The motion for the Adjournment is by Senator Naughten, to ask the Minister for Health to outline any changes in his plans since 1 January 1990 for general hospitals, psychiatric, geriatric, community care services in County Roscommon.
Adjournment Matter. - County Roscommon Health Services.
First, I want to thank the Cathaoirleach for allowing me to raise this very important issue of health services in County Roscommon. This is an old chestnut with which this Minister, no less than his predecessor, will be familiar. Indeed, I had the pleasure of asking questions of the present Minister for Health in the other House in the lifetime of the previous Dáil.
What I want to refer to tonight is what is now basically known as the Foxe deal. Deputy Foxe has reported specific assurances. He has referred to the County Hospital receiving ten extra nurses and 20 extra beds and also stated that an additional physician would be appointed at the County Hospital. Deputy Foxe has decided, for his own best reasons, to be general rather than specific on those matters and thus I would like this House to be enlightened on the specifics by way of the procedural guidelines to be followed; dates by which the appointments will be in being; the precise nature of the appointments and the type of appointment.
In the publicly advertised posts for physician it has been stated that it would be temporary for six months. I would like to draw the Minister's attention to the fact that there were three advertisements for this post, two of them sought a physician and one sought a physician with a special interest in geriatrics. I would like the Minister clearly to put on record for the House this evening the type of post that is being filled. Last Monday I met senior consultants and doctors in Roscommon hospital and they generally believe that a temporary physician will not take up duty in Roscommon, that the post will not be sufficiently attractive.
Some sceptics would say that this particular deal is very vague and deliberately so, perhaps in order to give the Taoiseach the time he needs to complete his Presidency of the EC. I would like the Minister to put clearly on the record tonight what precisely was agreed; what exactly is coming to Roscommon; what exactly is coming to Castlerea, the cost and the timescale. They are all factors that we, the people of Roscommon, are entitled to know.
As regards the nursing appointments, will there be re-employment of some of the 40 nurses who lost their jobs in the county hospital two years ago when they were paid off because of lack of sufficient funding to carry on the posts there? Again, in view of replies to parliamentary questions from me and other representatives whereby the Minister endeavoured to justify the closure of 65 beds at Roscommon County Hospital, is there now an admission on the part of the Minister for Health of being misled in his figures and calculations two years ago in this regard, in view of the provision of 20 additional beds now?
I have the figures which were quoted by the CEO at the last Western Health Board meeting on 5 January. It would appear that while there was great overcrowding in the medical ward the surgical ward was half empty. Those are the figures give by the CEO and it is difficult to understand why an additional 20 beds were just put, ad lib, into the hospital. Or, is a new faculty coming to the hospital? Will there be an additional service there? This is something I would like the Minister to deal with in his reply. Will there be a paediatric unit in Roscommon hospital? Rumour has it that there may be. Again, I would like clarification.
I wish also to refer to recent statements by the Minister of State at the Department of Trade and Marketing, Deputy Leyden, concerning the precise status of Roscommon County Hospital when he endeavoured to imply that were it not for his intervention as Minister of State, County Roscommon General Hospital would now be closed. I feel it necessary to put on record this evening that the Minister did absolutely nothing on this issue and appeared to be totally helpless when the decision was taken by the executive of the Western Health Board to close Roscommon County Hospital. It was I and the other Roscommon members of the Western Health Board who by lobbying our colleagues in Galway and Mayo, succeeded in transferring £½ million from the regional hospital budget in Galway in 1987 to Roscommon and it was that which protected Roscommon County Hospital even though it had only 60 beds. Unfortunately, the transfer of funds was insufficient to retain any more and as a result we lost 65 beds in the hospital at that time along with the nursing and auxiliary staff.
In relation to St. Patrick's Hospital in Castlerea, this again in an ongoing chestnut since 1986. The then Minister for Health decided that acute psychiatry should no longer be carried out at St. Patrick's Hospital, Castlerea but rather at a new unit in Roscommon which has since been funded and has lain idle for the last three to four months. Again it is no different from the mentally handicapped centre in Swinford which was completed in May 1985 and basically is lying idle. There is accommodation for 200 mentally handicapped people and there are only 30 people in the whole building. The cost per patient, because of the difficulty of heating the whole unit, of having lectures there to cater for maybe 100 residents when there are only 30, is an appalling scandal. It is a reflection on the planning that has gone on in the health service that this huge white elephant should have been built there and there is no money to fund it.
