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 Header Item Hospital Staff (Continued)
 Header Item Hospital Services

Thursday, 13 February 2014

Dáil Éireann Debate
Vol. 830 No. 3

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(Speaker Continuing)

[Deputy James Reilly: Information on James Reilly Zoom on James Reilly] However, 14 of these posts are covered by agency locum non-consultant hospital doctors employed on a temporary basis to ensure continuation of service delivery at the hospital. Efforts are continuing to recruit additional NCHDs to the existing vacant posts.

  Particular difficulties are being experienced in Letterkenny General Hospital regarding the recruitment of NCHDs in general medicine, and this is replicated in many hospitals nationally. There at 8.5 whole-time equivalent posts vacant in the general medicine specialty, comprising 7.5 registrar and one senior house officer posts. The recruitment and retention of non-consultant hospital doctors is required to support service delivery, address reliance on agency locums and facilitate the achievement of compliance with the European working time directive.

  Last summer I set up a group under the chairmanship of Professor Brian MacCraith to undertake a strategic review of medical training and career structure.

  Additional information not given on the floor of the House

The group is to make recommendations aimed at improving the retention of medical graduates in the public health system, planning for future service needs and achieving the maximum benefit from investment in medical education and training. The group provided an interim report in December 2013 with a focus on training. It is examining career structures and pathways following training with a view to submitting a report by the end of March 2014. In addition, the HSE is considering the establishment of a new service grade of non-consultant hospital doctor. The establishment of the hospital groups will also assist hospitals such as Letterkenny as the revised structures will facilitate the use of resources across the group. Indeed, the current shortages at Letterkenny are being considered in the context of the NCHD resources available to the west and north-west hospital group.

Deputy Charlie McConalogue: Information on Charlie McConalogue Zoom on Charlie McConalogue I thank the Minister for his reply. He has referred to national and international shortages in the supply of non-consultant hospital doctors. He has stated that shortages are particularly acute in regional and more peripheral hospitals such as Letterkenny General Hospital. His response is that this is something with which we must live. His response does not provide specific solutions which is what I asked for in my question. He has outlined that where there should be 121 NCHD posts in Letterkenny General Hospital. Currently 26.5 posts are vacant, with 14 being filled by agency doctors, no doubt at a more significant cost than the full-time posts.

The hospital normally had ten medical registrars but currently there are 8.5 posts. To comply with the working time directive, that number needs to increase to 15 posts. On many days recently there were significant backlogs in the accident and emergency department with people on trolleys, and neither Sligo nor Altnagelvin were able to take the overflow. The public had to live with that difficulty

An Leas-Cheann Comhairle: Information on Michael Kitt Zoom on Michael Kitt I will come back to the Deputy.

Deputy Charlie McConalogue: Information on Charlie McConalogue Zoom on Charlie McConalogue It is not acceptable that the medium-term solution is that we must continue to live with it.

An Leas-Cheann Comhairle: Information on Michael Kitt Zoom on Michael Kitt I must call the Minister.

Deputy Charlie McConalogue: Information on Charlie McConalogue Zoom on Charlie McConalogue I will finish on this point. I ask the Minister to elaborate on what steps he can take to address that situation to ensure it does not continue for the next few years.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly As the Deputy has acknowledged, we have approved more posts for Letterkenny. The reality is there is a difficulty in recruiting but we continue to recruit actively and to use agency locums to ensure we provide a safe service for the people of Letterkenny. I congratulate the staff of Letterkenny General Hospital and the wider hospital group which provided support from Galway from Bill Maher and his team and the board. I also acknowledge the help from Altnagelvin during the flooding. The unit is fit to re-open and we look forward to seeing the Deputy at the opening. Letterkenny General Hospital is a critical part of our health service and it will be supported. I have no doubt we will be able to attract more doctors to Letterkenny by means of rotation within the hospital group. This is one of the benefits of the hospital group because staff will not be recruited to work in Letterkenny specifically but will be recruited for the north-west hospital group and will go on rotation between the hospitals during the course of their training. This system will also make available to Letterkenny and the people of Donegal a greater level of expertise than was the case heretofore.

