Deputy Seán Sherlock was in possession and there are ten minutes remaining in this slot.
Hospital Services: Motion (Resumed).
The following motion was moved by Deputy James Reilly on Tuesday, 10 February 2009:
That Dáil Éireann:
noting the conclusions of the Teamwork-Howarth Review of Acute Hospital Services in HSE Mid-West which recommended:
that the current staff complement of three A&E consultants in Limerick must be upgraded to eight in order to allow for a consultant delivered service (which have not been advertised or implemented);
135 additional new acute inpatient beds (which are not in place);
an increase in the number of ambulances (which have not been delivered);
a high dependency unit in Limerick Regional Hospital (for which planning permission has not yet been sought); and
the necessary upgrade of the A&E unit in Limerick Regional Hospital (which has not taken place);
and considering that:
currently between 15 and 30 people are regularly on trolleys for durations in excess of 24 hours in Limerick Regional Hospital;
the putative cost in the original draft of the report was €380 million and apparently only €6 million is available to implement the changes;
local GPs in the area have expressed serious concerns about A&E cover and patient safety if this plan goes ahead; and
the implementation of the HSE Teamwork-Howarth report is unlikely to take place in the current economic climate;
calls on the Government to:
maintain current A&E services at Ennis and Nenagh hospitals; and
proceed with the planned upgrade of Ennis and Nenagh hospitals.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"—strongly endorses the Government's commitment to patient safety, quality and fairness as the priorities in the delivery of health services throughout the country;
supports the Government's view that fairness to patients throughout the country requires that all patients should have access to the appropriate care in the appropriate place at the appropriate time, provided by the appropriate person;
recognises that the plan to reorganise hospital services in the mid-west is evidence-led and in accordance with the principles of patient safety, quality assurance and fairness;
notes and welcomes the conviction of the Royal College of Surgeons in Ireland that the reforms should continue in the mid-west and elsewhere;
welcomes the clinical leadership in the mid-west region in the project to deliver better services to patients;
urges everyone in the health service and public representatives in the region to work together to put patient care first above all other interests;
welcomes the HSE's commitment that Ennis, Nenagh and St. John's Hospitals will deliver additional day surgery and diagnostic services, including CT scanning and that many patients from Clare and North Tipperary who currently have to travel to Limerick will now be able to access these services in their local hospitals;
welcomes the additional specialist services such as dermatology, neurology and rheumatology which will be available in Ennis and Nenagh Hospitals;
supports the HSE's plans to appoint eight additional hospital consultants to enable the delivery of these new services and specialties at Ennis and Nenagh Hospitals;
welcomes the HSE's intention to enhance the ambulance service in the mid-west through the deployment of 12 advanced paramedics and increased out-of-hours ambulance cover;
supports the HSE's intention to develop a regional critical care service involving the provision of a dedicated new critical care block which will have a total of 40 specialist intensive care, high dependency and coronary care beds and a new emergency theatre;
recognises the necessity to make capital investment in all four hospitals in the region to support the reconfiguration plans; and
welcomes the significantly reduced reliance on locum positions to provide services and their replacement with full-time consultant staff for the region which will result from the reconfiguration programme."
—(Minister for Health and Children).
We wish to support the motion on the basis that the permutations of the HSE Teamwork-Howarth report for the delivery of care for people in the mid-west will have untold consequences for those who do not live in the region served by Limerick Regional Hospital. In addressing this motion I wish to speak specifically for the southern region, where the national service plan has been published. We have also recently received a document from the HSE stating that new efficiencies to the value of €80 million are sought in its operations. The Teamwork-Howarth report has not been published in the south. Having read the Fine Gael motion and the prescriptions of the Teamwork-Howarth report for the mid-west, I do not doubt that the delivery of services in the combined Munster region, as espoused in this document, will have a negative effect on hospitals in Nenagh, Ennis and Mallow. While I might be accused of being parochial, it is important to note that the hospital in Mallow is like those in Ennis and Mallow, and to address this as a Munster-wide issue.
There has been no politically accountable, coherent analysis of the HSE's proposals. This is the first time that the House has had an opportunity to properly debate their implications and it is happening on Opposition time. The Government should make time available to debate the issues adequately so that we can go through the implications of these proposals euro by euro, and hospital by hospital.
We have witnessed the erosion by stealth of services at the former county hospital in Mallow. A CT scanner was put in place a few years ago and became operational last year for approximately ten to 15 hours per week, but now runs for between four and six hours per week. Last week, we found out that the ear, nose and throat services will be taken away in one fell swoop. We have also been notified that no children under the age of 16 will be treated within the hospital and that the long-term plan is to replace the accident and emergency unit with a nurse-led minor injuries clinic.
The motion notes that between 15 and 30 people are regularly on trolleys for over 24 hours in Limerick Regional Hospital. If services in Mallow are further reduced the same will apply to Cork University Hospital. We in the Munster region are arguing for a re-think of the policy. Clinicians who advise me, and the 120 GPs who serve the hospital, say that there should be no diminution in services in Mallow general hospital until the HSE can guarantee that the services are available in Cork University Hospital. That is the logic of the argument being applied to Limerick Regional Hospital and to the hospitals in Nenagh and Ennis. There is a complete lack of foresight in the approach to this. Every time I raise the issue with the upper echelons of the HSE management in the southern region, I meet vague answers and lack of specifics.
I do not see how the Minister can dress up the service plan for the southern region as a configuration, or a reconfiguration, because it drives a coach and four through the services being delivered to the catchment areas of Mallow, Ennis and Nenagh. Those who reside in the catchment areas will have to travel further to get into Cork University Hospital and Limerick Regional which will force more people through a narrow bottleneck. The services and capacity do not exist within those hospitals. There is no logic in seeking to further downgrade the satellite hospitals that serve Cork University and Limerick Regional Hospitals. We want a proper debate on this and I ask that the Government make time available for it. I appreciate that Fine Gael raised this issue and we support it.
How much time do I have left?
The Deputy has three minutes and ten seconds.
There is a Ceann Comhairle in the making.
Every second counts.
The Government will never be stuck while Deputy O'Connor is there.
He is doing a good job.
The Minister of State at the Department of Community, Rural and Gaeltacht Affairs, Deputy Conor Lenihan, would be delighted.
Allow the Deputy to speak without interruption.
Why are Fianna Fáil Deputies elected by these constituencies allowing this to happen? Why do those Deputies constantly move to blame it on the HSE? Are we to believe that Professor Drumm, by virtue of his management of the HSE, is the de facto Minister for Health and Children? Is there no voice on the Government backbenches from the Munster region served by the hospitals at Mallow, Ennis and Nenagh that will call a halt to what the HSE is trying to do? If we proceed with the degradation of services at these hospitals there is no way that hospitals such as Cork University and Limerick Regional will be able to deal with the capacity. That will have untold consequences.
The hospital in Mallow serves over 100,000 people in four counties. I speak to the staff in Cork University hospital and if one visits it on any given day, one will see that the accident and emergency unit cannot cope with the numbers coming through. Why would the Government seek to further diminish services to the satellite hospitals?
We support the motion and believe that if the Government backbenchers who represent constituencies served by the hospitals at Ennis, Nenagh and Mallow have any backbone they will support such motions because in that way they will support the people.
I wish to share time with Ministers of State at the Department of Health and Children, Deputies John Moloney and Barry Andrews, and Deputies John Cregan and Michael Lowry by agreement.
Is that agreed? Agreed.
I welcome the opportunity to contribute to the debate on the hospital services in the mid-west. I will concentrate on how the proposed review relates to Limerick city. I strongly believe that the reforms set out in the report are long overdue. Ultimately, they will be good for patient outcomes in Limerick. I also believe that it will not happen overnight and that the change must be incremental. One cannot go from an imperfect system to a perfect system overnight. This means we cannot make this into a political football, and it also means involving all of the stakeholders in the process, which will take some time.
Everyone in this debate agrees on several matters. Best practice in the delivery of medical services is changing in Ireland and abroad. Technology for the delivery of those services is also changing. That means we must not do things the way we did them before and it also means not doing things in the places we did them before. It means doing them in different places with better people who are better able to produce better outcomes. We all agree that the report concludes that if those internationally recognised best practices are implemented, better outcomes will be achieved. We might disagree on how we go along with this journey, but at least that is a good starting point for all of us.
