Adjournment Debate.

Hospital Services.

Mr. Connolly

This afternoon I raised with the Minister for Health and Children a letter the consultants in Cavan and Monaghan sent to management flagging the difficulties imminent within the service. I was shocked today when the Minister told me a bed was available for Pat Joe Walsh in Cavan but that it was not made known to staff at Monaghan General Hospital. What makes this more difficult is the fact this issue was flagged.

I would like to explain the manner in which it was flagged. The letter sent by the consultants stated:

We, the undersigned consultant surgeons met at a joint Department of Surgery of Cavan and Monaghan Hospitals on Thursday 8th September '05 in Cavan General Hospital and unanimously decided that Monaghan General Hospital should go back on call for acute surgical emergencies. This is following an unprecedented number ... of patients waiting for treatment on trolleys in Cavan A&E Department and we would be grateful if you could arrange for adequate resources including hiring of theatre nurses in Monaghan General Hospital for evening and night duties and meetings with the regional ambulance control to ensure there is no delay about Monaghan going back on call for acute surgical services.

That letter clearly states that there is a major problem. All the consultants in Cavan and Monaghan have outlined that the system they are expected to operate is unsafe, not workable and is costing lives. Worse than that, it will cost lives in the future and it is not a matter of if but when these lives will be lost. To date, 16 people have lost their lives in Monaghan General Hospital as a result in the change in services. This requires an urgent remedy.

It brings health care to a whole new dimension to think surgeons must flag a difficulty. The configuration of services devised by the steering group of chief executive officers was brought in to ensure safe services. These consultants who are asked to deliver the service are the experts and they have told us it is not safe and what they are expected to do is not good. However, we still read about patients on trolleys in Cavan General Hospital. They simply cannot cope with the level of demand for services in Cavan and Monaghan general hospitals.

The letter sent by the consultants was dated 15 September, yet no action was taken on foot of it. This is unacceptable. If something had been done, a death such as Pat Joe Walsh's could have been avoided. I call on the Health Service Executive to take action.

There is a new six-day accident and emergency unit at Monaghan General Hospital but resources have not been provided to open it fully and to make it operational. It is state-of-the-art with facilities to deal with infectious disease and so on in that it has positive-negative air ventilation systems. We hear there is no lack of resources but management will say it has not been allocated additional resources to open and increase the six-day accident and emergency unit at Monaghan General Hospital.

The consultants hit the core of the issue as well and have called for adequate resources, including the hiring of theatre nurses. It beggars belief that this issue has been ignored. Today I felt the Minister hid behind the fact the steering group report stated that this is the level of service we should have. In September 2001 the then chief executive issued what he called a configuration of health services. He made numerous attempts to get people to agree to and endorse what he considered an adequate service for the hospital. The consultants in Cavan and Monaghan have tried this system for a period but it is not working and is unsafe. Safety was allegedly what drove this. Responsibility lies with the Department. When something is not working, the Minister must take a hands-on approach and demand answers.

Mr. Crawford

I cannot say I welcome the opportunity to speak on this issue because it is one of tragic proportions. I sympathise with the Walsh family on their great loss. I ask the Tánaiste and Minister for Health and Children to visit Monaghan General Hospital. It is a simple request so that she can see for herself the excellent staff, the brand new theatre and the potential to save lives which could have been used in this case.

The Tánaiste has visited other hospitals and I am aware that when she sat opposite a few days ago, she said she had got private individuals to go to one of the hospitals near this town to talk about building a private health sector. Here we have a brand new theatre, capable staff and facilities which could be utilised in the public sector but which are underutilised.

I listened with interest and some trepidation to the Taoiseach. He said the most important issue was patient safety and that it must come first. Is insurance the main issue? Since Monaghan General Hospital went off call in 2002, there have been 16 deaths. That does not say too much about safety, yet the Taoiseach insisted that he and the Minister for Health and Children must go by the experts.

Why was Mr. Patrick Walsh transferred, in the first instance, from Our Lady of Lourdes Hospital to Monaghan General Hospital? Is it correct that three intensive care beds were vacant on that Thursday in Drogheda? If the protocol introduced by the former health board CEO and the so-called expert group was as good as the Taoiseach said today, why was there not a back-up service in Cavan or why did Drogheda not accept the patient back? Does the Tánaiste have any confidence in the management of the health service in respect of the hospitals in the north east and, if not, what will she do about it?

