Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank the Leas-Cheann Comhairle for allowing me to raise this important issue on the Adjournment tonight and the Minister for coming in to answer, I hope, positively.

Several people have contacted me recently regarding the fact that they must travel for dialysis to Dublin's Beaumont Hospital, which is already overcrowded and working 24-hour shifts to keep up with demand. One patient from Monaghan had to travel 180 miles three days per week, and he is well over 80. That is totally unnecessary. Another patient living just a few miles from Cavan General Hospital had to leave home at 2.30 a.m. three days per week for dialysis at 5 a.m., arriving home some time after midday. This is costing €600 or €700 in taxis. However, I welcome the fact that the patient in question is now back in Cavan as a result of some unfortunate deaths as well as transplants.

I ask that the necessary funds be provided for Cavan General Hospital to ensure that an extra shift can be put in place to save people from having to make that unnecessary journey three days per week. There was a tremendous effort to have the renal dialysis ward set up in Cavan, and it provides a great service, dealing with 45 patients. We seek an extra shift, which is absolutely logical. I have a letter here from one lady who wrote directly to the Minister concerned. She said that the extra shift in Cavan General Hospital would help with the desperate problem of overcrowding in Beaumont as well as the unnecessary travelling by people in need of dialysis from the Cavan-Monaghan area. She had to travel 170 miles to and from Dublin three days a week, something that is very hard on one, physically as well as medically, and I am sure it is worse for older people — the lady in question is just 49. Older people, several in their 80s and with other serious or related illnesses, find it impossible to understand why they must make that journey.

If the money spent on travelling expenses were put to better use by supplying the extra shift in Cavan, it would make a huge difference to that person and all other patients travelling from the Cavan-Monaghan area. The patient went on to say that, as far as she could see, the problem was the result of bad management of resources in the health board area. At one stage, we were told that we would get a new consultant in Cavan and that that was the reason for the delay. Is the consultant position all that important? The hospital has excellent trained nursing staff. In the three months that the lady was on dialysis, she never once saw a consultant in Dublin.

I have a letter from the person in charge of another case in Cavan, who said that the consultant will be appointed in March and that the hospital may re-examine the situation then. However, the issue is urgent. There is a failure to use resources properly. The Cavan unit is brilliant and everyone is very happy with it. I cannot emphasise enough the excellent service that it has given to those patients from Cavan-Monaghan who have been able to use it. It is hard to explain to someone why a unit in Beaumont can work 24 hours per day, with the person having to travel during the night to use it, when a unit is available in Cavan. It is a matter of rostering the necessary personnel and easing the load on Beaumont, the travelling expenses and the unnecessary pressure on patients and families that the journey imposes.

Tim O'Malley (Limerick East, Progressive Democrats)
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On behalf of the Tánaiste and Minister for Health and Children, I wish to respond to the Deputy's concerns regarding dialysis services at Cavan General Hospital. The Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Responsibility for the provision of dialysis services at Cavan General Hospital rests with the executive.

My Department has been advised by the Health Service Executive, north-eastern area, that the current position on the dialysis unit at Cavan General Hospital is as follows. A locum consultant has been in place at the unit since July 2002. The executive has further advised me that a consultant physician with a special interest in nephrology will take up duty at the unit in early March 2005. It is anticipated that this development will provide an opportunity for the executive, in conjunction with the new consultant, to review all aspects of the service being provided, including the number of patients being treated.

My Department is advised that the current complement of the unit is 47 patients. It is the intention of the executive to examine the following issues relating to the dialysis unit upon the arrival of the new consultant: the feasibility of providing haemodialysis services to an increased number of patients; the provision of an enhanced service on an outpatient basis; and consideration of making available continuous ambulatory peritoneal dialysis to patients in the north-eastern area. All the above would require additional clinical input in the areas of dietetics, psychological services and counselling, and social work supports to patients and families.

The executive further advises that it liaises very closely with renal units in the Dublin hospitals to minimise inconvenience as much as possible for patients who have to travel for treatment from the north-eastern region. Renal services have been identified by my Department as one of the main acute hospital priorities for development.

The requirement for renal dialysis services is growing at a high rate. The net increase in new dialysis patients is between 10% and 15% per annum, and it is likely to continue increasing at that rate for the foreseeable future. The number of patients on dialysis increased from 641 to 1,106 between 1998 and June 2004, an increase of 72.5% in six years. There are many reasons for that large increase, including greater levels of obesity, a greater number of diabetics, especially where diagnosed at a late stage, and increased longevity in the population.

My Department has provided additional revenue funding of over €28 million since 2000 to develop renal services in Ireland. An additional €8 million was provided in the 2005 Estimates. Total additional funding of €2 million has been provided for the development of renal services in the north-eastern area since 2000, of which €475,000 was allocated for the current year. That significant investment has supported the development of renal services on a regional basis, with the approval of seven additional consultant posts specialising in nephrology, including the new post at Cavan General Hospital.

I assure the Deputy that my Department will continue to support the provision of dialysis services in a way that takes account of the needs and preferences of patients, and of the communities in which they live. The configuration of those services is a very important aspect of the role of the new Health Service Executive.