I also welcome the fact that this reform has been led by clinicians, who are the experts on this. It is not necessarily led by politicians, although it is assisted by them. It is essentially led by people such as Dr. Paul Burke and Dr. Cathal O'Donnell, who are both highly respected people. I have met these people on several occasions, and I can say that their sole motivation is the best outcomes for patients. It is not about turf wars and about keeping practices in some hospitals rather than other hospitals. Their motivation is simply the best outcome for patients. Do we accept their good faith and do we work with them in delivering their best expert advice? I say that we should do so.
St. John's Hospital has played a prominent role in recent years in the delivery of services in Limerick. I believe the hospital is well placed strategically to play a prominent role in the emerging infrastructure in the mid west, following on from this report. Consultant appointments to the hospital in recent years have been on the basis of a shared commitment with the regional hospital. In addition, the hospital has participated in joint ventures such as the development of minor injury services in Limerick, and the co-ordination of pathology and radiology services. That is very welcome. The initial discussions that began with the management of the hospital about its contribution have been productive. They are concentrated on providing increased consultant input into the accident and emergency consultant level delivery of services in St. John's Hospital, which is to be welcomed. The possibility of expanding the scope of the minor injury services in the hospital to cover the weekend period is extremely welcome.
The programme of change also includes an expansion in the range of diagnostic facilities, and an expansion of outpatient and day surgery capacity in the smaller hospitals in the region, which includes St. John's Hospital. A reference in the report has been made for a throughput in the hospital of up to 30,000 people per annum, which is very welcome. If this report is ultimately delivered, it will be good for St. John's Hospital and the regional hospital. It will mean a very significant investment in the medical infrastructure in Limerick, an emergency operating theatre in the regional hospital, an expansion of the ambulance service, and a critical new care block in the regional hospital. That is to be welcomed, but it will not happen overnight. Everybody needs to work together and we need to take the best advice from the best people with the right motivation at heart, working to deliver the sort of services that Limerick and the mid-west deserve.
I am not from the region, so I cannot be accused of being parochial. I rise to support the Minister of State and Deputies from the region who support Government policy. I do so on foot of what I have heard last evening and again tonight. I was here for a similar debate ten years ago, which was about the provision of cancer services. Everything I hear now is a repeat of what happened back then.
One of the Opposition Deputies stated that we should support the people, and I accept that. For five years, I was on the wrong side of the people in my constituency. When it comes to health issues, there is always a concern for politicians that the people may be right, especially when huge crowds gather to explain how wrong we are. It is often important to rely upon independent medical advice, especially when we are talking about life and death issues. It is not for me to be critical of anybody who supports a different point of view, but I would like to make a few points.
In the early 1990s I was in the peculiar position of supporting a Fine Gael Minister for Health and Children, Deputy Noonan. He came out with the national cancer strategy and supported Tullamore as opposed to Portlaoise. The issues that are being raised today were raised then. Huge pressure was brought to bear on Opposition Deputies. I do not quote Members when they are not in the House, but I found it difficult to hear the current Minister criticised by the Fine Gael spokesperson on health, when he stated that what had happened in Portlaoise lay directly at her doorstep. The Minister is a much greater political thinker than I am, because she did not want to enter that particular debate. The issue is about the reconfiguration of health services based on the premise of ensuring patient safety in the first instance. The most important part of the debate back then was that by ensuring a critical mass of people presenting to busy clinical hospitals, the consultants would be upskilled therein, which is the same debate today.
The president of the Royal College of Surgeons in Ireland made the point that the college supports this reform. I find it difficult that the current Minister can be accused of creating difficulties in my hospital, because if Deputies from the Fine Gael-led Government of the 1990s had supported their then Minister for Health and Children, the difficulties we have had in Portlaoise in the past two years would never have occurred. We are being accused this evening of not listening to the people, but the reality back then is that had we listened to the independent medical advice that has been given today, we would never have had the sorry situation that occurred in Portlaoise. The centre of excellence would have been in Tullamore and it could not have been used as a political football as it was last night.
I want to go back to the Teamwork report, which identified the same issues that occurred in Laois and Offaly ten years ago. Some Members of the Opposition, especially Deputy Reilly, might want to forget about them. The Teamwork report identified a number of significant issues relating to how hospital services in the mid-west are organised. The most important part of the report is that the core specialties of general medicine, general surgery, accident and emergency services and critical care are too fragmented. This underpins the strategy involved here and the difficulties that were involved when the national cancer strategy was being rolled out. I must give credit to the Minister, Deputy Harney, for initiating the national cancer strategy that is now working, and now clearly initiating a national cancer strategy for the reconfiguration of hospitals throughout the country. It is a confirmation of the Government's policy of maximising and improving public health, the cost of which is often a little political pain on the ground. In the context of the debate in this House, I would prefer to be on the side of those who support patient safety.
I welcome the opportunity to make a brief contribution to this important Private Members' debate. There was a time when many public representatives sat on health boards throughout the country. To be fair, when we were members of health boards, we felt obliged to protect our own patches. We felt it was our duty to do so. A change took place when it was felt that politicians should not be involved in making decisions such as that taken by the HSE in this instance. While many of us did not support that move, in fairness it has removed parochialism from the decision-making process. We have entrusted the HSE with the running of the health service and the development of our hospital network. I strongly feel that there is a responsibility on public representatives to ensure that all patients who present themselves at our hospitals enjoy good outcomes. There is an obligation on every Member of this House to support the development of surgical and emergency medicine. The Government's decision has been made on the basis of the best medical advice possible. The many highly regarded medical personnel who have been involved in making the decision to roll out the new strategy for the mid-west region should be given a chance. Similarly, the report should be given a chance.
All of us are concerned to ensure that the necessary resources are available in Limerick Regional Hospital to cope with additional demand when the new regime is in place. On the basis of what I have seen in the report and heard from the Minister, Deputy Harney, I do not doubt that the resources will be put in place before the system changes. While people are entitled to have genuine concerns, it is important for them to acknowledge the fact that additional resources will be put in place before additional demands are made of Limerick Regional Hospital. I welcome the commitment of the Minister and the HSE to ensuring that the additional resources and support services that are required will be put in place.
I am extremely proud of Limerick Regional Hospital and its staff. I have been in public life for many years. I accept that people have to lie on trolleys for a certain period of time, unfortunately, in hospitals throughout the country. I respectfully suggest that the alternative is to put a sign on the door of each hospital saying, "sorry, we are full". With the best will in the world, we cannot do that. By their nature, hospitals will always have enough patients to fill their beds, regardless of how many they have. It is a difficult situation. As one cannot put a "full house" sign on the door, the next best thing one can do is provide trolleys for people to lie on. We would all prefer if that were not the case. With the exception of such cases, I can count on the fingers of one hand the number of complaints my constituents have made to me about the treatment they have received in Limerick Regional Hospital. The hospital is absolutely second to none. On nights like tonight, we should recognise the contribution the hospital's staff members are making. We often take such matters for granted rather than giving the praise that is deserved.
I will be somewhat parochial by mentioning two recent developments in St. Ita's Hospital in Newcastle West, which is the only hospital in my constituency. The matron and staff of this fine geriatric hospital deserve the height of praise for the manner in which they perform their duties. Fortunately, in recent times, two capital projects at the hospital — a special dedicated Alzheimer's unit and a special dedicated hospice unit, which will operate in conjunction with Milford Hospice — have been sanctioned. I call on the Minister to ensure that these two tremendous facilities are opened at the earliest possible date. I welcome the appointment of a clinical nurse manager at the hospital. I welcome the confirmation that a person is in place to carry out the manager's duties. It is important to drive ahead with the opening of the facilities I have mentioned.
I fully support the Government's amendment to the Fine Gael motion. I understand that the changes at the hospitals mentioned in the motion will be implemented step by step. The hospitals in question, both of which play an important role for the people they serve, will not be closed or downgraded tomorrow.
I wish to share time with Deputy Lowry.
Is that agreed? Agreed.
I welcome the opportunity to speak on this important matter, which is one of the issues to arise in the context of the challenges posed by the national restructuring of the HSE. Many Deputies have highlighted the danger of politicising certain issues, such as health and crime. It is a common theme. I am a great defender of politics as a profession. The influence of politics in the health system is a positive one. However, there comes a time when we have to acknowledge that the overwhelming weight of clinical evidence and opinion is pointing us in a certain direction. We should be honest enough to accept that our narrow self-interest needs to be put to one side in favour of a greater interest. In this case, a greater interest has been identified by clinical leaders in this area. A similar approach should be taken in other areas of public policy if a clear and strong professional opinion is pointing in a specific direction. It may not suit our personal interests, but greater interests have to be borne in mind. Acknowledging the obligation to show moral leadership on certain issues is at the core of politics.
