Deputy Lowry gave me notice of his intention to raise the matter of the proposals of Comhairle na nOspidéal to the Mid-Western Health Board regarding consultancy appointments to Nenagh General Hospital.
Adjournment Debate. - Consultancy Appointments to Nenagh General Hospital.
I wish to express my views on the recent decision of Comhairle na nOspidéal to make unsuitable consultancy appointments to Nenagh General Hospital, an appalling and devastating decision which will undermine and downgrade the status of that hospital. The proposed arrangements are unrealistic, impractical and unworkable. I predict that, if this decision is implemented the profile and character of the hospital will change dramatically with serious consequences for the level of medical and surgical services available in Nenagh for the people of north Tipperary. In taking that decision Comhairle na nOspidéal ignored the advice of the consultants and medical staff of the hospital and acted contrary to the unanimous wish of the Mid-Western Health Board executive and members.
I call on the Minister for Health to intervene and inform Comhairle na nOspidéal that their decision is unacceptable and incompatible with health board policy to maintain Nenagh General Hospital as an acute hospital. If there is the political will this decision can be rescinded. Indeed such change is demanded by the people of north Tipperary.
The Mid-Western Health Board has requested the appointment of a consultant physician with an interest in respiratory medicine in view of the impending, regrettable retirement of the current physician at the hospital, Dr. Brian Lemass. Instead Comhairle an nOspidéal ignored the board's recommendation and decided to appoint a consultant physician with an interest in geriatric medicine. They also ignored the recommendations of the board in regard to a second appointment, that of a consultant surgeon with an interest in vascular medicine — with a full-time commitment to Nenagh General Hospital. Rather the commitment of the new appointee who will replace the eminent surgeon, Mr. John Hickey, will be divided between Nenagh General Hospital and Limerick Regional Hospital.
The effect of these decisions will be twofold, the first representing a blatant departure from stated policy, which was that Nenagh General Hospital would retain its status as an acute hospital with attendant relevant services. Second, this decision can only be interpreted as constituting the thin edge of the wedge, ultimately bringing the viability of the hospital into question. There is no doubt that Nenagh and North Tipperary generally are once again being blatantly trampled on, with facilities representing the people's entitlement being stripped down and-or dismantled almost on a daily basis.
In relation to the decision of Comhairle na nOspidéal to appoint a consultant physician with an interest in geriatric medicine, let me point out that there are no geriatric beds at present in the hospital. I am aware of the proposals with regard to the dispersal of geriatric beds throughout the county, with the possibility of new geriatric units being built at Thurles and Nenagh. However, in the case of the unit at Nenagh, it is much more likely that such geriatric beds will be provided at the expense of the existing medical and surgical beds.
The appointment of a geriatrician at Nenagh will not be welcome if done at the expense of the medical and surgical services so well provided in Nenagh to date. Indeed I must emphasise that the demand for such services does not show any sign of declining. This begs the question why there should be any diminution or dilution of the services available. The appointment of a geriatrician rather than the requested specialist in respiratory medicine is an indication of the thinking motivating the members of Comhairle na nOspidéal, indicating clearly that they perceive Nenagh General Hospital as having a limited future with attendant limited services, totally unacceptable to me and to the people of North Tipperary I represent. We demand to be taken out of the health care limbo to which we are being rapidly consigned and without any consideration.
Ironically Comhairle na nOspidéal may be one of the most ill-named statutory bodies in the country, "comhairle" being the Irish word for "advice" or "counsel". Surely that has a hollow ring in this instance where the element of advice is totally absent and there is, instead, dictatorship of a kind which should have no hand, act or part in the administration of a service for the sick and injured in our society.
The personnel of the Mid-Western Health Board are the people at the front line of this service, those with the firsthand knowledge of what is required on a regional, local basis. In this instance they have made two specific recommendations which Comhairle na nOspidéal have chosen to ignore. Public reaction to this decision in Tipperary is one of very real anger born out of the manner in which the decision was taken and its serious consequences for the future viability of the hospital. It is time to stop buffeting the health care system. The people of my constituency have endured terrible uncertainty vis-à-vis the health services available to them. Most important of all, it is time to examine seriously the strains and stresses to which hospitals and their personnel are subjected, particularly in view of shortages of personnel and equipment.
I would ask the Minister for Health to intervene with Comhairle na nOspidéal, advising them that their actions and decision are unacceptable. I appeal to him to exercise his ministerial responsibility, instructing Comhairle na nOspidéal to rescind their decision.
