Seanad Éireann debate -
Wednesday, 20 Feb 2002

Vol. 169 No. 6

Adjournment Matters. - Hospital Services.

Mr. Nolan

I welcome the opportunity to raise this matter. As the Minister of State and many Members of this House, and indeed of the Dáil, will be aware, the single most important issue as far as the people of County Carlow are concerned is the lack of a properly funded locally-based health service. Twenty-five years ago Carlow had a district hospital, a maternity hospital and a psychiatric hospital which catered not only for the people of Carlow and County Carlow but also for the people of County Kildare. Today Carlow still has a district hospital and, thankfully, a geriatric hospital, but the maternity hospital has been closed and the psychiatric hospital has lost the function of servicing the people of County Kildare. Indeed, under care for the psychiatric sector, acute psychiatric admissions are now taken to St. Luke's Hospital in Kilkenny.

Carlow people in urgent need of hospital treatment must travel 26 miles to the general hospital in Kilkenny, that is, St. Luke's Hospital. If they attend the regional hospital, they must travel further again to Waterford, which sometimes is a two hour drive from Carlow. As one of the few counties – there might be only one other – without the services of a general hospital, we are seeking immediate action on the part of the Minister and the Department to remedy this unacceptable position. All medical procedures, even minor ones, must be performed outside the county and all births, apart from home births, take place outside the county. Patients are directed to the regional hospital in Waterford to which it can take up to two hours to travel when it could take less than an hour to get to the fully functional and first class facility in Tallaght.

I welcome the Government's investment in health which has doubled since the Government came to power in 1997. While we do not have the luxury of a general hospital in County Carlow, every other county in the South Eastern Health Board region does. Wexford and Kilkenny have one and Waterford has a regional hospital. Tipperary South Riding, which is half a county, has two general hospitals, while we are a full county without the facility of one. We deserve better treatment than we receive. Perhaps the Minister of State will give a commitment in this regard.

The Department of Health and Children's primary health care strategy, on which I compliment the Minister and his Department, outlines that three diagnostic centres will be established throughout the State on a pilot basis. In welcoming this announcement, I ask the Minister of State to ensure that one of those centres is located in Carlow for all the reasons I have stated. The provision of such a centre would go some small way towards giving the people a limited health service along the following lines.

Blood tests taken by general practitioners in Carlow are sent to Waterford or Dublin for analysis and are returned a day or two later. Apart from the lack of locally-based facilities, these tests are being sent to places already extended beyond their limits and this increases the pressure on the services there. An ultrascan facility would also be part of the diagnostic service. Until now, patients in need of a gallbladder scan or similar scan have to go to Kilkenny, which takes a full day and places additional pressure on an already over-burdened service. While we have an X-ray facility, the provision of a diagnostic service would give us a new state-of-the-art X-ray unit. A DEXA scan facility for bone scanning would also be part of the diagnostic service.

The most important part of the centre would be day clinics, the provision of which would be very welcome to the people of Carlow. Appointments could be made locally, saving the South Eastern Health Board the cost of transporting patients to and from Kilkenny hospital. It would also save patients from the frustration they encounter there because of the length of time they must wait to meet consultants. Consultants and specialists would come to the centre to see their patients. This would be part of a one-stop-shop health facility for Carlow. I hope the Minister of State will assure us that he will look favourably on this.

The first doctors' out-of-hours co-operative service, Caredoc, was established in Carlow in June 1999. It was started on a pilot basis and has proved to be an outstanding success, with patients and providers taking advantage of its merits. This out-of-hours service has been duplicated throughout the country and it is hoped every area will have access to this service by the end of 2003.

We in Carlow have a proven track record of delivering when we are given the chance and the resources. We have proved we have the expertise by the establishment of the out-of-hours co-op service. All we need is the opportunity and the Minister of State's commitment to our small county. I hope he and his Department will not let us down on this occasion.

Dr. Moffatt

I take the opportunity afforded to me by Senator Nolan to set out the position regarding medical and hospital services available to the people of County Carlow. The primary responsibility for the provision of health services for the region rests with the South Eastern Health Board. In 1996 the chief executive officer of the South Eastern Health Board set up a review group to examine the health needs and status of the Carlow population, especially from the perspective of key groups within that population. In determining their service needs, the review group examined the level of existing services and carried out needs assessment surveys of particular client groups. All interested parties were invited to make submissions. Recommendations for service development to meet the identified needs were formulated and published in the policy document, Health and Social Gain for Carlow – Local Services to Meet Local Need, in November 1996.

