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Dáil Éireann debate -
Tuesday, 5 Jul 2011

Vol. 737 No. 3

Hospital Services: Motion

I move:

That Dáil Éireann calls on the Government to stand by its commitments and ensure:

the continuation of all existing accident and emergency services at hospitals across the State as promised by candidates of the Fine Gael and Labour parties in advance of the general election, including Roscommon, Navan, Letterkenny, Portlaoise, St. Columcille's (Loughlinstown), Portiuncula (Ballinasloe), the Mid-Western (Limerick), Clonmel, Mallow and Bantry;

the retention of key services such as orthopaedic services at St. Mary's Hospital, Cork and the return of comprehensive breast cancer services to Sligo, also as committed by candidates of the parties now in government; and

equal access to safe and efficient hospital services for all, without discrimination based on income or geographic location.

I think the Leas-Cheann Comhairle has the list of those with whom I am sharing time. I move the motion on behalf of Sinn Féin Teachtaí Dála and urge all Deputies to support it.

There is grave concern and growing anger among communities across the State at the prospect of the closure of accident and emergency departments in a range of hospitals. The level of that concern and anger has been increased because of the total lack of clarity on the part of the Minister for Health, Deputy Reilly, the Government and the HSE on exactly what is planned for these hospitals. This is in the context of the shortage of junior doctors and the imminent turnaround date of 11 July and, importantly, what is to happen in the medium to long term.

What we know for definite because the Minister and the Taoiseach have told us is that the 24-hour accident and emergency service at Roscommon County Hospital is to be axed. This has been confirmed this evening by the Health Service Executive. The accident and emergency service at Roscommon County Hospital is to be no more and replaced with a medical assessment unit-urgent care centre. This is an absolutely disgraceful decision. This action is in flagrant violation of the clear and unambiguous commitments given by Fine Gael Deputies in advance of the general election. Deputy Naughten, now chairperson of the Joint Committee on Health and Children, stated:

... a clear commitment on the hospital's future has been provided by Fine Gael's Health Spokesperson, Dr. James Reilly. Not only will Fine Gael retain all existing services at the hospital but we will also enhance and develop services ... Under our proposals the future of services at Roscommon Hospital will be determined locally. We want to have a local board appointed by staff, patients and the community to run the hospital in conjunction with local management and not have it run by faceless bureaucrats within the HSE ... The reality is that Fine Gael is the only party which has delivered a written commitment on the future of Roscommon Hospital and is the only party with a plan to reform the health service as a whole.

These commitments can still be read today on his website. Interviewed for the Roscommon People newspaper he stated: “I made it clear that if, down the road, those commitments were not delivered upon, then yes, I would be prepared to resign the party whip.”

Deputy Feighan stated: "... Fine Gael is determined that its plan to retain and enhance services at hospitals like Roscommon will finally put a halt to this much-touted reconfiguration plan of hospitals in the west which essentially amounts to downgrading by stealth." Labour Party candidate Senator Kelly stated: "The future of the hospital is very safe in Labour hands."

Even more significant than these clear commitments was the commitment made by the then Fine Gael spokesperson on health, Deputy Reilly, now Minister for Health, who, in an open letter to the people of Roscommon published in the local press prior to the general election, wrote:

I would like to confirm that Fine Gael undertakes, in accordance with the Fine Gael Policy on Local Hospitals, to retain the Emergency, Surgical, Medical and other health services at Roscommon Hospital which are present on the formation of the 31st Dáil ... Furthermore, in the event of the A&E being downgraded, we are committed to reinstating a 24/7 service, where feasible.

When replying to health questions last week in the Dáil the Minister tried to sow confusion about this letter. The only meaning — make no mistake about this — that can be taken from it is that, in the event of accident and emergency services at Roscommon County Hospital being downgraded prior to Fine Gael entering government, it would reinstate a 24-7 service, where feasible. That is what the Minister intended; that is what he meant and any twisting of words will not alter this one iota. The accident and emergency service in Roscommon County Hospital was not downgraded prior to the general election but is to be under a Fine Gael-Labour Party Government. Without question, the Minister, his party and coalition partners collectively are breaking their commitment to retain at the hospital the services which were present on the formation of the Thirty-first Dáil.

The Minister claims the accident and emergency service at Roscommon County Hospital is not safe but also claims that he was not aware of this at the time he made his pre-election commitment. However, I put it to him that it was well known all along that the accident and emergency service was under threat in the so-called reconfiguration plans for hospitals so ardently pursued by then Minister for Health and Children, Mary Harney, and the former HSE chief, Professor Brendan Drumm. Otherwise, why would the Minister and his party colleagues have felt it necessary to make these commitments to, in the words of Deputy Feighan, "finally put a halt to this much-touted reconfiguration plan of hospitals in the west which," he correctly indicated, "essentially amounts to downgrading [of services at Roscommon County Hospital] by stealth"? This Sinn Féin motion is not only about Roscommon County Hospital. If the axe falls on its accident and emergency department, as indicated, it will surely fall elsewhere also.

