asked the Minister for Health if he will approve an allocation to fund the appointment of a consultant obstetrician/gynaecologist and consultant paediatrician to the maternity wing of Roscommon County Hospital with full back-up staff; and if he will outline the cost of this proposal.
Ceisteanna—Questions. Oral Answers. - Roscommon County Hospital Appointments.
7.
I am not satisfied that such a development could be justified, having regard to the many unsatisfied demands for developments which have been fully justified and to the fact that full consultant staffed obstetric and paediatric services which are capable of catering for Roscommon mothers and their children are already available in the Western Health Board area. In this regard the extension to the Maternity Unit at Galway Regional Hospital which cost over £4 million was commissioned in August 1985. A second paediatrician took up duty at Portiuncula Hospital, Ballinasloe, in November 1985. These developments, in addition to the facilities already available, ensure a comprehensive obstetric and paediatric service in the Western Health Board area.
I do not have available to me the additional funds which would be required to provide a consultant obstetrician/gynaecologist and consultant paediatrician at Roscommon County Hospital. The cost of providing a full time consultant in these specialities with appropriate back-up staff would be about £182,000 for the obstetric service and £238,000 for the paediatric service.
In view of the developments which I have outlined above expenditure on this scale could not be justified.
Is the Minister aware that the services are not being provided for mothers in County Roscommon, that there is now no service being provided at the County Hospital in Roscommon for maternity cases, that the maternity unit, which is fully equipped and was provided at considerable cost, is now under-utilised because an obstetrician/gynaecologist has not been appointed by the Minister and the paediatrician has not been reappointed? The Minister should reconsider his decision in relation to the need for maternity services in County Roscommon because the necessary facilities are there. The Minister should be aware also that Comhairle na nOspidéal approved the appointment of an obstetrician/gynaecologist in the maternity unit of Roscommon County Hospital and that the Comhairle also approved the appointment of a paediatrician who took up his position in the county hospital in Roscommon, who has left and has not been replaced. In the light of the history of this hospital and the need for the services there, I am availing of this opportunity to ask the Minister to reconsider his decision.
I should first put to rights the inaccuracy stated by the Deputy concerning the role of Comhairle na nOspidéal. The Comhairle, on 22 November 1985, having considered all of the factors involved, decided that the application should be refused on the grounds that, as a matter of policy, they do not support the concept of single-handed consultant appointments in situations where the potential for a second appointment does not exist. Second, the policy of An Comhairle, as set out in their 1979 publication on the development of hospital paediatric services, is to develop general paediatric services in parallel with maternity and neo-natal units.
The Deputy and his colleagues in Roscommon should accept that there is no justification whatsoever for what might be described as the commencement of a consultant staff maternity unit in Roscommon County Hospital. The last figures I have relate to the year 1984 — there were only six maternity and ten children beds there anyway — when there were 23 live births in the hospital. On the basis of any assessment — population projections, birth rate projections, the facilities in Galway, the facilities at Portiuncula, the fact that, relatively speaking, the hospital is a small county type one with a minimum consultancy staff of one physician, one surgeon, one anaesthetist, one radiologist — it is not suitable for the development of a major maternity unit which, in order to be fully viable, would need approximately 1,200 to 1,500, and preferably 2,000, births per annum.
On that basis only could one justify the appointment of a paediatrician in the area. Therefore, there is no medical, maternity or other rational reason why that should be persisted with. I know the Leader of the Opposition has said time and again that we will have a large, full scale maternity unit in Roscommon hospital while, at the same time, there is no justification for it as has been shown by any examination carried out by my Department or Comhairle na nOspidéal. Indeed, any consultant obstetrician or paediatrician to whom I have spoken has said it is a nonsense to so suggest. But of course promises are made time and again all over the place and people tend to complain that that is what is wrong with the delivery of the health services.