All of us have been affected in one way or another by this issue. In recent years, we have all seen reconfigurations of hospital services in our local areas It is painful, difficult and hard to put self-interest to one side, but it is necessitated by the greater interests I have mentioned. Reference has been made to the overwhelming professional opinion in this area. I would like to refer specifically to the comments made by a consultant surgeon in Limerick, Dr. Burke, on "Prime Time" last Thursday night. He agreed with the other 12 surgeons in the area that all acute and emergency surgery should be centralised because that would lead to the provision of a safer and better service. It is clear that Dr. Burke's comments, along with all the other evidence that has been furnished over recent weeks, point us in one direction only — the configuration of services in this area, as suggested by the HSE. We all have a duty to convince our natural constituencies to follow us on that road.
The Minister, Deputy Harney, reminded the House last night that these proposals were first ventilated almost 40 years ago. The difference now is that we have a Minister who is prepared to tackle the vested interests and face down the narrow self-interest that has unfortunately dogged this country's health policy for too long. Professor Tom Keane has demonstrated the benefits of centralisation and specialisation. Anybody who has had to avail of this country's paediatric services will agree that there is no debate in this respect when it comes to paediatric oncology, for example. We all agree that the centralisation of paediatric services is working. People do not mind having to travel to Dublin because they know that one of the best paediatric services in Europe is available at a single location there. That argument has been proven for some time. We now have the political will to match the strong professional opinion that has prevailed for many years.
The Teamwork-Horwath report states that "the core specialties of general medicine, general surgery, A&E and critical care are too fragmented, carry increased risks for patients and staff, and are not sustainable in their present form". Dr. O'Donnell has said that the extra time taken to get to a specialist service improves survival rates by 25%. As the Minister of State, Deputy Moloney, pointed out, the president of the Royal College of Surgeons in Ireland has added his weight to the argument that substantial reform has to be continued in this area. It has been suggested that the accident and emergency department in Limerick will be unable to cope with the additional demand on it. Statistics show that, in January 2009, the number of people who had to wait for long periods of time in the unit was quite small. They indicate that the department has the capacity to absorb any extra demand that may result from the changes that are being proposed.
In regard to the mid-west, an examination of the number of cases presenting in general reveals that in a six-month period Ennis General Hospital had 28 surgical cases and St. John's Hospital had only 21. Of the 105 emergency cases requiring treatment in one month in Nenagh, only 12 involved a general anaesthetic. It is clear there is a need for us to change the way we think about these issues. This debate presents an opportunity for a bipartisan approach to these issues to ensure we have better patient safety and better outcomes for patients.
During my political career I always have been committed to addressing the many and varied problems at Nenagh General Hospital. With others, I have battled long and hard to preserve and protect it over the years. My only motivation and objective was to ensure the provision of the best possible health service for the people of north Tipperary. Health care must be outside politics. It should not be used solely to win votes and enhance reputations. For as long as I can remember, Nenagh General Hospital has struggled to survive.
Health care is an emotive issue and affects people in a deeply personal way. Personal health and well-being is the key priority. What we need is a quality of care that is community focused, addresses the needs of everyone equally and locates the most intensive services in locations where they will be most valuable and widely available.
We have confronted many challenges facing Nenagh General Hospital over the years arising from policy decisions initiated by different Governments under former Ministers for Health such as Barry Desmond, Deputy Hanlon and Deputy Noonan. Nenagh General Hospital has again reached a critical juncture. The decisions we take now will determine whether it has a future.
As a politician, I feel obliged to listen and take notice of the professional medical advice on the structures and procedures that are considered to give the best possible patient care. I have consulted widely with all the important stakeholders. I believe that consultation with senior and experienced medical professionals is the correct way to make informed judgments. The surgeons in the front line, including the head of the Royal College of Surgeons in Ireland, Professor Frank Keane, support the reform of surgical facilities in the mid-west. Senior accident and emergency consultants, such as Cathal O'Donnell and Paul Burke currently working at the coalface in the mid-west, say that the current system operating in small hospitals is costing lives. How can any politician ignore those statements?
Listening to the one-sided debate about Nenagh General Hospital, it would be easy to get the impression that everything is perfect at present. Let me put on record that Nenagh General Hospital in its current configuration has significant problems. Its surgical unit is inadequate for major elective surgery, as it does not have the adequate recovery rooms, intensive care unit and anaesthetic systems required by modern-day medical practice.
The Health Information Quality Authority was established in response to malpractice and systems failure in other hospitals that had disastrous consequences for unsuspecting patients. This same quality authority conducted a hospital-wide audit of Nenagh General Hospital in 2007. The quality authority put Nenagh's management on notice that patient safety and infection prevention standards were not up to an acceptable level within the sterile services structure of the hospital. The sterile services are located within the operating theatre. These operating theatres are in place since 1954. They are outdated as well as structurally and clinically redundant. If they are not demolished and replaced, we will face an order for closure of the current surgical theatres.
Also in 2007, it was recognised at clinical level that Nenagh General Hospital did not have the range or diversity of clinical skills to cope effectively with or manage major trauma. In reaction to this reality a trauma bypass protocol was put in place at the beginning of 2008. Nenagh General Hospital is now bypassed in the case of events such as major car crashes because it is deemed the existing surgical and back-up facilities cannot cope. Under this protocol the paramedics at the scene of an accident or emergency situation were given the discretion to determine the extent of injuries or condition of the patient and make an instant decision as to which hospital would best meet the medical requirements of that patient.
We hear much talk about the golden hour concept and in that context it also should be realised that under the present system between the hours of 5 p.m. and 8 a.m. radiographers and laboratory technicians are not in the hospital and are only on call. This means there is an inevitable delay of up to one hour when a critically ill patient arrives at the hospital. At present one has to wait for the radiographer or the laboratory technician to be called and arrive at the hospital before an X-ray can be completed or a blood analysis conducted.
In short, I am saying those leading the agitation for the existing system to be retained at Nenagh are misinformed, misguided and putting patient care in jeopardy and the future of the hospital at risk. Retaining the status quo at Nenagh without capital investment will lead to stagnation, unsafe standards and ultimate closure.
Nenagh General Hospital needs investment to survive. Without a multimillion euro upgrade of outdated facilities, the hospital has no future in any capacity. If we do not have capital investment, it will close. As a way forward Nenagh hospital needs to assert itself to the extent of its ability as a centre of excellence in its own right. To this end, it needs a cash injection of millions. When I committed to the support of this Government, I placed priority on the provision of funds for capital projects at Nenagh General Hospital. I sought and received verbal and written commitments from then Taoiseach, Deputy Ahern, later endorsed by the current Taoiseach, Deputy Cowen. These included the provision of two new surgical theatres, a new endoscopy unit and diagnostic centre, together with ancillary facilities and accommodation.
Since the publication of the Teamwork report I have had extensive discussions with the Minister, Deputy Harney. I advised her that the reform suggested to improve the delivery of health services to the people of north Tipperary must be predicated on fully operational and functioning alternative structures being in place. It became apparent during those discussions that there was in existence three separate development plans for Limerick, Ennis and Nenagh. I was understandably concerned that Limerick Regional Hospital's proposed development would be funded, progressed and completed. We could then have a nightmare scenario for north Tipperary whereby the HSE might say that Limerick had the capacity to meet all needs, Nenagh was surplus to requirements and a doomsday decision would be made not to proceed with investment in Nenagh.
To avoid that possibility I secured from the Minister a commitment to commission one overall integrated plan for the mid-west. The Minister gave me a further guarantee that the development of Limerick and Nenagh would take place in conjunction with each other. She also gave a commitment that the capital projects for Nenagh, included in my agreement with the Taoiseach, would be delivered. These multimillion projects such as the new surgical theatres, the endoscopy and diagnostic units will be included for funding under the multiannual capital programme of the Department of Health and Children to be announced in the coming weeks.
The Minister has undertaken to ensure the existing CAT scanner at Nenagh General Hospital will be fully commissioned and staffed. She has committed to a significant enhancement of the ambulance service in the mid-west through an increased out-of-hours ambulance cover. She fully appreciates the crucial role of advanced paramedics in the new structures and has committed to the provision of an adequate number to cover north Tipperary. Day surgery and diagnostic facilities are to be extensively developed and easily accessible.
