Dáil Éireann debate -
Wednesday, 11 May 2005

Vol. 602 No. 2

Adjournment Debate.

Hospital Services.

Mr. Healy

I wish to raise the urgent need for the Tánaiste and Minister for Health and Children, Deputy Harney, and the Health Service Executive to implement the High Court agreement for the provision of general hospital services in south Tipperary, including the transfer of general surgical services to South Tipperary General Hospital at Clonmel, the approval and opening of a general practitioner assessment unit, the staffing of the newly completed units at Our Lady's Hospital, Cashel, and the approval for the funding, completion, staffing and opening of the acute medical unit at South Tipperary General Hospital, Clonmel.

I am once again disappointed tonight that the Tánaiste has not taken the time to respond on this debate. It is disappointing to say the least that the Tánaiste, who was in the House a few moments ago, chose to leave rather than take this Adjournment debate. I understand that Deputy Cowley has another health related Adjournment issue. It is extremely disappointing that the Minister should not take this debate. She has been hiding from this issue. This is the sixth occasion on which I have raised it in the House since 1 February and on each occasion the Tánaiste has refused to take the debate or answer any of my questions.

During the passage of the legislation to establish the Health Service Executive last December, the Tánaiste assured us that she would ensure that our questions in this House were answered. Once the Bill had completed its passage, that was simply changed. One now receives replies to questions along the following lines.

Under the Act, the Executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision of health services in south Tipperary. Accordingly, my Department has requested the chief executive officer of the Health Service Executive ... to deal with the matter.

The Tánaiste is hiding from this issue and many others. I hope the Minister of State will have some positive news for me. I have enough documentation to paper every wall of this House, most of it ráiméis that I have heard over the past ten years. I want to know when the Tánaiste and the Health Service Executive will approve the revenue funding for units that were completed 12 months ago at Our Lady's Hospital, Cashel. When will the Tánaiste approve the GP assessment unit at the hospital? When will she fund the acute medical unit that is three-quarters complete at South Tipperary General Hospital, Clonmel? When will the transfer of surgical services from Cashel to Clonmel take place? I have enough paper to cover the walls of this Chamber, and I need answers tonight, as do the people of south Tipperary.

The county council asked for a deputation to meet the Tánaiste but received the reply that she was too busy to meet it, just as she is too busy to be in the House tonight to respond to this Adjournment debate. The reply to the county council maintained that the Tánaiste had a very full programme in the immediate future. Part of her responsibility is the provision of quality health services for the people of south Tipperary. This goes back to 1996 and a High Court agreement made between the South Eastern Health Board and the Cashel hospital action committee, and approved by the then Department of Health. Nine years later, we still have not implemented that agreement.

When will this happen? When will staffing be provided for the Cashel units? When will the funding be made available? When will the transfer take place? We were promised that it would take place last March, then by 1 June this year, and now it is up in the air. We do not know when it will take place, since it is now the property of the Health Service Executive for which the Tánaiste apparently has no responsibility. In any reply to a question that I get from the Tánaiste, she kicks matters into touch by referring it to the Health Service Executive. She is hiding from this issue, and I want answers from the Minister of State tonight. Please do not give me more of the same.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

I am giving this reply on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney.

Mr. Healy

I hope the Minister of State has something to say.

Mr. B. Lenihan

I thank the Deputy for raising the question once again. It seems to fall to me to reply to him. In general, I certainly recall——

Mr. Healy

That is the same paragraph as in the Minister of State's last reply. I hope that he can do better than that.

Mr. B. Lenihan

I recall replying on this subject to the Deputy before.

Mr. Healy

Six times in the past two months.

An Ceann Comhairle

I ask the Deputy to allow the Minister of State to speak without interruption.

Mr. B. Lenihan

The Ceann Comhairle is very indulgent in allowing the Deputy to raise the issue.

Agreement was reached in 1996 to amalgamate acute services in south Tipperary requiring the transfer of surgical and accident and emergency services from Our Lady's Hospital, Cashel, to South Tipperary General Hospital, Clonmel. Deputy Healy referred to the historical background. That agreement provided for the development of disability, palliative care and mental health services and services for older people on the site of Our Lady's Hospital, Cashel. It is planned to complete the developments in Cashel in two phases. The first phase has now been completed, comprising three units, a 20-bed unit for the elderly mentally infirm, a 12-place supervised community residence, day hospital and day centre, sector headquarters for mental health services, 12 independent living units and a day care centre for people with physical disabilities.

Mr. Healy

If the Minister of State wishes, he can cut it short, since I have heard it all before.

Mr. B. Lenihan

The planning stage of phase two of the Cashel development has been completed. Refurbishment of the main hospital building is required to accommodate the following services: a 20-bed GP assessment rehabilitation unit, a five-bed palliative care unit, a 15-bed convalescent unit, a 25-bed specialist geriatric rehabilitation unit, a day hospital for older people, and the outpatients department. The development of phase two is contingent on the transfer of surgical services to Clonmel, the subject the Deputy has raised, and the provision of capital funding for the project.

In recent years a major capital development programme to provide the infrastructure to facilitate the transfer from Cashel to Clonmel has been undertaken to bring surgical and acute medical services together on a single site. The integration of acute services on one site will greatly enhance the services available to patients in the region. The amount invested in this is €30 million which is for the new facilities at South Tipperary General Hospital, Clonmel. There are various elements to the newly constructed facilities and they have been outlined to the Deputy in previous replies.

