Dinny McGinley
Question:1 Mr. McGinley asked the Minister for Defence if he has satisfied himself with the level and standard of medical services being provided for the Defence Forces; and his plans for improving these services. [26151/02]
Ceisteanna – Questions. Priority Questions. - Medical Services.
Joe Sherlock
Question:2 Mr. Sherlock asked the Minister for Defence if his attention has been drawn to the claims made at the recent annual conference of RACO that medical services for the Defence Forces are close to collapse due to the shortage of doctors and dentists; the number of doctors and dentists available on a full-time basis to members of the Defence Forces; the steps being taken to ensure adequate medical services for the Defence Forces; and if he will make a statement on the matter. [26150/02]
I propose to take Questions Nos. 1 and 2 together.
In common with other public sector health service providers, the Medical Corps encounters difficulty in the recruitment and retention of medical personnel. The Department of Defence, in consultation with the director of the Medical Corps, is endeavouring to seek ways to recruit additional medical personnel, notwithstanding these difficulties. Competitions are held regularly for the recruitment of medical practitioners and dentists as direct entry commissioned officers in the Medical Corps. Where Medical Corps doctors or dentists are not available, suitable local arrangements are made with civilian medical and dental practitioners to ensure that the appropriate level of professional care is available to members of the Defence Forces.
There are 33 medical officers serving in the Defence Forces. The most recent competition to recruit doctors for the Medical Corps was advertised in March 2002 and so far has resulted in four applicants. One of these candidates was found suitable but declined an offer of appointment, one was found unsuitable and two candidates await interview. A competition to recruit dentists for the Medical Corps was advertised in July 2002 and so far has resulted in three applicants, one of whom is due to be appointed on 6 January 2003.
The Medical Corps has been unable to attract more than one or two medical officers per year into the service and these generally leave the Defence Forces after one or two years. It is suspected that a significant component of the difficulty in attracting suitable applicants may be due to the unique nature of military medical officer appointments. Service in the Medical Corps is not a professional training employment, such as non-consultant hospital doctor appointments or vocational training schemes in general practice. Service with the Medical Corps for a young doctor tends to be seen as a short-term expedient for the experience and challenge of overseas service, rather than as a long-term career option.
The Medical Corps incorporates the following service components: a planning and advisory function, aimed at ensuring that the Defence Forces maintain the necessary resources to meet medical eventualities; a training function, aimed at ensuring that the skills identified as being required to carry out all elements of the Medical Corps function are maintained; the provision of a medical service in peacetime, including a service to peacekeeping operations overseas and preparedness of a medical service in the eventuality of hostilities.
As day-to-day medical care of personnel must take precedence, resources are provided for the planning, advisory and training functions on the basis of their availability. Within the constraints of available medical manpower the corps is, however, increasing its capacity to support personnel on peace support duties overseas through the purchase of equipment and training. Personnel are referred to civilian facilities, where necessary, to maintain the required level of medical services.
The re-organisation of the Medical Corps, which was effected as part of the Defence Forces review implementation plan in November 1998, was embraced as an opportunity to redirect the focus of military medical care in the Defence Forces from a predominantly hospital-based service to one in which primary care, occupational medicine and field support would continue to be further developed. In addition to St. Bricin's Military Hospital, Dublin, three military medical facilities are located at the headquarters of each of the field medical companies in Cork, Athlone and the medical detachment supply and services unit in the Curragh. These have associated infirmaries for the care of living-in personnel – largely recruits and other training course students – who may be injured or become ill. There are appointments for a physician at each facility. There are X-ray, pharmacy and screening audiometry services at each medical facility and physiotherapy services at Cork and the Curragh.
Nurses of the Army nursing service have taken up new appointments as members of occupational care teams in the Air Corps and Naval Service and it is planned that more nurses will be offered similar appointments in the larger barracks.
I am sure the Minister is aware of concerns within the Defence Forces at the level of medical service available to it. Having attended the PDFORRA and RACO conferences in recent weeks he will know it was one of the major items on the agendas of both organisations. Does the Minister agree that failure to take corrective action has led to severe shortages? In the opinion of many the system is close to collapse. What steps does the Minister intend taking to ensure that adequate services are available to the Defence Forces? Does he agree that one of the essential characteristics of a military service is that it places high demands on the health of officers and men? At the moment military personnel are obliged to go to the ordinary public service system to get adequate medical attention. The Army should have its own up-to-date service. Have any representations been made by the representative bodies mentioned above seeking action in regard to their concerns?
