Seán Sherlock (Cork East, Labour)
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The people of Mallow, north Cork, south Tipperary and east Limerick fear for the future of Mallow General Hospital, MGH. The 100 general practitioners who wrote to the Minister in September stated they are in despair and that "a blinkered vision of health delivery is slavishly following foreign models without taking into account the existing nature and makeup of the Irish Health Service". They contend, as do I, that all patient contact should be in centres of excellence, be it in primary, secondary or tertiary care. MGH is a primary example of a secondary facility that has punched above its weight, in spite of concerted efforts to downgrade it.

The Government, by reducing the hospital's budget by more than €500,000, did not take into account the fact that the information being supplied to warrant a cut is at best misleading and does not take into account certain factors. The hospital networks section of the HSE south, when asked to provide specifics in reply to questions I have posed to the Minister, responded with generalities which leave us none the wiser. I have tabled numerous questions to the Minister on the future of the hospital, the appointment of an executive management structure, the appointment of a radiologist, casemix, and the appointment of a radiographer to oversee the CT scanner that has been sitting in an empty room for years.

On the issue of casemix, I refer to Parliamentary Question No. 400 on 30 January 2008, where the HSE in response to my question on the €500,000 cut to the hospitals budget stated:

Mallow General Hospital has received a negative casemix adjustment of €571,233 for 2008 (which is based on 2006 activity). Management at the hospital are examining the underlying causes of the negative casemix adjustment for 2008 and a rigorous scrutiny of the hospital's base costs will be carried out.

MGH's budget had been cut because the workload of the hospital had been under measured through casemix because of a lack of clerical staff, but it does not suit the HSE to admit this. I have it on good authority that only 95% of MGH's workload was captured. The HSE's official line is that the budget was cut because of "inefficiencies". Nobody disputes that MGH's budget is the lowest in the country or that its workload is greater than many comparable hospitals. How is it then that its budget is cut?

I refer to the appointment of an executive management board. Why has Bantry hospital, with a smaller catchment area than Mallow, an EMB? I applaud Bantry hospital in this regard but it is lucky. The answers I received are an insult to the people I represent. I refer to Parliamentary Question No. 119 of 31 January 2008, in which I asked about the make up and reintroduction of the executive management structure. In its reply, the HSE stated that management of both the Cork University Hospital group and Mallow General Hospital are keen to enhance the management structures at the hospital and have over the past several months been working with the HSE's performance and development unit to facilitate the process of establishing an executive management board at Mallow hospital. It continued that key stakeholders have been met on a one-to-one basis to explore concerns, expectations, visions for the future and development needs, that discussions are ongoing and that a proposal to re-establish the executive management board at the hospital is currently being finalised.

According to the HSE, the review has taken slightly longer than anticipated because its scope was broadened to incorporate community-based services and to allow wider consultation with key stakeholders, including medical staff from the Mallow catchment area. Again, the HSE speaks in generalities but is short on specifics. It fails to acknowledge that an executive management board was in place Mallow General Hospital which ceased to operate and was never replaced. As for its assertion that there was a consultation with key stakeholders, this is stretching the truth. I can name 95 GPs who are key stakeholders in the area but were never consulted. I know of nobody in community-based services who was consulted. Which key stakeholders and medical staff from the Mallow catchment area were consulted? What does the HSE regard as the Mallow catchment area?

In the same reply, the HSE states that the acute hospital services review in HSE south will determine overall governance arrangements. To whom has the proposal for an executive management board for Mallow General Hospital been sent? On the issue of the CT scanner, which is also addressed in the reply, if the HSE see the benefits of the scanner, why did it not put a proper management plan in place in 2005?

We are concerned for the future of the hospital and that the acute hospitals review will seek to downgrade our accident and emergency services, postpone further appointments when current surgical terms of employment end and further delay the building of a day procedures unit. We want to see the appointment of a radiographer because we have waited too long for one. We want Mallow General Hospital to be a centre of excellence for secondary care. We are proud of our Hospital. If the HSE persists in downgrading the hospital by stealth, we will protest vigorously.

Pat Gallagher (Donegal South West, Fianna Fail)
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I thank Deputy Sherlock for giving me the opportunity to reply on behalf of the Minister for Health and Children, Deputy Harney.

I am advised that capital funding of €1.5 million was sanctioned by the Department of Health and Children for the installation and dedicated accommodation of a CT scanner at Mallow General Hospital in October 2004. Following receipt of fire certification and planning approvals, tendering arrangements for the entire project were put in place and work on the premises commenced in late 2005. In the meantime, tendering arrangements for the purchase of the scanner were also put in place. The scanner was delivered in December 2006 and the necessary commissioning works were undertaken by the supplier and completed in August 2007.

In regard to staffing, formal sanction for the posts was received by the HSE in September 2007 and the necessary arrangements to commence the recruitment and appointment of the appropriate staff were put in place without delay. Interviews for the clinical specialist radiographer, CT technician and senior radiographer were held during November 2007 and suitable candidates were identified. I understand that the HSE will be in a position to progress these appointments in the coming weeks.

Mallow General Hospital and Mercy University Hospital have approval for two consultant radiologist posts in a reciprocal sessional arrangement between the hospitals. The filling of these posts has been held up due to the consultants talks. The management of Mallow General Hospital, Mercy University Hospital and the southern hospital group are now in discussion on the timeframe for the filling of these posts. Subject to the staff being in place, it is expected that the CT scanner should be operational by May.

In regard to the budget, Mallow General Hospital has received a negative casemix adjustment of €571,233, based on 2006 activity. Casemix was introduced in an effort to collect, categorise and interpret hospital patient data related to the type of cases treated to assist managers define their services, measure productivity and assess quality. Casemix contributes towards equity, efficiency and transparency by clarifying and categorising hospital throughput. By allowing peer group comparisons, it creates an incentive for better performance. Management at Mallow General Hospital is currently examining the underlying causes of the negative casemix adjustment for 2008 and a rigorous scrutiny of the hospital's base costs is being carried out.

In regard to the other issues raised by the Deputy, I will obtain a copy of the report and request the parliamentary affairs division of the HSE to correspond directly with him.