Tuesday, 17 May 1983
Dáil Eireann Debate
Mr. B. Desmond: The North-Eastern Health Board have sought a meeting with Comhairle na nOspidéal, which have the statutory function of regulating the number and type of consultant medical appointments in hospitals, to discuss the appointment of an obstetrician-gynaecologist to the County Hospital, Dundalk.
The health board has also recently sought funding from my Department for this post. A letter has issued to the board drawing attention to the new procedures to be followed in respect of applications by health agencies for sanctioning of posts falling within the ambit of the Comhairle. The new procedures, which were set out in a letter of 8 March 1983, from my Department to health agencies, involve the completion by the health agency concerned of a form indicating the total costs to which the post will give rise and the extent to which these costs can be met by redeployment of existing resources. When this information is received my Department will indicate the funding possibilities to the health agency and the Department's response should be included in any application to Comhairle na nOspidéal. These new procedures have been arranged to meet difficulties posed by the current financial situation.
Dr. O'Hanlon: Is the Minister aware that there is a unique situation in Dundalk County Hospital? The county physician is expected to act as obstetrician-gynaecologist in 1983. He is not qualified to carry out such procedures as caesarian sections, and he is obliged to call on the county surgeon to carry out those procedures for him. The county surgeon who  did that down through the years resigned and the new county surgeon does not carry out these procedures. The county physician is in an impossible position, and so are the patients. I am sure the Minister is aware that at Dundalk County Hospital there were 700 deliveries——
Mr. B. Desmond: There are 14 maternity beds in Dundalk County Hospital and obstetrics services are provided by the physician at the hospital as the Deputy indicated. In 1981 the number of births was 500. I have not got the figure readily available for 1982. I will accept the Deputy's figure of 700 and have it checked. An advertisement for a locum obstetrician-gynaecologist in the Dundalk hospital appeared in the Irish Independent of 13 April last. The CEO decided to advertise the post without waiting for Comhairle approval, and without having the Department's agreement on funding.
We had no option but to inform the CEO that the filling of the post should not be proceeded with until Comhairle approval is obtained and until funding is agreed with the Department in accordance with the new procedures. I am not indicating that we will not reach agreement, but I am adamant that the new procedures will have to be adhered to. It is not just a question of appointing a consultant. It is a question of costing the additional back-up staff and all the other  arrangements on a revenue basis. When that is available we will make a decision.
Dr. O'Hanlon: Does the Minister accept that the problem is between the Department of Health and the Comhairle and that the CEO recognised the responsibility of the health board when the advertisement for a locum obstetrician-gynaecologist in the interests of the patients in the hospital? Is the Minister aware that the health board received a letter from the Comhairle stating that they were waiting for the Department of Health to decide on the future of the maternity unit in Dundalk before making any recommendation on the matter? Does he also accept that a certain amount of confusion has arisen as a result of his own action in changing the role of the Comhairle?
Mr. B. Desmond: At the moment I have applications for 79 separate consultant appointments on my desk. We have not got the money. These posts are throughout the country. Each can vary in terms of current revenue from £50,000 to £500,000 per annum. On 28 January last my Department had detailed discussions with representatives of the North-Eastern Health Board on maternity developments in the area. I can assure the Deputy that we are very conscious of the situation in Drogheda and in Navan. I will do my utmost. Our projection of births is around 6,400 per annum. We have done a detailed study on the needs of Dundalk and Navan.
Mr. B. Desmond: That is part of the general review. I do not claim to have complete professional knowledge, and far be it from me to interfere, but I have to find the money and nobody will start anything until the money is found.
Mr. Leonard: asked the Minister for Health if he will approve a second consultant obstetrician-gynaecologist post at Monaghan General Hospital, in view of projected births for the area contained in the recent report presented to the board on maternity services; and if he will make a statement on the matter.
 An application to the Comhairle by the North-Eastern Health Board for approval to a second post of obstetrician-gynaecologist at Monaghan County Hospital was refused in March 1981 on the grounds that the workload in obstetrics and gynaecology at Monaghan would not justify the appointment of a second consultant. The health board have not to date submitted a further application to the Comhairle.
Mr. Leonard: Does the Minister realise that the Department of Health and the Comhairle have reduced the number for double cover from 1,500 to 1,000? There is an anticipated increase in the area. We had 1,000 live births in the area, and 700 of them in that hospital. If we had a second gynaecologist the number using the hospital would increase. There is a projection of a 20 per cent increase to 1,230 births by the end of the century. Is this not the time to prepare?
Mr. B. Desmond: In 1981 the number of births in Monaghan hospital was 621. Admittedly, a second post of obstetrician-gynaecologist was established in Cavan County Hospital in 1978. The duties of the second post in Cavan were to include a cross-cover arrangement with Monaghan County Hospital, but the cross-cover services have not proved workable for some reason. I accept that the projected number of births in County Monaghan in 1990-91 is 1,231 but, as the Deputy knows, the Comhairle could justify consultancy staff to a maternity unit with two obstetrician-gynaecologists only where births ranged between 1,500 and 2,000 a year.
Mr. Leonard: Does the Minister agree that in the advertisement for the post in Cavan it was stated clearly that there would be cross-cover for Monaghan, but as it transpired it did not materialise? What is the Minister's view on the advertising of the post?
Mr. B. Desmond: I am rather curious about it and I intend to find out why it did not materialise because it was on that  basis that the second post of obstetrician-gynaecologist was established in Cavan County Hospital.
Dr. O'Hanlon: Is it correct to say that the health board cannot apply to the Comhairle without first making application to the Department of Health? If that application is made will the Department of Health recommend such an appointment?
Mr. B. Desmond: The position is that if the health board wish to approach the Comhairle the Department of Health must be advised of the cost implications. We will then make our observations known to the health board and our observations, together with the health board's application, go to the Comhairle. It will be two-way traffic in future and as a former Minister for Finance will agree it is about the most appropriate way of doing this.
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