The director of the Medical Corps recently brought forward through the chain of command a paper containing proposals and suggestions for the future development and enhancement of the corps. His proposals and his deep appreciation of every issue involved will carry great weight when further action is considered.
It is the nature of the work involved that there is no comparison with hospital opportunities and that has contributed to the current scenario. There has been no fall off in the provision of medical services to the Defence Forces. When provision cannot be made from existing resources, facilities outside are made available. I assure the Deputy that every possible care and attention is brought to bear on the provision of medical services. We advertise and deal carefully with the responses we receive. Soldiers are entitled to free medical and dental care, which is a significant undertaking that would not be possible to meet but for the fact that the majority of soldiers are fit and healthy. We want to keep it that way.
I read a recent statement to the effect that the military medical service is close to collapse because of the critical shortage of doctors and dentists. Soldiers, particularly those in the Dublin area, have been put on long waiting lists and have to queue up for medical checks before serving overseas on peace missions. What justification is there for a cutback of 31% in funding? Does he agree that there is a statutory obligation to provide a medical service for the members of the Defence Forces which is not being fulfilled? At the end of October there was a 49% deficiency in the number of doctors and a 55% deficiency in the number of dentists in the service. Against the background of the 31% cut in funding, what steps does the Minister propose to take? He has said a great deal in reply to the questions put down, but he has not mentioned the positive steps he proposes to take. Does he accept that reducing the allocation by 31% does not speak well of his intentions?
Deputy Sherlock is wrong about the Estimate. There is no provision for a 31% reduction in the provision for medical services. He is not correct about the deficiencies outlined in the paper to which he refers. Some of the establishment figures quoted relate to a time when the numbers serving in the Defence Forces were significantly higher than they are at present and there was little recruitment. In the last five years, a substantial number of young people have joined the Defence Forces while 40% of soldiers going overseas are doing so for the first time. The need, except in the case of accidents, for the intensive medical supports the Deputy is talking about is questionable. That said, there are 33 medical officers in the corps and we would like to have more. We are in the process of recruiting and we enable soldiers to avail of outside services where required. I have not received a complaint from any soldier with regard to the level of medical services and support that we provide.
Across the spectrum of society, the medical provision made to soldiers by specialists at St. Bricin's Hospital, at the Curragh, in Cork and Athlone is as good as one will find. I pay tribute to the men and women who provide these services. I will enhance them when I can get additional people who apply and are deemed suitable to take up the vacancies which exists. In terms of the overall requirements, no deficiency exists. In fact, there has been a significant reduction in the need for medical services since thousands of 17, 18, 19 and 20 year olds joined up over the last four or five years.
The Minister must be aware that there is great concern within the Defence Forces at the deteriorating level of health services available. In his initial reply, the Minister mentioned cases in St. Bricin's Military Hospital, a facility which has provided an excellent service to defence personnel over the years. Many of our generals from the War of Independence were given great care there. I understand that even minor surgery is not available in St. Bricin's Military Hospital. Service there is almost non-existent and it has been allowed deteriorate.
Time is running out.
Has the Minister any plans to improve the situation in St. Bricin's Military Hospital because we deserve to have a military hospital for our military personnel?
I am delighted Deputy McGinley has raised the issue of St. Bricin's Hospital. During the past two years we have been negotiating with the Eastern Regional Health Authority and the Mater Hospital with a view to having a more significant linkage between the two hospitals where consultants would work for the majority of their time in the Mater Hospital and spend a lesser amount of time in St. Bricin's Military Hospital training and keeping abreast of what is happening in the medical services. We have made a significant investment in St. Bricin's Hospital to prepare for that eventuality. Deputy Gormley will be aware of the pressure for beds in Dublin. We have additional space that is not required for the military. The hospital is required to service our needs but we do not require its full complement of beds. I would like to see those beds used in the wider context of meeting the needs in Dublin and at the same time, with the exchange with other hospitals, improve the facilities provided. I am extremely anxious to explore that possibility and bring the matter to finality.