Denis Naughten (Roscommon-South Leitrim, Fine Gael)
Link to this: Individually | In context

I thank the Leas-Cheann Comhairle for selecting this matter for the Adjournment debate. I want the record of the House to show that the Minister for Health and Children, who was present for Question Time, has left the House. I thought she might at least show me the courtesy of staying to hear what I have to say.

In August 2006 the Health Service Executive, HSE, announced its plans to transfer inpatient surgery from Roscommon County Hospital to Portiuncula Hospital in Ballinasloe as an interim measure before its transfer to University College Hospital, Galway. In September that year the now Minister of State at the Department of the Environment, Heritage and Local Government, Deputy Michael Finneran, had the plan postponed until after the general election. On the eve of the general election the then Minister for Finance, Deputy Brian Cowen, told RTE on the steps of Roscommon County Hospital that the hospital would not be downgraded. The plan was shelved until February this year when it was resubmitted to the hospital network manager of the HSE and on 28 April the green light was given by Ms Ann Doherty of the National Hospitals Office. The decision was made to implement the transfer of inpatient surgery from Roscommon County Hospital to Portiuncula Hospital in Ballinasloe.

In April the HSE advertised for a consultant surgeon to fill Mr. Flynn's position in Portiuncula Hospital and three more posts for consultant surgeons will be advertised shortly. The appointments will be made between now and the end of the year and, if they are lucky, they hope to make all the appointments for the posts already advertised. Appointments will be made of five general surgeons with no particular speciality. The only appointment that needs to be made prior to the transfer of sources from Roscommon to Portiuncula is to fill Mr. Flynn's position. Once that is done the HSE insists it can implement the transfer of surgery from Roscommon County Hospital to Portiuncula Hospital within 12 months. The HSE was to give an outline of its plan to Roscommon County Council on 26 May but that meeting finished after less than an hour because the Government was to meet the National Hospitals Office on 28 May.

I do not understand why the second option, put forward by local consultants, has been rejected and why the HSE and the Government have not been prepared to outline their plans regarding the hospital. The Government has not issued a statement on the future of the hospital because if the news were positive local representatives of the Government would trip over each other to claim credit. It is important that the Government issues a statement as we do not want another agreement made behind closed doors. The Minister of State, Deputy Finneran, knows well what happened the last time. We want a clear statement on the floor of this House regarding the plans for inpatient surgery at Roscommon County Hospital. It is important that the Government and the HSE stop hiding behind closed doors. If the HSE and the Government are so confident that the downgrading plans are in the best interests of Roscommon County Hospital and the people who rely on it, why are they not prepared to talk to the media or engage in public debate either here in the House or at a meeting of Roscommon County Council? The HSE claims it is not a cost-cutting exercise but the reality is different. Not one additional bed will be provided in Portiuncula Hospital, Ballinasloe, which will see a doubling of inpatient surgery. In fact, there will be a reduction in capacity of two beds at Portiuncula Hospital. No additional day surgery will be carried out at Roscommon County Hospital and there will be no additional investment in the ambulance service in County Roscommon. The next stage is the removal of the accident and emergency department, initially to Portiuncula Hospital and subsequently to University College Hospital, Galway, in line with the Government's policy as stated in the Hanly report. This is already happening in Louth County Hospital; inpatient surgery was moved to Drogheda and now the accident and emergency department is to be transferred by the end of the year. That is being used as the blueprint for the downgrading of services at Roscommon County Hospital, as categorically stated by the hospital network manager for the western region.

It is vital that we are given a clear and unambiguous statement on the future of inpatient surgery at Roscommon County Hospital, the retention of acute medical services and the accident and emergency department. I ask the Minister of State to tell us whether the green light has now been given to the HSE to proceed with the transfer of inpatient surgery services from Roscommon to Portiuncula and when that decision was made. Has the Government taken any action on this to date? Why have no additional resources been put in place for emergency acute medical services in Roscommon?

Mary Wallace (Meath East, Fianna Fail)
Link to this: Individually | In context

I will take this Adjournment matter on behalf of my colleague, Deputy Mary Harney, the Minister for Health and Children.

The Government is committed to ensuring the delivery of the best quality health services possible and to doing so effectively and efficiently. Ensuring patient safety is of paramount importance so that people can have confidence in the service and the best possible patient outcomes can be achieved.

The Health Information and Quality Authority was established on a statutory basis in 2007 and is responsible for driving quality and safety in the health and social care services. In 2007 a new Medical Practitioners Act — the first major overhaul in 30 years of the law regulating the medical profession — was enacted. Also in 2007, the Minister for Health and Children established the Commission on Patient Safety and Quality Assurance to develop proposals for a service-wide system of governance based on corporate accountability for the quality and safety of all health services. In this context it is essential that every health care provider and facility is fully cognisant of patient safety and quality issues and takes account of these in the organisation, management and delivery of services. The priority is to provide safe services as close as possible to where people live.

The HSE has conducted a review of surgical and anaesthetic services at Roscommon County Hospital and Portiuncula Hospital, Ballinasloe. The difficulties faced by Roscommon and Portiuncula in maintaining surgical services independently, and the need for closer co-operation between them, was highlighted by the former Comhairle na nOspidéal in March 2006. The best way of retaining and developing services at Roscommon and Portiuncula hospitals is for both hospitals to work together. In the past, these two hospitals operated independently, with two consultant general surgeons in each hospital. Advances in clinical care and ever-increasing levels of specialisation mean this model of care is no longer sustainable. Small stand-alone hospital services will not be able to offer their doctors the opportunity to treat a sufficient volume and variety of patients to maintain their skills. Nor will they be able to provide the range of experience required for training new doctors. As a result, it will prove increasingly difficult, and perhaps impossible, to fill consultant posts on a permanent basis.

The development of joint departments of surgery and anaesthesia will provide a better service for patients of both hospitals. The plan is to combine the staffing and workload of the existing small service units in Roscommon County Hospital and Portiuncula Hospital into joint departments of surgery and anaesthesia serving both hospitals. This will involve joint consultant surgical and anaesthetic posts. While the more complex surgical cases will be treated in Portiuncula, this represents only about three cases per week on average. Roscommon Hospital will continue to provide surgical services for the rest of its patients. It is likely that more Roscommon patients than heretofore will be able to have surgery performed at the hospital because most surgery can be carried out on a day basis, which is also more convenient for patients.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
Link to this: Individually | In context

Does that mean in-patient surgery is gone?

Mary Wallace (Meath East, Fianna Fail)
Link to this: Individually | In context

The HSE has advised that there is no proposal arising from this review to close the accident and emergency department at Roscommon County Hospital.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
Link to this: Individually | In context

Shameful.

Mary Wallace (Meath East, Fianna Fail)
Link to this: Individually | In context

I have endeavoured during my reply to stress the terms "patient safety" and "quality of care". The Deputy did not address that in his speech, but it is important that he take this into account——

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
Link to this: Individually | In context

The Minister of State obviously did not listen to what I said.

Mary Wallace (Meath East, Fianna Fail)
Link to this: Individually | In context

I was listening to the Deputy.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
Link to this: Individually | In context

A second option was put on the table.

Mary Wallace (Meath East, Fianna Fail)
Link to this: Individually | In context

I did not hear much from the Deputy about quality and safety, which are important issues.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
Link to this: Individually | In context

The Minister for Health and Children did not think it worth her while to stay and listen to what I had to say.