I wish to place on record the wider ranging confusion that now exists about St. Patrick's Hospital in Castlerea, its patients, the range of services and staff arising out of the recently published reports in all areas of the media. Initially, I wish to state that in June 1989, I issued a press release after consultation with my party leader, Deputy Alan Dukes, and our front bench spokesman, Deputy Ivan Yates, to the effect that St. Patrick's Hospital should be retained for the provision of high support hostel accommodation for psycho-geriatric patients and a psycho-geriatric section and that the administration of psychiatric services for County Roscommon should remain in Castlerea. Naturally, I welcome the statements which have been issued since. Since that time, having regard to the policy of the Government from June to January when the Minister of State at the Department of Health visited Castlerea, where he met myself and other members of the health board, the whole purpose was to close down the hospital in Castlerea. That was the purpose of the visit. Since last June it has been quite evident that the Government were prepared to run down the Castlerea hospital. Moves were made to get CERT and FÁS involved in taking over the hospital in Castlerea and providing training courses there. This is something I certainly welcome because it would give a major injection of capital to Castlerea. There would be lecturers and many students moving in there and I do not think there would have been any jobs lost on the psychiatric side the facilities been in position in Roscommon. That is where the difficulties arose.
Deputy Foxe asserts that psychiatry will continue in Castlerea and that acute hostel accommodation will be provided in Castlerea. I would like to know from the Minister is this the situation. Will it be a new purpose-built acute hostel or a conversion of part of the building? I would like to know why this line is apparently very acceptable now when such action was alien and unthinkable two years ago.
The recent visit of the Minister of State at the Department of Health, Deputy Treacy, to County Roscommon seemed to copperfasten the Fianna Fáil policy by virtue of having Roscommon as the centre of the principal psychiatric services both within the health institutions of the town and also the use of the county surgeon's residence as a high support hostel for long-stay psychiatric patients. There was also the provision of the alcoholic unit in the grounds of the hospital. This new unit was under construction at the time the Minister of State was there. I would like the Minister of State at the Department of Health to specify precisely what will happen with that unit. Will it remain in Castlerea? Will the new building that is provided in Roscommon lie vacant?
In my role as Chairman of the Special Hospital Care Committee of the Western Health Board, I would like to be informed as speedily as possible of exactly what U-turn has taken place over the last 12 months. As chairman of the committee dealing with special hospital services, as yet I do not know what exactly will be the future of psychiatric services in Roscommon. The Minister might be able to clarify the matter here tonight.
I also want the Minister to inform the House of the precise steps being taken to improve the geriatric services in County Roscommon and, indeed, in the whole Western Health Board area. As the Minister is well aware, my committee sought an additional £400,000 to improve the level of nursing care. In very many of our hospitals the level of nursing care is below a safe standard at present simply because there are more dependent patients due to the admissions policy that has been operating in the Western Health Board over the last number of years. The number of staff has decreased and the number of dependent patients has increased. We need immediate additional funding for geriatric hospitals, not alone in Roscommon but in the whole of the Western Health Board area.
Repeated references are made by the Minister to community care services, with the result that I sometimes feel that he is out of touch with the major reduction that has taken place in the Western Health Board in this area of activity. Is the Minister aware of the high level of emigration from County Roscommon and the resulting pressures on care for elderly patients? The situation has been reached in Roscommon that there is massive emigration which creates major problems for elderly persons living alone. Their families have emigrated and they are now dependent on either being admitted to the geriatric hospital if they are lucky enough to get in, or on getting into private homes or, alternatively, they have to depend on the Western Health Board service of the district nurse and so on. Due to the serious cutbacks that have taken place over the past number of years, that service has been run down and together with the high emigration it has caused major problems for elderly people in remote communities in County Roscommon. I appeal to the Minister to see what can be done for these forgotten people. It is equally important that their needs and their requirements are looked after.
There are a couple of further questions I would like to ask with regard to the costing of this reputed package. Could the Minister give us an accurate costing of this package? I understand that it is somewhere in the region of £1.8 million, between the retention of St. Patrick's, the provision of an additional 20 beds in Roscommon and the provision of additional nursing staff together with other back-up staff.
