Vol. 519 No. 6
21 Mr. G. Mitchell asked the Minister for Health and Children if he will intervene to resolve the ongoing dispute concerning the full-time appointment of a paediatric consultant in Dublin; and the action he will take to ensure the vacant post is not abolished by Comhairle na nOspidéal, as threatened [14550/00].
98 Proinsias De Rossa asked the Minister for Health and Children his response to the threat by Comhairle na nOspidéal to abolish the outstanding post of paediatric surgeon for the three Dublin paediatric hospitals; and if he will make a statement on the matter [14526/00].
155 Mr. Shatter asked the Minister for Health and Children if he will intervene to resolve the ongoing dispute concerning the full-time appointment of a paediatric consultant in Dublin; and the action he will take to ensure the vacant post is not abolished by Comhairle na nOspidéal, as threatened [14553/00].
I propose to take Questions Nos. 21, 98 and 155 together.
The consultant paediatric surgeon application referred to by the Deputies is a restructuring of an existing post which is currently shared by the three Dublin paediatric hospitals, Our Lady's Hospital for Sick Children, Crumlin, the Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, and the Children's Hospital, Temple Street. The application envisaged a new structure for the position to be shared between two of these hospitals, Our Lady's Hospital for Sick Children, Crumlin, and the Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital.
Comhairle na nOspidéal is a statutory body established under the Health Act, 1970, and one of its main functions is to regulate appointments of consultant medical staff in hospitals providing services under the health Acts and to specify qualifications for such appointments. In December 1998 Comhairle published its report on paediatric surgery services. The report recommended that specialist paediatric surgery for children throughout the State be concentrated in one unit in Dublin with all three children's hospitals providing non-specialist paediatric surgery and less complex urology. Comhairle is satisfied that the report and its recommendations represented the best way forward for the organisation and delivery of high quality and safe paediatric surgical care for children in the State given the presence of three paediatric institutions in Dublin.
Comhairle has indicated to the Department that it welcomes this joint application for the post as evidence of co-operation between two of the hospitals involved. It considers, however, that the structure of the proposed post is contrary to that envisaged in its report. It does not indicate that specialist paediatric surgery will be concentrated in one unit. It leaves one hospital short of sessions, it does not address the restructuring of existing posts and has adverse implications for the structuring of other posts as set out in its report.
A Council for Children's Hospital Care has been established and includes representation from the three Dublin paediatric hospitals. The council's primary role is to assist the paediatric hospitals to work with each other and the ERHA to plan and develop acute paediatric services on a co-ordinated basis in the functional area of the authority. One of the priority items identified for the council's work programme is the organisation of paediatric surgery in Dublin. The Department has already indicated its support for the restructuring of paediatric surgical services.
The chair of the Council for Children's Hospital Care and the regional chief executive of the ERHA met last week with senior officials of the Department to review progress on the council's work programme and to identify a number of priorities, including paediatric surgery, which the ERHA and the council will address this year. The Department and the authority support the council's view that the area of specialist paediatric surgery merits immediate attention and that Comhairle na nOspidéal also has an important role to play in this regard. It was agreed that a further meeting should be arranged between all the parties, Comhairle, the Council for Children's Hospital Care, the ERHA and the Department, to clarify the respective roles and expectations and to agree a defined timeframe for resolving the outstanding issues regarding consultant appointments in paediatric surgery in the best interest of patients.
Will the Minister confirm that either he or his predecessor approved or agreed to the making available of funding for this appointment? Does he agree that at a time when there is a substantial backlog in relation to children's in-patient hospital waiting lists it is unacceptable that a post should remain vacant for four years? Will he explain why he provided the financial sanction for a post to which Comhairle na nOspidéal is refusing to sanction the making of an appointment? It is not prepared to agree that the appointment should apply to the two hospitals jointly as opposed to being aimed specifically at one hospital.
A locum has been in place since the permanent vacancy became available in 1996.
They are also threatening not to reappoint the locum.
We are aware of that. The Department, council and Comhairle are working together. The bottom line is that we must achieve consensus. What this illustrates is that not all parties are working together on the issue and have not been for a number of years. It is not acceptable in this day and age that there is unnecessary rivalry between hospitals as to who gets what. That is at the core of the issue. My main concern are the children who require the requisite surgery at the various locations. I respectfully suggest to all concerned that it should not be beyond their capacity to agree a structure which provides a sufficient degree of complementarity of services and the best service for the children of the region. That is what I am anxious to achieve. I have asked the various agencies to work towards that end.
Does the Minister accept that parents find it inconceivable that delays are being created because hospitals cannot agree on a particular way forward and that children are suffering as a consequence? I represent an area in which a new health board has been established and in which there is no paediatrician. Does the Minister accept this is an extraordinary deficiency? Efforts have been made by parents in my locality to provide for an ad hoc or temporary arrangement for a paediatrician at St. Columcille's Hospital. This gives a sense of urgency to the filling of the post. Does the Minister accept the waiting list in Temple Street Children's Hospital is growing and that there has been only a marginal decrease in Crumlin? Will he respond to the case that children cannot afford to wait—
The Deputy's time has concluded.
—for the various establishments in the children's hospitals to come to an agreement? He must take action on what is a serious issue.
I ask the Minister and Deputies to respect the Standing Order which allows Deputies one minute to ask a question and the Minister one minute to reply.
I share the Deputy's frustration. It is extraordinary that there is no paediatric service in County Wicklow. I have discussed the matter with the chief executive of the ERHA who is very keen that something be done urgently about it. That is one of the reasons and the rationale behind the establishment of the ERHA which aims to develop a regional strategic approach to services as opposed to allowing individual centres to grow in accordance with whatever turf wars are being engaged in. The ERHA will ensure a degree of co-ordination of services and a greater spread over time. Comhairle was established to regulate the appointment of consultants. We need to make up our minds on whether we agree with the devolution of statutory authority in respect of a number of issues to various bodies. While people have spoken about their desire for regional health authorities, they do not want to accept that authority and responsibility should lie in the regions in respect of the development of services.
They have to be criticised.
I have no problem criticising them but the bottom line is that we are working within statutory constraints to try to arrive at a solution to this issue.
The Minister's minute has concluded.
In the meantime, a service will be provided.
Would the Minister confirm that his predecessor, Deputy Cowen, gave an assurance to the National Children's Hospital, Harcourt Street, now part of Tallaght Hospital, that it would continue to retain a paediatric surgical service? Would he also confirm that he or his predecessor sanctioned funding for this appointment? Would he further agree that the failure to make this appointment and the ongoing difficulties in this area have contributed to large numbers of children waiting far too long for surgical and medical care to which they are entitled? Will he intervene and resolve this dispute once and for all so that parents will know their children will receive the treatment to which they are entitled within a reasonable period?
I have already been in touch with a number of the bodies concerned. I have spoken to the ERHA and the Department has been in touch with the council and An Comhairle. No one is in any doubt about my desire to resolve this issue as quickly as possible.
Is the Minister disagreeing with his predecessor?
However, I respect An Comhairle's statutory authority to regulate posts. The issue is not one of funding but of strategy and identifying the best strategic approach to paediatric surgery in the region over the next decade. That is the function which the Oireachtas collectively gave to An Comhairle. The Deputy may wish to address that fundamental issue in his questions, and he can endeavour to bring everything back to the Minister if he wishes. However, this House established a body with responsibility to do certain things. I have held discussions with An Comhairle and it has given me significant feedback on the appointment of consultants and so on. We are working together to ensure that we have a faster lead-in time and a faster process for the appointment and filling of consultant posts as they become available.