Today I was asked where the Tánaiste was hiding and why she could not visit the hospitals in this area, especially Monaghan General Hospital. Has she met the hospital alliance group or the hospital consultants who, as Deputy Connolly said, have demanded that Monaghan General Hospital be put back on call for emergency surgery? Are the Tánaiste and the Taoiseach suggesting that the consultants in Cavan and Monaghan general hospitals know less about the needs of the area and the services they must provide than non-medical executives?

The Taoiseach stated that he cannot understand what is going on in this part of the country. However, it is no secret that he did not visit Monaghan General Hospital when he visited County Monaghan on Friday last. That would have been an opportunity for him to clarify the issue for himself. He did not meet the elected councillors who requested a meeting to deal with the hospital issue. While I welcome the inquiry into the death of Mr. Patrick Walsh, more committees or expert groups are not needed for Monaghan General Hospital. As the hospital alliance committee advised the Taoiseach, if the surgical nurses were put back on staff for night purposes, everything else would be in place.

I welcome the efforts of the steering committee to bring Monaghan General Hospital back on-call for medicine, as many lives have been saved since last January. However, it is unfair to say, as the Taoiseach did today, that the steering committee was happy or satisfied with the surgery situation in the hospital. The laws were laid down by the chief executive officer and it had no choice but to sign on the agreement. All surgery consultants in the Cavan General Hospital are demanding an emergency surgeon be put back. All consultants in Monaghan General Hospital say the same. I urge the Tánaiste and the Minister for Health and Children to listen to the experts on the ground. She must do as she has done on the IT issue and take control of services at Monaghan General Hospital.

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

I thank Deputies Connolly and Crawford for raising this matter. I offer my sincere sympathies, and those of the Tánaiste and Minister for Health and Children, to the family of the late Mr. Patrick Walsh, rest in peace, who died tragically at Monaghan General Hospital last Friday.

The Health Service Executive has commissioned Mr. Patrick Declan Carey, a consultant surgeon at Belfast City Hospital and an honorary senior lecturer at Queen's University Belfast, to carry out an independent and external review of these circumstances. This review will be completed and a report issued within a timeframe of eight weeks or less. The Tánaiste and Minister for Health and Children expects the review to answer all questions around this tragic case as a matter of urgent public interest.

It is disturbing to learn, even in advance of the review, that a fully staffed intensive care bed was available at Cavan General Hospital. It has also emerged that a high dependency bed was available at Our Lady of Lourdes Hospital, Drogheda. The position of Beaumont Hospital is being clarified by the Health Service Executive.

On the specific questions raised by the Deputies about surgical services at Monaghan General Hospital, the Health Service Executive has advised the Department that the policy approach in respect of surgical services across the Cavan-Monaghan Hospital Group was set out in the 2004 report of a steering group established by the former North Eastern Health Board. The group was representative of all key stakeholders and included consultant representation from both hospital sites in the disciplines of surgery, medicine and radiology. The Department is further advised that the members of the group unanimously approved the recommendations of the steering group. The executive board of the former North Eastern Health Board accepted the steering group's recommendations in late 2004.

The steering group recommended major and emergency surgery should be carried out in Cavan General Hospital and that Monaghan General Hospital should provide selective elective surgery. The report's recommendations took account of advice received from the Royal College of Surgeons in Ireland. In accordance with the recommendations of the steering group, a full surgical team based in Cavan will provide services at Monaghan General Hospital in the form of selective elective surgery on a Monday to Friday basis. The Health Service Executive has also recently appointed a non-practising lead consultant surgeon at the Cavan-Monaghan department of surgery whose remit is to oversee an implementation plan arising from the college of surgeons' advice on the future configuration of surgical services in Cavan and Monaghan.

In accordance with the steering group's recommendations, Monaghan Hospital returned to 24-hour, seven-day medical cover in January 2005. A third consultant physician has been in post since November 2004 and five new anaesthetic non-consultant hospital doctors have been recruited to facilitate the return of the hospital to medical on-call status.

The arrangements outlined are being put in place by the Health Service Executive. They are designed to enhance the overall level of surgical services across the Cavan-Monaghan Hospital Group. The Tánaiste will give her consideration to Deputy Crawford's invitation to visit Monaghan.

Mr. Connolly

I wish to ask one question.

An Leas-Cheann Comhairle

I call on Deputy Connaughton. He has five minutes.

Mr. Connolly

I need to ask one question.

An Leas-Cheann Comhairle

There is no provision in Standing Orders for questions at this point.

Mr. Connolly

The Minister of State refers to a report in 2004. However, our consultant surgeons say publicly that this arrangement is not working. This situation needs to be re-examined.

