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Hospital Services.

Dáil Éireann Debate, Wednesday - 7 April 2004

Wednesday, 7 April 2004

Ceisteanna (3)

Liz McManus

Ceist:

3 Ms McManus asked the Minister for Health and Children the meaning of the promise that 24-hour medical cover will be retained by local hospitals in regard to the commitment given by the Taoiseach on 5 March 2004; if the 24-hour cover at accident and emergency services will be provided by general practitioners and junior hospital doctors or by qualified accident and emergency consultants; and if he will make a statement on the matter. [10918/04]

Amharc ar fhreagra

Freagraí ó Béal (24 píosaí cainte)

I have asked the groups dealing with the implementation of the Hanly recommendations in the mid-west and east coast regions to ensure that medical cover will continue to be provided overnight in each acute hospital. The issue will also form a part of the work of the acute hospitals review group which is to develop a national hospitals plan in line with the principles of the Hanly report.

Medical cover means that a doctor is available to provide a medical assessment or treatment overnight. The grade of doctor called on to provide medical cover will be in line with anticipated patient need. There may be a number of options for ensuring appropriate overnight medical cover. These could include, for example, consultants, doctors in training, general practitioners, medical officers or a combination of these, depending on the circumstances.

The issue of medical cover relates to services for patients who need medical attention overnight. I look forward to constructive proposals emerging from the two local implementation groups and the acute hospital review group in this regard.

We will work to ensure that arrangements for overnight medical cover are in keeping with the requirements of the European working time directive, under which no doctor may work for longer than an average of 58 hours per week by 1 August this year. This will reduce to no more than an average of 48 hours per week in August 2009.

I have already taken a number of steps to develop further the services being provided in smaller hospitals. In Ennis General Hospital I have given approval for the appointment of a design team to plan for infrastructural improvements. This underlines that I am committed to developing smaller hospitals appropriately rather than closing or downgrading them, as some have claimed.

Regarding accident and emergency services, I have put in place a number of initiatives to deal with pressures in emergency medicine departments. An additional 20 consultants in emergency medicine have been appointed and a further nine appointments are in train. This more than doubles the number of emergency medicine posts in place since 2000 when there were just 21 such posts. The total is now 51 approved emergency medicine posts.

The Mid-Western Health Board has recently advertised for a number of emergency care physicians. These are fully registered doctors who will complement service delivery in emergency departments in the region. I have also announced my intention to provide, as soon as possible, extra resources for the roll-out of training for emergency medical technicians.

I have provided €21.4 million to facilitate the discharge of patients from the acute system to more appropriate settings, thereby freeing up acute beds. I have also taken steps to reduce the extent to which emergency medicine departments must deal with injuries and conditions which are more appropriate to the primary care setting. A total of €46.5 million has been allocated for the development of out-of-hours co-operatives since 1997.

Will the Minister accept that his answer demonstrates the deep confusion about the Hanly report recommendations? Is he aware that the implementation body in the East Coast Area Health Board region has not met yet and will he comment on that? Does his response mean that he is now in conflict with the Hanly recommendation on local hospitals? The report states on page 68: "Ultimately there should not be a requirement for on-site medical presence overnight or at weekends." Is the Minister saying that has now been shelved? It seems to be clear now that what the Minister means is that accident and emergency services will no longer be available in local hospitals and that at least is consistent with Hanly.

The decision and recommendation in Hanly is to downgrade accident and emergency to the point where it is meaningless in the sense that it is specifically described in the report as a minor injuries unit which is nurse-led, open during the day, not open at night and all medical emergency care is directed to a major hospital. This is specific in the Hanly report. Will the Minister now acknowledge publicly that accident and emergency services in these local hospitals in the pilot areas, which obviously are the model for everywhere else, will be put out of existence if Hanly is implemented?

There are industrial relations problems at present affecting the participation of consultants on a variety of committees. It is no surprise that applies to the local implementation groups in respect of the Hanly report. The Deputy did not need Question Time to elicit that information because it is a fact. It is delaying the situation and the progress of the implementation groups and their work and that is regrettable. I do not believe the action is justified, especially given the work being done to resolve the medical indemnity issue.

The Minister should stick to answering the questions I have asked. He should not go down that cul-de-sac.

I want to have time to answer the Deputy's question about whether or not the groups have met. I have explained why they have not met. The Deputy knows the reason but she asked the question.

In terms of overnight medical cover, I met David Hanly last January. As far as he and his group are concerned, if this can be organised within the requirements of the European working time directive, there is no issue. We will provide overnight medical cover.

The Hanly report uses the term "ultimately" and that does not mean next year or the following year and if it can be done without having to do that, we will do it. It is not as if every line of the report is set in stone and that is my policy in terms of that issue. It is wrong to state that accident and emergency services will close or be reduced. The Hanly report does not state that. The report makes it clear that 70% of what is going through accident and emergency services will continue to be dealt with by such services in smaller hospitals.

Some people have a nerve to go on about emergency services given that, up to the year 2000, there were 20 emergency care consultants in the entire country. They have deliberately given the false impression that emergency care consultants were available at night in every hospital. That was never the case. Deputy McManus and every Deputy in the House is aware of that.

The Government wants to take proper and effective action on behalf of patients and that means, above all, providing funding for the training of emergency medical technicians to an advanced level so that the first point of contact with a patient on the side of the road is much more effective. In the past, emergency medical technicians were not legally allowed to administer drugs. Development of primary care in the regions and the physical upgrading of hospitals, including emergency treatment rooms, is taking place in Ennis, Roscommon and other hospitals. Significant investment has been made. Accident and emergency services will continue to be provided in these hospitals. It is important to put that on the record.

This is just huffing and puffing on the part of the Minister. This is bluster and rubbish.

The local elections are on the way.

I refer the Minister to page 63 of the report which states: "All hospitals providing emergency care must have acute medicine, surgery and anaesthesia on site." That means an irreducible minimum of 21 specialist doctors. That is written in stone as far as this report is concerned. The Minister can pretend and try to obfuscate all he likes but this report has been accepted by his Government. Just because local elections are coming up does not let the Minister off the hook. The report is a serious document which has been accepted by him and its recommendations are crystal clear. According to the report, emergency services cannot be delivered in local hospitals because they will not have 21 specialists. It is an irreducible minimum. Both the Minister and I know that local hospitals do not have that capacity at present.

With all due respect, the Government has accepted the Hanly report.

Then the Minister should live up to it. He should have a bit of courage.

Deputy McManus is exploiting the content of the Hanly report to try desperately to win votes for her party in the local elections. She is deliberately——

Is the Minister saying I am misquoting?

——exploiting the contents of the Hanly report.

What is the Minister doing?

The Chair calls Question No. 4.

That is what the Deputy is doing. She knows very well, as do all Deputies, that there never was overnight cover by 21 senior consultants in surgery, anaesthesia or medicine in any hospital.

Will the Minister deal with Question No. 4?

I want to clarify a point. It is right and proper that victims of major trauma——

Medical emergencies.

——should go to the hospital where the most appropriate treatment is available. We should not cod people——

The Chair has called Question No. 4.

——by pretending that alternative services are better for them when they are not.

The Chair has called Question No. 4.

Medical emergencies, not major trauma — emergency care.

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