The Minister has also committed to appoint eight additional hospital consultants to enable the delivery of these new services and specialties in Nenagh and Ennis hospitals. She has made a commitment to me that primary care teams will also play a major part in the proposed reform of health services in north Tipperary. Currently, two teams are successfully up and running in Roscrea, Borrisokane and Cloughjordan. In Thurles, the development of two primary care teams is well under way. The process will be expedited to provide care teams in Templemore, Nenagh, Ballina and Newport. These are critical to ensure the success of any local health reform and will ensure the people of north Tipperary are treated effectively in their own localities.
A new medical assessment unit will be provided at Nenagh General Hospital. This will be accessible by a GP referral system. What this means in effect is that most of the patients currently treated at Nenagh will continue to be treated there. There will be no reduction in the services provided to the public of north Tipperary requiring medical care. The staff at Nenagh General Hospital are professional, dedicated, caring and committed. I have been assured that under the new proposed reconfiguration all permanent nursing, attendant, porter, cleaning, catering and clerical officer staff will retain their jobs.
The Teamwork report set out to put in place upgraded services to improve patient care and to treat the patient in the most appropriate setting based on the recommendations of medical staff, that is, doctors, nurses, consultants and general practitioners. I am of the firm belief that if the components of this report are not implemented in their totality, there is no future for Nenagh General Hospital and it will be allowed to whittle away and die. The people of north Tipperary know the extent of my commitment to them and to what is in their best interests. In that respect, this is the correct decision to best serve the interests of the people of my community.
I wish to share time with Deputies Joe Carey, Pat Breen and Tom Hayes, if that is in order.
At the outset, I acknowledge the role played by the staff, medical and otherwise, of Nenagh General Hospital and Limerick Regional Hospital. I acknowledge also the emergency services who provide such a fantastic service, in difficult situations, to the people of north Tipperary.
Deputy Lowry provided a list of what we all want in north Tipperary. I share those wishes, going as far back as my time on the health board when a development plan was put forward by the eminent consultant, Mr. Paul Burke, who has been much mentioned in the House. That plan saw a role for the four hospitals in the mid-west in providing a complete service for the entire region. Specific specialised services with a dedicated consultant-led team were to be provided in each hospital in the region.
For Nenagh General Hospital, those would have been neurology, vascular surgery, ENT and cardiovascular surgery. That was to be welcomed. In the development plan drawn up by the health board, of which I was a member, Nenagh General Hospital was put forward also for upgrading of theatres and an endoscopy suite, all the items that Deputy Lowry now promises. That was at the beginning of the Celtic tiger era when Deputy Mary Harney became Minister for Health and Children, Deputy Lowry did not support the Government and Fianna Fáil promised the sun, moon and stars to the people of north Tipperary. Did that party deliver in times of plenty? I put that question to my colleague, the Minister of State at the Department of Health and Children, Deputy Máire Hoctor, whom I welcome to the House tonight.
Yes, it did.
I am glad she is not at a Labour Party rally tonight. Did the party deliver? It did not. What confidence and trust can the people of north Tipperary now have in Fianna Fáil's ability to deliver, aided and abetted by Deputy Lowry? I say they can have none and I offer an example, although Deputy Lowry has left the House. This time last year, capital funding was planned to provide for a 20-bed stay unit in Borrisokane. Such step-down facilities to get people out of hospital are so important, as we are told in the Teamwork report. On 31 December, this plan was withdrawn in another example of reneging.
Can we be assured of the funding? The word is that it will be announced presently, as part of a deal by Deputy Lowry, just as the unit for Borrisokane was. We are to believe it will be announced, for sure, and that there will be great drama over it, but will the plan ever go ahead? How long must we wait before it is withdrawn as in the case of Borrisokane?
That is the problem with this report. Deputy Lowry mentioned different consultants and the advice they have given. I, too, have listened to consultants. I have spoken to Mr. Paul Burke and have met him. He said he was quite happy because 80% of the people in the mid-west region were within 35 minutes of Limerick. The 20% who come from north Tipperary and from County Clare did not matter to him. They may live more than 50 miles away and be well over an hour away from Limerick Regional Hospital. Before this year is out, they will matter to Mr. Paul Burke, the HSE and the Minister of State, Deputy Hoctor. I know she is concerned about the people but these issues must be addressed and that is not happening.
We have heard about the ambulance service. Deputy Lowry will speak of another deal and say he secured an ambulance base for Thurles. The ambulance personnel there are working in deplorable conditions. What happened to that promise? Why is that not being delivered? The same applies to an ambulance base in Nenagh which was not delivered in times of plenty. The Minister of State has told the House that all will now be implemented at a time when the Government is on its knees, having broken the country and with not a penny left in the banks. Who is codding whom? One can cod some of the people some of the time, but one cannot cod all the people all the time.
I know Mr. Burke well, but I wish to deal with some of the issues. If Deputy Lowry gets his way, we will have a day care centre in Nenagh. That is fine, but we will not have a hospital because there will be no surgery in that hospital. Is it not ironic that the Teamwork report states clearly that acute services will be transferred from Nenagh General Hospital to St. John's Hospital in Limerick? Deputy Cregan said no parochial element or politics were involved. We heard it from the Minister of State, Deputy Power. What kind of politics is that? It is not considered good enough to operate on people from north Tipperary in Nenagh General Hospital. Instead they are to be moved to St. John's. The Deputy called out the figures which are less than those in Nenagh. Where is the critical mass we are told is so essential for safety? Of course it is a political matter.
The people of north Tipperary deserve better and the Minister of State knows that. We have our hospital that has served us well, and other generations too, throughout the years. I listened to the Minister for Health and Children, Deputy Mary Harney, last night. She spoke with passion and I admire her for that. She talked about delivering quality medical care, and we all want that. I share that wish with the Minister, but the difference lies in how and where it is provided. We want quality care as it was, and is, provided at present in Nenagh. We want that care to be continued there. What we have we will hold. The premier people of the premier county will rise up and speak and the Minister of State will know this well before the matter is out. She knows the anger that is palpable among the people of north Tipperary about the way they are being treated.
I recently had experience of Nenagh General Hospital. Late on a Saturday night I was brought into the accident and emergency department there. I could not have been treated better. I was stabilised, comforted and diagnosed, and was sent to Limerick Regional Hospital the following Sunday evening for an operation on Monday morning. I will say two things about that. First, when I got to Limerick on the Sunday night I had to go through the accident and emergency department for an X-ray. By God, I was horrified. It was worse than a Beirut battlefield, with the bodies strewn on the corridor. The trolleys were all used up as were the beds and the chairs. Everything was thrown about everywhere. When I met the professional who was to treat me she told me that, as a public representative, I must take action and do something about the situation. She said that staff could not stand the pressure, which she described as unreal. She had 83 patients to attend to after treating me.
The second reason I mention my experience is because in Nenagh we got such wonderful service. Last night, I listened to the Minister, Deputy Harney. She implied criticism of the four emergency consultants who lead a wonderful emergency department in Nenagh and questioned their professionalism and abilities. When this service was put into Nenagh as a cutback, the same Minister and the same Fianna Fáil Party told us it was the answer to all our needs and our medical requirements in north Tipperary. It is quite a turnabout to hear the Minister imply criticism of professionals, as if they were not doing their job correctly. It is amazing.
The problem here is trust in the Minister and in Fianna Fáil who are hiding behind the HSE concerning the delivery of their promises. A man said recently at a public meeting that if he were fed on Fianna Fáil promises, he would weigh 50 stone. I am fairly overweight but I would surely weigh 50 stone if I were fed on the promises that have been reneged upon by Fianna Fáil. The people cannot trust, and that is the problem with the proposal in front of us. It puts the cart before the horse, closing down the services that are there and have served the community well without putting in place what was promised, and which is unlikely ever to be in place. The only way these promises will ever be put in place will be when Deputy Reilly moves over to the other side of the House. Fine Gael will deliver as it has done in the past.
It is time for the Government to end the hypocrisy regarding the future of the 24-hour accident and emergency services at Ennis General Hospital. I support my party's spokesperson on health, Deputy James Reilly, and the position he has taken on this matter. I commend him for bringing this motion before the House.
The Minister for Health and Children, Deputy Harney, stated in this House last night that the reason County Clare people are worried about what will happen when services are removed from Ennis General Hospital is because politicians are telling them that patients will die. That was an outrageous statement for a Minister to make. If the Minister had bothered to come down to meet with the people of County Clare, she would know they are worried about their health and the health of their children. They are also worried about the promises they got from Government politicians in election after election. Government politicians stood on the steps of the O'Connell monument in the square of Ennis promising that Ennis General Hospital was safe, but as soon as the election was over, the promises went out the window.
