asked the Minister for Health his Department's plans for the future of the Roscommon County Hospital; and whether it is proposed to up-grade the hospital as promised.
34.
Ceisteanna — Questions. Oral Answers. - Roscommon and Monaghan Hospitals.
33.
asked the Minister for Health the position of Monaghan County Hospital in the context of the FitzGerald Report.
With your permission, a Cheann Comhairle, I propose to take Questions Nos. 33 and 34 together.
In considering the future of the county hospitals in the context of the FitzGerald Report, it must be emphasised that the implementation of the recommendations in this report will take a considerable time and will require very heavy capital investment. It will be necessary to concentrate at first on proposals which are of major priority. A reorganisation of the existing facilities in Dublin and Cork is urgently required because of the need to replace buildings which are in poor condition, which contain major medical specialities, some of national significance, and which have an essential role in the training of our future doctors.
Many county hospitals are modern buildings in good condition and, while I accept the recommendations in the FitzGerald Report that they need to be reorganised into larger units, the need for action is not as urgent as in the metropolitan centres. A serious drawback of the present county hospital system is the relative isolation of the consultant medical staff at individual centres. It is hoped that this will be mitigated by the reorganisation of local health structures provided for in the current Health Bill, but some steps in this direction can be taken in advance of the introduction of regionalisation.
In the case of Monaghan County Hospital closer ties should be formed with Cavan County Hospital. The staffs of both hospitals can, on a voluntary basis, commence to work in closer co-operation. This will provide an immediate improvement in co-ordinating the services for patients and the working conditions for the existing medical staffs at both hospitals. In this connection I am pleased to say that the Monaghan County Council and the Cavan County Council have recently agreed to proceed with the appointment of an obstetrician/gynaecologist to serve in both hospitals.
In the case of Roscommon County Hospital, some ties have already been formed with the Regional Hospital in Galway. Pathology, E.N.T., paediatric and orthopaedic services for Roscommon are provided either direct from the regional hospital or in close association with the staff of that hospital. I would like to see an extension of these ties, particularly in the fields of general medicine and general surgery.
In County Monaghan, as is pretty well known, we have a fairly modern hospital which can accommodate under pressure up to 190 beds. The FitzGerald Report proposes a unit of 300 beds. We have there this modern hospital capable of taking up to 190 beds and I should like to know if the Minister would give any decision or if he intends to downgrade the hospital or to develop it as a regional hospital as outlined in the FitzGerald Report?
Would the Minister be able to indicate whether the assurance given by the Minister for Transport and Power that the hospital in Roscommon would not be changed or downgraded in the slightest respect can be upheld?
In reply to Deputy Fox, I have not made any decision about the Monaghan County Hospital in relation to the proposals in the FitzGerald Report. This is an immensely complicated report that requires very careful consideration. Might I add for the benefit of all Deputies, as the years go by, the FitzGerald Report will be outdated and there will be still further changes? Anything that anybody says at any general election is likely to be altered by subsequent information and subsequent circumstances.
No one knows that better than the Minister.
The Deputies may laugh but they will laugh out of the other sides of their mouths when they hear the final results of what has to be done in this country in relation to the Todd Report on the training of doctors. We had to examine that and to learn what the Royal College of Surgeons in Great Britain and some of the other colleges which have branches here and what our own general practitioners think of the implications of the Todd Report on the training of doctors. It is only when we have examined that that we will then be able to see the effect of that upon the general concentration of hospital facilities in this country, the kinds of consultant services that will have to be provided and new arrangements for the training of general practitioners. So, there is no need for the Deputies to laugh. The Todd Report itself, with its many important proposals, has to some extent already modified the implications of the FitzGerald Report and this is going to continue. There is nothing unnatural in Deputies of any Party choosing to make expressions of opinion and policy in a world that must inevitably change. We cannot wait forever to make declarations.
I am not concerned with the FitzGerald Report or the Todd Report. I am concerned with the Lenihan report. Can the people of Roscommon take it that the guarantee given by Deputy Lenihan, the Minister for Transport and power, that the Roscommon County Hospital will not be downgraded in the slightest will be honoured?
Of course, if you take the definition that it means that the hospitals in any one area will be integrated, that there will be greater consultant services of an out-patient character in every hospital whether or not surgery is performed, if you take the inevitable linking of the Galway Regional Hospital with all the other hospitals in the Western Regional Area, then what the Minister for Transport and Power said was true: we do not intend to downgrade hospitals in that sense. There may be a change in their functions. There may be increases in some functions and decreases in others.
The Minister has been taking lessons in evasion.
May I just ask——
Deputy Fox who put down the question is trying to get in a supplementary.
Can we assume from the Minister's reply that Monaghan County Hospital will continue as it has done to date with the possibility of developing it?
I have told the Deputy that I have made no decisions in regard to any of the county hospitals in relation to the FitzGerald Report, and that is that. The Deputy does not need to worry about any imminent changes in the characteristics of Monaghan hospital or Roscommon hospital or any other such county hospital save where decisions have already been made as is the case with Tralee where we intend to build a new hospital which is in consonance with the FitzGerald Report and where the decision was, in fact, taken some time ago.
Would the Minister be able to confirm or deny what his predecessor said here in reply to Deputy L'Estrange immediately before the general election, that it would be 15 or 20 years before any change would be made in the hospital system?
I could not define the time. That depends on capital and——
The Minister would not deny that it could be?
I have also indicated to the House that those who want to do it can read the Todd Report on the future of medical training.
Do not mind the Todd Report. That will be outdated too.
We shall have to bear in mind the Todd Report when we have fully examined its implications in my Department. The main decisions came to us in July and no statement made during the election was made with the Todd Report in mind.
Is the Minister able to answer "Yes" or "No" without going any further into the question? Will he agree with his predecessor-in-office that it may be 15 or 20 years before anything is done about the hospital system of this country?
It might be a very considerable time before every step is taken in relation to every proposal. This is a progressive programme.
It will be 15 years, then.