Dr. Cowley

Hear, hear.

An Leas-Cheann Comhairle

I call on Deputy Connaughton.

Rail Services.

Mr. Connaughton

The case for the western rail corridor has been well made. All the signs of a poorly designed transport system are visible to hard-pressed motorists trying to negotiate their way into and out of their workplaces in every city and provincial town every day of the week, every week of the year. The sharp increase in car ownership is destined to continue and, irrespective of what happens in the road building programme, nobody expects roads alone to solve traffic problems.

To achieve viable regional and spatial development, few projects could bring as much economic, social, cultural and environmental benefit to the area stretching from Cork to Limerick to Sligo as the western rail corridor. The western rail corridor committee has applied the litmus test under several headings to the project and on all fronts it passes the evaluation with flying colours.

Most members of the public do not realise the daily traffic flow at Kinnegad, County Westmeath, where the Sligo traffic joins up on the Galway route to Dublin, amounts to 21,599 average daily journeys. However, 120 miles west at Claregalway, near Galway city, this figure jumps to an astonishing 30,000 journeys under the same measurement.

The potential service area for the western rail corridor includes the Sligo gateway, Knock International Airport, the Knock Shrine, large-scale industrial development, including that at Oranmore and Athenry with up to 5,000 new skilled jobs planned, the Galway gateway, including Galway Airport, linked to Shannon Airport and the Limerick gateway. We do not even know what the area will get out of decentralisation, if anything.

Can one imagine the importance of a rail link running down as the backbone of the entire BMW area when planning new housing estates? For the west, it would be similar to a Luas type train service, with the same effect on the lives of the people of the west as the Luas now has on the lives of many people in Dublin.

International consultants, Faber Maunsell, commissioned by Iarnród Éireann, estimated that the cost of opening the line would be €366 million, which compares favourably with the strategic rail review figure of €310 million using 2002 prices. In the language of the Minister for Communications, Marine and Natural Resources, Deputy Noel Dempsey, where €150 million is small beer, this amounts to two beers. For the price of two beers, we could have a new railway line.

An appraisal of the benefits of the corridor was conducted by a sub-group under the direction of the Rail Procurement Agency. It addressed sustainable regional development, accessibility and social inclusion, interregional economy, environment and quality of life, implementation, efficiency, stakeholder and public support and freight and commercial operation. Out of 36 parameters, 33 were found to be either beneficial or strongly beneficial. The investigation showed it was beneficial on 16 counts, strongly beneficial on 15 counts, neutral in one instance and negative on only two counts. One negative was in regard to the need for multiple handling of certain consignments of rail freight and the other concerned the possibility of some objections to the redevelopment from adjacent landlords.

Another group looked at the demand for rail travel. Research was carried out on the take-up if an efficient train service at an affordable price was introduced. It suggested the bus and road traffic volumes on the Sligo-Claremorris road, 2.5 million passenger journeys per annum, with 3.5 million extra between Claremorris and Lough George and a further 6 million between Lough George and Galway, represent a pool of 12 million current passenger journeys from which to draw rail passengers. It is estimated the railway enjoys approximately 10% market share of the traffic on the Athlone bypass annually. It is reasonable to believe this type of market share could be taken off the road and onto the trains under similar circumstances.

The Government has given an undertaking on several occasions that it would approve the western rail corridor. Several Ministers and several commissions later, there is still no approval. The least the Government can do, given it has decided to put a new railway line from Dublin to Kildare, announced last week, is to approve the restoration of the western rail corridor forthwith.

Mr. T. O’Malley

The western rail corridor is the name given to a proposed rail link that would connect Sligo, Galway, Limerick and Cork. The corridor was one of more than 150 proposals evaluated as part of the strategic rail review which was undertaken on behalf of the Department of Transport and published in 2003. It was not included in the review's recommended investment strategy because, among other things, it was not supported by complementary land use and settlement strategies at that time. The Minister for Transport has stated before that such strategies are essential for the viability of any public transport project because they provide the basis for the travel demand that would justify the level of capital investment, put at approximately €400 million in current terms.

The western rail corridor was, however, identified by the review as fitting particularly well with the aims of the national spatial strategy, particularly in terms of balanced regional development. To explore fully the issues surrounding the development of this corridor and to allow an opportunity for all aspects of the proposal to be examined, the then Minister for Transport established a working group in 2004. This group, chaired by Mr. Pat McCann, group chief executive of Jurys Doyle hotel group, provided a forum for the proponents of the western rail corridor to put their case to the chairman of the group, as well as to Iarnród Éireann, CIE and the Department of Transport. The working group met in plenary session on four occasions after its establishment. The group and its sub-groups have now concluded their deliberations and the chairman of the working group delivered his report to the Minister for Transport on 10 May last.

