Dáil Éireann debate -
Wednesday, 9 Feb 2005

Vol. 597 No. 3

Hospital Services.

Mr. Ring

I thank the Ceann Comhairle for allowing me to raise on the Adjournment an important issue that affects the orthopaedic unit of Mayo General Hospital, County Mayo. Last year we were delighted the orthopaedic unit was opened at Mayo General Hospital. Everything was going well. For the first time in many years the waiting lists were reduced and many people had hip and knee operations carried out in their own county. The tradition in the past was that all patients from County Mayo had to go to Galway. For some in north Mayo, that could involve a journey in excess of 200 miles to see a consultant.

On 4 January there was an announcement to the effect that Mayo General Hospital would also deal with trauma. A few weeks later there was an announcement that in order to set up the trauma unit there would be no further surgery relating to planned operations. This is outrageous. We have an orthopaedic team up and running in the hospital. The trauma unit has not been as busy as expected and there is a full team of consultants and 14 or 15 vacant beds at a time when there is a crisis in the health service. Planned surgery for hip or knee operations will not take place even though the team is in place. There is no point in putting funding in place, in having empty wards and a team that wants to operate and get rid of the waiting lists and not using them.

An official from the Department should go to Mayo General Hospital tomorrow and investigate why the unit for planned surgery is closed. This is outrageous. We have an orthopaedic team up and running in the hospital. The trauma unit is still going ahead. We have vacant beds, a full team in place and many operations could be performed. This is bad management of the health services. Why was the unit opened if the staff was not in place? Why was the staff not put in place before the trauma unit was opened? I met many elderly people who had a knee or a hip operation and were delighted with the service. It was the first time in many years that the hospital waiting lists for Mayo were reduced but we are back to the bad old days again.

We fought hard for the orthopaedic unit. In 1994 when I was elected in a by-election to the Dáil that was one of the big issues raised and it is probably one of the reasons I am here. The money was put in place and the orthopaedic unit was opened.

When the Minister of State responds he will give me a bland reply on what is going on. I want fully investigated the reason 15 beds are vacant while there is a crisis in the health service. There is a team is in place that wants to work and can operate. I want an official from the Department in Mayo General Hospital tomorrow to deal with the issue and have the operations taking place. There is no reason they cannot be performed and I want to see them being done. I do not want the orthopaedic unit operating in a half-hearted way because that would continue for the next few years and coming up to the next general election it would again be an issue. The wards, staff and consultants are in place and there are plenty of patients to be operated on. I want taxpayers' money to protect it and the Department of Health and Children to move immediately to deal with the issue.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

On behalf of my colleague the Tánaiste and Minister for Health and Children, Deputy Harney, I am glad of the opportunity afforded to me this evening by Deputy Ring to discuss Mayo General Hospital.

I wish to outline some facts in regard to Mayo General Hospital which will underline the Government's commitment to develop hospital services for the people of County Mayo. The Government has invested heavily in the infrastructure at Mayo General Hospital.

Phase II of a major development programme at the hospital, which cost €50 million, included the following developments: a new accident and emergency department, a medical assessment unit, a geriatric assessment unit, an obstetric and delivery suite, CT scanning facilities, a new helicopter landing facility, improved mortuary and post-mortem room, a new information technology system and a new administration and medical records department.

The phase II capital development also provided the necessary facilities for the development of orthopaedic services at Mayo General Hospital including ward accommodation and a state of the art orthopaedic operating theatre in which to carry out orthopaedic surgery. Annual revenue funding for Mayo General Hospital is now more than €50 million. The hospital employs approximately 830 wholetime equivalent staff. These staff are providing additional and improved hospital services to the people of Mayo.

Activity at the hospital has increased year on year. The hospital's inpatient and day case activity for 2004 was approximately 22,000 patients. More than 25,000 people attend its emergency department. The hospital's outpatient department treats more than 30,000 people. There has been an increase in the number of beds at the hospital over recent years. The number of beds at the hospital is currently 317. The new 33-bed orthopaedic unit will be a particularly valuable addition to the hospital and will be of great benefit to the people of County Mayo.

The Government has provided specific funding of €10.9 million to allow for the opening of the new orthopaedic service at Mayo General Hospital. This is a new service at Mayo General Hospital. Outpatient orthopaedic services for people from Mayo began when the new unit opened and the waiting list for an outpatient appointment has been reduced from 1,700 to 300.

