asked the Minister for Health when he proposes to appoint an extra orthopaedic surgeon in the South Eastern Health Board area with particular responsibility for South Tipperary.
Ceisteanna—Questions. Oral Answers. - Health Board Orthopaedic Surgeon.
2.
A post of orthopaedic surgeon has been approved by Comhairle na nOspidéal for South Tipperary with a commitment to the hospitals at Kilcreene, Cashel and Clonmel. The board have applied to my Department for approval to the filling of the post.
This is one of a number of consultant posts which have been approved by Comhairle na nOspidéal, but for which it has not been possible, having regard to the prevailing economic circumstances, to provide the necessary funding. The position is being kept constantly under review.
Does the Minister realise that there is an extreme need for this appointment in South Tipperary and that effectively the people in South Tipperary have been neglected from the point of view of orthopaedic care and have been treated virtually as second class citizens? The next routine orthopaedic appointment that I could get if I were a doctor referring a patient to Our Lady's Hospital, Cashel, would be in July 1984. Does the Minister realise this? Does he realise also that there is a delay in hip joint replacements of something like 17 or 18 months in South Tipperary in comparison with Kilkenny 5.2 months, Carlow 6.2 months and Wexford 8.8 months? We are getting an appalling service. Since the comhairle have sanctioned it and the Department have recognised the need for it, will they take some action in the near future?
The health board have submitted a proposal to my Department in which they say that in order to comply with a requirement to reduce the overall numbers employed, a post of house officer at Our Lady's Hospital, Cashel, can be suppressed to allow the orthopaedic surgeon post to proceed. That proposal is currently being examined in my Department to ensure that the appointment can be funded from within the board's approved allocation and that there will be no consequential cost implications.
Does the Minister realise that if his Department accede to the health board's request to drop one junior member of the medical staff to facilitate this appointment — which is absolutely necessary — the actual surgical services which now exist in the hospital will suffer? They just cannot afford to drop one junior member of the medical staff to facilitate this appointment. All these are needed. I ask the Minister not to accede to the request of the health board in this respect because to do so would undermine the other services.
That is one of the reasons why we are examining the situation. They have made a proposal to suppress the house officer's post. That is a health board proposal. Certainly I will examine it in the light of what the Deputy has said, but that is the situation. If the suppression can be agreed presumably the orthopaedic surgeon's post can proceed.
Have the Department been made aware of the fact that the two consultant surgeons at Our Lady's Hospital, Cashel, have indicated very clearly to the health board that they would be unable to operate the hospital as it exists from a surgical point of view if one member of the junior staff were dropped?
I am not aware of that. I am aware of what the health board have submitted to the Department rather than the relationship between the hospital and the health board as such. I will examine it, but at the moment the proposal before me is that the house officer's post be suppressed and then the orthopaedic surgeon's post should proceed.
Whilst the Minister is trying to sort out how soon he can make this orthopaedic appointment — which I know he recognises now as urgent — can he make any arrangements through the health board that certain types of orthopaedic patients could be seen on a more urgent basis in the interim? Until July 1984 is a long time if you have a bad pain and need an orthopaedic opinion. Is there any way that these patients who have acute pain can be seen urgently?
I am reluctant to interfere in the day-to-day administration of the health board, particularly in relation to the waiting list for orthopaedic work. Really I should not interfere and I am quite reluctant to do so, otherwise my Department will finish up running every hospital in the country.
This is certainly the last supplementary.
Does the Minister realise that patients are suffering appallingly as a result of this delay? It seems quite inhuman to leave them to continue to suffer as badly as they are suffering. Would the Minister make some recommendation to his Department as a matter of urgency?
The proposal submitted by the health board has been fair and reasonable. We have two pre-occupations: (1) that they can make this appointment within their approved allocation; (2) that there be no consequential cost implication. It is up to the health board to organise their medical and surgical appointments within that context. I will examine it, but we have a very stringent budget for that health board and that budget for 1983 and indeed that for 1984 also must be adhered to.
Would the Minister accept that as Minister he has an obligation to ensure equality of service for everybody in the country? While his Department are coming to a decision on this matter, will he request the South Eastern Health Board to ensure that the existing services are spread evenly throughout their area to ensure that the patients in South Tipperary will get the same level of service as other patients in the area?
I would think that there is no marked discrimination or diminution in the services as between the South Eastern Health Board and any of the other health boards even up as far as the North Western Health Board. There is no way in which every hospital in this country can have an orthopaedic surgeon. I am trying to ensure that Cashel will have an orthopaedic surgeon. With respect to the health board, if they had sorted out the anomaly between Cashel and Clonmel in relation to what is required regarding those two hospitals, the problem could have been resolved years ago.
A Cheann Comhairle——
I have been generous with the Deputy. He cannot debate this.
I agree, but could I ask the Minister if he will make the recommendation as a matter of urgency? With all due respect to him I think he has tried to confuse the issue by that old hobby-horse of bringing in Clonmel and Cashel. It is confusing the issue and has nothing to do with the orthopaedic surgeon's post.
That is the last supplementary on this question.
Cashel and Clonmel are only 15 miles apart. That should be remembered.
I am well aware of that.
I will certainly convey the Deputy's view to the health board and to my Department and have the proposal as it is now framed re-examined.