The chairman's report identifies five main sections of the proposed western rail corridor and proposes that much of it be restored on a phased basis subject to various conditions and reservations. The report recommends that a line survey be carried out on the Athenry to Ennis section with a view to re-opening it in the short term. This would provide direct rail links between Galway, Limerick, Waterford and Cork and implement one of the main national spatial strategy objectives of creating greater linkages between these four cities. While the Athenry to Galway section is not strictly part of the western rail corridor, the report recommends that improvements on this section would be necessary for Galway-Limerick services to become a reality. The report suggests that a commuter rail service between Athenry and Galway could also be developed relatively quickly and inexpensively.

According to the report's recommendations, the next section to be considered for restoration should be the Tuam to Athenry section. It notes that the introduction of a rail service between Tuam and Galway city would serve to strengthen linkages and advance the objectives of the national spatial strategy for the region. Restoring this section would also provide connections to Dublin-Galway intercity train services and the cities and towns to the south via the Athenry-Ennis section. The report concludes that in the short term a commuter service to Galway should be introduced.

The report notes that the restoration of the line from Tuam to Claremorris would link up the western rail corridor with the Castlebar to Westport and Ballina lines and thereby link these Mayo hub-towns with Galway and the cities in Munster. The development of rail freight could also make this section more viable and the report therefore recommends that a thorough study to quantify the potential for rail freight in the region be initiated.

The section from Claremorris to Collooney would be by far the most expensive to restore, accounting for 54% of the restoration costs of the entire line. As things stand, the report finds that the case for its restoration is weak. This section is characterised by low population densities with few towns of reasonable size. However, the report acknowledges that restoration of this section would connect, by rail, the Sligo gateway with the other gateways and hubs on the western and southern seaboards. For this reason, it recommends that the section should be preserved in its entirety, that Mayo, Roscommon and Sligo county councils should make the necessary arrangements as soon as possible and that the viability of restoring this section should be reviewed in three years to see whether the objective conditions for line restoration have changed.

The report also recommends that an implementation group be established to oversee the implementation of the report. The full report is available on the Department of Transport's website.

Upon receipt of Mr. McCann's report, the Minister for Transport requested his officials to examine the content to ensure that it is fully appraised in advance of the final preparation of the multi-annual capital investment framework for transport, as it is in that context that decisions will be made on the future of the western rail corridor. I understand that the framework is being finalised at present and the Minister expects to be in a position to bring his proposals to Government shortly.

School Transport.

Mr. J. O’Keeffe

I wish to raise the denial of school transport for 26 pupils from the Dunbeacon area of west Cork to Schull community college. This year marks the re-establishment of an historic injustice perpetrated by the Government against the parents from the Dunbeacon-Goleen area in west Cork and their children who attend Schull community college. No school transport is being provided this year for the 26 pupils who live four or five miles from and attend that school. An excuse has been given that the arrangement for school transport made last year by the school with the support of the County Cork Vocational Education Committee was exceptional pending a longer-term solution. The only solution offered by the Government this year is to leave them to their own devices and return them to school transport limbo.

Another excuse that will be offered by the Minister of State is that the pupils in question reside within the Bantry catchment area. This is not correct and I will explain why. I raised this issue in the Dáil some years ago with the former Minister for Education and Science, under Question No. 799 of 6 November 2001. In the reply I discovered that the catchment boundaries were established in the late 1960s in the context of the free education scheme. There were no specific regulations accompanying the determination of catchment areas. Effectively, parish boundaries determined them and revision would take place as the need arose. At that time the catchment boundary extended along the Mizen peninsula between Bantry and Skibbereen. Schull community college did not exist at that time. It was not built until 20 years later and the new catchment boundary between Schull and Bantry was never established.

It was parents such as those from the Dunbeacon area who campaigned for the school in Schull and naturally sent their children there. Why would they not? It is only four or five miles away. They lived in the same parish, which the Minister of State defines as a relevant consideration. They had been to a primary school in the same parish and had been going there since the local primary school in Dunbeacon had closed. A new catchment area boundary was established between Skibbereen and Schull, including provision of a common catchment area east of Ballydehob, but no catchment boundary was agreed or established between Bantry and Schull. No school transport was provided until the temporary arrangement last year.

