Adjournment Debate. - Appointment of Paediatrician to Portlaoise Hospital.

I thank you for allowing me to raise this very important matter and also thank the Minister for making himself available at such short notice. In raising the question of the appointment of a paediatrician to Portlaoise General Hospital I am merely endeavouring to reflect the views and concerns of the people of Laois and others outside the county who for many years have been using the facilities at the hospital.

Over the past three years we have developed the hospital to general hospital status and have developed in a very advanced way the obstetrical and gynaecological services as part of that overall development. The only outstanding speciality is the provision of paediatric services. Credit for the development of specialities and for the excellent standard of care is due to the surgeons and consultants and the dedication of the nursing and domestic staff who are working under rather difficult conditions due to the general understaffing of the hospital.

Credit is due also to the CEO of the Midland Health Board and the members of that board who, despite very severe financial restrictions, through their prudent management have maintained services at the highest possible level. From the moment the decision was taken to upgrade our hospital to the status of a general hospital, which by implication means the provision of the widest possible range of specialities, the health board under their chairman, backed by the hospital staff at all levels, worked extremely hard to bring the hospital to its present stage of development. The final stage of development programme was the establishment of a paediatric unit. This unit was refused by Comhairle na nOspidéal in 1979 but under pressure from Members of this House and from the then Minister for Health, Deputy Woods, as well as the united voice of the people of County Laois, the comhairle agreed subject to certain conditions to the provision of a department of paediatrics to be shared by Portlaoise and Tullamore. This plan would envisage a resident paediatrician in both hospitals, with a third consultant providing cover for the two hospitals. For both Laois and Offaly this was an excellent arrangement and it was accepted fully by the people of County Laois.

The conditions laid down by An Chomhairle were that Portlaoise would develop the structural facilities for the unit and immediately the health board responded with the erection in Portlaoise of a new purpose-built paediatric unit — one of the most modern, may I say, in the entire country. All the conditions for the establishment of the unit had now been completed, with the board and staff accepting, in a responsible manner, that due to the embargo on public sector recruitment the post could not immediately be filled. They went about their task of providing the highest possible level of service and patient care in the hospital and were content to wait for the appointment which they understood was coming. Then came the bombshell. The Minister for Health, Deputy Barry Desmond, was present at the Labour Party Conference at Portlaoise on Tuesday, 20 March. Members of his party asked him the obvious question — when the paediatric post would be filled at Portlaoise. I now quote fromThe Nationalist and Leinster Times of 6 April:

Mr. Desmond told the conference that it was intended to appoint the paediatrician to the health board at Tullamore. There would, he said, be no paediatrician at Tullamore and Portlaoise, in other words that there would be duplication of services.

I do not want to display any discourtesy to the Minister by reading from that paper the comments which followed from the members of his own party at that conference. It was natural that the Labour Party members in Laois would react as they did to that startling announcement. It was also natural that the people of Laois, having read that report, reacted as they did. It is only natural that I, as one of their public representatives, reacted as I did by immediately tabling a Dáil question. On 3 April 1984 I asked the Minister for Health the following question:

If he would confirm that a paediatrician is to be appointed to the General Hospital, Portlaoise, and how soon that appointment will be made.

The Minister's reply was as follows:

The Midland Health Board submitted a proposal in August last year indicating the financial implications of creating a paediatrician post at Portlaoise General Hospital. This proposal is still under consideration in my Department. Approval of the post will, however, be primarily a matter for Comhairle na nOspideél, who have responsibility for the numbers and types of consultant appointments in the health services.

It is not possible for the Minister to state when a decision will be made on this proposal.

The Deputy has about a minute left.

I have no desire to accuse the Minister of misleading the House or myself in relation to that reply, but it is very evident that there is a clear contradiction between what the Minister said in this House and what he said at the Labour Party Conference in Portlaoise. Neither have I any desire to score any unfair political points. I am merely giving the Minister an opportunity tonight to put the record straight and assure the people of County Laois that the services that they understood would be provided at the General Hospital in Portlaoise will in fact, be provided.

