Denis Naughten
Question:87 Mr. Naughten asked the Minister for Health and Children the status of plans to move inpatient surgery from the County Hospital, Roscommon; and if she will make a statement on the matter. [35304/06]
Other Questions.
Hospital Services.
Roscommon County Hospital and Portiuncula Hospital, Ballinasloe are closely linked and many consultant appointments are shared between the two hospitals. The HSE aims to maximise the range and volume of surgery and other services in each of the two hospitals by developing greater collaboration between them. This is designed to increase access by patients in Roscommon and east Galway-west midlands to high quality services locally.
The HSE has decided to create a joint department of surgery-anaesthetics between Portiuncula Hospital and Roscommon County Hospital, with shared consultant appointments. There are no plans to discontinue any surgical services at either facility. The HSE, in consultation with the staff in both hospitals is working out an implementation plan to give effect to this decision. The objective is to provide an appropriate structure for a high quality, sustainable and, above all, safe service for the people of the area in the future.
I thank the Minister for her reply. The initial announcement by the HSE indicated the transfer of inpatient surgical services from Roscommon County Hospital to the overcrowded Portiuncula Hospital, 40 minutes to an hour away, which is struggling to cope with the increased demand being placed on it from the west midlands, including Athlone. This would mean that patients in west Roscommon, for example, would have to travel for up to one and a half hours to access acute emergency care. Will the Minister clarify whether inpatient surgery will be retained at Roscommon County Hospital not only in the short term but in the medium term?
Will she also clarify whether the two surgeons currently based in Roscommon will remain there rather than being transferred to Portiuncula Hospital? A threat was made by the HSE to the effect that future developments at Roscommon County Hospital would not go ahead if it did not accept the original proposals. Will the Minister clarify the position in this regard?
Surgical activity was of a low volume at both these hospitals. In the case of Roscommon County Hospital, I understand there were as few as two to four procedures per week. The only way to ensure a safe environment for treatment is to maintain the skill base of surgeons through higher volume activity. As has happened in County Louth, for example, Roscommon County Hospital and Portiuncula Hospital will become effectively a single surgery department operating on two sites. Anybody who has concerns in this regard should go and see what is happening in Louth. I have seen the remarkable developments for patients, doctors, nurses and other staff.
Dundalk and Drogheda are only up the road from each other.
Both those facilities now have a far higher volume of activity and shorter patient waiting times. Developments have taken place that it was previously believed would never occur.
Provision has been made for a CAT scanner in Roscommon County Hospital and all the other developments to which the Deputy referred are proceeding. I understand the two consultants to whom the Deputy made reference are co-appointed and that this has always been the case.
That is not true.
I believe it is true. I am not certain they worked in both hospitals but I understand they were appointed to both places.
No, my understanding is that one of the appointments was a co-appointment but the other was a full appointment to Roscommon County Hospital. Will the Minister clarify whether the two surgeons will be based on the Roscommon campus? Will inpatient surgery services there be retained in the medium to long term?
I understand a consultant in emergency medicine, a third consultant physician and a consultant anaesthetist were to be appointed to Roscommon County Hospital. In addition, a consultant surgeon was to be appointed to serve both Roscommon and Portiuncula hospitals. A threat was issued, however, that these appointments would not be ratified on a formal basis, especially the third consultant physician post, unless the original proposals were accepted.
I said in my response that the new appointments would be to both hospitals. In other words, they will share anaesthetic and surgical staff and there will effectively be a single department operating on two sites. Subject to correction, I believe such posts were in the past appointed to both hospitals but it may not have operated in this way for training and other reasons. The main issue of concern in Roscommon is whether activity will continue there. I confirm that it will as long as it safe for it to do so. If the team is appointed to both hospitals, that level of activity can continue on both sides.
Is the Minister aware of the criteria and terms of reference being used in regard to the review of acute hospital services in the southern region? Is she aware that the appointment of two consultant radiologists to Mallow General Hospital, promised since 2001, is still not completed?