Tá straitéis ann le fada chun seirbhísí in ospidéil timpeall na tíre seo a ghearradh siar. Ní rud nua é seo. Bhí sé mar phríomh-aidhm ag iar-Aire Sláinte agus Leanaí Harney, le tacaíocht ó Fhianna Fáil i rialtas ó 1997. As a Deputy representing counties Monaghan and Cavan, I can speak from long and bitter experience. The words we are hearing from the Minister and the HSE were the words used to justify the downgrading of Monaghan General Hospital which was downgraded and dismantled service by service, beginning with maternity services and the removal of the accident and emergency unit. The strategy was to starve the hospital of resources up to the point where it was deemed unsafe.

There is an interesting parallel between the removal of all acute services from Monaghan General Hospital just under two years ago, on 22 July 2009, and what is happening now. Both scenarios involved an election. In July 2009 I was reliably informed from within the HSE that then Taoiseach, Brian Cowen, and the then Minister for Health and Children, Mary Harney, were closely involved in the decision to axe these services. It was signalled by the HSE that the services were to go in November 2008, then at the start of 2009 and then in the early summer. Of course, the local and European elections followed and the axe was hidden until polling day had passed. It was merely being sharpened and two days before the Dáil went into summer recess until September 2009 we had the announcement that the axe would fall on 22 July. It flew in the face of all appeals from front line health care workers, including nurses, general practitioners, consultants and support staff, and the community across all political affiliations, including, strongly, colleagues of the Minister.

As happened in Monaghan, lives will be put at risk day and night if more communities lose vital hospital services, including emergency and inpatient medical care services. Lives were lost when Monaghan General Hospital was off-call for emergencies in the past, as we pointed out in July 2009. As the Minister is aware, there are approximately 1,600 public hospital beds closed due to cutbacks. Today on "Morning Ireland" on RTE the former HSE chief, Professor Brendan Drumm, was still maintaining that we had too many hospital beds, this at a time when accident and emergency units are overflowing and waiting lists for acute hospital beds are growing. When Monaghan General Hospital was downgraded and acute care services ended, not one additional inpatient bed was provided at either Cavan General Hospital or Our Lady of Lourdes Hospital, Drogheda to which patients formerly treated in Monaghan must go. These hospitals continue to be over-stretched and under-resourced. All of the promised support services due to be put in place before the axing of acute care services in Monaghan General Hospital were not put in place. In the HSE's confidential so-called transformation planning document of April 2008 which I revealed at the time rehabilitation, respite and step-down facilities are described as "alternatives to acute inpatient care". The Minister is a general practitioner and knows they are no such thing. They are distinct from acute inpatient care services. Their availability may free up some beds inappropriately occupied, but they are not alternatives to acute inpatient care for those who require it. However, not one additional inpatient bed was provided.

This is the type of scenario other hospitals face if they are given what I can only describe as "the Monaghan treatment". The emergency department at Navan hospital is hanging by a thread. No ambulances are accepted there and those who present are assessed and diverted to Our Lady of Lourdes Hospital, Drogheda. In 2010 Deputy English of Fine Gael stated:

The news that all trauma cases will drive by Our Lady's Hospital Navan is a terrible blow to Meath and all its residents. The HSE has clearly deliberately downgraded Navan Hospital to pave the way for this decision ... The Lourdes Hospital will not be able to cope with the increased numbers coming from Meath, which means lives will be put at risk.

Deputy McEntee of Fine Gael stated:

This moves make no sense at all. Navan is located at the heart of Meath and is easily accessible from all parts of the county, but most of the roads to Drogheda are of a poor standard. The main road to Slane is currently closed and the diversion via back roads is barely suitable for ambulances.

The downgrading of Navan hospital was also criticised by the then Labour Party health spokesperson, Deputy Jan O'Sullivan. There are real and well grounded fears that the Midland Regional Hospital, Portlaoise could share the same fate. It may be that the emergency measures being introduced to address the junior doctors issue will prevent the downgrading of the accident and emergency department at Portlaoise for now, but I urge those campaigning on the issue not to desist. Almost 42,000 people attended the accident and emergency unit there last year and there must be no question of the department being closed or services being reduced there.

In Letterkenny hospital senior clinicians are seriously concerned about what will transpire there from 11 July. Any diminution of accident and emergency services there would be a disaster for the people of the north west. In the case of St. Columcille's Hospital, Loughlinstown, the proposed downgrading of accident and emergency services would deprive the people of County Wicklow of a vital service and place further pressure on St. Vincent's University Hospital, Dublin.

An indicator of the doubts and concerns raised by the junior doctors shortage was the fact that the board of the Mid-Western Regional Hospital in Limerick had indicated that its complement of non-consultant doctors had been halved and that it would be obliged to close the accident and emergency service, the second busiest in the country, for 12 hours duration overnight. HSE West regional director, Mr. John Hennessy, has since stated no decision had been taken to close or curtail the emergency service. I call on the Minister to confirm that this is the case and give a clear commitment that definite action will be taken to ensure nothing of the kind will be allowed to occur and that this will apply to all of the other hospitals mentioned in the motion, as well as the accident and emergency unit at Clonmel.