Mayo General Hospital commenced an inpatient elective orthopaedic service in September 2004. Between September and December 2004, approximately 70 patients received elective treatments in the hospital. In January 2005, to allow for the development of the orthopaedic trauma service at the hospital, elective treatments were suspended temporarily. It is important to understand that the temporary suspension of elective treatments will allow for the development of an orthopaedic trauma service, the completion of the recruitment staff for the orthopaedic unit and the provision of training for staff at the new unit. These are all necessary steps to develop the service at the hospital.

Trauma orthopaedics by its nature will always take precedence over planned elective work. The orthopaedic trauma service has been running since the beginning of January with a significant number of patients being treated in Mayo General Hospital who would otherwise have had to travel to Galway. I understand that Mayo General Hospital plans to reintroduce elective orthopaedic surgery at the end of this month.

Health Services.

Ms B. Moynihan-Cronin

I thank the Ceann Comhairle for the opportunity to raise this important matter in the House this evening. It is an issue which, for too long, has been neglected, swept under the carpet and in many instances ignored. I refer to the chronic underfunding of rape and sexual assault services throughout the country, particularly in my county. I pay tribute to the Irish Examiner newspaper for highlighting this issue in recent days and welcome its efforts to push this scandal to the top of the political agenda. I have raised this matter on the Adjournment of the House on other occasions.

According to the most recent crime figures available, a total of 447 rapes, including section 4 rapes, were reported in 2004, compared to 370 in the previous year. The number of sexual assaults in 2004 was 1,046 but it is known that the proportion of such crimes which are reported to the Garda is very small and has declined steadily in recent years.

It must be asked why men and women who experience crime and sexual assaults are so reluctant to come forward to report these incidents to the authorities. The reasons are manifold, including the emotional and psychological distress involved in pursuing a criminal prosecution against the assailant; the fear of reprisal from the assailant, who is often a family member, a relative or known to the victim; and the difficulty in securing a conviction. Some 95% of all rape cases do not end in a conviction which is a truly alarming statistic. Crime figures have not fallen but rather people are not reporting the crime. Another key reason for the low level of reportage of rape and sexual assault is the chronic shortage of legal, medical and psychological support available to the victim.

My native county is fortunate to have the Kerry Rape and Sexual Assault Centre to provide such a service for those in the county who need such support but it is chronically underfunded, has no financial security and has no ability to expand its valuable service in the current funding climate.

First established in 1992, the Kerry Rape and Sexual Abuse Centre in Tralee provides a free and confidential counselling service for survivors of sexual violence, both male and female. They offer wonderful care and support for survivors in the greater Kerry area. Apart from counselling and support, the centre provides assistance with medical procedures, legal advice, accompaniment to court proceedings where necessary, education and awareness and other information. It has a small but dedicated team of full-time, part-time and voluntary workers.

Last year, the centre in Tralee had 160 new clients but it is struggling to provide the services that are required and is fearful of its ability to provide those services in the future in a financial vacuum.

Staff at the centre have not received a wage increase in three years and the director is fearful of losing these professional, qualified people in the absence of appropriate remuneration.

Anybody who works with the Rape Crisis Network and associated services will confirm that in the aftermath of a rape or sexual assault, the immediate needs of the victim are for comfort, safety and security and to receive prompt medical and forensic treatment, reassurance and advice, all of which need to be provided in a safe and comfortable environment.

In Kerry, there is no round-the-clock availability of medical personnel to treat a rape victim. There is only one doctor available to treat victims. This doctor cannot be expected to work 24 hours a day, seven days a week. In many instances therefore, the Rape Crisis Centre in Tralee has to arrange to refer a victim to Cork for examination and treatment 80 miles away. The articles in the Irish Examiner in the past few days describe the trauma suffered by these people and the suffering they endure on an 80-mile journey just to access the required facilities.

One of the most pressing needs of a man or woman who is raped or sexually assaulted is the need to wash and cleanse themselves physically following the assault. I ask the Minister of State to imagine the trauma of the victims and to read the Irish Examiner articles. I have more to say but five minutes speaking time does not allow me enough time to outline the difficulties experienced by the rape crisis centres and the sexual abuse centres all over this country which do wonderful work.

There is no joined-up government. Six Departments deal with sexual abuse. I ask the Minister of State to put his mind to this issue and to ask the Minister to do likewise and deal with it as a matter of urgency.

Mr. T. O’Malley

I thank the Deputy for raising this matter on the Adjournment. The national steering committee on violence against women was established following the report of the task force on violence against women, 1997. It is chaired by the Minister of State at the Department of Justice, Equality and Law Reform. My Department is represented on the national steering committee and the Health Service Executive is also represented.

