First, I would like to thank the Chair for affording me the opportunity of raising this question. It relates to surgical services at the County Hospital, Roscommon, and I raise it in the light of a report by Comhairle na nOspidéal, namely, Review of Surgical Services in the Western Health Board Area dated June 1986.
May I quote from the first paragraph of this report? It states:
In a letter to an Comhairle dated 23rd January, 1986
the Department of Health, in the light of pending consultant vacancies in general surgery in Western Health Board area, suggested that "it would be appropriate at this stage, to carry out a full examination of the requirements in surgery at Galway and this examination might usefully be extended to the Western Health Board area as a whole".
This report went on to talk about surgical services in the light of vacancies that had arisen and in the light of possible changes that were needed in all of the surgical services in all of the hospitals that operated surgery throughout the Western Health Board area. When it reaches its examination of Roscommon County Hospital we found something that worries very much people in County Roscommon and that is the future of the county hospital. In the past number of years this hospital has had a number of threats to its existence and while these threats have not come to pass, we are particularly worried about the content of this document. With the Leas-Chathaoirleach's permission I would like to read to the House the relevant portions of what it states in relation to surgical services in the County Hospital in Roscommon. It states as follows:
Roscommon County Hospital (58 surgical beds) is staffed by a single-handed General Surgeon. There is also a single-handed Anaesthetist who is due to retire in 1991. The General Surgeon accepts that his single-handed situation is untenable and points to the impossibility of one person providing the required 24-hour, 7-day service all the year round. However, he strongly argues in favour of the appointment of a second General Surgeon. Having carefully examined the detailed workload statistics for this unit and having given careful consideration to the arguments advanced locally in favour of a second appointment, the sub-committee sees no evidence at present, nor any indication of a future potential, for a sufficient volume of surgical activity to justify the appointment of two General Surgeons. Also, great difficulty can be anticipated in replacing the single-handed Anaesthetist on her retiral. The Surgeon, of course, could not function without an anaesthetic service and his position would become totally untenable.
Having carefully considered all aspects of the situation in relation to the surgical services of Roscommon Hospital, the sub-committee has come to the conclusion that the surgical unit there is not viable and that the position of the single-handed General Surgeon would become increasingly untenable as there is no prospect of a second post being justified at any stage in the future. Therefore, on the basis of existing policies and the organisation of hospital services in the area, the sub-committee is of the view that consultant surgical services at in-patient level should be discontinued at Roscommon and that arrangements should be made to accommodate the work performed at Roscommon in other surrounding surgical units at Galway, Ballinasloe, Castlebar, Sligo and Mullingar. The sub-committee considers that the volume of surgical work performed in Roscommon could reasonably be accommodated in these surrounding units. The implications of this recommendation will, obviously, demand the most careful consideration and planning at local level, so that alternative arrangements will be made to ensure that a satisfactory level of surgical services can be continued for this area. This consideration must involve careful study of a number of complex matters including transport problems, the question of accessibility, redeployment of staff etc. The position of the existing consultant staff and other hospital personnel at Roscommon will obviously have to be protected but it is understood that this can be achieved through existing personnel procedures. It must be stressed that the aim should be to devise alternative plans to provide a better standard of patient care and safety than is possible by means of a locally-based, single-handed, consultant-staffed surgical unit, despite the best endeavours of the consultants and the other staff of such a unit.
I would have to reject the findings in that report which state that the surgical services and the position of a single-handed surgeon at Roscommon County Hospital is untenable. I would hope in the course of this brief submission to prove by figures that, in fact, surgical services are highly viable in Roscommon and that everything must be done to ensure that they continue.
I will also be making the point that not alone is there a case for ensuring the continuation of the single surgeon, single anaesthetist situation we have there at the moment but that there is a case to be made for the appointment of a second general surgeon for the hospital. I will give a little historical background to this hospital. This hospital in Roscommon is one of the most modern in the country. It was built and opened in 1941 or 1942. It is stone built and laid out in a very modern way etc. It has a very modern theatre. It has a radiologist; it has an anaesthetist and of course it has its general surgeon. Along with the surgical side it has a major medical side and a major emergency side like casualty and coronary care etc. This county hospital compares favourably with any county hospital of its size in the country in terms of the service it gives and in terms of the throughput of patients. I am comparing it with the surgical units in the country that have a single surgeon.
