Breeda Moynihan-Cronin (Kerry South, Labour)
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I had hoped the Minister for Health and Children would listen to this debate as it concerns a health issue. I am very disappointed she has left. I am pleased the Ceann Comhairle has afforded me the opportunity to raise this issue. Sadly, it is not the first time I have had to highlight the difficulties at Kerry General Hospital, Tralee. I reiterate my disappointment that the Minister has left the House in the past few seconds and would not wait five minutes to hear my point.

The management and staff at Kerry General Hospital are a team of dedicated and committed professionals who provide a wonderful service to the people of Kerry and to our visitors during the summer months. Their commitment and dedication is not matched by the Department of Health and Children and the Government in terms of resources, funding and personnel for the hospital, particularly in accident and emergency which is the focus of this debate.

I had the opportunity to visit Kerry General Hospital with my colleague, the Labour Party spokesperson on health, Deputy McManus. We met management and staff who raised a number of concerns, particularly the delay in progressing the much-needed extension to the accident and emergency unit. The need for such an extension is indisputable. The staff see 20,000 patients per annum and waiting times are short. However, there is a need to extend the unit to enhance the services provided. There are just four cubicles with three beds in the resuscitation ward. These are used as an overflow for emergency cases. The facilities for families and relatives are insufficient and staff often operate in cramped conditions.

There is a pressing need to have the medical assessment unit open on a 24-hour basis. Since 1993 the unit has given priority access to general practitioner patients who may not need admission to the hospital but need urgent medical assessment. This takes pressure off the accident and emergency department. The medical assessment unit is open between 9 a.m. and 5 p.m. from Monday to Friday, but as we are all aware, people get sick not only during these times, they also get sick during the night and at weekends. The medical assessment unit needs to be open 24 hours per day, seven days per week if it is, as the HSE states, "to fulfil its true potential and to alleviate waiting periods in the accident and emergency department".

This needs to be addressed with the necessary funding and personnel to make the unit operational around the clock. The cap on public sector recruitment is having severe consequences in Kerry General Hospital. The accident and emergency consultant told me that the extension of the accident and emergency unit would resolve the space and capacity difficulties in the unit. However, staffing levels would need to be increased, to include three new registrars, to use the new facilities. The cap on recruitment imposed by the Government will make that impossible. Building the new accident and emergency unit will be worthless if the staff are not available to make the extended unit operational.

I ask the Minister, through the Minister of State, to address three specific issues. A clear timeframe needs to be provided for the extension of the accident and emergency unit at Kerry General Hospital. Funding must be provided to allow for the recruitment of staff to open the medical assessment unit on a 24-hour basis. The cap on public sector recruitment needs to be addressed as this will prohibit the functioning of the new accident and emergency unit when it is extended.

We have a very efficient accident and emergency unit at Kerry General Hospital, but significant problems need to be addressed. This is prevented by the failure of the Government to sanction the extension of the accident and emergency unit and to provide the necessary funding and personnel to allow it to operate at full capacity. I ask the Minister of State, in the absence of the Minister, how much longer the people of Kerry will have to wait for the Government to respond to these issues.

Tim O'Malley (Limerick East, Progressive Democrats)
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The Deputy will be aware that 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 Kerry General Hospital.

The Department of Health and Children has been advised by the Health Service Executive southern area that a project group has been established and is preparing a statement of need for the upgrading and extension of the existing accident and emergency department at Kerry General Hospital. The proposed development includes a resuscitation room, X-ray facilities, extra treatment and observation places, improved waiting areas and special facilities for children.

The detailed capital funding programme for hospitals for 2005 is being finalised in the context of the Capital Investment Framework 2005-2009. This process will be concluded in the near future and the Health Service Executive will then be in a position to make progress on its capital programme, in line with overall funding resources available in 2005 and beyond. A decision on the extension and upgrading of the accident and emergency department at Kerry General Hospital will be made in the context of the agreed capital framework for the executive.

A medical assessment unit was established at Kerry General Hospital in 1993. The main objective identified for the unit was to give priority access to GP patients who may not necessarily need admission to hospital but who need urgent medical assessment. Another objective was to assist the hospital bed management services in managing bed demand.

As the Deputy is aware, the unit is open from Monday to Friday, 9 a.m. to 5 p.m. The HSE recognises that for the unit to fulfil its full potential and to alleviate waiting periods in the accident and emergency department, it would be necessary to extend the opening hours to a full 24 hours per day, seven days per week service.

The additional resources required to operate the unit on a 24-hour basis is a matter for the Health Service Executive to consider in the context of available resources. I am confident that Kerry General Hospital will continue to provide high quality services to the people of Kerry.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this issue. There is a need for the Taoiseach and the Tánaiste to take a similar interest in the position regarding Monaghan General Hospital as they are prepared to take in regard to Ennis General Hospital. The Taoiseach has pledged to personally intervene in the upgrading of services in that hospital. The provision of an improved casualty unit, a high-care unit with a reasonable level of surgery, is the minimum we want in Monaghan General Hospital. That is what was promised but at this point everything is uncertain and that is extremely worrying. The casualty unit was to open in February but as yet the funding — out of a national fund of more than €11 billion — has not been provided to staff this unit.

