Martin Daly: Roscommon's 'See and Treat' Unit Needs Support

Thank you Ciarán and thank you Minister for being here this morning. This is a success story which you'll be glad to hear about and I suppose the question really is how are we going to support it and expand this service that exists in Roscommon University Hospital. The reconfiguration of Roscommon University Hospital which caused huge controversy at the time has turned out to be a great success with many innovative departments being developed and services, new services for people, especially elderly people. But in the last 15 years a plastic surgery unit has been developed under the care of Ms Deirdre Jones, plastic surgeon, a see and treat model. In 2025 they received 8,000 GP referrals from Donegal, Leitrim, Sligo, East Mayo, East Galway, Westmead and Offaly. They developed a photographic referral system so that GPs could take photographs of skin lesions and send them with the referral letter and that happened during COVID. It meant that 2,000 of the 6,000 referrals, of the 8,000 referrals were able to be triaged back to the general practitioner for appropriate treatment without having to be seen. Of the 6,000 patients that have been referred there, 2,000 of them have come to surgery but there's also screening of skin cancers, diagnosis of skin cancers and then the treatment of skin cancers. So 2,000 surgeries carried out by one plastic surgeon, a part-time plastic surgeon and 8 ANPs working for different levels of time. Now it's a hugely productive unit in an area where there is a high prevalence of skin cancer. The West of Ireland has one of the highest prevalence of skin cancers, not just in Ireland but internationally and there is no plastic surgeon from the tip of Mallinhead in Donegal right down to Roscommon. So we have patients who are travelling from Sligo to Donegal right down to this unit in Roscommon which is providing this exemplary service. Also in addition to that, 10% of all melanoma cases, which is a deadly skin cancer, are treated in this unit in Roscommon University Hospital. Now the problem for them is they are treating approximately 50 patients a week. They have the capacity from a staff point of view to treat 150 cases a week and this is really, really important because they are constrained by the infrastructure in which they're working in. They're working out of two small treatment rooms and then an area where they assess patients. So I really would ask the Minister to urge the HSE and the Department to consider the expansion of the physical infrastructure in which this unit operates so that it can operate at the maximum efficiency that it can and to its maximum potential. And as I said, this is a success story. It's a story of productivity. It's a story of slaughter care. It's a story of a hospital which has reimagined itself but needs ongoing support. It has a tremendous endoscopy unit which serves the region. It also has developed services for elderly patients. We know our demographic is getting older, so frailty clinics, falls clinics, memory clinics and a range of outpatient services. But this really is something that's worth supporting and I would urge the Minister to try and intervene with the Department and the HSE to support this unit in any way it can. Thank you Deputy Daly and I'm so glad to have the opportunity to discuss this with you and I want to compliment the work of Deirdre Jones but I also want to compliment the work of the hospital manager, Mary Dourley, who I think, as you say, has transformed Roscommon Hospital into an enormously important part of the infrastructure of the North West and it is doing great work and we want to see it doing more great work. As you referenced there, so obviously it's a level two hospital. We've been pleased to be able to invest as a government together an increase of 63% of its budget has increased by 63% from €28 million in 2020 to €46 million in 2025. The number of beds in Roscommon has grown by 31%, inpatient bed capacity has grown by 5% but as you're aware of what we're trying to do there is so much about day case procedures and you've referenced the, for example, the endoscopy suite which I actually think, and I'm going to go and see it, I think could run harder in the evenings, we could do more there for that, but where we can see really efficient practice of course that's what we want to support. So the services you've said that is run by Deirdre Jones and the clinic, a lot of A&P support there as well, it's a real example of what is good about slaughter care and what's possible about slaughter care. There is no reason for people from Roscommon to have to travel to Galway for this service when it can be delivered so capably and as is being delivered so capably in Roscommon. It's led of course by a consultant, provides day case and outpatient care and of course it has the ancillary benefit of reducing pressure on the acute hospital in Galway which doesn't need to be seeing these day case procedures