Roscommon County Hospital has a catchment area of around 50,000 people and there will be an argument made that that is a small catchment area for a two surgeon unit. I would argue in contradiction to that that County Roscommon has proportionately the greatest number of older people in its population of any county in the country. At all the crucial age breaks. For example, the proportion of people over 45 years is much higher in Roscommon than elsewhere. That is the case, too, so far as those over 65 are concerned. For that reason we need a better health service. People's likelihood of illness naturally increases after the middle years.
In the report of the Department of Health which was relevant to the health services of 1985 and which was prepared and published by the planning unit of the Department we find that in 1983 there were over 2,000 patients admitted and discharged from the surgical unit of Roscommon County Hospital. We find that the percentage occupancy in the surgical unit in Roscommon in 1983 was almost 77 which is very high, that the number of surgical patients discharged was 2,038, that the average length of stay was 7.3 days and also that the weekly average expenditure per occupied bed was £671.28 which is well below the national average. Castlebar Hospital has three general surgeons. In the same year there were 3,777 surgical discharges there, the length of stay was 5.4 days and the average weekly expenditure on an occupied bed was £734.11. In the Galway Regional Hospital the weekly average expenditure on an occupied bed in that period was £838.52 and in Merlin Park Hospital the weekly average expenditure on an occupied bed was £769.29. These figures show that the county hospital in Roscommon is run more economically. I am making the point about economics because, underlying the entire report by An Comhairle, is the question of economics.
Portlaoise County Hospital in 1983 had 1,838 surgical admissions, two surgeons incidentally, and 47 beds which bring it very close to Roscommon hospital. It had a weekly expenditure per bed of £745. Naas hospital, which is a smaller unit than Roscommon, had 1,535 admissions in 1983 and like Roscommon it has one surgeon. The average stay is 7.1 days per patient and it has a 63 per cent bed occupancy. In Mallow hospital which about 25 miles from Cork city there are two surgeons and it had 2,043 admissions in 1983. It has 50 beds and the average stay is 7.9 days which is roughly the same as Roscommon hospital. I could go on and on with these figures but that would possibly tire the House and cloud and confuse the issue. I wanted to illustrate the fact that the figures for Roscommon stand up and that the suggestion by An Comhairle that surgical services should be withdrawn is totally unacceptable. It is made all the more unacceptable when one reads the figures from other centres and other units which show clear comparisons with Roscommon where they are doing slightly better or slightly worse and there is no threat to their surgical services. I have already made the point that the profile of the population serviced by this hospital is older than the national average, and that has implications.
If surgical services are taken from the county hospital in Roscommon they will leave a vacum in that whole area. The report talks about sending patients to Mullingar hospital. Mullingar is about 50 miles from Roscommon town and more than 50 miles from most people in County Roscommon. It talks about transferring patients to Sligo hospital. Sligo is close on 60 miles from Roscommon town and much further from people living elsewhere in County Roscommon. Galway is at least an average of 60 miles from most points in County Roscommon and Castlebar is almost as far. Portiuncula in Ballinsloe is the only hospital which is near, but access to it from County Roscommon is very bad as it is not serviced by a major road. In fact, the main artery — although that is not the correct term for it — that services Ballinsloe from any part of County Roscommon is little better than an ordinary regional road.
For all these reasons I plead that this report from An Comhairle is not acceptable. I have to question the assumption made in the report that, when the anaesthetist retires in five years time, in 1991, she may not be replaced, that nobody may wish to take up the position. I do not know how that assumption can be made five years before the event. Because the single surgeon in Roscommon states that his workload is very difficult — and we can see from the figures I have given that he has a throughput usually handled by two surgeons in most other hospitals — this is interpreted as meaning the unit must be removed, that it becomes untenable. One cannot draw any such assumption. Dedicated surgeons are willing to undertake a workload that is far above the average and far above what is expected of them, but to draw the assumption that his position is untenable, because his workload is such, is ridiculous. Therefore, I appeal to the Minister to ensure that his Department do not implement the findings of this report.
The Minister visited the hospital in 1984. At that time it was suggested maternity services should be available in the hospital. The Minister very categorically and very courageously stated that the figures and statistics proved maternity services could not be provided in the county hospital. He said the present position of the hospital was guaranteed, that its medical services, surgical services and emergency services as they existed in 1984, were guaranteed. I now ask the Minister for an undertaking that that position obtains and will obtain into the future.
