Accident and Emergency Services.

I thank the Minister of State for his presence and I look forward to hearing his response which I hope refers to the continuation of an adequate casualty service at Our Lady's Hospital, Manorhamilton, County Leitrim. That hospital serves the catchment area of north Leitrim, west Cavan and much of mid and south Leitrim as there is no proper accident and emergency service in the county.

Less than two weeks ago a notice was placed on the door of Our Lady's Hospital which stated that casualty was closed. I lived in Manorhamilton for 11 years, during which time my family was able to access the casualty service at the hospital when faced with life-threatening crises. If I lived in Manorhamilton now that would not be the case, which is shocking. Those who live there and in surrounding areas no longer have access to a proper accident and emergency service. The Minister of State knows that you cannot put a price on such access.

Before I came to the House, I had another look at the health strategy proposed by the Government. It has four goals, including fair access and responsive and appropriate care delivery. In the strategy we are told that the patient is at the centre of planning care delivery and that its underlying principle is to provide the right care in the right place at the right time. For the people of north Leitrim the right care is a continuation of the accident and emergency service which was in place until two weeks ago. The right place is Our Lady's Hospital in Manorhamilton and the right time is now. I understand that this is not a simple matter. I have been in contact with the chief executive officer of the North-Western Health Board who has outlined the difficulties faced by the board in trying to maintain the service. I am not being unrealistic and unreasonable when I say that difficulties must be dealt with, issues must be faced and problems must be solved.

I understand that the Irish Medical Council has issued new national guidelines and policies which dictate the circumstances in which junior doctors can operate in casualty units. The council has legitimate concerns, but while it has a very important role to play in ensuring the service is competent and professional, it is just one of the participants in this service. If, as the health strategy states, we must have the right care in the right place at the right time, the buck stops with the Minister.

Rather than simply complain or accept that the doors have closed for good, I wish to put forward a workable suggestion. I propose that the service be maintained at Our Lady's which deals with life-threatening conditions and emergencies by stabilising patients before sending them by ambulance to Sligo General Hospital. This will have the effect of providing a service in Manorhamilton while taking some of the pressure off the casualty service in Sligo.

I call on the Minister and the North-Western Health Board to do everything possible to ensure that staff in Manorhamilton get the maximum training from consultants in Sligo to deal with life-threatening crises, such as, for example, the administration of the thrombolytic drug scheme, whereby heart attack patients can be stabilised, thus significantly increasing their chances of survival.

I call on the Minister to use his best efforts and negotiating skills to ensure that the notice which appeared on the door of Manorhamilton hospital two weeks ago, stating "Casualty Closed", will be removed and that he will reinstate the service.

I thank Deputy Harkin for the opportunity to clarify the position in relation to Our Lady's Hospital, Manorhamilton. Responsibility for the provision of services at Our Lady's Hospital, Manorhamilton, rests with the North-Western Health Board. Accident and emergency, and casualty services for the counties of Sligo and Leitrim are provided at Sligo General Hospital.

Our Lady's Hospital, Manorhamilton, consists of a rheumatology department and a community hospital. The rheumatology department is a regional service providing treatment for patients with muscular-skeletal disorders and-or physical disability for Counties Donegal, Sligo, Leitrim and west Cavan.

The community hospital provides medical and rehabilitation services to the local community. A minor injury service has been provided at the hospital under the management of the medical officer and staffed by the rheumatology department. The service did not have the back up of accident and emergency staff, anaesthetics, surgery, orthopaedic or paediatric services. No coronary care or intensive care services were provided on site.

The Department was advised today by the board that the Medical Council recently indicated, as Deputy Harkin outlined in her speech, that non-consultant, trainee doctors in the rheumatology department could not continue to provide a service to this minor injuries unit in the absence of accident and emergency consultants. This ruling was made for the purposes of supervision and training. The Medical Council is the independent statutory body responsible for the establishment of standards in the medical profession. This, in effect, means that the unit could not be medically staffed. The chief executive officer of the board has advised that the hospital does not have the necessary critical mass of population to sustain the unit, having regard to the guidelines and policies of the Medical Council.

Accordingly, individuals who present to Our Lady's Hospital requiring acute assessment or treatment will be advised to attend their general practitioner or the emergency department at Sligo General Hospital. Patients who are referred by a general practitioner or a doctor to Sligo General Hospital will be accepted for follow-up nursing treatment in Our Lady's Hospital. Such treatment will include wound care, phlebotomy, administration of pre-prescribed medications and the removal of sutures.

If a patient is brought to the hospital requiring life-saving measures, any doctor on duty will be contacted. When the patient is stabilised he or she will be transferred to Sligo by ambulance or cardiac ambulance for treatment. An ambulance service is based in Manorhamilton. I understand that the board has informed local general practitioners, schools and employers of the position.

The Dáil adjourned at 9.25 p.m. until 10.30 a.m. on Thursday, 13 February 2003.