When former Taoiseach Bertie Ahern breezed into County Clare in 2006 he pledged his support for the hospital to a local journalist. He said:
The hospital is safe. People should be supporting this Government which is investing in this hospital instead of chasing rabbits and hares around Clare.
He even proclaimed that this commitment was written in stone when he said, "I have given this commitment in writing and people should stop beating the drum." The former Taoiseach has plenty of time now for chasing rabbits and hares. I was elected by the people of County Clare and I will never stop beating the drum for them. Sadly, the people of County Clare will pay a high price for the reckless abandonment of pre-election promises by Fianna Fáil and the Green Party.
The under-investment in Ennis General Hospital by the Minister's Government over the past ten years is testament to this Government's lack of political will and ability to speak up for the people of County Clare. The management and staff at the Hospital have been starved of resources for years and every request for funding from the Government and the HSE has been met with resistance. In October 2004 this lack of resources prompted the consultants working in Ennis General Hospital to comment in an open letter:
Consultants working within the mid-west region noticed a marked superiority in the resources available to patients presenting to Limerick Regional Hospital compared to Ennis General Hospital. This inequality of access to health care is wrong.
Last night here the Minister said the HIQA report will be published shortly. I hope it will have some comforting news for the Moriarty and Kelly families. They deserve this after their tragic losses. Lessons must be learned, but I hope the Minister will not use this report as a means of closing services at Ennis General Hospital, or even closing the hospital.
I will give an example of something that happened this week in south-east Clare, in Deputy Jan O'Sullivan's constituency. The HSE confirmed that the health centre which was built in Westbury in south-east Clare at a cost of €500,000 will not open due to a shortage of funding. Yet the Teamwork report requires €380 million. This plan to remove services from the hospital from 1 April must be an April Fools' Day joke. As a Councillor I served the people in west Clare, and the area is long and far from Limerick Regional Hospital. I welcome the members of Ennis General Hospital who are here to listen to this debate. The Ennis General Hospital development committee recently tested the "golden hour". It took one hour and 43 minutes to get from Kilbaha in west Clare to Limerick Regional Hospital. Some time ago a constituent of mine from west Clare told me it probably would be easier to phone the undertaker if we are to depend on this level of service.
In the absence of 24-hour accident and emergency services at Ennis General Hospital the ambulance service is expected to deliver mobile emergency care throughout the county. How is it expected to deliver this with the service already operating on a shoe string? On several occasions I have pointed out to the Minister, Deputy Moloney, the over-reliance on on-call services, private ambulances being called in from time to time and the lack of 24-7 cover in Scarrif ambulance station. The Minister has not invested one cent in upgrading the ambulance services. He says he will provide six extra advanced paramedics to cover County Clare. That is totally inadequate. It will not work with shift work and sickness.
This Government has lost touch with the people. Last night a patient was left on a trolley at Ennis General Hospital overnight because Limerick was not able to accept more patients. What will happen after 1 April? Where will the patients go? I urge the Minister to get real. This plan cannot work because the resources are not there. I appeal to the Minister to abandon it. It is time for the Government politicians to end the double-speak on Ennis General Hospital. Last night here my colleague, Deputy Dooley said, "It is incumbent on all of us to ensure that these changes are made without delay." He went on to say, "If the changes are to be successful, they should be supported by investment." Where is the investment? No wonder the people of Clare are confused and worried about what they hear.
There are very few of our colleagues over there tonight, but I invite them to come over here and stand with us in favour of the motion at the end of the night. I ask them to join us, to take one small step across the floor. If they do that it will be a giant step to secure the services at Ennis General Hospital. I invite them to join the people of Clare and Tipperary, and in the words of the great Munster anthem, "stand up and fight." They must fight for what is right, for what is in the best interests of the people of Clare and Tipperary, and support this motion.
Tonight we are at a crossroads. The signposts are clear. One path leads us to the continuation of 24-hour accident and emergency services at Ennis General Hospital together with the upgrade of that hospital. The other path leads us to the dismantling of County Clare's accident and emergency services and their replacement with an eight-to-eight nurse-led minor injuries clinic, relying on two paramedics in one car to cover the whole of County Clare and protect the 110,000 people who live there.
Last night I listened to the Minister, Deputy Harney, saying this issue should be removed from politics and be above politics. This is a political decision. We are public representatives, elected by the people to articulate their views and represent them to the best of our ability. I make no apology for that. Since the year 2000, successive Ministers for Health and Children have made political commitments to the people of Clare. These political promises have been made by Deputies Martin, Cowen, Bertie Ahern and every Fianna Fáil Deputy in County Clare. Fianna Fáil political figures from the very top gave commitments that 24-hour accident and emergency services would remain at Ennis General Hospital and that the hospital will receive a €39 million upgrade. This is a political decision.
The Teamwork report does not move Loop Head any closer to Limerick Regional Hospital. It is still 74 miles. The Teamwork report ignores the "golden hour" principle. This is the standard international maximum time limit to treat anyone who has suffered a stroke, a heart attack or who has had an accident. Some 44,000 Clare people will be left outside the golden hour cover if the Minister's plans go ahead. There are alternative models of providing accident and emergency care to dispersed populations, such as that delivered in the highlands and islands of Scotland. The British NHS was moving to centralise services in Scotland but their Minister for Health recognised that it would not work because it was not safe or right to ask people to travel extreme distances. That Minister had the courage to ignore and reject a centralisation policy and adopted a more appropriate model. The same model operates in Cornwall on the south-west coast of England and closer to home at Downpatrick Hospital.
The shared factor in each of these examples is that since the year 2003, the NHS has been legally required to consult with patients and the public when any change in health care is proposed. The Minister and the HSE have done their best to conceal the HSE report from the people. GPs in County Clare and Nenagh were not consulted. Nurses were not consulted; nor were the people of County Clare. It is obvious the Minister is determined to provide accident and emergency services on the cheap while dressing them up as a standard of international excellence. This is being done with no consultation and little regard for the people on the ground who so desperately need, want and deserve speedy access to an accident and emergency unit.
Leaving aside the issue of the golden hour, nobody is convinced that any of these improvements can be delivered in Limerick Regional Hospital in such a short space of time. For example, six years ago the Hanly report promised a dramatic improvement in ambulance services, but nothing has happened. In fact, the service has disimproved. We have less capacity now than we did six years ago because an ambulance can carry only one person, and extra ambulances have not been provided. The HSE has failed to address this issue, and it continues to ignore the ambulance crew based in Ennis, who have campaigned for a year to be provided with a simple washing facility. They must clean the ambulances with a bucket and mop, using a tap in the public car park, with people walking in and out through it. The HSE has done nothing about this. How are we expected to believe the Minister will improve ambulance services? The Minister's plans are simply unrealistic. Will the 135 beds promised for Limerick Regional Hospital appear from the sky on 1 April? Will the five additional accident and emergency consultants required wander in off the streets and arrive in a new accident and emergency theatre?
Behind all these reports and planned cuts are real people with real lives and real stories to tell. About a year and a half ago, a good friend of mine — a young man from Ruan — was involved in a farm accident on the outskirts of Ennis, in a place called Larchill. When agitating slurry, he came in contact with the gas and inhaled it. He collapsed, but fortunately there was a man there to raise the alarm. He called the ambulance service and the young man was admitted to Ennis General Hospital. People in the area found out about this accident, concern was expressed, and a mass was held in Ruan. All the people of the area came, and I was there myself. We all prayed for that young fellow. Because of the intervention at Ennis General Hospital, that young man has made a full recovery. He is 100% better. If he had to travel to Limerick by ambulance, that man would be brain-damaged today. That is the real benefit of having an accident and emergency unit in one's locality. It saves lives and improves recovery. With that vital intervention, the young man was saved.
I ask the Minister, Deputy Harney, if she would ask any of her constituents to travel from Dublin to Roscrea for accident and emergency services. That sounds ridiculous, but it is the same distance as that from Loop Head to Limerick Regional Hospital. In recent weeks, sick people have been lying on trolleys for three days in Our Lady of Lourdes Hospital in Drogheda. Surgery has been cancelled as there have been insufficient beds. I ask the Minister not to make the same mistake in the mid-west. I demand the best hospital service for the people of County Clare. That will not be delivered by closing an accident and emergency unit or by transforming Ennis General Hospital into a glorified nursing home. Tonight I appeal to all Members of the House, of every political persuasion, to join in supporting this Fine Gael motion to preserve the vital 24-hour accident and emergency services in Ennis hospital and support its redevelopment.
