Dáil debates

Thursday, 28 March 2019

Saincheisteanna Tráthúla - Topical Issue Debate

Health Services Staff

5:10 pm

Photo of John BrassilJohn Brassil (Kerry, Fianna Fail)
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I very much welcome the opportunity to raise as a Topical Issue the provision of cardiology services in University Hospital Kerry as it is something which is absolutely critical to the functioning of the hospital. The Minister of State will be aware that University Hospital Kerry is a level 3 24-7 hospital with an emergency unit. As of early last year, it has been operating without the services of a full time cardiologist. This situation was brought about by the resignation of the previous cardiologist. At the time, there was great concern and I had a Topical Issue matter on it at the time. I was assured in response to my questions in June 2018, that in conjunction with Cork University Hospital, the South/South West hospital group was to appoint two additional cardiologists, split between the two hospitals, and the ratio was to be 75:25, which would effectively result in one and a half cardiologists for University Hospital Kerry, which would allow it to function as the level 3 hospital that it is. We are now into April 2019 and as of yet, we do not have those two positions.

Concern is growing about funding being diverted to the national children's hospital and spending being withheld until we see the downsides of Brexit. Conspiracy theories are emerging because the action that was promised almost a year ago has still not been delivered. Coupled with that, the coronary care unit in the hospital, which is a nine-bed room, is stretched to the limit. There are no facilities for proper consultation among staff or for carers and family members of patients. That sends out a message that there is no genuine desire to provide the type of cardiology services that are needed for a category 3, 24-7 hospital.

Can the Minister of State confirm that funding for the provision of two cardiologists shared on a 75:25 basis with Cork University Hospital is ring-fenced and that those cardiologists will be in place in a very short time, allowing the hospital to then plan for its future as a category 3 facility? Without such assurances, I will be extremely concerned about the hospital's ability to function as it needs to. I remind the Minister of State that such was the concern among the hospital's consultants last year when this issue arose, among many other issues, that every single one of them took the unprecedented step of writing to the South/South West hospital group requesting immediate action on the shortfalls in key positions, including cardiology, respiratory consultancy and emergency room consultancy. I look forward to the Minister of State's response and hope it gives me the reassurance that I and the hospital need.

5:20 pm

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister for Health, Deputy Harris, I thank the Deputy for raising this issue and giving us the opportunity to provide an update to the House. The cardiology department in University Hospital Kerry, UHK, performs a variety of testing on the heart such as electrocardiogram, echocardiogram, stress testing, Holter and blood pressure monitoring and pacemaker checks. It is important to note that, consistent with the recommendations in the national acute medicine clinical programme for model 3 hospitals such as University Hospital Kerry, patients with acute coronary syndrome are transferred to the primary coronary intervention centre in University Hospital Limerick. Cork University Hospital, CUH, is the tertiary referral centre for more complex cardiology patients.

In respect of the Deputy's specific query regarding the status of additional cardiologist positions for UHK, in June 2018, the South/South West hospital group advised that it was developing a business case for the appointment of two consultant cardiologist positions split between UHK and CUH. I am pleased to advise the Deputy that both posts are now awaiting approval by the HSE's consultant appointment advisory committee and, once approved, the advertisement of these posts can commence immediately.

With regard to the wider issue of consultant appointments in general, the Government remains committed to increasing the consultant workforce to support service delivery and to move to a consultant delivered service. While there are approximately 450 consultant posts that are not filled on a permanent basis and are filled by locums or temporary staff to support the delivery of essential services, the number of consultants has increased by 125 in the 12 months to the end December 2018 and by 540 in the past five years. At the end of December 2018, there were 3,096 whole-time equivalent consultants working in the public health services, the highest number in the history of the State.

The HSE is also committed to supporting consultant recruitment and retention, pursuing a number of initiatives, including improvements to the recruitment process, offering contracts to the hospital group rather than individual sites and focusing on family friendly arrangements. It has established a tripartite working group, including the Medical Council, the forum of postgraduate medical training bodies and the national doctors training and planning unit of the HSE to examine posts where the consultants are not on the specialist register as well as recruitment and retention challenges.

Photo of John BrassilJohn Brassil (Kerry, Fianna Fail)
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I thank the Minister of State for her response. I am knocked for six by the line that the advertisement of these posts can commence immediately. That is beyond belief. On 28 June last year, in response to a parliamentary question on the very same issue, I was told the replacement process commenced as soon as the official resignation was received from the previous cardiologist. The response further stated that UHK was working with the South/South West hospital regional cardiology group to appoint two additional consultant cardiologists split between UHK and CUH. Here we are ten months later, and I am told that the posts have not even been advertised yet. It is farcical. I do not know if the HSE gives us these replies and thinks we will forget about them and not refer back to previous answers when it comes up with this drivel. It is unacceptable to have told me almost a year ago that two consultants were to be appointed when here we are today and the posts have not been advertised yet.

I was about to speak about the fact that there is a 25% pay deficit between pre-2012 and current consultant contracts. If the HSE is looking for 450 posts, how in the name of God is it going to fill them when there is a 25% pay gap between two people who are doing the same job? I will not go into that now. The response leaves me beyond words but I will take this issue much further. The lack of respect and action is totally unacceptable. This is a 24-7 hospital operating without a cardiologist. What world are we living in?

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I do not have much to add. I have listened to the Deputy and know he is not happy with the response I have been given. The reply states that once the HSE consultant appointment advisory committee approves the advertisement of the posts, the process can immediately commence. I do not see what is wrong with that. I do not know the reason it has taken as long as it has to come to a point where the consultant advisory committee is still in consultation over the consultant posts. I do not know the history of that but I will certainly pursue it with the Minister and ask him to respond to the Deputy. I know the Deputy is not happy with the response but unfortunately I cannot ease his frustration with the reply he has received.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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It is considered that replies given to parliamentary questions and Topical Issue matters should reflect the best possible and most accurate information available at the time from any Department. The Minister of State is here in good faith, obviously. There is an appeal system in place for Members who are unhappy. It would appear to me that the Deputy has reason to be very unhappy.

Photo of John BrassilJohn Brassil (Kerry, Fianna Fail)
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It is not directed at the Minister of State. It is the content of the response that has me extremely frustrated.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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I suggest that the Deputy avail of the appeals process. The Minister of State is responding to the next matter as well.

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I am in the firing line again.