The purpose of the national steering committee is to provide a multi-disciplinary, multi-agency and cohesive response to the problem of violence against women and in so doing to progress the recommendations of the task force.

The steering committee is representative of a wide range of interests concerned with violence against women and its remit is to provide, inter alia, a multi-disciplinary and cohesive response to this issue. The committee has a number of objectives which include ensuring that regional and local structures are established; developing public awareness campaigns and co-ordinating and advising on the distribution of resources among the health regions; and co-ordinating and advising on ongoing development of policies, including those concerning perpetrators, criminal justice intervention, services and supports.

The Government is committed to working with all interested parties, including service providers, and has undertaken a range of measures to reduce the incidence of domestic violence, to respond to the needs of victims and perpetrators and to raise awareness among the public about the dynamics of this crime. These measures can best be seen in the following areas of Government policy: legislative measures; Garda response; health services; national steering committee on violence against women; and national research perpetrator programmes.

A key indicator of Government commitment to the issue is in the area of funding for service provision. While service provision for victims is provided primarily by the Department of Health and Children, other Departments, including Justice, Equality and Law Reform, Education and Science, Social and Family Affairs, Community, Rural and Gaeltacht Affairs and Environment, Heritage and Local Government, also contribute to responding to the issue.

Funding in the health Vote has increased from approximately €3.8 million in 1997 to approximately €12 million in 2005. This shows the commitment of Government and the Department to addressing this important issue. The distribution of this funding is now a matter for the Health Service Executive. The Department will continue to monitor the level of investment in services for women victims of domestic violence and work with the non-governmental sector to ensure there is adequate service provision to meet their needs. The Tánaiste and Minister for Health and Children has asked the Department, with the Health Service Executive, to undertake an analysis of the current level of service provision in this area with a view to planning future service needs.

The Kerry Rape and Sexual Abuse Centre provides a counselling and support service for the support of victims, both male and female, adults and children of sexual abuse. It receives ongoing annual funding of €151,184 from the Health Service Executive, southern area. Other income includes fund-raising——

Ms B. Moynihan-Cronin

It is a disgrace that those dealing with people in such circumstances must spend their time fund-raising.

Mr. T. O’Malley

——and other minor funding from statutory and voluntary agencies. The centre is one of 12 organisations in the southern area participating in the southern regional committee on violence against women, which is facilitated by the HSE southern area. I understand from the Health Service Executive that it is in discussions regarding its financial position.

Ms B. Moynihan-Cronin

It is not in discussions.

Cancer Screening Programme.

Ms Hoctor

Gabhaim buíochas leis an Cheann Comhairle as ucht an deis seo a thabhairt dom labhairt faoin ábhar tábhachtach seo. I am grateful for the opportunity to address this pressing issue in the mid-west region. I call on the Tánaiste and Minister for Health and Children, Deputy Harney, to give an update on and provide a timeframe for the start-up of the urgently needed BreastCheck screening service for women in the mid-west region.

In my first speech in the House shortly after I was first elected to the House to represent the people of north Tipperary in May 2002, I addressed this issue and called on the then Minister for Health and Children, Deputy Martin, to advance the breast screening service available in the mid-west region, which includes north Tipperary, Limerick and County Clare. I am aware the BreastCheck screening service commenced operation in various areas in March 2000, with the regions covered by the Eastern Regional Health Authority, the Midland Health Board and the North Eastern Health Board reaping significant benefits from the project at the time. It operated on the basis of screening women from the ages of 50 to 64 years, the period in their lives when breast cancer is most frequently diagnosed.

It is essential that the breast screening programme is extended throughout the country to include the mid-western region. I understand the pilot projects in the three regions to which I referred have been a tremendous success. We in the mid-west region recognise the success of the cervical screening programme which was first piloted in the region. Other regions now await its roll-out. My focus tonight, however, is on the breast screening programme urgently needed in the mid-west region, including north Tipperary. I stress its importance because of the loss of the mammography unit in Nenagh Hospital in 2002. While we felt this loss, it was pointed out to us at the time by experts in Limerick Regional Hospital that the unit was no longer reliable and was failing to detect cancer in some women. We decided, therefore, not to campaign for the retention of a service which did provide full detection.

We are grateful for the oncology services available in Limerick Regional Hospital, which the Minister of State no doubt supports. Nevertheless, we need access to the BreastCheck screening programme, which is administered by mobile units in the pilot regions. Under the programme, women are encouraged to present themselves for screening in order that cancers can be detected at an early stage. Approximately 1,700 women are diagnosed with new cases of breast cancer each year. It is alarming that the absence of this service in the mid-west region means cancers among women are not detected.