The Minister of State will say that the pupils from the Dunbeacon area reside in the Bantry catchment area and are fully eligible for transport to that post-primary centre only. I challenge that assertion; it is not correct. Apart from the ludicrous fact that the distance involved varies from ten to 15 miles, no school bus service is, has been or ever will be provided to Bantry from that area. County Cork VEC came up with a proposal last year and this year it is blocked because of stupid and ridiculous Civil Service gobbledygook that states it encroaches into the Bantry area. No boundary was ever agreed. There were no specific regulations. There should have been a revision on account of the new school but it never took place.

All that is needed now is the political will to get rid of this anachronism. If the Government continues to fail the parents and the pupils from the Dunbeacon area, a number of consequences will follow. They will be left in limbo as far as school transport goes. No transport will be provided to Bantry and transport will be refused to a school that they, their sisters and brothers and some of their parents went to since Schull community college was established. The cost is upwards of €1,000 per child. That is the penalty being placed on these parents. A private bus had been arranged by the parents in the past, but it clearly fell by the wayside with the temporary arrangement last year. These people are now left in limbo, with many informal arrangements for getting to school. Some parents drive in and out twice a day. Another issue that concerns me are informal arrangements where pupils themselves are driving to school and bringing colleagues.

Does the Minister of State know this area? Travelling in Mount Gabriel involves going over mountainous roads in rural Ireland. Does the Minister of State realise what could arise if an accident occurred involving those inexperienced drivers? If that happens, this Government will bear the responsibility, as it will be the consequence of what the Government is forcing these people to do. There is also the consequences of the disadvantage that these pupils are at with regard to education and points attainment in the competitive world of the Leaving Certificate.

Let us have an end to the Dunbeacon educational anachronism. It can be done and a boundary or common catchment area, or both, should be created. We should move on this issue now and if a political will is there it can be done. If such a will is not there, the Government will bear complete responsibility for the consequences.

Minister of State at the Department of Education and Science (Miss de Valera)

I thank Deputy Jim O'Keeffe for raising the matter on the Adjournment as it gives me the opportunity to outline to the House my position regarding school transport in respect of pupils from the Dunbeacon area travelling to Schull community college in County Cork.

By way of general comment, I should explain that one of the main objects of the school transport scheme is to provide a basic level of service for children who live long distances from schools and who might otherwise experience difficulty in attending regularly. There are approximately 135,000 primary and post-primary pupils using the school transport scheme on a regular basis. At post-primary level the country is divided into catchment areas, with each catchment area having a post-primary centre. A pupil is eligible for transport if he or she resides 4.8 kilometres, three miles, or more from the post-primary centre in the catchment area in which he or she lives. A school transport service will usually be established if there are at least seven pupils residing in a distinct locality. If it is not economically viable to establish a service, the parent of an eligible pupil may be paid a remote area grant to assist with the cost of making private transport arrangements. The maximum grant payable is €5.10 per day based on distance.

School transport services are operated by Bus Éireann on behalf of my Department.

Mr. J. O’Keeffe

The Minister of State should deal with the issues.

Miss de Valera

At second level, the chief executive officers of the vocational education committees assist Bus Éireann by acting as transport liaison officers. Post-primary pupils who are eligible for school transport to the post-primary centre in their own catchment area may sometimes elect to attend a post-primary centre in a different catchment area to the one in which they reside. In such circumstances, these pupils may apply for school transport to the post-primary centre they have chosen to attend. However, such pupils will only be offered transport if there are spare seats available on the relevant bus after all eligible pupils have been accommodated.

Mr. J. O’Keeffe

The Minister of State should deal with the issues. This is ridiculous rubbish.

Miss de Valera

Such pupils are referred to as catchment boundary pupils. Pupils from the Dunbeacon area reside in the Bantry catchment area.

Mr. J. O’Keeffe

This is not so, as I pointed out. The Minister of State should deal with the points raised.

Miss de Valera

These pupils are fully eligible for transport to the Bantry post-primary centre. I must point out, however, that under the school transport scheme these pupils are not eligible for transport to Schull community college.

Mr. J. O’Keeffe

They should be eligible.

Miss de Valera

They may apply, in the normal way, for catchment boundary transport to that college. It may be of interest to the Deputy that I understand that approaches have been made by the transport liaison officer from Cork VEC to initiate discussion on a common catchment area between Bantry and Schull schools. These approaches have been rejected at local level.

Mr. J. O’Keeffe

That is a pathetic response.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 19 October 2005.

Dáil Éireann debate - Tuesday, 18 Oct 2005