Dáil debates
Thursday, 5 February 2015
Topical Issue Debate
Hospital Services
4:00 pm
Eamonn Maloney (Dublin South West, Labour)
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The issue relates specifically to the MRI scan service at our largest paediatric hospital, Our Lady's Children's Hospital, Crumlin.
It has an impressive record of care for children and continues to have that reputation nationally and beyond. The issue is the delay in the scanning service. I have had representations from parents about the increase in the backlog and staff at the hospital have also highlighted this issue recently. We all share concern about the lack of out of hour MRI services for emergency cases. Waiting times for scans for children have continued to climb despite the fact that the hospital, to its credit, has moved to provide a Saturday morning MRI service, for which I praise it.
Out of every 74 requests the hospital receives for scans only 42 per week are carried out. We have to find a way to resolve this. I appreciate that, as staff have said, scans are time consuming. They can take up to 45 minutes and children under the age of two years require sedation while those under seven have a general anaesthetic. The service in Crumlin is used for 35 hours a week. The hospital management has discussed this with the HSE. Despite the difficult times we are in, improving the health services is not always a question of providing money. There are customs and practices that deserve to be considered. It is a matter of improving this service and trying to move away from a situation where some children wait as long as 27 months for a scan. I hope that, with the cooperation of the Department of Health, the HSE and hospital management, it might be possible to improve the service.
4:10 pm
Leo Varadkar (Dublin West, Fine Gael)
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My understanding was that this debate was about medical infrastructure in general. I am happy, however, to stick to the issue of the MRI in Crumlin, which is the Deputy’s major concern. By sheer coincidence I spent three hours in Crumlin today. I was there officially to turn the sod on the new hybrid cardiac catheterisation laboratory, Cath Lab, that is under construction but I took the opportunity to visit the intensive care unit, ICU, and the emergency department, to meet with the board, senior management and the senior medical and nursing staff and many others.
One of the issues we discussed was the delay for non-urgent MRIs. Urgent cases are prioritised. If an MRI is required in an emergency it is available 24 hours a day, seven days a week, in Temple Street Children’s Hospital which is the neurology centre. As the hospitals will be merged and brought together on one site they work together very well and patients are taken to Temple Street if they need an urgent MRI out of hours. The number of MRI scans has gone up from approximately 1,600 a year or two ago to 2,000. This is not a case of cutbacks but of rising demand. That is a feature of our health service. The hospital does do a list every second Saturday to try to deal with the delay.
There are two rate limiting factors. One, which the Deputy identified, is that the MRI scanner is used for only 37 hours a week. We would like that to move to an 8 a.m. to 8 p.m. service on weekdays at the very least. That is provided for in the Haddington Road agreement. It would require staff, overtime and so on. The board is working with the hospital group on a solution to extend the hours so more work can be done.
The second rate limiting factor relates to the need for anaesthetists because young children cannot stay still in the tunnel for long, they get very afraid because of the claustrophobic effect and the noise and need to be sedated or anaesthetised. There is a shortage of anaesthetists in Ireland as in most countries. It is difficult to recruit them. The hospital will be advertising for two additional anaesthesiologists very soon. I hope there will be applicants. Once those posts are in place the hospital can decide how best to use their time.
Eamonn Maloney (Dublin South West, Labour)
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I thank the Minister for his interesting reply. Some argue that a simple solution to the problem would be to provide more equipment but of course that is extremely expensive. It costs, I think, over €1 million. In these times we will not see too many additional scanners. I am encouraged by what the Minister said about moving on to utilise the service and expanding it. I did not realise we had a shortage of anaesthetists. I would be curious to know why – I am sure the Minister has an answer.
I acknowledge the Minister’s point because the staff say that emergency cases are facilitated and it has a good track record in that area. By good fortune the Minister had his own discussions this morning with these people. Developing the Saturday morning service would go a long way to solving the problem. The National Health Service, NHS, in Britain has many practices that have improved the service including Saturday service. Some hospitals in Scotland did the same. It would encourage parents and staff if the service could be used to its maximum. It is good to hear that it is going in that direction.
Leo Varadkar (Dublin West, Fine Gael)
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I do not have much to add other than to answer the Deputy’s question about the shortage of anaesthetists or anaesthesiologists. There are not enough of them around the world. There are shortages in many jurisdictions. If there are any unemployed ones I have never met them. They take a long time to train, six years in medical school and another five or six years of higher training. Health services around the world are competing for senior doctors. Last week, the HSE, the Department and the Irish Medical Organisation, concluded an agreement on revised salary scales for new entry consultants to make it more attractive for them to take up posts in Ireland, to make sure that the salaries are competitive with those in Australia and England. I hope that will result in more applications for the 200 or so vacant consultant posts in our health service. There are those who believe we should have income equality to the extreme, that nobody should be paid over €100,000 or should pay 60% or 70% tax on income over €100,000. The effect of that in Ireland would be to have virtually no hospital consultants, and patients would suffer and die.
Eamonn Maloney (Dublin South West, Labour)
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There would be no anaesthetists.