asked the Minister for Health if he will state in detail the services which will be available in community hospitals, recently announced in the Government plan in relation to hospitals.
Ceisteanna—Questions. Oral Answers. - Community Hospital Services.
16.
As I indicated in my announcement in relation to the national hospital plan, community hospitals will have a very significant role in the total pattern of the health services but their exact functions will be worked out by my Department in consultation with the health boards. A discussion document on the role of the smaller hospitals, produced by Comhairle na nOspidéal, has been circulated to Deputies. This document suggests the type and range of services which might be provided in community hospitals and will form the basis for the consultation between the health boards and my Department about the detailed way in which each designated community hospital will work.
Community hospitals should have a range of consultant out-patient services, the type and frequency of which would be related to local needs. Examples would be medical, surgical, obstetrical, gynaecological and psychiatric clinics but others would be considered also. This means that a high standard of out-patient care would be available. Immunisation and vaccination clinics and child welfare clinics could also be held at the hospital if circumstances so indicated.
In addition it could be expected that radiology and pathology services would be available for both in-patients and out-patients.
In so far as in-patient services are concerned, there would be a medical officer in charge of the hospital, probably local general practitioners given right of access to continue treatment of their patients and consultants, including those attending out-patient services, would be available on a consultative basis to see in-patients in the community hospital, including patients of their own discharged from the general hospital. Resuscitation facilities would be available for local accident cases before treatment in the general hospital.
In addition, the hospital should provide an active service related to patients who need medical care below consultant level or nursing care, including patients needing examination and tests prior to admission to the general hospital, or who require continued hospital care after discharge from the general hospital.
Therefore, no operations will be undertaken at the community hospital.
Minor operations such as those undertaken by general practitioners could be carried out there but not major surgery.
I take it that there will not be an anaesthetist at the community hospital?
That is correct.
Therefore, Tullamore hospital as well as others for which there are the same types of plans are being turned into what I can only call little casualty outfits or places where one might spend a little time before going on to the next world.
A kind of purgatory.
These hospitals will be no more than first-aid centres.
The Deputy is not entitled to make a speech at Question Time.
This is the sort of service that the people of Offaly are to get from this regime.
The Deputy has accused me of endeavouring to downgrade Tullamore Hospital whereas he is the one who has downgraded it by what he has said.
The Minister is trying to camouflage what he said.
I have described the services that will be available there and these are not in accord with the description given by Deputy Connolly.
We are changing over from a hospital to a county home situation.
Order.
What is the point in the Deputy asking a question if he is not prepared to listen to the answer?
I understand very well what is meant by the answer and regardless of the language in which it is couched the people of Offaly will realise that their hospital is being turned into a home.
There will be nothing left for the people there to do but to take an apple a day.
Although there are to be radiological and pathological services in those institutions would the Minister not agree that these will not be of much benefit since there will not be specialists available to interpret results? Since this would mean that results would have to be posted to other places, is this not a very unsatisfactory situation?
The Deputy omits the point I made regarding the attendance of consultants at these centres. This provision will enable results of radiological and pathological tests to be interpreted.
But there will not be a consultant to attend at every accident.
No, not every accident.
An accident involves X-ray and if there is not somebody to interpret the result of an X-ray, everything is held up.
As I have told the House, such cases would be referred to a general hospital if it was found that they could not be treated at a community hospital.
Does this mean that all those people would be referred to a general hospital in the first place?
That would be the procedure in the case of serious accidents.
Does the Minister not foresee serious problems arising in areas where these general hospitals are allowed to become run down? I have in mind the serious problems that could arise in the interim period. For instance, in the case of Monaghan what is to happen in the period between the change-over and the making available of the new facilities at Cavan? What plans has the Minister to deal with that sort of situation?
These hospitals will not be run down in the interim. They will function as community hospitals until the additional and improved facilities are available in the areas designated for development as general hospitals.
We must move on to the next question. This must be the final supplementary.
In regard to Monaghan or Tullamore where it is intended to change ultimately the status of the existing hospitals will there not be a problem in the meantime in that top-class people will not apply for positions at these hospitals so that they will gradually be downgraded with the result that the people at present availing of the facilities at these hospitals will be deprived of such services in the interim between now and the provision of the new centres?
The Deputy will appreciate that no matter what plan is put into operation—be it the Fitzgerald, the Fianna Fáil or the Haughey plan —a situation like this must be coped with.
How?
There will be no deterioration in the services in the existing general hospitals which, afterwards, will be described as community hospitals until such time as the general hospitals are in operation. It is possible that people may not apply for posts in the designated hospitals but this is a problem which we must endeavour to cope with.
It is obvious——
We cannot debate this matter today.
I do not think Deputy Haughey would agree to retain the present situation of hospitals with one surgeon but he must agree that the hospital services have to be updated and upgraded. There may be many snags involved but these will have to be resolved.
The Minister is downgrading these hospitals.
If I am to establish a certain number of hospitals which will be a vast improvement on the existing county hospitals, the task will have to be undertaken in the way proposed.
Would the Minister not agree that the additional mileage involved in taking seriously injured people or people who are haemorrhaging as a result of perforated ulcers to hospitals some distance away constitutes a hazard to life? Should there not be facilities to treat such cases at places nearer than the hospitals proposed?
They will be treated at the nearer centres apart from exceptional cases. According to the guidelines that were adopted by the health boards and various other bodies, no patient, unless the circumstances are exceptional, will be required to travel more than 30 miles for treatment.
What about Mayo?
That is the situation at present in many county hospitals.
Would the Minister not agree——
I have called the next question. The Chair must be obeyed.
May I ask a question?
Not on question No. 16.
I propose, with your permission, to raise this matter on the Adjournment.
The Chair will communicate with the Deputy.
On a point of order, I wish to clarify the situation.
I have called question No. 17.