Again, I wonder if the Minister is aware of the fear being expressed by GPs and consultants in Roscommon of not being able to get an anaesthetist to work in a single practice such as exists in Roscommon. There is grave concern on the part of GPs and consultants that it will not be possible to fill the post. The only way they see it being filled is by having a second post of surgeon provided in Roscommon. They do not see the post being filled without there being two surgeons operating in Roscommon. I would ask the Minister if he or his Department have given this matter any consideration or examined the danger of not being able to fill this post that will become vacant at the end of the year.
In the Foxe deal there was also mention of extra specialist cover. I would like the Minister to inform the House as to what precisely is meant there. Is it envisaged that this cover would be provided in the Western Health Board? What type of cover are we talking about? Is it now the "in" thing again in the Department of Health to have a link-up with Ballinasloe, to have a sort of federation between Roscommon and Ballinasloe? Some people seem to indicate that that may be the case. Again, I hope the Minister in replying will take the opportunity to deal with that situation.
As I have mentioned earlier, I would like the Minister to state whether the additional beds are being put into the hospital or are they for a specific purpose. Have the Department examined the possibility of having them defined as a particular type of bed, as an additional service in the hospital, rather than just having 20 additional beds?
I ask the Minister to indicate clearly, first, the costings of this package and, secondly, a time-scale for it. When will it come into being? Are we talking about three months or six months? I understand the temporary position has been advertised. When will the extra beds be provided in the hospital? I understand certain capital works have to be carried out in the hospital to make room for those additional beds. When will the new acute psychiatric unit be opened in the County Hospital which has been ready and vacant there for the last four months? I ask the Minister to give the dates for the implementation of all the issues I have raised. What will be the time-scale?
I am surprised in a way at Senator Naughten because listening to him you would think he believes that something has been put in place of which he disapproves. Then further on there seems to be a contradiction because he seems to feel that everything that is being put in place in Roscommon is necessary. As far as I am concerned, I want to achieve improvements in the health services in County Roscommon similar to other areas where problems arise from time to time.
I had discussions with representatives of health boards and with public representatives not alone from Roscommon and indeed the Western Health Board area, but from every other health board. I have discussed the development of health services in County Roscommon with a number of public representatives, including the Cathaoirleach of the Seanad, the Minister of State, Deputy Leyden, Senators Mullooly and Finneran and Deputy Foxe, with Senator Doherty, as chairman of the Western Health Board, and the chief executive officer on a number of times and agreement has been reached on the nature of such developments in Roscommon.
First of all, I want to assure the Senator and the Chamber of my commitment to the continuation of services at Roscommon General Hospital. The Senator has been a little unfair to Deputy Leyden who was Minister of State in 1987 when rationalisation of the acute hospital service was taking place. As Minister of State in my Department, Deputy Leyden made me very much aware of the need to retain Roscommon hospital as a general hospital providing acute surgical and acute medical services. I was very impressed by the arguments he made.
With regard to the responsibility of the health board and the responsibility of the Department of Health, there seems to be confusion about the date when the transfer will take place of the acute psychiatric unit to Roscommon. We, in the Department, would not finalise that date. I understand that discussions are going on between the Western Health Board and the stafff about the move to Roscommon of the acute psychiatric unit.
As an indication of my commitment to the continuation of services in Roscommon, I might say that in February 1989, I approved a request from the Western Health Board to proceed with their application to Comhairle na nOspidéil for the replacement of the anaesthetist at Roscommon General Hospital when the present incumbent retires. I have also arranged to expand services at the general hospital to include the appointment of a physican, the provision of 20 additional beds with appropriate staffing and also the opening of the acute psychiatric unit.
My Department had ongoing discussions with the Western Health Board regarding the provision of services at this hospital. There is no doubt that the occupancy levels at the hospital over the past few years indicate that the level of services provided is about right, but it is always difficult to get this balance exactly right since we cannot always predict what will happen in advance. However, I am aware of an increase in patient numbers over the last couple of months. This has put a strain on the staffing and on the board's resources.