We are seeking to organise hospital services based on the need for patient safety. Procedures will continue to take place in a particular environment where it is safe for them to do so. Where it is unsafe for them to continue, there must be change. I have pointed on many occasions recently to the example of breast surgery. In 2003, the last year for which we have figures, of the 1,800 breast surgeries that were carried out, 39 of the consultants involved performed fewer than five such surgeries per year. We know from international evidence that this is a highly dangerous scenario in that outcome survival rates are poor when such a low volume of surgeries is carried out. It is not a safe environment in which to operate. That happens in other surgical areas as well and not only in surgery. We cannot allow that situation to continue. I have said on many occasions that we cannot downgrade patient safety. We must be able to give assurance to a woman in Donegal, as much as to one in Dublin, that she will have access to the same standard of care.
In regard to the region about which the Deputy spoke, the idea is to ensure Mallow, Bantry, Cork and Tralee work closely together as a team providing an acute hospital service for the region, bearing in mind that we must also take on board patient convenience issues because of the long distances involved.
I have a very high regard for Mallow hospital because it came number one in the first hygiene survey and number two in the second one. It is a hospital I hope to visit shortly because what they do there is very impressive. The Deputy need not worry about Mallow hospital.
Primary Care Services.
Aengus Ó Snodaigh
Question:88 Aengus Ó Snodaigh asked the Minister for Health and Children the progress on the delivery of the network of primary care centres promised in the programme for Government; and if she will make a statement on the matter. [35470/06]
The primary care strategy is the roadmap for the future development of primary care services in Ireland over a period of ten years, both as the appropriate service for the delivery of the majority of people's health and social care needs and to complement the services provided by acute hospitals. At the heart of the strategy is the aim of developing services in the community to give people direct access to integrated multi-disciplinary teams of general practitioners, nurses, health care assistants, home helps, occupational therapists and others.
I was encouraged to learn that in excess of 1,000 general practitioners replied to invitations from Health Service Executive local health managers for expressions of interest to become involved in the further development of primary care services and, in particular, in the formation of primary care teams either this year or in coming years. The HSE has been working with stakeholders to finalise arrangements for the establishment of a significant number of primary care teams in development in 2006. The HSE envisaged that between 75 and 100 would be established in 2006 and it has indicated that it expects this target to be achieved.
As part of this development process, the HSE advertised in September for applications for up to 300 additional frontline health professionals from a range of disciplines and this recruitment process is approaching completion. A considerable amount of work is being undertaken by the executive to realign HSE services to give best efficiencies for team-working and to determine ideal team compositions to meet the needs of identified areas.
The HSE has informed me that work will also commence during 2006 with GPs who will help to form teams in 2007 and my Department will continue to work with the HSE to monitor progress in this regard.
Is the Government still committed to the primary care strategy? For instance, what has happened to the ten pilot projects established under that strategy? What about the roll-out of the network of primary care centres that were to have been put in place? What is the status of that proposition at this point?
Will the Department carry out a comprehensive survey of GP cover area by area throughout the country? Why has the Department not already done so, recognising that there are large swathes of this jurisdiction where GP cover is clearly inadequate and where locally-based GPs are making heroic efforts to provide cover to their dependent communities? It is not only in rural areas in different parts of the State that there is inadequate GP cover but it is also a fact of life in many urban centres, including, in particular, the north inner city area of Dublin.
On the need for additional trained medical cover, what is being done to increase the number of training places for medical students who intend to go and are committed to going into general practice?
Taking the last question first, we have increased the number of training posts by, I believe, approximately 17 this year. The college was not able to deal with anymore. I hope we can increase that further next year and provision is being made to do so. A number of general practitioners are prohibited under an industrial relations agreement with the Irish Medical Organisation to practice as general practitioners under the GMS scheme and that is a matter I am examining.
The primary care strategy is being rolled out differently from the ten pilot projects because it would take an enormous amount of time and money to do so on that type of basis. In regard to the manner in which it was rolled out last year, 1,000 GPs applied and 75 to 100 will be supported. We hope to do the same next year and by 2008, we hope to have rolled it out to approximately 300 further GP practices. It will be done on the basis of the initiative funded in 2006.