There are five consultant surgeons in Cavan General Hospital and one in Monaghan General Hospital. The plan of the Health Service Executive is to place the three new surgeons in the Cavan-Monaghan hospital group. It is clear every effort is being made, even by devious means, to persuade or encourage the one surgeon in Monaghan General Hospital to either move from Monaghan General Hospital or base himself in Cavan General Hospital.

I welcome the information I received today that the junior surgeons will be allowed stay in Monaghan General Hospital for another six months. However, that is no way to run a business not to mention a hospital structure, lurching from month to month with no long-term commitment. Staff times are being changed so that surgery has to close at 5 p.m. Often that means the operating theatre is closed at 4 p.m. to ensure deadlines are adhered to. Valuable theatre and other services are only partially used at a time when the Government is funding, ad lib, the national treatment purchase fund that could easily and safely be used to carry out procedures at Monaghan General Hospital. I remind the Minister of State that only a few years ago patients were brought under contract to that theatre in Monaghan General Hospital from Northern Ireland and now it is half closed.

Lack of services in Monaghan General Hospital is forcing patients into Cavan General Hospital where the accident and emergency department is overflowing. There is a lack of management of resources at both sites. Clearly, there is a need to ensure full and proper use by the Health Service Executive of facilities at theatre and bed level. The information available to me leads me to question who is in charge.

The Tánaiste and Minister for Health and Children cannot wash her hands of this ongoing problem with the Cavan-Monaghan hospital group. Tonight I am dealing with Monaghan General Hospital but one cannot ignore the fact that it is supposed to be a joint group.

On 29 September 2004 the then Minister for Health and Children, Deputy Martin, promised that a 24-hour seven-day large emergency room would be operational from the end of February, ten additional beds would be coming on stream immediately at Monaghan General Hospital, and a CAT scan would be provided at Monaghan General Hospital. We want no more promises. We do not expect what was promised at the election but we need acute emergency services to be retained at Monaghan General Hospital. We must be able to have accident cases stabilised.

We do not want another case such as that highlighted at an inquest in Dundalk this week where the consultant, Dr. Lynch, said that if the patient had been dealt with in Monaghan General Hospital the patient might have had a chance of survival but none at all after the journey. The coroner in Dundalk was angry and said he could not place blame. He could not believe the services were not available in Monaghan General Hospital. Only if worthwhile surgery remains in Monaghan General Hospital can the overall unit be retained as an emergency unit. If it is not retained it raises major questions so far as industry, sport and so on is concerned in that area. In the absence of the Tánaiste, I beg the Minister of State to ensure that when the funding is distributed in the next few days that proper recognition is given to the Border region and that we are no longer ignored.

Tim O'Malley (Limerick East, Progressive Democrats)
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I welcome the opportunity to respond to Deputy Crawford on this matter and to outline to the House the position with regard to the provision of surgical services across the Cavan-Monaghan hospital group.

Under the Health Act 2004, the Health Service 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 services at Monaghan General Hospital rests with the Health Service Executive.

My Department is advised by the Health Service Executive north eastern area that the position in regard to the reconfiguration of surgical services is as follows. In April 2004 the chief executive officer of the former North Eastern Health Board issued a directive to establish a steering group for the Cavan-Monaghan hospital group, to determine the level of service to be provided at each site. The steering group reported in October 2004.

My Department is advised by the Health Service Executive, north eastern area, that the position in regard to the reconfiguration of surgical services is as follows. The steering group, following consultation with the Royal College of Surgeons in Ireland, has recommended that major emergency and elective surgery be carried out at Cavan General Hospital and that selective elective surgery be performed at Monaghan General Hospital.

In accordance with the recommendations of the steering group, a full surgical team, based in Cavan, will provide services at Monaghan General Hospital, Monday to Friday. There will be a consultant surgeon present at the Monaghan site on each of these days. This joint department of surgery team will provide selective elective surgery, endoscopy and outpatient services and consultation on inpatients as required.

In accordance with the steering group's recommendations, the hospital returned to 24-hour seven day medical cover in January 2005. A third consultant physician has been in post since November 2004 and five new anaesthetic non-consultant hospital doctors have been recruited to facilitate the return of the hospital to medical on-call. Their role is being developed as part of a joint department of anaesthesia and will include ensuring the safe transfer of patients when required and to assist the consultant anaesthetist in theatre during surgery.

Consistent with the recommendations of the steering group, ten additional day beds are to be commissioned at Monaghan General Hospital to facilitate the development of surgical services across the Cavan-Monaghan hospital group. The executive has advised that gynaecological and obstetric services, including outpatients, ante-natal services and day gynaecological services including colcoscopy, are now provided at Monaghan General Hospital.

Interviews are being held this month for three permanent replacement consultant surgical posts for the Cavan-Monaghan hospital group. It is envisaged by the Health Service Executive that the appointment of these three consultants will see an enhancement of surgical services provided at Monaghan General Hospital and the early implementation of the steering group's recommendations in regard to surgery across the Cavan-Monaghan hospital group.