In the case of the other hospitals referred to in the motion, those in Mallow and Bantry, the downgrading plans are being implemented. If Fine Gael and the Labour Party were sincere in their claimed commitment to these smaller hospitals, they would reverse the cuts. The parties now in government also made commitments to the retention of key services such as orthopaedic services at St. Mary's Orthopaedic Hospital, Cork, as well as to the return of comprehensive breast cancer services to Sligo. Rightly, the people are demanding that these commitments are kept also. We make the same call again on the floor of the House in our motion.

The context for the hospitals crisis is the regime of savage cuts to public health services imposed as a result of the continuation by the Fine Gael and Labour Party Government of the Fianna Fáil and Green Party Government's disastrous economic policies. The Minister and the Taoiseach have stated the over-spend in hospitals this year is €99 million. However, on 29 June the Government paid out €12 million to senior Anglo Irish Bank bondholders with unguaranteed bonds. On 20 June it paid out €20 million. By the end of the year it will have paid €779 million to the same cohort of gamblers. Apparently, seriously ill patients must wait but bondholders cannot.

The latest cuts in my region, the north east, are to services for sick children. In the Louth Meath Hospital Group the HSE has reduced the number of paediatric outpatient department clinics and increased waiting times for routine outpatient department appointments from approximately 16 weeks to 32. Children with cancer previously admitted to Our Lady of Lourdes Hospital, Drogheda will not now be admitted but transferred to Our Lady's Children's Hospital, Crumlin.

The other aspect of the current context is the the non-consultant hospital doctor issue. The Government is undertaking stop-gap measures to meet the shortage of junior doctors from the turnaround date of next Monday, 11 July. These measures, including the Medical Practitioners (Amendment) Bill, are necessary, but we are unclear as to how far they will go. They may avert full or partial closure of accident and emergency services at some hospitals such as at Portlaoise general hospital. However, what is to happen in the medium to longer term? As I pointed out, there is a long-standing strategy of downgrading hospitals and centralising services in a handful of regional hospitals. The junior doctor issue is being used as a smokescreen to implement the policy of the Minister's predecessor in government, whom he berated here day after day for the same pursuit. The non-consultant hospital doctor issue is not a new problem. It has been known and widely recognised for years that the hospital system is totally over-reliant on junior doctors. Successive Governments have failed to address the issue and now it is looming again, worse than ever. Recruiting sufficient additional junior doctors will be required in the short term, but this is not enough. Nurses should be freed up to fulfil more responsibilities in accident and emergency departments, as they are qualified and willing to this work. Hospital consultants should be required to fulfil their contracts to serve the public hospital system, contracts which continue to be widely breached. More consultants are required in the public hospital system. The current excessive remuneration for consultants must also be reduced to facilitate the employment of more consultants.

I urge all Deputies to support the motion. Let us make no mistake about it: the immediate backdrop to our meeting in the Chamber is the announcement by the HSE this evening that accident and emergency services at Roscommon County Hospital are to cease as we have known them.

The right to access to safe and efficient health care should not be conditional on one's postal address. There can be no discrimination on the basis of geographic location or the size of one's bank account. Tragically, that all too often is the reality in Ireland today and will become the reality for many more thousands of Irish citizens. The people were led to believe by the parties now in government that change was coming and that in the health service, above all, a new chapter would be written. It is time these elected representatives, as well as the Minister and his Cabinet colleagues, listened to the people again. They have a duty to keep the commitments they have given. I commend all those who have been campaigning in defence of hospital services and for health care justice. They are courageous people of all political views and none and I urge them not to give up but to keep on campaigning, to unite with other communities nationwide and avoid approaching the problem as individual communities with a sole hospital focus. Instead, they should merge into a single strong campaign and stand together in demanding the protection of and a guarantee in respect of the continuation of accident and emergency and all other essential services currently in place across the network of local hospitals across the State. The destruction of the public health services must be prevented. Therefore, I urge all Members to support the motion.

It is known that countries with comprehensive primary care systems tend to have lower health care costs, lower mortality rates, longer life expectancy rates and greater satisfaction rates in their health care systems. As long ago as 2001, Deputy Martin of Fianna Fáil, then Minister for Health, announced with great fanfare his Government's primary care strategy, A New Direction. The outcomes, of course, have fallen far short of the promises made by him. While time has passed, the fundamental flaw of Fianna Fáil's strategy lives on in the Government's plans for primary health care provision.

Primary care teams need facilities, but, to date, sufficient buildings have not been provided to complement the Government's primary care strategy. Instead, the few virtual primary care teams available have no buildings from which to deliver services and are unable to develop robust relationships with their communities or one another. Despite this recognised failing of Fianna Fáil's health strategy, the programme for Government does little to right this wrong. Although experience shows that primary health programmes work best when appropriate infrastructure is in place, primary health care centres get a mere passing mention in the Government's post-election commitments.