I welcome this opportunity to clarify the position regarding Nenagh General Hospital which was brought to my attention two weeks ago by Deputy Michael O'Kennedy. At the outset I should say that Comhairle na nOspidéal were established under the Health Act, 1970, their main statutory function being to regulate the number and type of appointments of consultant medical staff having regard to current trends and requirements of the health services as a whole and of individual hospitals. Among their statutory functions is that of advising the Minister for Health on matters relating to the organisation and operation of hospital services.
In October 1989 the Mid-Western Health Board requested Comhairle na nOspidéal to review consultant manpower requirements for the mid-west region in the light of a large number of consultant vacancies, both current and pending, in the region at that time. Comhairle na nOspidéal established a committee to undertake a wide ranging review of those consultant services whose report was completed in July 1991.
It should be noted that in 1988 the Mid-Western Health Board carried out a review of their hospital services which concluded that Limerick Regional Hospital should be the flagship hospital of the boards acute hospital sector, the other acute hospitals in the region performing a complementary, supplementary role.
The primary recommendation of the report of Comhairle na nOspidéal on consultant manpower in the mid-western region was that formal structures should be established which would mould the consultant manpower into larger groupings so that they could plan and organise themselves into multi-disciplinary teams, delivering the most effective services to patients in the region. It envisaged that the Mid-Western Health Board would provide a wide range of specialist services, with the exception of a relatively small number of specialties of a national dimension — such as cardiac surgery, neurosurgery and organ transplantation. Accordingly, consultants would deliver services on a sessional basis to the different hospitals. I must add that this is not exceptional but rather is the way hospital services are delivered in many areas at consultant level at present.
The Comhairle na nOspidéal report recommended that Nenagh General Hospital continue as an acute medical and surgical centre and that its medical department be strengthened by the appointment of a consultant physician in geriatric medicine. This was in recognition of an increasing geriatric dimension to the medical workload, a phenomenon being experienced not only in the mid-western region but also in other health board areas. The consultant appointments due to be made in Nenagh must therefore be seen in the context of the comprehensive report produced by Comhairle na nOspidéal after detailed and careful consideration.
At present Nenagh General Hospital has two general surgeons and two general physicians. Vacancies have arisen, owing to retirements, in respect of one of the general surgery posts and also in respect of one of the general physician posts. I understand that Comhairle na nOspidéal have recently approved a proposal from the Mid-Western Health Board that the special interest of the replacement surgical post should be in vascular surgery, on the basis that the appointee would have a commitment of eight sessions per week in Nenagh General Hospital and three sessions in Limerick Regional Hospital.
As I have already mentioned, the Comhairle Manpower Review report indicated a need to provide consultant expertise in geriatrics in Nenagh General Hospital. I understand that at their meeting of 20 March 1992, Comhairle na nOspidéal approved the creation of a consultant physician in geriatric medicine post in place of the general physician post, the present holder of which is retiring. The question of the special interests to be attached to posts such as those in Nenagh General Hospital is one for the Mid-Western Health Board and Comhairle na nOspidéal in the first instance.
It should be noted — this is important —that 48 per cent of all patients admitted to Nenagh General Hospital are aged 65 or over and they account for 67 per cent of all bed days at the hospital. All of the beds at the hospital are acute beds. The establishment of a geriatric assessment unit in Nenagh Hospital for North Tipperary is currently the subject of discussions between the Mid-Western Health Board and my Department. The coming on stream of a geriatric assessment unit will, therefore, increase the number of acute beds in the hospital.
I wish to stress that the appointment of a consultant physician in geriatric medicine does not mean that Nenagh Hospital will be downgraded or become a geriatric hospital. On the contrary, the provision of an acute geriatric service means that there will be a higher patient throughput — in other words, patients will not be inappropriately placed and better use will be made of the beds. The appointment of a consultant physician in geriatric medicine will mean that once elderly patients are assessed they can be placed in more appropriate accommodation, if this is required. This course of action is recommended in The Years Ahead — a Policy for the Elderly, in which it is recommended that every general hospital should have assessment and rehabilitation beds for the elderly.
I understand the concerns of the Deputies from the area about this issue — Deputy Michael O'Kennedy has spoken to me at length about it. I will look again at the issue and discuss it with Comhairle na nOspidéal and the Mid-Western Health Board to see if the hospital meets the needs of the area. I promise to do this at the earliest possible opportunity.