What is at issue tonight affects not only the people of Nenagh and Ennis but all people living in rural Ireland, no matter from what part of the country they come. In recent years we have been obsessed with the notion that making things bigger automatically means better services. I will draw a comparison which might sound funny. Those of us from rural constituencies will remember the amalgamation of creameries many years ago, and how this was to change the face of rural Ireland. We now see the difficulties the dairy industry is in. In my own constituency of south Tipperary, Mullinahone Co-op, a small unit that was left there on its own, is now probably more efficient than any other unit. I am making that comparison because we are obsessed, in every facet of life, with making things bigger and amalgamating them.
South Tipperary has suffered one of the most divisive events to occur in the health system, the amalgamation of services at Cashel and Clonmel. The debate went on for about 40 years and divided the people and the towns. Ten years ago the two hospitals were amalgamated and the surgical hospital was taken to Clonmel. A great plan was put in place. Now, ten years on, it is proposed to move some of the services to Waterford, including the maternity service. Last Monday the Oireachtas Members for south Tipperary were briefed and told the Teamwork report would be shortly moving south. What is happening in the mid-west region will happen to us. There will be more amalgamations in Wexford, Kilkenny, Waterford and south Tipperary. The people of north Tipperary and Clare are right to stand up and fight every inch of the way. This amalgamation will not bring more efficiencies to the health service. That is our experience. I ask every public representative on all sides of the House to consider what has happened in south Tipperary. It could have been a good experience but, alas, I do not believe it was. People in Cashel are waiting for services, while some have been put in place. The staff contact me on a regular basis about all the things that have not yet been provided. There is a fear in north Tipperary and Clare that the improvements that have been promised will not occur. There is no confidence that these changes will bring about an improved service. That is what is wrong. To say people will get better services looks good on paper and sounds better. However, the reality is that services have not improved over the years. When we had small hospitals in every town around the country there were better services, and people supported that. That is why I say the Teamwork reports, when their recommendations are put in place, do not necessarily result in a better service.
Last night and this evening we have heard a range of views about the planned changes in the organisation of hospital services in the mid-west. The Minister, Deputy Harney, noted that the issues being discussed and the reasons advanced for maintaining the status quo have changed little over a period of 30 to 40 years. However, there has been a shift in the nature of the debate. We are all now familiar with the expert advice that, where the delivery of complex care is concerned, better outcomes for patients are achieved if this takes place where the necessary staff and equipment is to hand and sufficient volumes of activity take place. Despite what others may suggest, the available evidence also emphasises the need to provide timely emergency care to patients in an appropriate setting and that this leads to lower rates of death, fewer complications and longer life. Therefore, while we may still differ on matters of detail or on how change is to be brought about, I believe that among health professionals and the general population there is recognition that change is necessary and that it will ensure higher quality and more sustainable services for the future. Both the Government and the HSE are committed to a process of change which is incremental, with appropriate consultation and discussion with those affected. The HSE, with Mr. Paul Burke as clinical lead, is working with stakeholders to develop, explain and give effect to the reorganisation plans.
He is just telling them what is happening.
It is very important that we explain clearly to the population of the mid-west what the changes will involve and the reasons for them. However, it is equally important that they are not misled as to their nature and purpose. It is sometimes alleged that the Government and the HSE want to "downgrade" smaller hospitals in order to save money. This is not so. It is in nobody's interest, least of all that of the people living in the mid-west and north Tipperary, that anybody should seek to perpetuate a configuration of acute hospital services which is not sustainable and which will not deliver the best health outcomes for patients.
I am a native of Nenagh; I was born in Nenagh hospital. I will not stand in defiance of professional opinion and the evidence-based policy to achieve greater patient safety. The nature of health service delivery is changing and the direction of future development is towards an increased proportion of diagnosis and treatment taking place on a day or outpatient basis. This is much more convenient for patients and their families as well as much more cost effective. Each of the acute hospitals in the region will continue to have a very significant role as parts of an integrated regional service.
This cannot be implemented without significant investment in Nenagh, Ennis and Limerick hospitals. This Government and Fianna Fáil-led Governments through the years have a history of investment in Nenagh hospital, from coronary care to the extension and to the expanded X-ray and accident and emergency unit.
Look at the CAT scan. There were only three staff for it.
The Opposition has no record of capital investment compared to this Government.
Ennis hospital is on its knees.
We will continue to invest in Nenagh hospital in the future.
While complex and specialist cases will be treated in the regional hospital in Limerick, Nenagh, Ennis and St. John's will see the continued development of day surgery and diagnostic services, such as CT scanning and endoscopy. At present, approximately 700 patients per year from Nenagh and 1,000 from Ennis are referred to Limerick for CT scans. Under the new arrangement, this service will be provided in the local hospitals, which will be more convenient for patients and the general practitioners, who will have direct access to CT referrals.
We have heard that promise for the last two years.
Nenagh and Ennis will continue to provide medical care on an inpatient basis and to accept medical admissions from general practitioners out of hours. This service will also come within the scope of a regional structure and arrangements will be in place to facilitate the seamless transfer of patients between the local and regional hospital.
That is not happening.
It will mean that patients will be able to quickly access specialist care. These arrangements will be kept under ongoing review to ensure that they are working as intended and that patients are enabled to access the care they need as quickly as possible.
The shortcomings of the existing accident and emergency arrangements in Ennis and Nenagh and the small patient numbers involved have been set out. The restructuring of services will therefore involve full accident and emergency care being provided from the Regional Hospital, Limerick, supported by Ennis and Nenagh which will have medically supervised local emergency centres for non-major emergencies, minor injuries and self-referred medical problems. These will be open for approximately 12 hours per day and will operate under agreed governance structures and protocols. Governance structures are not in place at present in Nenagh and Ennis with regard to the accident and emergency physicians. They are doing a very good job but governance is not in place and that is not sustainable for the future in the interests of patient safety.
I appreciate that people are concerned about services for those who fall seriously ill or are involved in an accident in areas further away from the regional centre in Limerick. The key to quality emergency and trauma management is pre-hospital care that enables life-saving treatment to be provided quickly to patients. Stabilisation can be carried out by advanced paramedics who travel quickly to the patient. Six of these staff, with specially equipped emergency response cars, are being deployed in north Tipperary and six in County Clare in the coming months.
There is one car.
Once stabilised, all seriously ill patients should be brought to the major regional hospital without stopping at local hospitals. That is already happening.
There is no recognition from the Opposition of the investment in the new fleet of ambulances which has taken place in the last three years in the mid-west. There has been serious investment in the ambulance fleet.
The capacity has gone done.
One would think there was no investment whatsoever if one listened to the Opposition Members.
The general practitioners have shown a certain concern about this issue. A leaflet was recently circulated in the name of the general practitioners but I have discovered that many of the general practitioners in north Tipperary were not consulted and did not authorise the leaflet.
They have not dissociated themselves from it either.
However, I have always been available to and supportive of the general practitioners in north Tipperary. The additional resources which undoubtedly will be needed in the reconfiguration of the hospitals in question will also be needed to support the general practitioners in their work. I will support them in that regard and, indeed, in any other way possible.
I will share time with Deputy Neville and Deputy Reilly. Team work implies that everybody works together; it involves people working to a particular and agreed objective. Most of all, it involves consent, effort and everybody rowing in the same direction, like a rowing boat team in a race, towards the target of better health for everybody. I can offer to the people of the mid-west my experience of the so-called Teamwork report for the north east. The lessons that have been learned there have obviously not been taken on board by the Government.
There is no team work. It is health administration by diktat by people who are not nameless but who are certainly not publicly accountable. There is no transparency about their actions and no knowledge about what is happening. They decide and dictate. There is total chaos in the north east. The so-called team work principle of people working together does not apply there. The Minister for Health and Children, her Department and the HSE have refused to insist on the basic tenet of team work, a principle the Minister enunciated, that no service will be closed down until a better one is in place for the people.
It is quite reasonable and clear that if one has a serious illness that requires specialist knowledge and technology to treat it, one will travel to the ends of the earth to get it. In the north east the smaller hospitals are being closed down, with the services being put into two hospitals, one in Drogheda and one in Cavan. Every day this week in Drogheda there was an average of 20 patients on trolleys. People spend their nights not in hospital beds or rooms but in offices. It is an appalling situation in which people are treated very badly. This is happening while there are vacant beds in other hospitals which could accommodate those patients. They are not being sent there because the HSE Teamwork plan is to close them down. However, it is not putting the replacement services in place.