This problem is compounded by the ongoing shortage of general practitioners. Dublin's north inner city, which I am proud to represent, has the lowest general practitioner coverage per head of population and the highest incidence of closed GP lists. It also has some of the worst health and deprivation indices in the country, with the poorest access to primary health services. While the north Dublin inner city training programme in general practice is trying to address these imbalances, the lack of primary care facilities continues to thwart the efforts of those concerned. It is time the Government stepped up and delivered desperately needed primary care facilities to the inner city, as well as increased GP training places. The evidence shows that the establishment of general practitioner training programmes in places in which it has been traditionally difficult to attract GPs leads to an increase in the number of GPs working in these areas and this is what must happen. These are not options or luxuries but basic must-haves.

I take the opportunity to note the news that an independent review group has recommended the Mater hospital site as the best location for the new children's hospital. I support the call of my colleague, Deputy Ó Caoláin, for the publication of that review, as well as the concerns he has raised as to what will happen in the interim to Temple Street, Crumlin and Tallaght hospitals. These hospitals must be properly resourced and supported to continue to provide excellent hospital services for children, while awaiting the opening of the promised new facility. Moreover, now that a decision has finally been made on the location of the children's hospital, action is needed.

The Government must also address the ongoing shortfalls in existing hospitals, including the large acute hospitals in Dublin. I note the HSE recently gave the Mater hospital a red card for unsatisfactory performance in respect of waiting lists for patient admissions. I am conscious this problem is not unique to the Mater hospital, as the numbers languishing on hospital trolleys across the State testify. Moreover, an estimated 200,000 citizens are waiting for outpatient appointments in hospitals across the State. This is simply stunning and a shameful figure for any Government to stand over. As Members debate this issue, what the Minister intends to do about it is anyone's guess. The Sinn Féin motion calls on the Government to maintain services and provide access to quality services on a universal basis. I commend it to all Members of the House.

As my colleague, Deputy Ó Caoláin, has dealt comprehensively with the State-wide picture, I intend, as a Deputy representing Donegal North-East, to focus my comments on its local hospital, Letterkenny General Hospital. The Minister will be aware that not long ago 15,000 people gathered together in a county that previously had not been renowned for massive public protest. They gathered in the pouring rain to seek equality in cancer care, to ask for services to be upgraded in the region and for the full spectrum of cancer care services to be provided. That campaign was led by women who had moved to County Donegal from Scotland, Belfast and Monaghan. Through their personal experiences and determination, they inspired thousands of others and their campaign has been successful.

People in County Donegal thought this would be the beginning of a new dawn for health care services in the county. They thought that at last the long neglected needs of the people living in the county and region would begin to be addressed comprehensively. However, to their horror, they have watched the debacle over the extension to Letterkenny General Hospital unravel into a farce. The building company which was awarded the contract, McNamara Construction Limited, was closed down by NAMA, as in turn were the subcontractors who had carried out the work in the hospital. Most importantly, the people who had waited so long for proper and adequate accident and emergency facilities and modern facilities in the wards in the floors above were let down.

The aforementioned project will have been delayed by one year, but even when it comes on-stream, cutbacks in the HSE mean wards in the existing hospital building will be closed and not a single additional new bed in the three-storey building will have been created. This constitutes a damning indictment of how health services are run. While it is bad enough that people were obliged to wait another year, after decades of waiting for proper facilities, on its completion it will only offer a nicer environment in which to work but no new capacity. The impact of this development is that patients are to be found on trolleys in the accident and emergency unit there on a regular basis and no doubt the position will not change when the new building finally comes on-stream.

The impact of the cutbacks and the impossible budgetary demands placed on staff of the hospital results in outpatient clinics and elective surgery being cancelled regularly. There is ongoing suspension of elective surgery. People who are crippled with pain — mostly elderly persons — have to wait long periods for basic operations. Consultants are paid huge salaries, yet they are sitting around twiddling their thumbs. As they have said this publicly, they do not need me to say it. It is ridiculous.

Due to the failure to appoint junior doctors, the continuation of the 24-hour accident and emergency service at Letterkenny General Hospital is under real threat. We await clarification as to when junior doctors will be appointed and what is envisaged as a permanent solution. There has been a downgrading of critical services in the hospital, in comparison to hospitals serving much smaller areas. The morale of the often heroic staff on the front line is being sapped. They do not know what to do with themselves as a result of the pressure and the impossible demands being imposed on them by the system.

The motion implores the Minister and his colleagues who campaigned for change and appealed to the real desire of the people for a new beginning after the crisis we have endured to do the right thing. It appeals to the Minister to find the resources to honour the commitments made, not to neglect regions of the State which have been neglected for far too long. It also appeals to him to give the people the health service they deserve and for which they pay taxes.