The South Eastern Health Board continues to implement the recommendations contained in this report. There have been a number of significant developments which I will outline. Acute hospital services for the local catchment population of Carlow and Kilkenny are provided at St. Luke's Hospital, Kilkenny. Proposals for the development of services at the hospital have been set out by the South Eastern Health Board. The overall aim is to have a comprehensive, integrated, quality and efficient hospital capable of meeting the challenges of the times.

This development plan contains proposals to enhance existing services on the St. Luke's site, including general surgery, general medicine, obstetrics, gynaecology, accident and emergency and diagnostic services. It proposes to provide all hospital services on one site in a way that combines ease of access to the public with a cost-effective service. The development plans take account of national policy, which is to have a strong network of local and general hospitals that serve defined catchment areas for general medical and surgical facilities. The plans and developments at St. Luke's Hospital constitute a major increase in the level and quality of services provided to the people of counties Carlow and Kilkenny.

The single most important limiting factor for admission to hospital is bed availability. The Minister for Health and Children recently announced the commissioning of an additional 709 acute beds nationally at a cost of €65 million. This is the first phase of the provision of an additional 3,000 acute beds nationally in the per iod to 2011, as announced in the health strategy. Under this initiative, funding of €2.8 million has been made available for an additional 28 acute medical beds to be provided in Lourdes Hospital, Kilcreene. These beds are in addition to the 28 new beds recently provided in St. Luke's Hospital, Kilkenny, and the new six bed coronary care unit also located in the hospital. This extra bed capacity will help to ensure that the acute services available to the people of counties Carlow and Kilkenny are responsive to their needs.

The development of the GP co-op, Caredoc, was alluded to and has improved the provision of primary care services in County Carlow. This development has facilitated greater access to out-of-hours services, including improved access to GP services, high quality and up-to-date medical equipment and nurse advice. This is a new service with 35% of the calls being dealt with by way of nurse advice. This is a very beneficial service for first-time mothers and elderly people. I am advised that the introduction of Caredoc has led to a reduced number of attendances at the accident and emergency department in St. Luke's Hospital, Kilkenny. Minor injuries are treated, as required, in the Caredoc premises in Carlow, thereby decreasing the need to travel to Kilkenny.

The South Eastern Health Board's service plan for 2002 states that the board intends to hold extensive consultation with the various stakeholders on the roll-out of the primary care strategy, including examining the feasibility of setting up a community-based diagnostic service serving community and hospital needs in the Carlow area, as has been alluded to.

As regards mental health services, the development of the new 45 bed department of acute psychiatry at St. Luke's Hospital, Kilkenny, will ensure that all patients requiring admission for acute psychiatric care will be managed at the hospital. An active therapeutic day hospital will operate at St. Dympna's Hospital on a seven day week basis where patients will be referred by GPs for assessment and treatment on an out-patient basis where they do not require care in an in-patient facility.

A fuller community based service will be provided at Carlow and a new 14 place high support hostel has also been established that will provide care for patients on discharge from the department of acute psychiatry. A further ten place hostel will also be available. The community focus of the mental health service has been strengthened by the approval of additional posts of family behavioural therapists, nursing staff and social workers.

The provision of services for older people will be enhanced by the appointment of additional staff to support hospital and community based services and through the appointment of a co-ordinator of services for older people in Carlow-Kilkenny. There are plans to develop a new unit to accommodate elderly mentally infirm patients at the Sacred Heart Hospital, Carlow. This will increase the number of elderly beds available within Carlow and the number of day places.

Research shows that unhealthy behaviours adopted in childhood have a negative impact on health in later life, particularly where the behaviours are carried on into adulthood. As part of the South Eastern Health Board's health promotion strategy, the board has introduced a five year smoking prevention and education programme in primary schools in County Carlow. The aim of the programme is to delay and prevent the onset of smoking among young people and to encourage participation in active lifestyles. This health promotion programme aims to positively influence the health of the population in County Carlow by providing a supportive environment to help young people make the healthier choice.

The overall objective is to ensure the services available to the people are responsive to their needs. I am confident the measures I have outlined, which have been undertaken by the South Eastern Health Board, will continue to impact favourably on people in County Carlow who require health care services.

Some of the services can be improved. Much can be done by way of modern technology at district hospitals and other units in counties such as Carlow because digital radiography facilitates ultrasound and other such services. The basics already exist in Carlow and it is just a matter of providing extra facilities in the unit consistent with modern technology.