Dáil Éireann debate -
Wednesday, 9 May 2001

Vol. 535 No. 5

Adjournment Debate. - Hospital Services.

Mr. Healy

I thank the Minister for coming to the House to reply to this matter. I compliment the staff at all levels in the maternity department of St. Joseph's Hospital, Clonmel. They provide an excellent service, often in difficult circumstances because of inadequate resources. The department covers a wide geographical area, including south Tipperary, north west Waterford in the South-Eastern Health Board region and Thurles in the Mid-Western Health Board region. It is a busy unit which last year handled just under 1,000 births, 1,000 theatre procedures, an epidural service, ante-natal clinics in outlying areas, including Tipperary town and Thurles, and a walk-in ultrasound/scan clinic. The medical, nursing and non-nursing staff also provide a consultant gynaecological service to in-patients, outpatients and in theatre. The staff is highly skilled, well trained and committed. However, equipment and staff shortages compromise the service.

The level and quality of service being provided can only be maintained and developed by the provision of adequate staff and equipment resources. It is not possible to continue to properly meet the demands of the service if the structures and staffing do not develop in line with the increasing number of referrals. It is important to remember that there is no provision for the maternity unit in terms of upgrading or a new building in the new hospital development at St. Joseph's.

The current position is that consultants work a one in two rota. This is unsustainable, particularly given that the number of Caesarean sections is increasing and there are changed maternity practices. The level of anaesthetic staff is inadequate and includes a non-existent junior anaesthetic staff. This means the epidural service is effectively part-time for 16 hours a day and there is no night epidural service. There is a requirement for at least six to eight additional midwifes, including the provision of a dedicated theatre nursing staff out of hours, additional non-consultant hospital doctors, support staff and additional updated equipment.

When does the Minister intend to approve the request for the appointment of the third consultant obstetrician/gynaecologist? This request has been with the Department for a considerable time and when I raised this matter recently in a parliamentary question, I received unspecific information; the reply amounted to a lot of waffle. When does the Minister intend to properly staff, equip and resource the department? There is an emerging concern in the county and at hospital level that the Minister's Department and the South-Eastern Health Board may have embarked on a policy of starving the department of resources with a view to running down the service at Clonmel, leading to its eventual closure and possible transfer to a regional centre, such as Waterford. This would be unacceptable in south Tipperary and it will be opposed tooth and nail by the people.

I ask to the Minister to confirm his categorical support for the maternity unit at St. Joseph's Hospital, Clonmel, his opposition to any suggestion of running down, closing or transferring the unit and his approval for additional staffing and equipment necessary to maintain a quality maternity service for the people of south Tipperary based at the hospital.

Minister for Health and Children (Mr. Martin)

I appreciate the opportunity to discuss the issue of maternity services in St. Joseph's Hospital, Clonmel, and the overall development of the hospital. The Deputy's suggestion about possible changes involving the unit is most unfair to the Department of Health and Children and the Government because no such agenda exists. The Government is responsible for the biggest investment ever in the hospital. A £15 million development programme is currently under way, which is the single largest project since the opening of the hospital. My colleagues in the constituency, including the Minister of State, Deputy Davern, and others, have lobbied for that programme for a long time and it is wrong to create false fears about the maternity service which handled 900 births last year. It is a sustainable and feasible service and its continuation will be supported. There is no question of me or the Department—

Mr. Healy

I am very pleased to hear it.

Mr. Martin

The Deputy may have been keeping one eye on the next 12 months. He is learning fast to—

Mr. Hayes

Perish the thought. That would be unknown to the Minister.

Mr. Martin

—create a fear, have it dismissed and then claim he was responsible for having the fear dismissed.

The issue of maternity services is a matter for the South-Eastern Health Board in the first instance. As the Deputy suggested, people occasionally by-pass the health boards in terms of statutory authority. The health boards must also develop policies on these matters. In this instance, the health board has identified and confirmed that the provision of a comprehensive quality driven and readily accessible obstetric and gynaecological service is a fundamental and integral part of care services for the region. A comprehensive obstetric/gynaecological service is provided at St. Joseph's Hospital, led by two consultants and their non-consultant support staff who deal with approximately 900 births annually.

Paediatric services at the hospital are provided by two paediatricians, one of whom has a special interest in neonatology. The South-Eastern Health Board has also approved an additional post of registrar as an interim measure to enhance the current service to patients. The appointment of a fifth consultant anaesthetist at the hospital has been sanctioned and it is currently being processed by the Local Appointments Commission. This will improve the situation significantly in relation to epidural cover.

An application has been made to the Department by the South-Eastern Health Board for financial approval of a third consultant obstetrician/gynaecologist post at the hospital. This application, which includes provision for non-consultant support staff, is being considered by the Department in the context of available resources and the priority accorded to the post by the board. The Department will be in contact with the board and will revert to the House on the matter. As the Deputy is aware, the creation of an additional consultant post is subject to the approval of Comhairle na nOspidéal.

The number of patients waiting for gynaecological services at St. Joseph's Hospital reduced by 20% during the period December 1999 to December 2000. This reduction reflects the national trend in the same period which showed a 46% reduction in the number of patients awaiting gynaecological procedures. Such figures are not often mentioned in relation to the improving situation with regard to the waiting lists for certain categories. I am confident that the substantial resources which have been provided under the waiting list initiative will continue to reduce waiting lists and improve services generally in hospitals. The objective is to provide a patient focused service within which the priority must be equity of access to high quality care, based on clinical need.

In terms of the overall development of services at St. Joseph's Hospital, Clonmel, phase 1 of a major £15 million development is under way. This development will include the provision of a new accident and emergency department, ward accommodation, operating theatres, an ICU and a central sterile supplies department. This development is evidence of the Government's ongoing commitment to providing high quality services to people in the South-Eastern Health Board region.