In supporting tonight's motion I reiterate the importance of securing funding for essential hospital services across this island. Our health system is failing people across this State and nowhere is this more clearly recognised than in my constituency of Dublin South-West. Tallaght hospital, despite the best efforts of its hard-pressed staff, exemplifies much of what is wrong with the health care system. A shortage of key personnel such as radiologists, physiotherapists, dermatologists and even clerical workers, reflects the difficulties within the hospital. The way a nation treats its most vulnerable and weakest citizens reflects how a society functions.

Sinn Féin calls on the Government to stand by its pre-election commitments and to respond to the worsening crisis which is denying access to the most basic care. The failure to provide funding to ensure sustainability and development of essential services has had a profound impact on the lives of people who are dependent on public health services when sick or injured. Tallaght hospital has the busiest accident and emergency department in the country and in 2010, 93,000 people were treated there yet it remains chronically under-funded since its opening. In a recent newspaper article, a patient describes its corridors as being a breeding ground for infectious bacteria, a view substantiated recently by the Dublin County Coroner, Dr. Kieran Geraghty, who described the hospital as a very dangerous place. His comments were made after a local man, Thomas Walsh, died after being admitted to Tallaght hospital with a severe ankle pain. He had been left in a so-called virtual ward, a euphemism for abandoning sick patients in hospital corridors while awaiting a bed in a ward. The sheer obscenity of having dozens of sick patients lying on trolleys with no privacy, a lack of basic hygiene facilities and no real health supports, brings into sharp focus the cuts in the health service. I was present in the hospital one night when more than 50 patients were lying in rows of trolleys. A family grieved around the bedside of their elderly mother — no dignity for the dying and no dignity for their families.

I welcome the fact that HIQA, the Health Information and Quality Authority, has published the terms of reference for a statutory inquiry into the safety and governance of care at Tallaght's accident and emergency department. I understand that under the eight terms of reference, the inquiry will assess the quality, safety, governance and accountability of services provided to patients who attend the accident and emergency department. It will also examine whether the board of the hospital has been effective in managing risks to patients. The inquiry must begin immediately and the focus must be on implementing radical improvements in the hospital.

The Minister might also look at the lack of after-hours GP services in Tallaght and its impact on the accident and emergency department. He might also look at an area such as Fettercairn in Tallaght, with a population of 7,000 people but with no general practitioner based in that area. My colleague, Deputy McDonald, cited the recent announcement about the new national children's hospital. There will be no celebration in my area. Sinn Féin was the first party to highlight the difficulties its siting creates for families or individuals trying to cross to the Mater site. We outlined the length of travel time on public transport.

I ask the Minister to also look at the policy on the rolling out of children's hospital services, the paediatric services, in this city. There will be no overnight beds for sick children on the south side of Dublin. He needs to look radically and quickly at this difficulty which families will face.

Tá Sinn Féin ag taispeáint ceannasaíochta sa Dáil arís, agus an rún seo á phlé againn. Tuigim go mbraitheann gach rud ar cad a tharla roimhe seo. Dá mba rud é nár bhuaigh Fine Gael an toghchán deireanach, bheadh an tAire ar an taobh seo den urlár agus ag tabhairt tacaíochta don mhéid atá le rá againn. Cúpla mí ó shin, bhí an rud céanna á rá aige agus ag Teachtaí eile atá ina hAirí agus mar pháirt den Rialtas anois. Dúirt siad gur chóir na seirbhísí cuí a choinneáil sna ceantair thuaithe, agus na seirbhísí otharlainne a choinneáil mar atá siad agus feabhas a chur orthu. Tá sé cinnte agus iontach soiléir anois go bhfuil na gealltanais bhriste ag an Aire, ag an Taoiseach agus ag Teachtaí Dála Fine Gael agus an Lucht Oibre. Thug siad na gealltanais sin le fáil isteach sna cathaoireacha ina bhfuil siad inniu.

It is very clear and I do not have to repeat what other speakers have said earlier and again this evening that this Government has broken the promises to the electorate. It has broken the promises to people in very vulnerable areas who depend on their health services, from Navan to Drogheda, from Roscommon to Leitrim and areas in my constituency in Donegal. Not only had the Government parties given the nod and wink to the constituents during the election campaign that they would ensure that the services were maintained, but they went further. In the case of my constituency and the hospital with a catchment area in part of my constituency, Sligo General Hospital, one of the Government Deputies went so far as to say that he would resign from Government if cancer services at Sligo General Hospital were not restored within one hundred days. I am sure the Minister is disappointed at the lack of honesty of that Deputy, the lack of honesty to the electorate and the people who elected him, who believed that by electing him to this House and this Government, he would defend the rights of cancer patients across the north west. He has failed, just as the Government is failing to deliver the health services it has pledged to the people across the State.

This issue was inherited from the previous Government which ran down the health services over many years. Deputy Ó Caoláin referred to it when he said the template to be used across the State for the downgrading of hospitals was the template used in Monaghan General Hospital. If there was ever a time when I wished Deputy Ó Caoláin was not correct, it was then. We have seen this transpire over recent years under the Fianna Fáil, Green Party and Progressive Democrats Government and now, unfortunately, we see this Government putting another nail in the coffin of health services throughout this State.