All the general practitioners, nurses and medical staff in the region have said that the transformation team is not working. I understand four directors appointed by the HSE to assist the Teamwork approach have resigned because they could not fulfil their obligations and provide the services that are so badly needed. Clearly, that is also happening in Clare and north Tipperary. The pressure will be put on Limerick Regional Hospital and it will be unable to cope.
The bottom line is that the Teamwork report is all about stress. It is about doctors complaining. A total of 41 general practitioners in Cavan and Monaghan have written recently to the Minister, Deputy Harney, about this issue. They clearly state that it cannot and will not work under the current arrangements because the Minister is failing to put in place a better, more effective and efficient service to deliver services to patients in the region. The two major hospitals are overcrowded, which is a cause for concern. There is concern about the number of anaesthetists on duty. There have been very serious errors in areas like radiology where people have died as a result of misdiagnosis, and the Minister does not want that to happen in Nenagh, Clare or Limerick.
The key is for the Minister to get her act together. If she is proceeding with a Teamwork report, it should only happen when there is team work, when everybody is on board — the nurses, the doctors, the consultants. The problem is that the Minister is working in the dark, is operating by diktat and working in a way in which the consultants are not involved. As a result, there is fiasco and chaos reigning in the hospitals in the north east because of Teamwork.
Our colleagues from the mid-west are clear about their concerns today. It will not get better. It will get worse because the Minister is not providing the investment before she moves the people to the hospitals. Is it any wonder they would be up in arms, worried and concerned?
If the Government wants to be successful, a good Minister for Health and Children will ensure that everybody buys into the process. In that regard a step by step process is better for everybody. One cannot close down services until new services are in place.
I would warn the HSE in the mid-west to look and examine what is happening in the north east, and to fully examine and understand the situation there. If the HSE would have sight of the letters of which the Minister has sight from all of the consultants, the general practitioners, the specialists in the region and the ordinary people, it would understand what a mess the Minister is making of the health service and how upset and how disadvantaged the people in mid-Munster or Clare, in north Tipperary and in Limerick will be as a result of the Minister's appalling and shameful operation of the HSE. A better name for it probably might be the "Hide-and-Seek Executive", especially when one considers the cases where one cannot make contact with the relevant officials. It is the health secrets executive. The Minister cannot get at the truth, cannot get accountability and transparency, and cannot get at the facts. She can never influence those decisions. That is why the Minister has all those people up in arms with her.
I would appreciate it if the Acting Chairman would let me know when I have one minute left.
I will do so.
I wish to join with Deputy Reilly and my Fine Gael colleagues this evening in expressing my deep concern about the proposed rationalisation of hospital services in the mid-west.
The HSE commissioned Horwarth Consulting Ireland and Teamwork Management Services to report on acute hospital services in the mid-west and the report was made publicly available in January of this year. While none of us can argue against best international practice that aims to maximise best clinical outcomes and improve patient safety as outlined in the report, we can argue about the way the Minister and the HSE plan to implement these changes and the potential negative impact they will have on patient care.
As the Minister, Deputy Harney, will be aware, the report clearly identifies a number of preconditions that must be met if the new plan for hospital services in the mid-west is to succeed. These preconditions include significant increases in medical manpower, further development of pre-hospital and primary care services as set out in the Primary Care Strategy 2001 and the development of critical infrastructure requirements including regional centres of excellence in Limerick city.
The purpose of this Private Members' motion is not to oppose reforms that are in the best interests of patients' safety. Its purpose is to remind the Minister of the precondition that must be met before critical hospital services are withdrawn as outlined in her report, and to remind the Minister of the over-riding principle, contained in the report, which states that no acute services will be withdrawn from the current general hospitals until the regional centre of excellence is resourced and ready to deliver that service with reference to international quality standards. Despite this clear recommendation, it seems that the Minister and the HSE plan to set ahead with the withdrawal of the accident and emergency services even though the essential upgrade of facilities in Limerick has not taken place, as well as ambulance, general practitioner and primary care provision.
We are extremely concerned about the provision of ambulance facilities from the Kilmallock area for which we have been pressing for a number of years. Currently there are three hard-working accident and emergency consultants spread across four accident and emergency services in the mid-west. This is contrary to the patient safety best international practice and is unsustainable in the long term. The report commissioned by the HSE strongly recommends that it take prompt action to reduce the current levels of clinical risk and improve patient safety.
The Deputy has one minute remaining.
I join with my colleague, Deputy Noonan, to pay tribute to the professionalism of the staff of Limerick Regional Hospital. I am proud that my family have been part of this. My sister Mary has been with the Mid-Western Regional Hospital for almost 40 years, my wife Goretti for 30 years.
I wish to pay a special tribute to the staff of St. John's Hospital for their caring for Goretti during her time there in recent years. Likewise I pay tribute to those in the Mid-Western Regional Hospital for their kindness to her. My family, Tom, Maria, Maeve, Danny and I, especially wish to thank Dr. Liam Casserly and the staff for their efforts to save her life on the 25 and 26 January last, and thank them for her peaceful departure on the 27th.
I thank all my colleagues who have taken part in this debate from all sides of the House.
The motion is clear in its intent. It does not seek to block progress. It seeks to ensure that all necessary arrangements are put in place, as recommended by the HSE's own Teamwork Management Services report, before any decision is made on the downgrading of the accident and emergency departments at hospitals at Nenagh or Ennis. It further calls for the immediate provision upgrades at both hospitals. The report specifically refers to 135 additional new acute inpatient beds, but the Minister last night told us because we are not moving services from Macroom or the services from the maternity hospitals that this will not be necessary.
This is the Minister being selective in her use of quotations. I first refer to the selective quote she takes from the Royal College of Surgeons, whose president favours this plan but who states clearly that it will be dangerous if they are put into overloaded accident and emergency departments. In other words, they do not want it implemented piecemeal fashion, and that is what is happening here.
I have a copy of the Teamwork Management Services report before me and I will quote from selected sections. It states:
However, consideration must be given to the economies of scale in developing the existing site to provide a modern, ‘fit for purpose' facility, or whether a new purpose-built regional ‘centre of excellence' should be developed. The list of reconfiguration/refurbishment . . . is substantial and includes:
New obstetrics, midwifery and neonatal unit;
New elective orthopaedics unit;
New or refurbished A&E;
New or refurbished critical care unit [the high dependency unit];
Complete ward refurbishment to infection control standards; and [not instead of]
New additional in-patient beds, totalling 135.
It will be seen from this that the 135 beds are in addition to obstetrics and orthopaedics, therefore, the Minister is disingenuous in what she stated last night.
While on the subject of maternity and this report, I refer to page 22 of the report where it states:
However, there are well recognised residual risks to mothers as the hospital [St. Munchin's] is not co-located with adult critical care support services. Furthermore, there is no on-site paediatric cover for babies which poses further risks. Plans are now agreed for a final move of the service to the Regional Hospital Dooradoyle.
However, the Minister told us last night that those plans will not be implemented.
Moving to page 36 of the report, the last paragraph states:
In the meantime [this is critical] until implementation of the new service configuration is completed, put in place transitional support arrangements, in the form of additional temporary medical staffing for Ennis and Nenagh in particular to improve the quality of current services.
Finally, lest there be any doubt about what this report contains, in heightened blue it states:
The over-riding principle is that no acute services will be withdrawn from the current general hospitals until the regional ‘centre of excellence' is resourced and ready to deliver that service with reference to international quality standards.
I am afraid the Minister, yet again, — as is her wont so often to selectively quote from various documents, reframe the truth and present it as something entirely different — has failed. These are additional beds and they need to be put in place.
The report further recommends an increase in the number of ambulances, which the Minister has not been able to guarantee. In fact, on "Prime Time" last week, the cock crowed three times and still she could not give an undertaking that these ambulances would be in place, because there were industrial relations and human resources issues. That is not good enough for the people of north Tipperary, I say to the Minister of State, Deputy Hoctor, and not good enough for the people of Clare, I say to the Minister of State, Deputy Killeen.
The report demands that a high dependency unit, consisting of 40 beds, be built at Limerick Regional Hospital. Planning permission is not even sought. It calls for an upgrade of the accident and emergency unit at Limerick Regional Hospital, and that has not taken place. It calls for additional accident and emergency consultant staff, to bring the number up from three to eight, yet not a single job has been advertised. It will take from 12 to 18 months to fill those posts. The general practitioners of the region are against it. Each one of them met with Mr. Burke, and not one voted for it. All voted against it because they had no confidence in it, as it is currently being implemented.
