John Crown (Independent) | Oireachtas source

I know that I have the opportunity to talk about the Midlands Regional Hospital in Portlaoise, but looking at it from a clinician's perspective, it looks like the basic interchange between two entities, with one administrative organisation criticising the other for what its perceives as an inadequate administrative response. I do not think that is a high priority. The problem is not unique to Portlaoise; it is emblematic of a set of broader problems in the health service which require fundamental structural change. I know that I sound like a broken record, but a big chunk of the problem is due to the number of specialists involved. I am grateful for the detailed answer to my question. According to the numbers, we have probably the lowest number of career level obstetricians per head of population of any country in the western world. Some 10% of obstetrician jobs, according to the figures provided today, are occupied by locums. This understates the disproportionate distribution of the problem. I suspect there are very few locums in the three Dublin hospitals and in the hospitals in Cork, Limerick and Galway. I could be wrong, but I suspect that in smaller units there is a disproportionate utilisation of locum services. No matter how well trained locums are, it is not as satisfactory an arrangement as having somebody who is providing for continuity of care throughout the entire course and trajectory of a pregnancy and in the provision of after care. Those who go on to have a number of children may want to have a consultant who is aware of their obstetrical problems from prior pregnancies. It is not a good arrangement.

The Minister comes very close to identifying the problem when he states it appears to him that some units are so unattractive to Irish graduates who are training, by and large, in international centres of excellence that they cannot recruit them to work and that as a result the jobs are being filled by locums, which is leading to the conclusion that perhaps the units might not be viable. I would like the Minister to think of an alternative explanation because there is one. The basic currency, for want of a better word, that determines the viability of an obstetrical unit is the number of births. The question is whether there are units which deal with an insufficient number of births that it is not possible to have sufficient obstetric, paediatric, midwifery and ICU resources to provide modern 21st century care and, if so, whether these units should be closed down. It is that simple. If that is the logic of what the Minister is saying, I would absolutely support him in gutting the number of units in the country and closing them down. However, it is not true. There were approximately 2,000 births in Portlaoise last year, or about six every day, which is enough to support a well staffed unit with enough obstetricians to provide attractive jobs for those who want to come back from the leading centres of excellence and with their own paediatric special care baby unit and on-site 24 hour intensivist paediatrician. This is not a remote part of rural British Columbia where people are spread over thousands of miles. This is a concentrated area in which there is a large number of births and which should have its own proper modern obstetric service. If we cannot attract good people to it, it is not because there are not enough births but because we have made a decision that the unit will not be adequately staffed.

I asked a question about medical schools and I am a little less happy with the quality of the answer I have been given. I am very interested in knowing how many are actually employed full time by medical schools working as academics at consultant level in the clinical specialties of internal medicine. The figures I have been given are not reflective of this but reflect people who have health service jobs because their job is based in a teaching hospital and have a degree of entitlement as "academics". The numbers I have been given do not add up. I will not go into all of the details today, but I believe the number of doctors employed in medical schools as full-time academics with dominant clinical academic components to their jobs is very small. We need to get to the bottom of this issue. It is hard to justify giving priority to reforming the medical school sector when there is no major constituency for this reform. Therefore, it is hard for politicians to see it as a high priority at a time when people have to wait for two years on a waiting list and deaf children sit at the back of the class and are not able to have their ears tested for six months at a time. We have six medical schools; we have twice as many per head of population as the European average and three times as many per head of population as in the United States, with an entirely inadequate level of staff. I have to be careful about how I say this, but I suspect that a very rigorous scrutiny by external agencies of the education service provided in these medical schools might result in greater urgency to fix them.

I am very grateful to Mr. O'Brien for clarifying the issues in respect of percutaneous transluminal coronary intervention. He needs to know a little about the hospital group idea. A hospital group is a good idea if we get the reforms right; however, it is not if we do not. It appears to have been ignored in the way services are being organised in Dublin. The Mater hospital and St. Vincent's University Hospital made a proposal to form one hospital group, with one university and one medical school. The very large cohort of cardiologists in the two hospitals who are very good and very experienced decided that they wanted to be seen as one entity for transluminal coronary interventions. They would work a 24 hour, seven day a week and weekend rota, but they were turned down. They are a little confused and cannot quite understand the reason for this. For hospitals which have not traditionally worked well together, becoming involved in hospital groups involves a certain degree of compromise. They believe this compromise is not being rewarded in dealing with the specifics of this issue and that it is not laid out as logically as it should be.