There is a crisis brewing and 11 July is the date when the non-consultant hospital doctors will not be available to provide adequate cover for many hospitals. The Minister has yet to tell the House which of those hospitals will be affected. Which rural hospitals will be affected? We understand that in Donegal, Letterkenny General Hospital might not be affected on 11 July. However, given that 67 of the non-consultant hospital doctors are locums and those posts will disappear a number of weeks after that, there is a serious threat to the downgrading of Letterkenny General Hospital. The accident and emergency department may not remain open after August and September. In answering questions from Deputy Ó Caoláin last week, the Minister said junior doctors would be directed to regional hospitals. I ask him to provide clarification for patients across the north west and the State on which hospitals will retain services.

The Minister told people the money will follow the patient. It is very clear from this Government that the only people whom the money is following are bondholders. Last week the Government paid out €12 million of unguaranteed debt to bondholders. Tomorrow it will pay out another €10 million. The debt of Letterkenny General Hospital is approximately €6 million to €8 million. On 2 November, €750 million in bonds will mature: the debt of Letterkenny General Hospital amounts to 1% of that. The Government is prioritising bondholders over the safety and health of patients.

I wish to share time with Deputies Simon Harris, Denis Naughten and Charlie Flanagan.

Is that agreed? Agreed.

I move amendment No. 2:

To delete all words after "Dáil Éireann" and substitute the following:

"—recognises that the first and over-riding priority for all hospital services must be the safety of patients;

supports the Government's approach to ensuring that all patients have access to timely, high quality emergency services;

notes the growing evidence that larger hospitals with a higher volume of patients treated by appropriately trained health professionals have significantly better outcomes for patients with complex or life-threatening conditions;

endorses the recommendations of the independent Health Information and Quality Authority on this issue and welcomes the Government's commitment to implementing the approach advocated by the Authority;

strongly supports the Minister for Health's establishment of the Special Delivery Unit within his Department, which has already started its work to reduce unacceptable waiting times in emergency departments, and will also address lengthy waiting times for in-patient, day case and out-patient treatments;

supports the Government's continuing emphasis on providing high-quality diagnostic and treatment services for patients with cancer irrespective of where they live;

commends the Minister for Health's work to ensure that there is a sufficient number of non-consultant hospital doctors to provide high quality acute hospital services throughout the country; and

endorses the Government's intention to introduce a system of Universal Health Insurance, which is based on fair access to healthcare for all, irrespective of income or geographic location; and resolves that no hospital will close but that some services will change."

I start by responding to some of the issues raised by Deputy Ó Caoláin. While it might have been known that Roscommon's emergency department, which is still referred to as an accident and emergency department, was under threat it was not known that it was unsafe. The Mallow HIQA report had not been released at that point and was not published until April. It was the first report to identify clearly the hospitals about which it was concerned. Nobody has raised this issue with me more and shown more concern about this than Deputies Naughten and Feighan. Senator John Kelly has been at my door on numerous occasions in regard to his concerns.

I want to touch on one or two things that were said about Tallaght and Fettercairn. I met the Tallaght Hospital Action Group today and we had a good conversation. It raised its concerns about staffing levels and the budget and I have taken that on board. I am equally aware and concerned about the fact that a place like Fettercairn has no GP service. It is an area to which I refer when I talk about the right of my Department to implement our social policy when it comes to supporting practices. If we open the GMS to all GPs I have no issue with that, but we will not support five practices on Grafton St. when there is none in Fettercairn.

In regard to the national paediatric hospital, the ambulatory care unit in Tallaght will be open first and the report alludes to the need for some overnight beds there, something which will certainly be considered. On the comments on Loughlinstown, the hospital is seven minutes from St. Vincent's Hospital. Therefore, what can be carried out safely there is obviously a matter of consideration and what can be achieved by moving a patient seven minutes down the road also has to be considered.

I made it clear before the last general election that if the cancer services in Sligo General Hospital were out of operation for more than a year it would be very difficult to reinstate them, but we have not closed the door to that possibility and are still in discussions. Deputy Doherty mentioned that money follows the patient but that the money has left the country. If we were to follow his advice and debunk on everything we would have to make an adjustment of €19 billion or €20 billion in one year. How many salaries and cuts would that cost? The system could not withstand the shock.

In regard to Roscommon in particular, I understand the fear of local communities. In the past it often meant death by stealth. That is not the case here and it is not the agenda of this Government. The Government is very clear that the future of smaller hospitals is bright. It is not the beginning of the end. In fact it is the beginning of a new lease of life, but in a much safer way by doing a lot of different work from what they did hitherto. We need our local hospitals and their capacity and expertise.

As the Taoiseach said, in regard to Roscommon we also need to be truthful. Not enough non-consultant hospital doctors will be available to us, something which I will outline in more detail. Smaller hospitals are not as safe as bigger ones in key areas. There is a wealth of international research to back this up. When it comes to multiple traumas, strokes and heart attacks, it has been proven internationally that one has a 25% better survival rate at a larger hospital which has a higher volume even if one is more than one hour away. In this context paramedics are very important.