Deputy Charlie McConalogue: Information on Charlie McConalogue Zoom on Charlie McConalogue I concur with the Minister and I thank him for his comments about the staff. What they and the management of the hospital have achieved has been heroic and amazing. The flooding of the hospital was one of the biggest disasters at any hospital in the history of the State. The accident and emergency department at Letterkenny General Hospital is the seventh busiest in the country, which shows the demands on the service. The hospital has had difficulty in recruiting the staff it needs and the numbers of staff which have been approved. This demonstrates the job of work faced by the hospital in dealing with its daily workload. We need to have solutions from the Minister. He has outlined that the number of NCHD posts has been increased to 126, but the real difficulty is in recruitment. The Minister has indicated there may be potential for rotation in the new hospital group. Whether the solution is in the system of rotation or else international recruitment in the medium term until there is more supply from this country, we need to see solutions quickly. We cannot continue with the current situation because it will mean more delays in the accident and emergency department which is unacceptable for patients in Donegal.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly The Deputy will be aware from earlier responses to questions that the model of care needs to change in both hospitals and in general practice. We need to move away from this episodic illness approach to a system of prevention and chronic illness management in primary care. The Minister of State, Deputy Alex White, is dealing with this aspect and he is in consultation with the GP organisations, for which I thank him. It is the case that NCHDs are doing work that could just as well be done by other health care professionals. I alluded to the skill mix where nurses are performing duties which health care assistants could undertake, doctors are doing work that advanced nurse practitioners could undertake, and both professions are doing work that would be better done by physiotherapists or speech and language therapists or other allied health care professionals. We must address this by innovative ways of using the resources available to us, which in my view will be more cost-effective and result in better outcomes for patients and would also be more rewarding for the professionals involved.

Hospital Services

 12. Deputy David Stanton Information on David Stanton Zoom on David Stanton asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the position regarding the dedicated stroke unit in Cork University Hospital; when this unit will be open; and if he will make a statement on the matter. [6795/14]

Deputy David Stanton: Information on David Stanton Zoom on David Stanton There is much concern about the delay in opening the stroke unit in Cork University Hospital. I understand a date has been set but I want to get confirmation from the Minister that this is the case and that the unit will open without further delay.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly I look forward to going to Cork but I will have to get a passport from the Minister of State, Deputy Kathleen Lynch, before I set foot in Cork.

Cork University Hospital provides a full, comprehensive range of stroke related services, including neuro-radiology, which includes intra-arterial thrombolysis. In plain language that means administering a drug to break up a clot causing the blockage. Other services will include acute neurology and elderly care medicine. To enhance this service delivery further, the executive management board allocated a ward to provide a dedicated stroke unit. Funding was provided by the national clinical stroke programme to enable some infrastructural upgrade on the ward.

To develop further the multidisciplinary role within the stroke service in CUH, the clinical programme also provided the necessary funding to recruit the following staff: one full-time clinical nurse specialist for stroke care, a 0.5 whole-time equivalent speech and language therapist, and a 0.5 whole-time physiotherapist. I am advised by the HSE that the infrastructural upgrade of the ward has been completed and that the staff for the unit have been recruited. The hospital is putting the final measures in place to open the stroke unit which will provide 12 beds for the stroke service. The opening is scheduled for Monday, 10 March 2014.

The HSE national clinical care programmes provide a national, strategic and co-ordinated approach to a wide range of clinical services. The objective of the stroke clinical programme is to provide rapid access to high quality stroke services, to save lives and to prevent strokes. The Deputy may be interested to note that I prioritised an improvement in thrombolysis rates and a target was set to increase the rate of safe thrombolysis from 1% to 7.5% by the end of 2013. I am pleased to say the HSE has recently reported a national stroke thrombolysis rate of 10.5% for the third quarter of 2013, which exceeds targets and is comparable to rates internationally. I am informed Ireland has moved from the bottom of the European league table to the very top in an 18 month period. This is having a real impact on patient safety and quality of life. Access to safe stroke thrombolysis is provided in 23 hospitals throughout the country, 24 hours, seven days a week. Ambulance access protocols are also in place whereby acute stroke patients are taken to the nearest hospital providing around-the-clock thrombolysis.

This is what the health service is supposed to do which is delivering better outcomes for patients. This is a very clear example of how the men and women who work in our health service have achieved that.

Deputy David Stanton: Information on David Stanton Zoom on David Stanton I thank the Minister for that very good news that the unit will open on 10 March. Has he information on how many patients will use that unit? Will the Minister personally perform the opening ceremony on 10 March?


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