Dáil Éireann debate -
Wednesday, 7 May 2003

Vol. 566 No. 1

Adjournment Debate. - Hospital Services.

Dr. Twomey

Earlier we dealt with the macro-picture of the reconfiguration of certain hospital services. The health strategy, primary care strategy and the value for money report were mentioned in passing. The Minister for Health and Children also promised that in the next six to eight weeks the Brennan, Prospectus and radiotherapy reports will be published. I refer specifically to the maternity and accident and emergency services in County Wexford. Comhairle na nOspidéil has a record of accident and emergency services as well as the final report of the steering group on nursing and midwifery resources.

Two reports are relevant at local level. These are the patient dependency report, enhanced midwifery practice, which was published in June 2001, and another commissioned by the Medical Protection Society which was published in January 2002.

Both of these reports show an increase in the number of births in Wexford General Hospital and both recommended an increase in the number of midwives and care attendants in the hospital. However, we have not seen any increase in either midwives or care attendants since the publication of the reports.

There were some reports this evening saying this was an unsafe practice, which it is. The reason young babies and their mothers still remain safe in Wexford General Hospital is because nurses work longer hours, they come in on their day off and, on occasion, have cancelled annual leave. This situation is unsustainable in the long-term. I assume the Minister received the reports since this morning so there is no need for me to repeat the figures. The people of Wexford would like to know what future there is for midwifery services in the county.

There are two issues in regard to accident and emergency services. The immediate issue is that two of the temporary registered doctors in Wexford hospital have resigned their positions earlier than expected. As a result, there is a strong likelihood that the Wexford accident and emergency department could be closed in the short-term. More importantly, Comhairle na nOspidéal, which recommended the appointment of an accident and emergency consultant to Wexford General Hospital, has sent back that application.

We need to know whether the long-term prospect for the Wexford accident and emergency department involves its closing down because Comhairle na nOspidéal does not seem to approve of sending a consultant to accident and emergency departments. Is it only Wexford that will be affected or could this affect all single-handed accident and emergency departments, not only in the south-east but throughout the country?

I know the Minister for Agriculture and Food, Deputy Walsh, cannot be expected to give answers to these questions as it is not his Department, but he may have answers for me and I thank him for waiting to reply. The issue has been ongoing for over a year.

We know how the situation works. College bodies, which appoint consultants, will not give accreditation for junior doctors to work in accident and emergency departments that do not have a consultant. There has been some leeway in this over the last year and a half where a consultant surgeon in the hospital can take over the role of the teaching doctor. This has allowed accident and emergency services to stay open. What I am hoping to hear is that the people of Wexford can finally be taken off the waiting game in regard to this issue. Can the Minister give me solid answers to these questions?

Mr. Walsh

I am pleased to reply to Deputy Twomey on behalf of the Minister of State, Deputy Tim O'Malley. As Deputy Twomey is from west Cork I will be even more pleased to give solid replies and as comprehensive and sympathetic a reply as I can.

I am pleased with the opportunity afforded to me to set out the position regarding accident and emergency services and maternity services at Wexford General Hospital. The provision of services at Wexford General Hospital is a matter for the South-Eastern Health Board in the first instance.

In regard to the accident and emergency department, I understand from the South-Eastern Health Board that there is no threat to the closure of this unit arising from registration issues regarding non-national or non-EU consultant hospital doctors.

Under the Medical Practitioners Act, the Medical Council is charged with responsibility for the registration and regulation of medical practitioners. Doctors are registered on the general register of medical practitioners. At present there are three types of such registration – internship registration, temporary registration and full registration.

Internship registration is granted to graduates of Irish and EU medical schools. Temporary registration is granted to medical graduates from non-EU countries. A doctor who has temporary registration for a minimum period of two years may apply for full registration. Full registration is also granted to those who are nationals of an EU member state, who are appropriately qualified and satisfy any other training requirements as specified under the Medical Practitioners Act.

Registration on the register of medical practitioners is a requirement for employment in the public health service. The Medical Council carries out inspections of hospitals for the purpose of approving posts for training purposes. It only approves temporary registration for doctors who are being assigned to approved training posts. Many fully registered doctors would also be undergoing ongoing training.

The Medical Practitioners (Amendment) Act 2002 came into operation on the 1 May 2002. Under the provisions of the Act the Medical Council has drafted rules relating to the registration of medical practitioners, the recognition of health care settings in which training may take place, the recognition of primary qualifications obtained from EU medical schools for the purposes of internship registration and rules relating to short-term, temporary registration. The consultation process regarding the Medical Council draft rules is almost concluded and the Minister hopes to be in a position to decide on the draft rules in the near future.

In the meantime, the Minister wishes to reiterate that no doctor has lost registration due to the period taken to consult on and prepare the draft rules. The Act makes provision for any medical practitioner who holds temporary registration, such as a number of non-EU doctors, and who has applied for full registration under the Act to have his or her period of temporary registration extended indefinitely until such time as a final decision is given regarding his or her application.

The interagency health care forum was set up late in 2001 with the purpose of facilitating ongoing communication between health service providers and managers to improve mutual understanding and co-operation. The need to balance registration and training issues, particularly in the context of service delivery, is one of the topics regularly discussed by the forum.

The Minister has provided this year for the appointment of three additional consultants in emergency medicine for the South-Eastern Health Board, one of whom will have responsibility for the accident and emergency department in Wexford General Hospital. I understand that the board is currently in discussion with Comhairle na nOspidéal regarding these posts.

As regards maternity services, considerable progress has been made in developing and improving services at Wexford General Hospital. The unit is staffed by highly-qualified, dedicated professionals who provide a safe and responsive service to patients. Further developments are taking place regarding this service.

A third consultant obstetrician/gynaecologist post has been approved and it is expected that the post will be filled next month. The hospital recently conducted interviews and established a panel to fill existing midwifery vacancies at the hospital. Other initiatives include the permanent appointment of a midwifery manager, the training of two staff midwives in ultrasonography and the advertising of a permanent post of colposcopy nurse with a special interest in women's health and in early pregnancy assessment.

Wexford General Hospital is beginning to operate a new Domino birth programme. The programme allows women to deliver their babies in hospital and be discharged within six hours of delivery with community midwifery support. This programme provides greater choice to the women of Wexford and will allow them to return to their home and family at the earliest opportunity after delivery. The development of this service will also help to reduce pressures in the maternity unit. A team leader and a midwife have been recruited for this programme and the recruitment process to appoint further staff is under way.

The Dáil adjourned at 9.20 p.m. until 10.30 a.m. on Thursday, 8 May 2003.