Liam Twomey (Wexford, Independent)
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I have four specific questions and one general question to put in respect of this matter. If the Minister of State cannot answer the four specific questions, perhaps he would reply to me in respect of them at a later date. All my questions relate to Wexford General Hospital. Before posing them, I acknowledge that certain actions have been taken to aid the hospital, such as an increase in consultant numbers, the medical admissions unit working and doing an excellent job, approval being granted in respect of appointing an accident and emergency consultant and the Caredoc out of hours co-operative working very well in the primary care sector.

The first of my specific questions is when funding to staff the new geriatric day ward will be provided. The ward was built more than a year ago but, unfortunately, is not being staffed at present. The second question relates to the maternity unit, the number of births at which has increased from 1,400 to 1,800. When will funding to employ extra midwives be made available because the staff in the unit are overworked? My third question relates to the medical director, Dr. Paddy McKiernan, who resigned from an implementation committee for an extra 19 beds for Wexford General Hospital. Will these 19 beds ever materialise? My final specific question is whether the Minister will stress to the South Eastern Health Board the importance of appointing the accident and emergency consultant as soon as possible, especially in light of the seriousness of the situation for both doctors and patients in County Wexford.

On my general question, in trying to maintain standards, we must maintain progress. How can we possibly maintain standards at Wexford General Hospital and similar hospitals throughout the country when we continue to rely on the wholly inadequate Hanly report in respect of reform of the health services? This report does not deal with industrial relations issues, and the future of all hospital services, especially acute hospital services, are dependent on such issues.

We talk about transferring workloads from the acute hospitals to the primary care sector, but the primary care strategy has more or less stalled. It is unlikely that general practitioners already working in the primary care sector will be able to cope with the extra workload. The ambulance service will be inadequate in terms of coping with additional journey times if local acute units are closed in any of the 36 hospitals because most ambulance drivers are not trained emergency medical technicians.

They have basic first-aid training. If a drip-line fell out of a patient no one in the ambulance service would be legally covered to replace it. Considering the extra journey times that will result from the proposed reforms of the health service, this is an important issue.

The final issue, which is under discussion at present, is that of consultants' contract. Reform of the health service in terms of the EU working time directive cannot work unless the consultants' contract is changed. This issue is not being progressed.

The Hanly report is being sold to patients in areas such as the one I represent, where we have a general hospital which feeds into an excellent, if under-resourced, regional hospital. I hope the Minister of State will answer these four questions at a later date and comment on the final question.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputy Twomey for his questions. Many of the difficulties and delays experienced in emergency medicine departments reflect a system-wide issue such as the demand experienced by each hospital, the resources available to it and the structure organisation and staffing profile of the hospital.

The Deputy will be aware that the provision of services at Wexford General Hospital is, in the first instance, a matter for the South Eastern Health Board. The Department of Health and Children has been informed by hospital management that the situation in the emergency department of the hospital has improved this week. On Monday no patients were waiting on trolleys for admission to hospital. Earlier this morning two patients were waiting for admission and both patients were subsequently admitted. Hospital management and medical and nursing staff are actively working together to deal with the current pressures. I fully understand the demands and pressures placed on staff in these circumstances and their tremendous work is very much valued.

In 2003 my colleague, the Minister for Health and Children, Deputy Martin, provided for the appointment of four additional consultants in emergency medicine for the South Eastern Health Board, one of whom will have responsibility for the accident and emergency department at Wexford General Hospital. The availability of senior medical staff in emergency medical departments should facilitate rapid clinical decision-making and enhanced management, diagnosis and treatment of patients.

The South Eastern Health Board acknowledges, in its 2004 service plan, that there has been an increase of 12% in the population of Wexford since the 1996 census. Based on data supplied by the board to the Department of Health and Children, there has been an increase of approximately 10% in attendances at the emergency medicine department of the hospital in the period January to November 2003 compared with the same period in 2002. Overall admissions to the hospital have also increased in recent years.

Increasing the bed capacity of the acute hospital system nationally is a key priority in improving access to acute services. More than 560 new beds have been provided in hospitals throughout the country under the acute hospital bed capacity initiative. Funding has been provided by the Department to the ERHA and the health boards to commission the remaining beds approved under the first phase of this initiative.

Wexford General Hospital opened ten new medical assessment beds with funding provided under this initiative. Increasing the acute bed capacity of Wexford General Hospital continues to be a priority for the South Eastern Health Board. In this regard, the board has plans for the provision of an additional 19 beds at the hospital. All new capital commitments for 2004 and beyond are being reviewed by the Department of Health and Children in light of the overall funding resources available. The provision of additional bed capacity for Wexford General Hospital will be considered in this regard.

The Deputy has raised the issue of casemix. Under the casemix budgeting system, which is part of the resource allocation process for the acute hospital sector, a positive adjustment of €409,000 has been applied to Wexford General Hospital for the 2004 allocation based on its activity performance and costs in 2002 relative to other hospitals which participate in the casemix system. Casemix contributes towards equity, efficiency and transparency by classifying and categorising hospital outputs. It also creates an incentive for better performance.

Since its inclusion in the casemix programme in 1998 Wexford General Hospital has consistently gained funding, with the exception of the year 2000.

The Department of Health and Children will continue to work with the South Eastern Health Board in identifying the capacity requirements of Wexford General Hospital and seeking solutions to the pressures being experienced at the hospital. I will try to ascertain the answers to the other questions Deputy Twomey has asked.