Colm Burke (Fine Gael)
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I thank the Minister of State for dealing with this matter. The matter I wish to raise relates to work being referred to Cork University Hospital. I will read from something that was sent to me:

Two of the large Dublin hospitals, namely St James's & St Vincent's hospitals, are unilaterally imposing very narrow catchment areas and returning letters to GPs with 'Out of Catchment' or 'Deflect' stamped on them. This means that the GP is then forced to re-refer the patient to a hospital that does not operate catchment areas although that hospital may be much further from the patient's home. A recent example of this is a patient from Enniscorthy, Co Wexford referred to St Vincent's, the letter is rejected and returned to the GP who then has no choice but to refer to Cork University Hospital where there are much longer waiting lists and is without a public transport link to Wexford.

Kathleen Lynch (Cork North Central, Labour)
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On behalf of the Minister for Health, I thank Senator Burke for raising this important issue and for the opportunity to update the House on the issue of hospital referrals and catchment areas. It is important to note that there is no statutory basis for hospitals imposing catchment areas. However, they have been part of custom and practice within the health service in general for many years. The Minister has been advised by the HSE that it has not altered or changed its national policy on catchment areas. In particular where hospitals traditionally accepted a referral volume to its hospitals from a geographical area, it is expected to continue this acceptance within certain volume referral limits. Furthermore, hospitals from time to time advise GPs on the most efficient referral routes for particular treatments if their capacity in a region increases due to the recruitment of a new consultant or changes due to the reorganisation of clinics or services across a network of hospitals.

In relation to the specific issue of dermatological services for patients from the Wexford area, University Hospital Waterford provides the catchment area referral services for dermatological patients within the south east, which includes Wexford General Hospital. The Minister has been advised by the HSE that there have been some staffing challenges in the dermatology department at University Hospital Waterford and, as a result, the hospital is temporarily unable to accept routine dermatology referrals. Efforts are continuing to recruit replacements for the vacant consultant dermatologist posts at Waterford. An interim arrangement is in place with South Infirmary Victoria Hospital in Cork to maintain provision of services for patients from the south east pending resolution of the staffing issues at Waterford. In addition to this arrangement, University Hospital Waterford is ensuring an ongoing and close linkage with the dermatology department at St Vincent's Hospital and, from 13 November, Waterford will also have a weekly attendance from a consultant dermatologist from Cork who will oversee provision of a service to non-urgent cases in the system. The hospital is also endeavouring to make arrangements with other hospitals in the surrounding regions to take some of the dermatology patients. The foregoing arrangements will be subject to review. The HSE is working with all hospitals to target specific improvements in waiting lists and times across all specialties, including dermatology. The HSE acknowledges that some hospitals will not be in a position to provide capacity for a referral from outside its local geographical area. All referrals are prioritised in line with the HSE's outpatient management guidelines to ensure appropriate scheduling of urgent referrals.

Colm Burke (Fine Gael)
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While I fully accept the Minister of State's response and the response from the HSE, the logistics of someone travelling from Wexford to Cork are not practical. The natural area for Wexford should be towards Dublin. The reason I am raising this issue is not so much that I am concerned about patients from Wexford, although I am concerned about them, but rather about the overloading of the system in Cork, where there is already huge pressure on the hospital, including on urgent issues like skin cancer, with which they must deal. They now find they are coming under increasing pressure and just cannot deal with even the urgent matters because of the volume that is coming in. There is a problem with Waterford, and I will talk to the Minister of State later about why the problem arose in Waterford. It is very important the vacancies there are filled at the earliest possible date, but the hospitals in Dublin should be asked to share the problem rather than passing the buck, as is happening at the moment.

Kathleen Lynch (Cork North Central, Labour)
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I will ensure Senator Burke's remarks are passed on to the Minister for Health and we can speak at a later stage about the need to ensure the posts that are vacant are filled. I have to say that it is not just in this area there is a difficulty in recruitment. Senators Crown and Burke have a particular interest in this. We have a serious issue with both replacing and retaining medical professionals.