The consultants, as referred to last night by the Minister, are becoming increasingly alarmed, particularly at the manner in which this is being implemented. The core of the matter is that the Minister is putting the cart before the horse yet again. The Government wants the people of north Tipperary and Ennis to forego their current service because it believes it is not safe, in favour of a nirvana which has not been put in place. Time and again the Minister has people giving up their current service for a promise of something wonderful to come, and in the gap that ensues people die.
The bottom line here is trust. I said this before and I shall say it again. The people do not trust this Minister, Fianna Fáil, the Government or the HSE to deliver the promises they make. They said there would not be cutbacks and there were. They said they would not hurt patients and they did. This Government promised it would vaccinate our children against cancer, and three months later turned its back on this. In finishing, I ask the Minister to do the right thing.
Amendment put.
The Dáil divided: Tá, 74; Níl, 61.
Tá
- Ahern, Michael.
- Ahern, Noel.
- Andrews, Barry.
- Andrews, Chris.
- Ardagh, Seán.
- Aylward, Bobby.
- Blaney, Niall.
- Brady, Áine.
- Brady, Cyprian.
- Brady, Johnny.
- Browne, John.
- Byrne, Thomas.
- Calleary, Dara.
- Carey, Pat.
- Collins, Niall.
- Conlon, Margaret.
- Connick, Seán.
- Coughlan, Mary.
- Cregan, John.
- Cuffe, Ciarán.
- Curran, John.
- Devins, Jimmy.
- Fahey, Frank.
- Finneran, Michael.
- Fitzpatrick, Michael.
- Fleming, Seán.
- Flynn, Beverley.
- Gogarty, Paul.
- Grealish, Noel.
- Hanafin, Mary.
- Harney, Mary.
- Haughey, Seán.
- Healy-Rae, Jackie.
- Hoctor, Máire.
- Kelleher, Billy.
- Kelly, Peter.
- Kenneally, Brendan.
- Kennedy, Michael.
- Kirk, Seamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lenihan, Conor.
- Lowry, Michael.
- McEllistrim, Thomas,
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- Martin, Micheál.
- Moloney, John.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M.J.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Brien, Darragh.
- O’Connor, Charlie.
- O’Dea, Willie.
- O’Flynn, Noel.
- O’Hanlon, Rory.
- O’Keeffe, Batt.
- O’Keeffe, Edward.
- O’Rourke, Mary.
- O’Sullivan, Christy.
- Power, Peter.
- Power, Seán.
- Roche, Dick.
- Ryan, Eamon.
- Sargent, Trevor.
- Scanlon, Eamon.
- Smith, Brendan.
- Treacy, Noel.
- Wallace, Mary.
- White, Mary Alexandra.
- Woods, Michael.
Níl
- Allen, Bernard.
- Bannon, James.
- Barrett, Seán.
- Behan, Joe.
- Breen, Pat.
- Broughan, Thomas P.
- Bruton, Richard.
- Burke, Ulick.
- Burton, Joan.
- Byrne, Catherine.
- Carey, Joe.
- Clune, Deirdre.
- Connaughton, Paul.
- Coonan, Noel J.
- Coveney, Simon.
- Crawford, Seymour.
- Creighton, Lucinda.
- D’Arcy, Michael.
- Deasy, John.
- Deenihan, Jimmy.
- Doyle, Andrew.
- Durkan, Bernard J.
- Enright, Olwyn.
- Feighan, Frank.
- Flanagan, Terence.
- Hayes, Brian.
- Hayes, Tom.
- Kehoe, Paul.
- Kenny, Enda.
- Lynch, Ciarán.
- Lynch, Kathleen.
- McCormack, Pádraic.
- McEntee, Shane.
- McGinley, Dinny.
- McHugh, Joe.
- McManus, Liz.
- Mitchell, Olivia.
- Morgan, Arthur.
- Naughten, Denis.
- Neville, Dan.
- Noonan, Michael.
- Ó Caoláin, Caoimhghín.
- Ó Snodaigh, Aengus.
- O’Donnell, Kieran.
- O’Dowd, Fergus.
- O’Keeffe, Jim.
- O’Mahony, John.
- O’Shea, Brian.
- O’Sullivan, Jan.
- Penrose, Willie.
- Perry, John.
- Reilly, James.
- Sheahan, Tom.
- Sheehan, P.J.
- Sherlock, Seán.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Upton, Mary.
- Varadkar, Leo.
Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and Emmet Stagg.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided by electronic means.
I note Deputy Timmy Dooley, who spoke so eloquently in favour of the motion last night, is not here. I would like to give him a chance to come into the House to vote in favour of the motion. As a teller, under Standing Order 69 I propose that the vote be taken by other than electronic means.
Deputy Paul Kehoe is a Whip, under Standing Order 69 he is entitled to call a vote through the lobby.
Question again proposed: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 74; Níl, 60.
Tá
- Ahern, Michael.
- Ahern, Noel.
- Andrews, Barry.
- Andrews, Chris.
- Ardagh, Seán.
- Aylward, Bobby.
- Blaney, Niall.
- Brady, Áine.
- Brady, Cyprian.
- Brady, Johnny.
- Browne, John.
- Byrne, Thomas.
- Calleary, Dara.
- Carey, Pat.
- Collins, Niall.
- Conlon, Margaret.
- Connick, Seán.
- Coughlan, Mary.
- Cregan, John.
- Cuffe, Ciarán.
- Curran, John.
- Devins, Jimmy.
- Fahey, Frank.
- Finneran, Michael.
- Fitzpatrick, Michael.
- Fleming, Seán.
- Flynn, Beverley.
- Gogarty, Paul.
- Grealish, Noel.
- Hanafin, Mary.
- Harney, Mary.
- Haughey, Seán.
- Healy-Rae, Jackie.
- Hoctor, Máire.
- Kelleher, Billy.
- Kelly, Peter.
- Kenneally, Brendan.
- Kennedy, Michael.
- Kirk, Seamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lenihan, Conor.
- Lowry, Michael.
- McEllistrim, Thomas.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- Martin, Micheál.
- Moloney, John.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M. J.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Brien, Darragh.
- O’Connor, Charlie.
- O’Dea, Willie.
- O’Flynn, Noel.
- O’Hanlon, Rory.
- O’Keeffe, Batt.
- O’Keeffe, Edward.
- O’Rourke, Mary.
- O’Sullivan, Christy.
- Power, Peter.
- Power, Seán.
- Roche, Dick.
- Ryan, Eamon.
- Sargent, Trevor.
- Scanlon, Eamon.
- Smith, Brendan.
- Treacy, Noel.
- Wallace, Mary.
- White, Mary Alexandra.
- Woods, Michael.
Níl
- Allen, Bernard.
- Bannon, James.
- Barrett, Seán.
- Behan, Joe.
- Breen, Pat.
- Broughan, Thomas P.
- Bruton, Richard.
- Burke, Ulick.
- Burton, Joan.
- Byrne, Catherine.
- Carey, Joe.
- Clune, Deirdre.
- Connaughton, Paul.
- Coonan, Noel J.
- Coveney, Simon.
- Crawford, Seymour.
- Creighton, Lucinda.
- D’Arcy, Michael.
- Deasy, John.
- Deenihan, Jimmy.
- Doyle, Andrew.
- Durkan, Bernard J.
- Enright, Olwyn.
- Feighan, Frank.
- Flanagan, Terence.
- Hayes, Tom.
- Kehoe, Paul.
- Kenny, Enda.
- Lynch, Ciarán.
- Lynch, Kathleen.
- McCormack, Pádraic.
- McEntee, Shane.
- McGinley, Dinny.
- McHugh, Joe.
- McManus, Liz.
- Mitchell, Olivia.
- Naughten, Denis.
- Neville, Dan.
- Noonan, Michael.
- Ó Caoláin, Caoimhghín.
- Ó Snodaigh, Aengus.
- O’Donnell, Kieran.
- O’Dowd, Fergus.
- O’Keeffe, Jim.
- O’Mahony, John.
- O’Shea, Brian.
- O’Sullivan, Jan.
- Penrose, Willie.
- Perry, John.
- Reilly, James.
- Shatter, Alan.
- Sheahan, Tom.
- Sheehan, P. J.
- Sherlock, Seán.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Upton, Mary.
- Varadkar, Leo.
Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and Emmet Stagg.
Question declared carried.