In September 2004, the Department of Health and Children, in the context of the commissioning of new units in acute hospitals throughout the country, gave approval to the South Eastern Health Board to commission the new facilities in Clonmel. In 2005, ongoing revenue funding of €3.8 million is available to the HSE's south-eastern area to open the new facilities at South Tipperary General Hospital.

Mr. Healy

What about the Cashel services and the transfer to Clonmel?

An Ceann Comhairle

Deputy Healy should allow the Minister of State to continue without interruption.

Mr. B. Lenihan

The Health Act 2004 provided for the HSE, which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision of services at the hospitals to which the Deputy referred. The Department has been advised by the HSE's south-eastern area that equipment is being purchased and a number of industrial relations issues addressed in regard to the transfer of surgical services from Our Lady's Hospital, Cashel to St. Joseph's Hospital, Clonmel. In respect of staffing at Cashel and Clonmel, business cases are being prepared by the HSE's south-eastern area with regard to the resources required for the services.

Ambulance Service.

Dr. Cowley

I am grateful for the opportunity to raise this important matter on the Adjournment. It is scandalous that there is a continuing delay in the establishment of an ambulance base for the Mulranny, Achill and Ballycroy areas. I cannot understand how the western area of the HSE and the Minister for Health and Children can stand over the dangerous situation whereby the health of those residing in these areas is at serious risk due to the unacceptable time lapse that exists between when an ambulance is called and when it arrives to take an ill person to hospital.

The failure to locate an ambulance base in the Mulranny, Achill and Ballycroy areas is unacceptable and is not in accord with the established national and international guidelines for patient safety. I urge the Minister to look at this situation forthwith. We are all aware of the importance of the "golden hour" but this is irrelevant when it takes an ambulance as much as two hours to get to Achill from Castlebar. Seriously ill patients would have some chance of recovery if ambulances were based in the areas I have mentioned.

The western area of the HSE is of significant size, measuring 5,500 sq. ft. and with a population of 380,000. It is a predominantly rural area in which ten ambulance bases are currently located. When one compares this with the situation nationally, it is clear the western area has one of the lowest numbers of bases in comparison with other similarly sized areas. The response times are dependent on a number of factors such as the road network, rurality, time of call and the location of the ambulance station.

The latter is the most critical factor. Recent analysis of response times shows that, on average, 68% of calls are dealt with within 20 minutes. However, there are significant variations between urban and rural areas. In Ballina, for example, 58.8% of calls are answered in 20 minutes and the corresponding figures for Belmullet and Castlebar are 55.6% and 58.8% respectively. This is unacceptable in comparison to figures in other areas. In addition, it is a policy of the HSE's western area that all ambulance bases should provide full cover 24 hours a day. It is also policy to ensure all citizens are within a 20-mile radius of the nearest ambulance station. However, an examination of the catchment areas indicates a number of them do not meet these criteria, a situation which is unique nationally.

In 2002, the former Western Health Board pointed to the urgent need for the provision of three new ambulance bases. However, the cost of such provision is beyond the revenue funding of the existing ambulance service and it has made repeated applications to the Department of Health And Children for increased funding. I urge the Minister of State to consider the distance involved. As a doctor, four babies have been delivered inside or outside my own home because an ambulance has not arrived on time to transport the mothers concerned to hospital.

I visited the accident and emergency department in Mayo General Hospital last night and found patients waiting for beds. There are inadequate step-down facilities in the county. The home for elderly persons in Ballinrobe lies undeveloped since 1972. We now have an orthopaedic unit, the campaign for which I started, a wonderful facility with a full complement of staff. All the necessary equipment is there but it is not used for elective work, which means patients must travel to Galway for procedures such as hip replacements. This is unacceptable.

These serious issues are being addressed by Independent Members while Deputies in the main parties merely make noise. The Independents are setting the agenda and dealing with the issues which matter most to people. I hope the Minister of State will have some news on the terrible situation whereby international guidelines on the provision of ambulance services are not being honoured.

Mr. B. Lenihan

Under the Health Act 2004, as the Deputy is frequently reminded, the HSE has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision of ambulance services. The HSE's western area provides emergency and patient transport ambulance services to a population of more than 350,000 people. As the Deputy correctly points out, this is a very dispersed area and Mayo is probably the most dispersed county in it. It is certainly the most dispersed constituency in this House.

The Department is advised that the emergency ambulance service is provided from ten stations across the catchment area. There has been a significant expansion of this service in recent years. Ten additional crews have been put in place, the number of 24-hour bases has increased from three to five and the overall hours of operation across all bases have increased significantly. In 2004, six new high-specification ambulances were provided. In addition, two new rapid-response vehicles have been introduced as back-up to the new fleet. Facilities at ambulance stations in Ballina, Boyle, Clifden and Roscommon have also been improved.

The HSE has responsibility for the continuing development of the service. In this regard, it is developing proposals for the establishment of a number of additional stations in the western area, including a station in the Achill-Mulranny area. I understand the Deputy's general practice is located in the Mulranny area rather than the Belmullet area. The provision of additional capital funding for these developments is a matter for the HSE having regard to funding provided under the capital investment framework for 2005-09.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Thursday, 12 May 2005.