Eithne Donnellan visited the town to talk to people about their fears for the hospital post-Hanly report
The accident and emergency department at Roscommon County Hospital sees about 13,000 patients a year. But the hospital does not have a full-time A&E consultant. It is visited one day a week by a locum consultant who travels from his main base in Galway.
Providing a round-the-clock service seven days a week, the unit is staffed by two junior doctors, and one of the hospital's two surgeons provides cover in an emergency.
The locum A&E consultant, Dr John Holmes, who visits the unit on Wednesdays, said the service would require an enormous commitment in funding and staffing to bring it up to an acceptable standard.
"The recent appointment of a part-time consultant position, which I currently hold in a locum capacity, is nowhere near adequate in addressing major shortfalls. The most pressing need is for good-quality clinical staff to be in the department 24 hours a day," he said.
"At present, apart from myself coming once a week, there are only two doctors on the A&E staff. This is clearly grossly inadequate."
The secretary of the Roscommon Hospital Action Committee, Ms Una Quinn, believes the A&E staff have been providing the best service they can and are extremely dedicated. "But in the light of what is now being dictated in guidelines for the staffing of these services this hospital would not meet those standards and is therefore under threat. We need a full time A&E consultant," she said.
Her colleague on the committee, local councillor Ms Paula McNamara, said: "We haven't an A&E service. One day a week is not a service."
At present patients attending the unit are seen in a temporary building. However, the health board stresses that this is because the old A&E unit was demolished to make way for a new, larger and more modern one. This €6 million unit is now nearing completion.
Ms Quinn, who was a Hospital Action Committee candidate in the last general election and secured 3,500 votes, said she was concerned the new unit will never open.
"We are very concerned that we will have a new A&E built and the ribbon will never be cut because of the inadequate staffing and because of the implications of the Hanly report," she said.
That report made recommendations in respect of two other health board areas only, the Mid West and East Coast Area boards, but it suggested that the model for those areas should be used for other regions.
A team is now working on a plan to roll out Hanly across the rest of the State. Given its recommendation that A&Es be provided only where there is sufficient consultant staffing around the clock, the Roscommon people have reason to be concerned about the report's implications for them.
"People locally would say how can they spend €6 million and not open something, but in our experience it has been demonstrated around the country that it is no problem to the Government to spend that kind of money on a facility and never equip or staff it," Ms Quinn said.
Dr Holmes shares her concern. "The building of the new A&E unit at Roscommon is to be welcomed. Whilst certainly not state-of-the-art, as has been claimed by some, it will nevertheless be well equipped and quite functional.
"However, a department cannot operate without suitable medical and nursing staff, and it is not possible to approach the development of such a service with less than 100 per cent commitment.
"It would appear then that if such commitment is not forthcoming the new buildings may indeed become a white elephant, and that would be a tragedy," he said. The hospital's general manager, Ms Susan Temple, said there was no question of the new A&E unit not being opened. The contractor owned the temporary structure which the A&E facility now occupied and it would have to be given back. She believed the first patients would be seen in the new unit in January or February.
She stressed that there had been a huge amount of investment in recent years in the hospital, which has over 300 staff and 97 acute beds. Its two theatres had been refurbished, as had one of its wards, and a new cardiac rehabilitation unit had been built.
Furthermore, she said, the consultant staffing had doubled.
"What we have now is a huge improvement on what we had before, but our aim would be to improve the service all the time."
The new A&E department would be double the size of the old one and would compare very favourably with any similar- sized hospital. It would, however, only have the same number of staff.
"We will have a brilliant piece of infrastructure, and I would be very confident that whatever the future will bring there will be a very important role for this unit to play," Ms Temple said.