I put it to the Minister that, in his reply, he is misleading the House. Comhairle na nOspidéal approved the appointment of an obstetrician/gynacologist in 1981——
Yes, made on a political basis. The appointment was made on a political basis. The paediatrician did not stay there. He had no work to do and it cost thousands of pounds because Deputy Haughey wanted to have a paediatrician there——
Would the Minister agree that he is also misleading the House in stating that there were 23 births only in 1984, whereas there were over 900 births to Roscommon mothers in Portiuncula, Galway, Sligo and other hospitals. In the light of the demand for such services in County Roscommon the Minister should review the position there because, if he does not, in time, others will. In the meantime would the Minister say if he proposes to use the maternity unit of Roscommon County Hospital for psychiatric patients from St. Patrick's Hospital in Castlerea?
I see absolutely no reason why the particular area in the county hospital which is totally redundant — the maternity and paediatric area — should not be put to effective use towards the delivery of an acute psychiatric unit thereby enhancing the role of the hospital. The way some people go on about psychiatric units — notably Deputy Dr. Woods — one would swear it constituted a total diminution of the services of a general hospital. I was in Roscommon County Hospital when there was one glorious little child there in a large maternity wing, the best cared for child in western Europe at the time, and the mother was doing well also. It should be remembered that in 1984, 23 children only were born in that hospital. They are all wonderful Roscommon children. It is great to be born in ones own county. But I would remind the Deputy that that was the most expensive child born in western Europe.
The Minister does not appear to be taking this situation seriously. Would he agree that if specialists are non-existent in Roscommon, one cannot then expect mothers to use a hospital that has not the full services required by them? I mean the services of an obstetrician/gynaecologist in particular. Is the Minister now stating that the hospital in Roscommon cannot be used as a maternity hospital? By closing the unit, turning it into a psychiatric one, would the Minister agree that he is virtually doing away with the possibility of having a maternity unit operable there? Furthermore, is the Minister aware that, under the Health Acts, he must hold a public inquiry before ceasing to provide such services in a general hospital?
The mothers of Roscommon have one advantage — they vote with their feet on such issues, and I have a great admiration for them. They go to a fully consultant staffed hospital, including the second paediatrician unit, at Portiuncula. As well, they go to Galway city where we spent £4 million building a grand new maternity unit, fully staffed with all the back-up services of an acute general hospital. There will continue to be medical and surgical facilities in Roscommon but there are only six maternity beds there which had an occupancy in 1984 of about 10 per cent, or less, and my function — I hope the Deputy would be inclined to share it — in regard to the women of Roscommon is to provide the best possible maternity services. My advice to women who wish to avail of maternity services is to go to Portiuncula, not so far down the road, where there is a magnificent maternity unit. In Galway there is another magnificent unit. Many Roscommon women come as far as Dublin to have their children in equally good facilities. In fairness, there is no justification for the arguments put forward. Fianna Fáil once again want catscanners, maternity units, major this and major that, in every county in Ireland. I am aghast at Fianna Fáil. What is wrong with the health services is that we are so criticised we cannot reorganise anything.
What is wrong is that the Minister has dismantled the health services.
I see it as my role to ensure that both services will be provided in Roscommon. My role is to see that we retain and develop those services. Is he required to hold a public inquiry before any services are withdrawn?
It is not required.
The Taoiseach has no confidence in the Minister as Minister for Health. He went to Roscommon and denied the Minister three times to the press and the public, in front of a very large gathering. He regards the Minister as being as foul-up in the Department of Health, "inadequate and premature", "human imperfection". The Minister knows this has been said about him in Roscommon.
An Leas Cheann-Comhairle
Will the Deputy ask a question?
Will Roscommon County Hospital be retained and before any closure takes place will a full public inquiry be undertaken? The Minister will have to assure us that the unit will not be used for psychiatric patients but retained for development as a maternity unit, as planned and approved by Comhairle na nOspidéal.
With due respect, I do not think that local politicians, including myself, who purport to deliver maternity services should indulge in this kind of prompting. The maternity unit in that hospital is practically non-existent and I have no intention of bringing on services in Roscommon as long as I am Minister for Health which would be hopelessly inadequate and which could not be delivered. I would not ask any consultant in the country to work in a unit where they would lose their skills and would have to spend more time playing golf than delivering children because they would get no work to do.