Wednesday, 13 November 2002
Dáil Eireann Debate
Does the Minister understand the seriousness of a situation where 150 patients are affected by a lack of cover by doctors, and must travel from Enniscorthy to Wexford for ordinary medical care? Is the Minister really aware of the position in the hospital? It is disorientating for patients, and elderly patients have had to be moved for routine medical care on several occasions in the past week. It can take over one hour to transfer a patient from St. John's Hospital to Wexford General Hospital and I want to know the provisions the Minister has made to deal with emergencies that may arise. I also want to know if the crisis is the result of poor communications or a lack of understanding of the patients' needs. Has the Minister for Health and Children any comment to make on nurses' liability for medical complications that may arise during this dispute?
When a patient is moved from the hospital in Enniscorthy to Wexford General Hospital, the casualty department in Wexford is held up. The patient must wait for routine treatment in Wexford while there is no doctor on call at St. John's. The Minister must resolve this problem as soon as possible.
Funding has been put in place for Caredoc in County Wexford, as have sufficient cars and equipment, and it will take only a small amount of money to bring the scheme to the county. Caredoc was to be introduced in October 2002. The Minister has known since September that this would happen but he did not react to the real needs of patients. He should introduce Caredoc to Wexford and, if he will not do that, he must solve this problem as soon as possible.
Mr. B. Lenihan: I thank the Deputy for raising this issue and for giving the Minister for Health and Children an opportunity to put the position on this matter on record. One of the key objectives of the Minister for Health and Children is to promote, develop and provide an effective and efficient system of general practitioner out of hours co-operatives. The development of such co- operatives forms a central plank in the Government's primary care strategy.
A good example of successful implementation of such a co-operative can be seen in Caredoc, operating in the South Eastern Health Board area. Since its introduction, the Department of Health and Children has provided more than €4 million in funding to Caredoc. This represents merely part of the approximately €20 million the Government has provided nationally to support the development of general practice out of hours co-operatives.
The current issue at St. John's Hospital involves the withdrawal of cover by a group of general practitioners who had an agreement with the health board to provide out of hours cover to the hospital. I understand that responsibility for the out of hours cover to St. John's was to transfer to the Caredoc co-operative when it commenced in the Wexford area. This was to be part of a proposed expansion of Caredoc. I am also aware that the existing formal arrangement for out of hours cover at St John's had been due to expire at the end of September, but that the doctors agreed to extend the arrangement for one month pending the planned start-up of the Wexford co-operative. Any decision regarding the expansion of Caredoc to Wexford is a matter for the South Eastern Health Board. In making a decision on expansion, the health board would have due regard to the range of financial and other issues involved.
Having considered these issues in late summer 2002, the South-Eastern Health Board decided to defer the expansion of Caredoc until it receives confirmation of funding for 2003. However, the board has informed my Department that the expansion of Caredoc into County Wexford remains a priority. Notwithstanding this, my Department is pursuing funding to expand Caredoc, and the co-operatives operating in other health board areas, through the 2003 Estimates process. Until the outcome of the Estimates process is known, my Department cannot give assurances to any health board over additional funding for 2003.
My Department has been informed that medical services continue to be available two days a week. In addition, support is available to the hospital from the geriatrician at Wexford General Hospital. For medical emergencies, it is normal practice for patients at St. John's to be transferred to Wexford, 15 miles away, and this procedure remains in place. Additionally, patients from St. John's will be fast-tracked through accident and emergency at Wexford General Hospital during the dispute.
The position in relation to additional funding to expand Caredoc into Wexford will obviously become clearer when the Book of Estimates for 2003 is published tomorrow. It is unfortunate that the issue of out of hours general practitioner  cover to St. John's Hospital has become embroiled in what is essentially a funding matter. However, the South Eastern Health Board has assured my Department that it is willing to work with the general practitioners involved to try to resolve any issues outstanding, no matter what  the outcome of the Estimates process. I encourage all sides in this dispute to make every effort to resolve this matter as soon as possible in the interests of the elderly patients concerned.
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