I appreciate that once the process of planning and organising the roll-out of the breast screening programme nationwide is completed, the service will be extended to the mid-west region and that we will benefit from the experience gained in phase one of the roll-out. The major question, however, is when this will take place. Various times have been given. Will the Tánaiste give a specific timeframe? According to the original commitments, the service will be in operation at this time next year. I am aware that a design team was appointed while the former Minister for Health and Children, Deputy Martin, was in office and the design of the building at the Galway unit has been approved by the Tánaiste. I understand, however, that she is awaiting approval from the Department of Finance.

From my discussions with the Tánaiste prior to Christmas, I am certain of her commitment to fast-track the extension of this programme to the mid-west region. I have tremendous regard for the Tánaiste and I know she means what she says. I want action and the service to be fully operational in the mid-west region as soon as possible.

The recruitment of staff is often used as an excuse for the long period required to implement the programme. I ask that, under the new Health Service Executive, the extension of the programme will no longer be delayed so that the women of north Tipperary can look forward to excellent breast screening services.

Mr. T. O’Malley

I thank Deputy Hoctor for raising this matter on the Adjournment. I welcome the opportunity to set out the current position regarding the BreastCheck programme and, in particular, its extension to the remaining counties.

The national breast screening programme commenced in the eastern and midland regions in February 2000. Screening is offered free of charge to women in the 50 to 64 age group in these regions. Last year the programme was extended to cover counties Carlow, Kilkenny and Wexford. The expansion to the south-eastern counties will result in an additional 18,000 women being invited for screening. Since February 2000, cumulative revenue funding of approximately €60 million and €12 million capital funding has been allocated to support the programme. As of September last year, 167,000 women had been invited for screening and approximately 120,000 had availed of the service. It is estimated that the cancer detection rate is approximately 7.8 per 1,000 women screened and to date more than 1,000 cancers have been detected.

The national roll-out of the BreastCheck programme to remaining counties is a major priority in the development of cancer services. The expansion of this service will ensure that all women in the relevant age group have access to breast screening and follow-up treatment where required. A capital investment of €21 million has been approved to construct and equip two static units, one at South Infirmary-Victoria Hospital, Cork, and the other at University College Hospital, Galway. This investment will also ensure that mobile units are available to screen all women in the relevant age group throughout the country, including women in the mid-western area.

Detailed planning for the static units is progressing as a matter of priority. A project team was established to develop briefs for the capital infrastructure required for the two new units. The design briefs for both sites were completed in January 2005. The next stage is to appoint a design team to complete the detailed design of the two units. Given the scale of the investment involved, EU tendering procedures will apply.

Capital funding for the facilities at Cork and Galway has been identified under the capital investment framework 2005 to 2009 and both developments will be progressed simultaneously. Funding has also been approved for the relocation and development of the symptomatic breast disease unit at University College Hospital, Galway. This unit will be developed in tandem with the BreastCheck development.

The Health Service Executive, in conjunction with the Department, is examining the health capital investment framework with a view to initiating as quickly as possible new capital commitments, both for this and subsequent years. The majority of women diagnosed with breast disease are treated outside of the BreastCheck programme. The report on the development of services for symptomatic breast disease published in 2000 found that the establishment of specialist breast units could best provide the necessary care. The report recommended the development of 13 such units strategically placed throughout the country, including one in Limerick, each treating a sufficiently large number of patients in order to maintain expertise and to promote best practice. Six of the units recommended in the report are now fully operational and the remainder is at advanced stages of development. Since 2000, more than €60 million has been made available for the development of symptomatic breast disease services throughout the country.

As regards the Health Service Executive mid-western area, there has been a cumulative additional investment of approximately €60 million for the development of appropriate treatment and care services for people with cancer, including breast cancer since 1997. This funding has provided for the approval of an additional eight consultants in key areas of cancer care. These include a surgeon with a special interest in breast disease. The funding has also provided for the appointment of 22 cancer care nurse specialists across the mid-western area.

The Tánaiste is committed to the national expansion of BreastCheck, the national breast screening programme. The design, construction and commissioning of projects of this nature generally take approximately two and a half years. It is anticipated that the advertisement for appointment of a design team will be placed in the EU journal in the coming weeks and I am confident the target date of mid 2007 for the expansion of BreastCheck nationally will be met.