointed.

  In 1994, 24 rehabilitation beds with linkages to the hospital were commissioned at the Sacred Heart Home in Roscommon. In 1997, educational, seminar and conference facilities for all the county's health services were provided with the refurbishment and renovation of the training centre at Roscommon County Hospital. In December 1998, new surgical facilities at the hospital were opened at a capital cost of €760,000. This provided for five additional beds, hospice accommodation, renovation of the surgical ward and an increase in single room accommodation.

  In 1999, a second consultant surgeon took up duty at the hospital. In May 2000, the hospital's drainage system was upgraded at a capital cost of €246,000. In May 2001, the doctors' residences were refurbished at a capital cost of more than €57,000. In June 2001, when the Minister visited the hospital, he provided €1.65 million to carry out additional capital works at the hospital. The screening room equipment has been replaced and the theatre department is being upgraded. It was hoped that St. Coman's ward would be accommodated in that €1.65 million.

[728]  In April 2002, the Minister issued approval to accept the tender for the development of a new accident and emergency department, nine bed admissions unit, medical records department, radiology film storage, staff changing facilities and ultrasound room, at an estimated capital cost of more than €7.8 million. Construction is under way, with an estimated completion date of later on this year.

  As can be seen from the list of developments I have outlined, the Government is committed to the development of facilities at Roscommon County Hospital. In particular, the development of surgical services has enabled the hospital to increase its day surgery work. My Department is very aware that St. Coman's ward is in need of upgrading. Plans have been agreed with the Western Health Board design team, local management and their technical services department. Unfortunately, the Western Health Board is unable to provide the funding for this project from within the funding of €1.65 million provided by the Minister last year. The funding provided has been utilised to purchase new X-ray equipment and refurbish the operating theatre.

  My Department is currently reviewing, from a national point of view, the national development plan for the health sector generally in light of the outturn position for 2002. This process involves providing for existing capital contractual commitments and commencing, where possible, the planning or construction of new projects nationally in 2003 or beyond. It is in this context that capital developments for the Western Health Board region, including the proposed developments at Roscommon County Hospital, are being considered. When the review is completed, the Western Health Board will be advised of the position in relation to the funding of further developments at Roscommon County Hospital.

  I greatly appreciate the particular and special interest in this issue of my good friend and colleague, Senator Leyden. I will certainly take note of his question tonight and come back to him as soon as the position is clearer.

  Mr. Leyden: I thank the Minister of State for his contribution. There is no doubt the Government has shown a clear commitment to the hospital because of its large investments since it was built in the 1940s. However, in order to complete the process, it needs a small capital investment. I am heartened by the words of the Minister of State and I would like him personally to take the matter on board in the Department. It would be a shame not to complete the work at the hospital and I look forward to seeing the Minister of State there in the near future.

  An Cathaoirleach: The Senator has made his contribution. He cannot make a second one.

  The Seanad adjourned at 8.35 p.m. until 10.30 a.m. on Wednesday, 19 February 2003.