People on all sides acknowledge that the national task force on medical staffing was made up of eminent medical experts. It is probably at this stage that any agreement dissipates – there is certainly not a lot after that. The point was made in the report that the task force took no account of industrial relations issues or political considerations. This is presented as a positive thing, but anyone who has had the opportunity of considering the report will have come to the conclusion that it is one of the negative aspects.
To be fair, the task force was required to present its report against the background of the European Working Time Directive, the unacceptably long hours worked by non-consultant hospital doctors, considerable publicity around waiting lists and other weaknesses in the health system and the expenditure of €9.3 billion annually, which is more than the full income tax take in the State. It was presented with a difficult job. However, despite the constraints and the difficult background, much of what is contained in the report is positive. Such negatives as there are can be worked through by the project teams. It is true that in the case of one of the pilot regions – the mid-west – it is not at all clear what criteria were used in designating whether hospitals should be general or local. That is a sticking point for Ennis, because on further examination of the report it does seem that Ennis meets the criteria for a general hospital.
I find it extraordinary that so many consultants, GPs and medical personnel are now vehemently opposed to the report, despite the fact that members of their own representative bodies were the very people who drew it up. The task force claims to have consulted widely, but that is not the view of people in the two pilot regions and in Ennis and Nenagh. If the level of consultation I am told about is correct, it was certainly not enough and people are quite right to complain about its quality. The task force people will say they offered the opportunity of consultation and it was not taken up. There is also a dispute about the number of people dealt with in the accident and emergency unit of Ennis General Hospital. The figure provided by the task force was 15,000, while the annual report of the health board says there were more than 22,000. This is a major discrepancy.
The Hanly report says there are two consultant cardiologists in the mid-west, but as far as anybody there is aware, there is only one. Certainly, when one considers the study's modus operandi and the fact that 350,000 is the designated population for a region, it does seem that an area with a population of more than 100,000 ought to qualify for general hospital status. It must also be pointed out that Ennis hospital has a wonderful record. More than 95% of people who present at the accident and emergency unit are dealt with without ever going elsewhere – they are either dealt with on the spot or admitted. The number of acute medical admissions, excluding geriatrics, is running at more than 2,500 per year, or 50 per week, which is a substantial number.
There are grave concerns at Ennis hospital and in the area about the proposals for accident and emergency services, which I share. I raised these concerns on day one with Mr. Hanly when he outlined what was involved in the report. On the other hand, some of those who have spoken on the issue have been extraordinarily alarmist. There is grave concern among hospital staff that the hospital's reputation is being damaged and undermined by some of the comments. This makes it hard for those of us who are serious about having the best level of service to address these difficulties. It is important that we obtain a good outcome from this report and from the Minister, Deputy Martin.
There is unanimous agreement in Clare, in the health board and right across the region that the case for including 24-hour accident and emergency services in both Nenagh and Ennis is well established. I urge the Minister to include the upgrading of accident and emergency services when he announces the development plan for Ennis hospital soon. The arguments about the distance of people from the hospital, the proximity of Shannon Airport, the industrial base in the area, the requirements of the national spatial strategy and the fact that Ennis is one of the fastest growing towns in the country, are all well known and it is quite clear that they were not properly taken account of in the preparation of the task force report.
The lessons of history suggest that the Hanly report could replace the Fitzgerald report as a template for health service development. The latter was completed in 1968 and was formally revisited two or three times in the mid-1970s and again in the mid-1980s. It was never quite adopted but has always hung over the development of services, making it difficult in the areas which were under review. I have taken a look back at various studies. The 1928 Government commission and 1933 hospitals commission were strongly critical of the small county hospitals on the grounds of inefficiency and unsafe practice. However, the people have long since voted with their feet. They have used the services of the local hospitals because they believe them to be top class. More and more, particularly over the last ten years, people have come to the view that the services in Ennis hospital are up there with the best.
For the record, Mr. Fitzgerald did not even propose a regional hospital in Limerick. He proposed two in Dublin, one in Cork and one in Galway. He wanted 12 general hospitals and said that Ennis hospital should have its role changed to that of a community health centre. At least in the Hanly report there is a stronger emphasis on the development of hospital services in Ennis and there is to some degree a template for going forward. However, unless the project team examining this in the mid-west, along with the others involved, reject the proposal for 24-hour accident and emergency services and ensure that the service is provided, this report will not be acceptable. It can be done relatively easily. I have also seen figures which suggest that it can be done much more cheaply than is proposed in the report.
The report sets enormous challenges for the development of health services in areas such as the provision of equipment and personnel for ambulance services and the recruitment of consultants. It goes some way towards addressing costs. Doing nothing is not an option. The deadline for the working time directive is closing in and there is no doubt that changes must be made. Everyone that has looked at this acknowledges that the only prospect of addressing the difficulties within the timescale of the working time directive is to improve services at all hospitals, including Ennis and Nenagh. This can only happen if they are retained as acute hospitals.
Unless a clear outcome is reached quickly on the mid-west and eastern region, the Hanly report will replace the Fitzgerald report and will hang negatively over the health service. We need to establish exactly what can and should be done. We must accept that the experience in accident and emergency departments in large hospitals is extremely negative for everybody using the service.
We need to face up to the implications outlined on page 118 of the task force report on capital costs. The State is not in a position to provide the funding that would be inevitable in capital terms alone were the Hanly report to be proceeded with. The State is certainly not in a position to provide the alternative services proposed within the timescale indicated. It is not in anybody's interest to do this at any stage. The implications of this part of the report, where it is made clear a number of costs are excluded, must be examined carefully by Government.
The project team that is to consider how the report can be implemented will quickly find that the cost of improving services at Ennis and Nenagh is several times cheaper than doing what has been proposed. Everyone realises that if the number of consultants is to be raised from 109 to 305, there must be places to locate them and their patients. Only 10% of this number would provide these services at no capital cost at Nenagh and for €15 million in capital costs in Ennis.