Séamus Healy (Tipperary South, Independent)
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I thank the Ceann Comhairle for allowing me to raise this matter, which is also health related. The population of south Tipperary is entitled to the highest quality health services, just like patients in any other county. However, a number of issues that have been on the Minister's desk for some time need to be addressed urgently and referred to the Health Service Executive for completion. I refer to two problems in particular — overcrowding in the accident and emergency department at South Tipperary General Hospital in Clonmel and the transfer of general surgical services from Our Lady's Hospital, Cashel to the South Tipperary General Hospital in Clonmel.

As we are all aware, there is serious pressure on accident and emergency services throughout the country. On a recent visit to South Tipperary General Hospital in Clonmel, I found overcrowding in the accident and emergency department, which had spilled over into the main hospital. There were 35 additional patients on trolleys, a situation which was neither helpful to patients nor staff. Everybody was frustrated and angry at the situation, and they had every right to be. I spoke to patients who were unable to sleep because they were lying on hard trolleys. They were thankful to be in the hospital but not satisfied with the facilities and services available. I spoke with staff who were frustrated at not being able to give the level of service they believed they should be able to give.

This situation was compounded by the fact that an area within the hospital earmarked for a future acute medical unit is three quarters complete. It is an area under the roof of the hospital and a request to complete the unit and open it as an acute medical unit has been with the Department for more than two years. That would help to a large extent the overcrowding problem in the hospital. It would also tie in to the policies recently announced by the Tánaiste regarding the accident and emergency area.

The second problem that arises in the county is the transfer of general surgical services from Our Lady's Hospital, Cashel. That is promised for March of this year but cannot go ahead without the approval for the completion of units in the grounds of the hospital. Those units have been completed for approximately 12 months and are waiting approval for equipping and staffing. Approval is also awaited for the 20-bed GP assessment unit for the main hospital. These units must be opened and staffed properly to allow the transfer of the general surgical services to Clonmel and give the people of south Tipperary the level and quality of services to which they are entitled.

Approval for the 20-bed GP unit at Cashel and the 23-bed acute medical unit at Clonmel would go a long way to redressing the effect of the unfortunate and wrong closure of St. Vincent's Hospital in the late 1980s when 50 beds were closed at the hospital. The health services in south Tipperary have been bedevilled by the impact of that closure ever since. The health board at the time was not able to replace those beds and that has led to overcrowding in the accident and emergency unit, in the wards and on hospital corridors. Approval for the GP assessment unit and the acute medical unit would go a long way towards solving that problem and the problem of overcrowding in accident and emergency units.

The idea of a GP unit at Our Lady's Hospital in Cashel, together with other diagnostic services proposed for the hospital, including X-ray, physiotherapy and laboratory services, is an ideal way of providing health services. It dovetails with proposals the Tánaiste earmarked recently in regard to accident and emergency overcrowding which will allow services to be provided, particularly at a diagnostic and inpatient level, on a different site and ensure that the same pressure is not placed on the main hospital, South Tipperary General Hospital in Clonmel. I hope the Minister of State has some good news for me.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputy Healy for raising this matter on the Adjournment. Agreement was reached in 1996 to amalgamate acute services in south Tipperary requiring the transfer of surgical and accident and emergency services from Our Lady's Hospital, Cashel to South Tipperary General Hospital, Clonmel. This agreement provided for the development of older people, disability, palliative care and mental health services on the Our Lady's Hospital, Cashel site. It is planned to complete the developments in Cashel in two phases. Phase I has now been completed. This comprises three units: a 20 bed unit for elderly mentally infirm; a 12 place supervised community residence, day hospital and day centre, sector headquarters for mental health services; and 12 independent living units and day care centre for people with physical disabilities.

The planning stage of phase II of the Cashel development has been completed. Refurbishment of the main hospital building is required to accommodate the following services: a 20 bed GP assessment-rehabilitation unit; five bed palliative care units; a 15 bed convalescent unit; 25 bed specialist geriatric rehab units; a day hospital for older people, and an outpatients' department. The development of phase Il is contingent on the transfer of surgical services to Clonmel and the provision of capital funding for the project.

In recent years a major capital development programme to provide the infrastructure to facilitate the transfer from Cashel to Clonmel has been undertaken to bring surgical and acute medical services together on a single site. The integration of acute services on one site will greatly enhance the services available to patients in the region.

In recent years, significant capital investment of €30 million has been provided for the new facilities at South Tipperary General Hospital, Clonmel. The newly constructed facilities in Clonmel include the provision of a new emergency medicine department, ward accommodation, operating theatres, intensive care unit, day care unit, central sterile supplies department, physical medicine department, education centre and consulting rooms.

In September 2004, the Department of Health and Children, in the context of commissioning new units in acute hospitals throughout the country, gave approval to the South Eastern Health Board to commission the new facilities in Clonmel. In 2005, ongoing revenue funding of €3.8 million is available to the HSE-South Eastern Area to open the new facilities at South Tipperary General Hospital.

The Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision of services at Our Lady's Hospital, Cashel and South Tipperary General Hospital, Clonmel.

In order to progress the developments and resolve the issues, including staffing issues arising at Cashel and Clonmel, the HSE South Eastern Area, formerly the South Eastern Health Board, has carried out an analysis of five options to resolve outstanding difficulties. These options will be the subject of discussions at an early date between the Department and the HSE, in the context of the HSE's service plan for 2005.