This recent surge in patient numbers has been investigated by my Department. In the case of Roscommon General Hospital, the board were in a position to defer certain elective surgical procedures and use the bed facilities for the extra medical patients. The board responded to the exceptional demand for services by the flexible utilisation of resources where this could be facilitated and additional staff were employed as considered necessary. This flexibility in approach to a problem is to be commended. The overall position regarding the level of services provision is a matter for ongoing contact and discussion between officers of my Department and officials of the Western Health Board.
I am fully committed to the continuance and maintenance of a general hospital service at Roscommon. I believe that the hospital provides a valuable service to the area and is of vital importance to the catchment population in that part of the Western Health Board. I have always maintained that view about Roscommon General Hospital. I hope that the beds will be used — indeed I intend that the beds will be used — as an assessment and rehabilitation unit having regard, as Senator Naughten said, to the increasing number of elderly people in Roscommon and the increasing percentage of the population who are elderly not alone throughout the Western Health Board area but throughout the country generally.
In relation to the psychiatric services in County Roscommon, it would be helpful if I outlined for Senators the Government's overall policy in relation to the development of our psychiatric services. I am sure Senators are aware of the report on the psychiatric services Planning for the Future, which recommended the establishment of a comprehensive community-based psychiatric service in each health board area. The policy outlined in this report has been accepted by successive Governments as representing a professional and humane approach to the treatment and care of people with psychiatric problems.
The Western Health Board have responsibility for the management of psychitric services in County Roscommon. The board have taken a decision to develop their psychiatric services in accordance with the policy outlined in the document Planning for the Future. The service developments in County Roscommon involve the provision of a new 30-bed psychiatric unit at the County Hospital in Roscommon. I have provided the necessary capital resources to enable this unit to be completed and the Western Health Board have agreed to open it as soon as possible.
In keeping with our policy of developing community-based psychiatric services, a range of back-up facilities, such as supported hostels, day centres, workshops and community residences, have been put in place in various locations throughout County Roscommon. Accommodation for the elderly at the Sacred Heart Home will be upgraded and certain psychiatric services at St. Patrick's Hospital, Castlerea, will be retained. A sector headquarters, day centre and workshop will be provided in Castlerea. On the point made by Senator Naughten about the delivery of services generally in Roscommon and the relationship to other hospitals, something that I have been saying over the last three years is that a hospital can no longer remain working in total isolation from other hospitals in the region and that there must be links between the hospitals. The day is gone when hospitals can totally ignore what is going on around them. We must have co-operation and co-ordination of services between the hospitals, whether they are hospitals under the aegis of the health boards or voluntary hospitls. I would see that applying in the Western Health Board area as it does in other areas and, indeed, we have established a committee, the Kennedy Coordinating Group, to ensure that that happens in the Dublin area because of the situation in Dublin where five of the major providers of acute hospital services are under different management. That is a policy, that there would be co-operation and co-ordination between all the hospitals and that would apply to Roscommon the same as to anywhere else.
With regard to cost, we are having discussions with the Western Health Board about the overall cost of providing all their services generally in the Western Health Board in 1990. I am also committed to the principle of providing service within the limits of the expenditure which the State can afford. In this context I am confident that the overall policy of the Government will ensure the maintenance of existing levels of service and as each passing year brings greater economic success and stability will provide us with the means to enhance our services in keeping with modern day needs and demands.
Could I ask one final question of the Minister?
Acting Chairman
I think the Minister has adequately answered the Senator.
It is normal procedure of the House that a Senator is allowed one question. With regard to the cost and time-scale, was the figure of cost approximately £1.8 million? Is that the cost for a full year? What is the time-scale for the appointment of a physician and providing the additional beds?
As chairman of the Western Health Board I am sure the Senator is competent to work out the cost. He is not dependent on his management. It is not anything like the figure he mentions to provide a physician, 20 beds and to staff 20 beds in a hospital. St. Patrick's is operating at the moment. I understand St. Patrick's has the longest-stay patients in the world. To keep patients there, who have been there for the past 20 years, the money is provided; there is not an increased cost for that. On the question of the appointment of the physician, a temporary post was advertised about a week ago. Obviously, as soon as the applications are in and processed a physician will be appointed there but in the future following the approval of Comhairle na nOspidéal, a permanent appointment will be made and there will not be any delay with that. However, these things, of themselves, do take some time.
The Seanad adjourned at 8.30 p.m. until 10.30 a.m. on Thursday, 1 March 1990.