I would ask the Chair to allot to my colleague, Deputy Flanagan, one minute to make a contribution.

It is not possible to do that and give the Minister time to reply. I must call on the Minister now.

I ask the Minister to give me one minute of his time. I am sure he will not take up all his time. I want to inform him that there has been grave disappointment on the part of everyone in the county of Laois as a result of the Minister's pronouncement in Portlaoise. The Midland Health Board had outlined that there were to be full paediatrician services available at Tullamore and at Portlaoise. We have an excellent medical staff in Portlaoise and every facility available. All that is needed is compliance with what was originally decided, that a permanent resident paediatrician be appointed so that the services can be maintained at a very high standard.

I must now call on the Minister. He has been called here to answer the question.

I also want to make a contribution.

I appreciate that, but it is quite unreasonable to bring a Minister in here to answer a question and not allow him time to do so.

I feel that I should be allowed to speak.

When I took up office I was very disturbed to note that there was — and still is — no locally based——

The Minister has only four minutes.

——paediatric service at all in the Midland Health Board area, apart from a unit opened some time ago in a private hospital in Ballinderry. I would have thought that the Deputies' concern would extend to Laois and Offaly, Westmeath and Longford, because there are no paediatric services at all——

Could the Minister add in Cavan and Monaghan?

We are here to listen.

——in these four counties, except the unit opened some time ago in the private hospital in Ballinderry. Limited paediatric cover is provided for the area from Temple Street Hospital in Dublin — mainly about 12 out-patient OPD sessions per month and very sizeable numbers from west Offaly and Westmeath go to Portiuncula Hospital, Ballinasloe for services. That is the situation. It is very disturbing and one which I want to put right immediately.

The maternity units at Portlaoise, Mullingar and Templemore are suffering because of the lack of a paediatrician, as births are tending to drift to units outside this area. I have recently had a communication from Comhairle na nOspidéal who have written to my Department separately, pointing out the serious lack of paediatric services in the midlands and have recommended the appointment of a consultant to Tullamore as a very urgent priority. I have accepted that recommendation and the proposal is that the appointment should be based in Tullamore because of its central location. The consultant is to provide scheduled out-patient department clinics at the other centres such as Portlaoise and Mullingar and look after various clinic services in these areas.

It is the view, also, of the health board that this is about the most reasonable approach to the development of immediate services in the area. Furthermore, Tullamore has a particular advantage at present in that the children's beds in the Tullamore hospital are looked after by staff at full nursing level, so that the start-up cost will be very substantially less in Tullamore, as of now, than in Portlaoise or, for that matter, in Mullingar.

The extra cost of the services in Tullamore will probably be less than £100,000 per annum, as distinct from £250,000 on average in the other centres because, as the Deputies know, one must provide not just a paediatrician, but also at least two non-consultant hospital doctors, ward sisters, staff nurses and, of course, secretarial assistants. It is not just the question of an appointment but of a whole new unit. I have to take a decision and am pleased to say that, in consultation with the health board and within that health board's budget, I shall be appointing the paediatrician to Tullamore. This will be a bit of history because as I have said, in Portlaoise, Mullingar and Tullamore there is no service at all. It is most undesirable for covering maternity and child care services in the area that there are no consultant staff beds for children at this time in the area.

Finally, it is the old story. One must do one's duty as Minister and I cannot yield to all the perennial competing claims between Mullingar, Tullamore, Portlaoise and——

While the Minister is at it, would he arrange for a second paediatrician for Tullamore, as well?

Order, please.

I cannot do it at this point of time, but I can do something, namely provide accommodation and services of a consultant staff nature in Tullamore immediately and the people of the midlands will have nothing to complain about——

It would be a good day's work to make the paediatrician appointment in Tullamore.

——in terms of delivery of those services.

The Minister should throw in the appointment of the second paediatrician.

Deputy, please be quiet.