2026-07-01

Let us keep the momentum going. An Teachta Martin Daly is next. His matter relates to plastic and reconstructive surgery services at Roscommon University Hospital.

I thank the Minister for being here. This is a success story that the Minister will be glad to hear about. The question is how we are going to support and expand the service that exists at Roscommon University Hospital. The reconfiguration of the hospital, which caused huge controversy at the time, has turned out to be a great success, with many innovative departments and many new services for people, especially the elderly, being developed. In the past 15 years, a plastic surgery unit that uses a see-and-treat model has been developed under Dr. Deirdre Jones, who is a plastic surgeon. In 2025, the unit received 8,000 GP referrals from Donegal, Leitrim, Sligo, east Mayo, east Galway, Westmeath and Offaly. The unit developed a photographic referral system in order the GPs could take photographs of skin lesions include them with referral letters. That happened during Covid. Of the 8,000 referrals, 2,000 were able to be triaged and referred back to the relevant general practitioners for appropriate treatment without the need for the patients involved to be seen by the unit. Of the remaining 6,000 patients, 2,000 have had surgery. The unit is also involved in screening for, diagnosing and treating skin cancers. The 2,000 surgeries to which I refer were carried out by one plastic surgeon, one part-time plastic surgeon and eight advanced nurse practitioners working over different periods. This unit is hugely productive. It is located in an area where there is a high prevalence of skin cancer. The west of Ireland has one of the highest prevalences of skin cancer, not just in Ireland but internationally. There is no plastic surgeon from the tip of Malin Head in Donegal right down to Roscommon. We have patients travelling from Sligo, Donegal and the other areas to which I referred to this unit in Roscommon, which is providing an exemplary service. In addition, 10% of all cases of melanoma, which is a deadly skin cancer, are treated at the unit. The problem for the unit is that it is treating approximately 50 patients per week. From a staff point of view, it has the capacity to treat 150 per week. This is really important, because those in the unit are constrained by the environment in which they are working. They are working out of two small treatment rooms and they have an area in which they assess patients. Will the Minister urge the HSE and the Department to consider the expansion of the physical infrastructure in which this unit operates in order that it can operate with maximum efficiency and to its maximum potential? As already stated, this is a success story. It is a story of productivity. It is a story of Sláintecare. It is a story of a hospital which has reimagined itself but which needs ongoing support. The hospital also has a tremendous endoscopy unit, which serves the region, and has developed services for elderly patients. We know that the population is getting older and that, as a result, there will be a need for frailty clinics, falls clinics, memory clinics and a range of outpatient services. This really is something worth supporting. I urge the Minister and her Department to intervene with the HSE to support this unit in any way it can.

I am so glad to have the opportunity to discuss this matter with the Deputy. I want to compliment the work of Dr. Deirdre Jones and that of the hospital manager, Marie Doorly, who has transformed Roscommon University Hospital into an enormously important part of the infrastructure of the north west. The hospital is doing great work, and we want to see it doing more great work. Roscommon is a level 2 hospital. The Government is pleased to have been able to increase its budget by 63%, from €28 million in 2020 to €46 million in 2025. Staffing has grown by 31%. In-patient bed capacity has grown by 5%. As Deputy Daly is aware, what we are trying to do at the hospital is so much about day-case procedures. He referenced the endoscopy suite, which I am going to go to see. I think that unit could run harder in the evenings and that we could do more there. Where we see really efficient practice is what we want to support. As the Deputy stated, the clinic in question is run by Dr. Deirdre Jones. There is a lot of advanced nursing practitioner support within the clinic, which is a real example of what is good about and what is possible with Sláintecare. There is no reason for people from Roscommon to have to travel to Galway for this service when it can be and is being delivered so capably in Roscommon. The service is led by a consultant and provides day-case and outpatient care. Of course, it has the ancillary benefit of reducing pressure on the acute hospital in Galway, which does not need to see these day case procedures that can be supported so well elsewhere. What I really admire about this treatment process and the way the hospital is running it is that it is a direct access model. It is a "see and treat" service, which is fantastic for patients because they do not have to come back again and again. It also runs a skin cancer surveillance service under the national cancer control programme, which has been in operation for 15 years. It ensures that all patients who have had any sort of cancer diagnosis are kept actively under surveillance and monitored. In the past three years, it has introduced a photo triage element of the service, which is fantastic. It means that GPs can send in a GP referral as requested but also include a photo, so they are getting ahead of the question all the time. The clinical nurse manager reviews that in conjunction with the consultant. It is a really streamlined pathway to the correct model of care. In many cases, the patient may not need an appointment and the GP is advised as such. Therefore, it is a very efficient, productive and caring model, where patients are prioritised on the basis of clinical need. Roscommon hospital has excised twice as many skin cancers - 1,200 in 2024 - as benign lesions, and has also treated 10% of Ireland's melanoma patients. That is quite an output for the work in a model 2 hospital. We will continue to invest in the plastic services, and the opportunities for expansion of the services can be reviewed. I happen to be in Roscommon in July, and I might drop in and have a look.

I thank the Minister for her comprehensive answer, which I appreciate. The important thing is the innovation that has happened at this particular unit in terms of the "see and treat" model, where patients are referred for photo triage before they attend. The service is led by a consultant but delivered by specialist advanced nurse practitioners, ANPs, in dermatology, who are trained in the screening and diagnosis of skin cancers and other skin lesions. These may not turn out to be skin cancers but it is important that this work is done. We need to support the advanced nurse practitioner model in this unit and develop it further. It needs more physical capacity. I have spoken to the HSE. I spoke to Mr. McCallion last week after the health committee meeting, and he said the HSE is going to look into that. It is worth supporting. The whole issue about Roscommon is that the public in the west, in particular in Roscommon and east Galway, were promised that with the reconfiguration of Roscommon University Hospital, it would be supported in all its endeavours to provide appropriate services, such as day services. It is important that we keep an eye on the replacement acute psychiatric unit, the car parking services and the outpatients unit, which does not have disabled toilet facilities or a ramp for disabled patients to use. We need to develop the endoscopy service. If the Minister can expand that, we would be delighted and would support her in that. There are so many good things happening in Roscommon University Hospital but it takes commitment. For example, Roscommon University Hospital was promised a neurological rehab unit in 2015, with an attached budget of €8 million. That was taken off the capital plan twice, and only after an intervention by me and my office has it been placed back on the plan. There is a dearth of neurological rehabilitation places in the west of Ireland. I urge the Minister to support Roscommon University Hospital in every way she can. This is an exemplar for the reconfiguration of that hospital.

I had the opportunity to see that for myself when Marie Doorly came to our regional meeting for the north west and presented on behalf of Roscommon hospital. It was clear to me. I have huge respect for Roscommon hospital and the role it is playing in the health architecture in the north west. As the Deputy knows, the local injury unit is highly regarded, with people coming from all over the north west - from Mayo and elsewhere - to that unit as an alternative to going to Castlebar. I am pleased to say there will be another injury unit in Ballina, which hopefully will take the pressure off Roscommon somewhat, because it has been filling that role. I know what it is doing in terms of endoscopy and helping with stepdown beds for the other hospitals to ensure the appropriate flow. What the Deputy is talking about is the excellent "see and treat" model of care, delivered away from acute hospitals in an excellent model 2 hospital for the people of Roscommon and beyond. It is an exemplar of Sláintecare. I compliment Marie Doorly, Dr. Deirdre Jones and all of the people working there who have delivered this. I will do anything I can to support that kind of committed Sláintecare focus they have had.