Dáil Éireann díospóireacht -
Thursday, 21 Nov 2002

Vol. 557 No. 6

Ceisteanna – Questions. Priority Questions. - Ambulance Service.

Paudge Connolly

Ceist:

2 Mr. Connolly asked the Minister for Health and Children his views on the recent remarks of a person (details supplied), medical adviser to the executive of the North Eastern Health Board, as reported in the local press, to the effect that there is a potential 5% acceptable level of mortality in medical emergencies in relation to the enforced transfer of patients by ambulance to hospitals other than Monaghan General Hospital; and if he will make a statement on the matter. [23106/02]

Mr. Martin

The North Eastern Health Board has advised my Department that the ambulance service in the region is operating to an agreed protocol in relation to the transfer of medical emergency cases to the nearest hospital site. It has further advised my Department that no such comment, suggesting that there is a potential 5% acceptable level of mortality in medical emergencies in relation to the transfer of patients, was made by its medical adviser.

Mr. Connolly

My information is that it was stated by people who attended a meeting in Kells to an audience of 1,500 people who were concerned about the services at Monaghan General Hospital. It was also widely reported in the paper that there was a potential for fatalities in 5% of cases. In view of the reckless disregard in respect of medical and surgical emergencies in County Monaghan, will the Minister inform me whether the NEHB has any policy objectives in relation to patients in the county?

Is the Minister aware that while beds are still being closed in Monaghan, there is no policy in the North Eastern Health Board for an upgrading of services in other hospitals throughout the north-east to care for these extra requirements? Is the Minister aware of the musical beds scenario in the North Eastern Health Board whereby patients are transported from Monaghan General Hospital to Cavan General Hospital to Our Lady of Lourdes Hospital, Drogheda, and Dublin or from Monaghan General Hospital to Dundalk, only to find there is no bed available, and back to Monaghan? Lives have been lost and this life threatening merry-go-round continues as a result of the downgrading of services at Monaghan General Hospital. Maintaining services in Monaghan could offset the expenditure involved in transferring patients to other hospitals. Is the Minister happy to preside over such a policy?

Is he aware in regard to the treatment purchase scheme agreement signed with the NHS more than 12 months ago, we are buying products that we were selling to the UK at the beginning of the year? Routine surgery was being performed for hernias, varicose veins—

An Leas-Cheann Comhairle

The Deputy is giving information whereas the idea is that he should ask for information.

Mr. Connolly

Is the Minister happy there is a five year waiting list for elective tonsillectomies in the north-east? Does he accept that as good practice?

Mr. Martin

Before I deal with the substantive elements of the questions, I need to clarify the allegation in terms of the statement by the medical adviser to the North Eastern Health Board. The question tabled by the Deputy states the adviser allegedly said there is a potential 5% acceptable level of mortality. We have consulted the health board and it denies such a statement was made. The board stated no such comment suggesting there was a potential 5% acceptable level was made. I do not know whether interpretations are being put on what was said but the statement needs to be clarified. We will not do that today but I have been informed that no such statement was made.

The Deputy stated there could be a possible 5% level which is different to "acceptable level". The question almost implies the medical adviser said there was an acceptable level of mortality in such scenarios. That is a strange statement to make and it should be clarified in fairness to the medical adviser.

Mr. Connolly

I wish to clarify the question I tabled. My concern was that the Monaghan hospital alliance met the medical adviser and deputy chief executive officer of the health board. It was the first such meeting ever with the medical adviser and during it he indicated that in 95% of cases there would be no difficulty with ambulance transfers from Monaghan. However, he stated that in the other 5% of cases resulting from serious accidents and so on, there was the potential for a 5% mortality rate. The group was concerned when he stated that, in the pursuit of best practice and patients' interests, this could happen and so be it.

Mr. Martin

Was the word "acceptable" used?

Mr. Connolly

No, the word "potential" was used.

Mr. Martin

The question used the word "acceptable" and that puts a totally different gloss on it. We can resolve this issue later.

With regard to the other issues raised, a proposal was put on the table last September and views were sought from the Royal College of Surgeons and the Royal College of Anaesthetists. That latter group, in particular, has endeavoured to be co-operative in attempting to arrive at a resolution to the issues in Monaghan. I am not happy that elective surgery cannot take place there. Given the investment in facilities at the hospital, particularly in the new surgical unit which cost more than £1 million, we want them to be used.

Compromise is needed and pending further talks and discussion, agreement is needed on an interim basis on the template that was provided in September because the vast majority of cases are dealt with by day. The number of surgical procedures that take place late at night is minimal. I wonder why there is such a dispute. We must also develop a Cavan-Monaghan axis in terms of training and accreditation. People must realise that future accreditation and training will be dictated by the criteria set down by the colleges of training, not by me or the health board. We must work with them to develop acceptable templates for training and accreditation. The Cavan-Monaghan axis is one in that locality.

Mr. Connolly

Compromise is an art. We are having difficulty engaging in meaningful dialogue. I agree with the Minister that the vast majority of procedures take place between 9 a.m. and 5 p.m. However, the most serious accidents occur between 9 p.m. and 3.30 a.m. and that has been borne out statistically.