What has happened here in recent years is something which has now been highlighted by HIQA. We all thought if there was an accident and emergency department with a doctor and X-ray machine the service was safe and could look after us if we were acutely ill, and that the skill set was available to deal with multiple traumas, double fractures, heart attacks or profuse bleeding. We have to realise that behind many of these hospitals the skill set is not there and there is no vascular surgeon, orthopaedic surgeon, anaesthetic consultant on-site at night or a person to carry out intubation. If a person has to wait 15 minutes for someone to come from down the road to intubate him or her, he or she will be dead.

We have to look at what constitutes safe practice and be honest with people. People are starting to vote with their feet. It is important to point out the attendance rates at smaller hospitals. In Roscommon 30 people attend on a daily basis on average, a total of up to 14,000 per year. Fewer than one person a day, or 360 patients a year, is transferred from the accident and emergency department to Galway, rather than the 14,000 some would have us believe.

The golden hour has been much talked about but has been superseded in recent years by a wealth of international experience that shows that a high-volume unit is where the best outcomes are achieved, even if it is well in excess of an hour away. This view was formally endorsed in Ireland by the Irish Association of Emergency Medicine, the medical director of the National Ambulance Service and the national programme director of the HSE's clinical programme on emergency medicine. Dr. Una Geary, the clinical leader in emergency medicine in this country, said at a press conference the other day, "There is not a single serving emergency department consultant in Ireland who believes differently." That is the reality.

The Deputies opposite referred to the statement I made during the election on Roscommon hospital. Any statement I made was made in good faith. Any utterance I made was born out of a strong conviction that all hospitals have a future with integrity in their communities. Anything I said was in defence of hospitals and out of a determination that no hospital should be downgraded out of existence. My priority is to defend patients and above all else ensure their safety when they are at their most vulnerable, when they are acutely ill and when they are utterly reliant on the skills of those around them to save their lives and ensure the best outcome for them.

The Opposition wants to sustain what is unsustainable and keep unsafe that which must be made safe.

I did not interrupt the Deputy. I do not accept that the changes to the emergency department at Roscommon hospital represent the downgrading of the entire hospital. I want to be clear about what I want to see. I want to see it made safe. I do so, as the Deputy rightly pointed out, with the background of a non-consultant hospital doctor shortage. We have known for the past 20 years about our dependence on non-national, non-consultant or junior hospital doctors in this country. However, in 2007 we changed the law and got rid of temporary registration, which made it more difficult and less attractive to come here. We changed the way we treated our non-consultant hospital doctor posts, so we have created training and non-training posts. Many of these non-training posts are simply not attractive either to our own doctors or to doctors coming from abroad. We have sought to correct that legal deficit, which is giving an advantage to our UK neighbours and others across Europe who are seeking doctors. In that way, we can now create new supervised posts with temporary registration which allows doctors to come here. They will be subject to an intense assessment, including a one-day exam followed by two weeks of assessment on site. These doctors will be extremely well assessed, therefore. Even if by some quirk, however, we find that an individual is not suitable for the post, he or she will not be able to leave that post — having come here to do surgery — and go off to do psychiatry in Cork and present a danger to patients. They will automatically lose their registration and will have to return to their country of origin.

I want to talk about the safety of emergency departments and the increased survival rates at bigger hospitals. In recent days, a draft report has become available which has not yet been finalised. Some of the statistics in the report, while rough, are so startling that they cannot be ignored. They were gathered over the past three years. One set of statistics shows that a patient attending Galway University Hospital has a 5.8% mortality rate compared with a 21.3% mortality rate in Roscommon, which is four times greater. That is not the fault of doctors in Roscommon hospital; it is a reflection of the fact that the skillsets and backup are not there. There is no intervention cardiologist or multiple trauma team to deal with patients. Talking about cardiology alone, it comes down to the fact that there is no ability to put a stent in, which is now the required standard of care. Thrombolytics only go so far. One must be able to get angiography and a stent in to where the blockage is. That is what improves survival and that is what one gets when one goes to a bigger hospital, but it is not available at Roscommon and other smaller hospitals. That realisation must be taken on board by all of us.

Does that mean that people in Roscommon will be left without a 24-hour service? Not if I can help it. I have asked that we should have an urgent care centre there and I am guaranteed it will be staffed from 8 a.m. to 8 p.m. by a non-consultant hospital doctor supervised by a consultant with the backup of a medical assessment unit. I can give an undertaking that between 8 p.m. and 8 a.m. there will be a new GP out-of-hours co-op service in Roscommon town, based in the hospital outpatients department. I hope that will only be a temporary situation and that we can ultimately move, within a month or so, to that being carried out in the urgent care centre with access to diagnostics. In the interim, and the HSE is trying to find the right person to do this because it involves a particular skillset, I am seeking one, but I think we will need two, non-consultant hospital doctors to staff the urgent care unit between 8 p.m. and 8 a.m. under the supervision of local consultants. This is only a temporary measure. It will be run on a bona fide, pro bono basis by local consultants and would not be sustainable in the long term. The Health Information and Quality Authority, HIQA, will not accept it for longer than a month, nor will the HSE’s clinical leads. However, it would buy time to allow the GPs to consider moving to the urgent care centre.