that can be supported so well elsewhere. What I really, really admire about this treatment process or the way in which they're running it, it's a direct access model, it's a see and treat service which is fantastic for patients that they're not having to come back and back and back, but they also run a skin cancer surveillance service under the National Cancer Control Programme which is 15 years in operation and it ensures that all patients who have had any sort of cancer diagnosis are kept actively in surveillance and monitored and in the last three years they've introduced a photo triage element to the service which is fantastic so what that means is GPs can send in, a GP referral is requested to also include a photo so you're getting ahead of the question all of the time and the clinical nurse manager reviews that in conjunction with the consultant and it's a really streamlined pathway to the correct model of care and in many cases maybe the patient doesn't need an appointment and the GP is advised as such so it's a very, very efficient, very productive model, very caring model where patients are prioritised on the basis of clinical need and Roscommon Hospital has excised twice as many skin cancers, 1,200 in 2024, as benign lesions and also treated 10% of Ireland's melanoma patients. It is quite the output for the work in a Model 2 hospital. We will continue to invest in the plastic services and opportunities for expansion of the services can be reviewed but I happen to be in Roscommon in July and I might drop in and have a now look myself as well. Thank you for your comprehensive answer Minister and I appreciate it. I think the important thing is the innovation that has happened at this particular unit in terms of the see and treat model as you said where patients are referred, photo triaged before they attend and then we have this service led by a consultant but delivered by specialist ANPs, that's Advanced Nurse Practitioners in Dermatology, trained in the screening and diagnosis of skin cancers and other skin lesions which may not turn out to be skin cancers but it's important that that's done. I think we need to support the Advanced Nurse Practitioner model in this particular unit and develop it more. They need more physical capacity and I have spoken to the HSE, I spoke to Mr McCallion last week after the Health Committee and he said they are going to look into that but I think it's worth supporting and I think the whole issue about Roscommon, the public in the West and in Roscommon and East Galway were promised with the reconfiguration of Roscommon University Hospital that it would be supported in all its endeavours to provide appropriate services such as day services and it's important that we keep an eye on the replacement acute psychiatric unit, the car parking services, an outpatients unit which doesn't have disabled toilets facilities, doesn't have a proper ramp for disabled patients to get into and to develop the endoscopy service if you can expand that we'd be delighted and support you in that. So there are so many good things that are happening in Roscommon University Hospital but it takes commitment, for example Roscommon University Hospital has promised a rehab unit, a neurological rehab unit in 2015 with an attached budget of 8 million euros and that was taken off the capital plan twice and only at intervention with myself and our office it has been placed back on the, and there's a dirt of neurological rehabilitation places in the West of Ireland so I'd urge the Minister to support Roscommon University in every way it can because it is an exemplar of the reconfiguration of that hospital. Thank you. Thank you Deputy and indeed I had the opportunity to see that for myself when Mary Dourley came to our regional meeting for the North West and presented on behalf of Roscommon Hospital and it's very clear to me, I mean I have huge respect for Roscommon Hospital and the role that it's playing in the health architecture in the North West. The local injury clinic, the local injury unit as you know is highly regarded with people coming from all over the North West from Mayo etc etc to that unit as an alternative to going to Castle Bar. I'm pleased to say of course there will be another injury unit in Ballina which hopefully will take the pressure of Roscommon somewhat because it has been filling that role. What it's doing in terms of endoscopy, what it's doing in terms of helping with the beds, step down beds from the other hospitals, the appropriate flow but really what you're talking about is see and treat, excellent model of care of see and treat model delivered away from acute hospitals in an excellent model to hospital for the people of Roscommon and beyond. It is exactly, it's an exemplar of slaughter care and I want to compliment Mary and Deirdre and all of the people working there that have delivered this and certainly I'll do anything I can to support that kind of committed slaughter care focus that they certainly have had.