Dáil Éireann díospóireacht -
Thursday, 25 Feb 1993

Vol. 426 No. 7

Adjournment Debate. - Cashel (Tipperary) Hospital.

Mrs. T. Ahearn

I thank you for allowing me to raise this important local issue in the House. I am disappointed that the Minister for Health, Deputy Howlin, is not present to hear the indignation, resentment and anger that exists in Cashel and in all south Tipperary concerning the shock decision by the South Eastern Health Board to end orthopaedic trauma services at Our Lady's Hospital, Cashel. I urge the Minister on behalf of the people in south Tipperary to refuse outright to ratify this decision, which is unfair, unwise and, indeed, damaging to the future health services in south Tipperary.

We are determined to fight this plan to centralise all orthopaedic trauma services in Ardkeen in Waterford. Regretfully, the decision is merely the continuation of an ongoing policy to undermine the health services in south Tipperary. This policy will reduce the number of health services available to the county. Furthermore, it will compel Tipperary patients to travel unacceptably long distances for urgent medical treatment. It is morally indefensible to dismantle this orthopaedic service, for two reasons. First, the waiting list, even for appointments with an orthopaedic surgeon in Cashel, is now 18 months to two years. Why is the South Eastern Health Board not taking steps to reduce this waiting list instead of abolishing the service and dashing the hopes of those unfortunate people of ever getting an early appointment in this new centralised service?

Second, the necessary infrastructure does not exist to facilitate a centralised service in the south east. The roads and the transport service are not good enough. As a result of this decision ten beds for orthopaedic care will be transferred from Our Lady's Hospital in Cashel. The chief executive officer stated that the decision was based on quality versus local convenience. Will the Minister agree that the availability of an immediate hospital service which saves lives is essential when there may not be time to travel for quality service? Health service is about people and this decision is a fatal blow, not only to Cashel but to the south east which will be totally dependent on hospital facilities in Waterford. The people of south Tipperary are not prepared to allow their health service to be gradually eroded. I appeal to the Minister to appreciate the concerns of all the people who strongly object to this decision.

I ask the Minister to protect the excellent services provided at present by Our Lady's Hospital, Cashel, and not allow south Tipperary to be stripped of a quality health service, which is not only appreciated but needed.

Minister of State at the Department of Health (Mr. O'Dea)

A major review of orthopaedic services in the South Eastern Health Board was undertaken by the Department of Health and Comhairle na nOspidéal during 1991-92. The reason for the review was the general dissatisfaction in regard to the organisation and level of orthopaedic services in the region. Waiting lists for elective orthopaedic surgery were growing because of the volume of trauma cases being dealt with in Kilcreene. It was envisaged that Kilcreene would be solely an elective orthopaedic hospital but, for a variety of reasons, the situation had developed where approximately 60 per cent of the workload being performed there was trauma-related. The review was undertaken to advise the South Eastern Health Board on the organisation of orthopaedic services for the region in the most effective and efficient manner.

The review group, in preparing its report, consulted widely within the South-Eastern Health Board area. Subsequent to the review group's report, the South-Eastern Health Board engaged in a lengthy and comprehensive series of discussions at local level. The report was discussed at the general hospital programme committee of the board and subsequently at the board meeting of 11 February 1993, where, as the Deputy is aware, a full discussion on all the issues took place.

The review group, in its report of March 1992, recommended that major orthopaedic trauma cases should be brought to Waterford Regional Hospital. It was not envisaged by the review group that all orthopaedic trauma cases would be brought to Waterford.

The Minister for Health was anxious that the board consider all aspects of the review group's recommendations and make a decision based on local needs having regard to the observations of the board's management following their detailed local discussions and consultations.

The review group recognised that there were a number of potential disadvantages to centralisation for the other hospitals in the region and, to minimise such disadvantages and extra travel impositions on patients, the review group recommended that regular and frequent consultant orthopaedic input should be made to Our Lady's Hospital, Cashel, by the consultant orthopaedic staff based at Waterford. The report envisaged that (a) two orthopaedic clinics per week in Cashel would be conducted by a designated consultant orthopaedic surgeon, at least one would be a fracture clinic; (b) in conjunction with these clinics, a ward consultation service in Cashel should be provided for in-patients at the request of locally-based consultants; and (c) the designated consultant orthopaedic surgeon should be responsible for providing an advisory service to Cashel on orthopaedic related problems to the staff of the local general hospital.

All the above elements will be incorporated in the new arrangements following the health board's recent decision. The South Eastern Health Board has also decided that the direct transfer of major orthopaedic trauma to Waterford Regional Hospital would not be adopted at this time. The board considered that such cases should be brought to the nearest acute hospital for assessment and emergency care in accordance with good medical practice.

The Minister for Health understands that the health board's recent decision, which involves in some respects a modification of the review group's recommendations, was made only after very detailed and careful consideration, and in the best interests of the population it serves.

Mrs. T. Ahearn

The Minister agrees with me.