Brian O'Shea (Waterford, Labour)
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There are glaring deficiencies in the provision of dermatology Services in the south east. The appalling situation at present is that one consultant dermatologist is single-handedly providing a service for a population 460,000 people. Comhairle na nOspidéal having consulted the literature relating to dermatology service provision in the UK, North America and Australia published a report in November 2003 recommending that there should be one dermatologist per 100,000 population. The greater Dublin area has the lion's share of consultant dermatologists. The south east which has the largest population outside Dublin remains the only region with only one consultant dermatologist.

Clinics are provided in Waterford Regional Hospital, Wexford General Hospital, South Tipperary General Hospital and St. Luke's Hospital Kilkenny. There are more than 3,500 patients waiting two to three years for a routine hospital appointment in the south east. While it is likely that this list will be somewhat reduced if validated, there are long lists for routine problems and patients are suffering. There is a weekly paediatric dermatology clinic with a current waiting list of six months.

Some general practitioners on the periphery of the region refer their patients to Cork Limerick and Dublin. These centres increasingly refuse to accept referrals from outside their regions which adds to the pressure on the inadequate provision in the south east region. Ever increasing incidents of all forms of skin cancer take up a considerable amount of time at the Department. The Dermatology Department in Waterford is small and inadequate, with one consultant dermatologist, one specialist trainee registrar, a specialist nurse and two nurses, who job share. The Department removes approximately 700 cancers annually. The Department runs a pigmented liaison mole clinic for the early detection of melanoma and provides a mole mapping service.

There is also a multi-disciplinary head and neck skin cancer clinic run in conjunction with the local ophthalmic plastic surgeon and an eye and ear surgeon, all of which generate surgical activity. Waterford is one of the few centres in the 26 counties which provides photodynamic therapy, a non-invasive treatment of superficial skin cancers.

This all amounts to a work load that is way too much for one consultant dermatologist. Added to this is the fact that no suitable locum dermatologist has been available in recent years to provide cover for the annual and study leave of the consultant dermatologist in Waterford.

Skin disease impacts on quality of life, interpersonal relationships and even job prospects. For the past 12 years this situation in Waterford and the south east has been ignored. This appalling situation cannot be allowed to continue and requires immediate and decisive corrective action. I call on the Minister for Health and Children to take urgent action to ensure that there are additional dermatologists and back-up teams appointed forthwith to the south east region within the HSE south, with the appropriate required accommodation.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am again taking this item on the Adjournment Debate on behalf of the Minister for Health and Children, Deputy Mary Harney.

The Government is committed to ensuring quality health services, delivered efficiently and effectively. Ensuring patient safety is paramount, so that people can have confidence in the services and that the best possible patient outcomes are achieved.

Dermatology is the medical specialty caring for illness predominately relating to the skin, hair and nails. It is mainly an out-patient/day care activity with a small in-patient requirement. The HSE recognises that dermatology services in the HSE south east region require further development. The proposed development of services is in line with the main principles and key recommendations as identified by the Comhairle na nOspidéal report of the Committee on Dermatology Services published in November 2003.

Among the main principles of the Comhairle approach are an equitable and patient centred service regional self-sufficiency and collaboration between primary and secondary care. At present there is one consultant dermatologist working in the south east region. The dermatology service includes in-patient care where required; day cases and out-patient consultations. Outreach clinics are provided in Wexford, Kilkenny and Clonmel. In Waterford Regional Hospital, the dermatology services include a range facilities including out-patient clinics, cryotherapy, minor surgery and nurse-led phototherapy services.

The HSE has identified the provision of a second consultant dermatology post among its priorities for development. This year the Minister allocated funding to the HSE for demographic service pressures, and the Executive decided to prioritise posts in vascular surgery and orthopaedics in the south east. These posts were approved and are now being progressed.

The HSE is faced with difficult choices in delivering its services within the resources available. It will continue to keep the scope for further developments in dermatology services under consideration bearing in mind the funds it has available. In line with the national service plan 2009 and its transformation programme, the HSE will review the current configuration of acute hospital services in the south east. A steering group is developing a plan for hospital reconfiguration.

This plan will seek to deliver optimal and cost effective services that are easily and readily accessible and that are delivered through centres of excellence. All hospitals in the south eastern hospital group are included in the plan for the revised model. The review, which includes a broad-based consultation within the services, is likely to be completed in 2010. Decisions on the services of any individual hospital will be taken following its completion.

It is within the context of this review that any expansion of the dermatology services in the south east will be considered.