Have they yet to consider it?

There will be many other services at Roscommon, including an additional ambulance. Therefore, there will be four ambulances in Roscommon during the day and three at night, two of them based in Roscommon town. There will be paramedics available in a car for Roscommon also. There will be additional diagnostics and screening, including colorectal cancer screening, that is, colonoscopies, at Roscommon. We intend to extend day surgery in order that it will not be 9 a.m. to 5 p.m. but from 7 a.m. to 10 p.m. or 11 p.m. It will be a 23 hour per day surgery and overnight surgery two or three days a week that will allow a much wider range of things to be done.

I find it extraordinary that people are going to big hospitals such as Galway, Beaumont and Tallaght for hernia repairs, gall bladder removals, varicose veins and other conditions that should be directed to smaller hospitals. It is our intention to have much more activity at the smaller hospitals but it will be safe. The future of Roscommon hospital is secure. There is no question of this being death by stealth or the beginning of the end. This is the beginning of a new lease of life for Roscommon.

There are now 180 vacancies for non-consultant hospital doctors and we have 200 plus medical people who have sought visas to work here. I cannot give a guarantee they will be here until they land, however, and they must also be trained to be fit for purpose. Last year, there were 150 such vacancies. I am hopeful we will end up with sufficient people to run the service over a two year period that will give them a guarantee, security of tenure, training and clinical up-skilling. It will also give us security of tenure to allow the forum to be established to report not later than the end of autumn to inform us about manpower training and to match undergraduate with postgraduate posts that are needed. It will also give a clear career path to doctors. Specialists who are qualified and to all intents and purposes could be consultants but do not have a job will be given work in this country. They will report only to a clinical director and no other consultant.

I have not had time to talk about the special delivery unit, which will certainly address a lot of the problems we have. It is my intention that Roscommon hospital will deliver safe and appropriate care, 24 hours a day, seven days a week. This is not the beginning of the end, as I said, but the beginning of a new lease of life.

It is my goal and that of the Government to bring in free GP care over the next few years and to lay the groundwork for universal health insurance in order that all patients can access primary and secondary health care without worrying whether they can afford it when they need it.

I welcome the opportunity to place my thoughts concerning the future configuration of our hospital services clearly and categorically on the record of this House. I commend the new Minister for Health on not ducking the issues and not passing the buck which we saw with so many previous Ministers for Health. Where his predecessors chose to abdicate their responsibility, referring to the Department of Health as Angola, or, in the case of the current Fianna Fáil leader, to create a monstrous bureaucracy unaccountable to the people and their representatives, the Minister is determined to reform our health service, including areas that have long been ignored.

The Minister's hands-on and innovative approach to addressing the shortage of non-consultant hospital doctors is to be welcomed. I am sure we all hope these efforts will bear fruit. As other Members have said, this is an issue that has been ignored for far too long.

When it comes to health care and the well-being of my constituents, I will not take my lead or advice from the Sinn Féin party or, indeed, any political party, my own included. The people I want to hear from and those whom the public deserve to hear from are the clinicians who treat patients every day on the front line in hospitals. These are the medical experts who can correctly assert what is safe medical practice and what is not. They, rather than a political party, the HSE or any individual politician, have the qualifications, expertise and background to make life-saving decisions for my constituents.

Historically, my constituency of Wicklow has been the poor relation with regard to health services, despite the previous economic boom. We have no general hospital and have been dependent on travelling for medical treatment to other counties, such as Dublin, Kildare or even Wexford in some cases.

I was extremely angry, frustrated, annoyed and insulted to hear through newspapers and other media about the HSE's proposals to reconfigure services at St. Columcille's Hospital in Loughlinstown, County Dublin. This drip-feed of leaked information does not allow for a rational debate or consultation on proposals. It creates an environment of fear and of genuine worry among the public. Unfortunately, on occasions, it also creates an environment in which some politicians try to tap in to that genuine public concern.

Medical professionals in St. Columcille's Hospital, Loughlinstown — and this also applies to the broader health services in County Wicklow — should hold a public information day when people could drop in to hear what services are on offer. They should be able to hear facts and figures without the political spin from any party.

They can see what services would be on offer under a changed system and how they would interact with people on a daily basis. I want to see plans for increased capacity at St. Vincent's University Hospital's accident and emergency department before any changes are introduced at St. Columcille's Hospital, Loughlinstown. We need a much improved ambulance service for County Wicklow, with ambulances located at the best possible point to serve people quickly and resourced with paramedics with all the necessary qualifications.

I agree with Deputy McDonald that we need to hear more about the roll-out of primary care facilities in my constituency in Bray, Greystones, Arklow and Wicklow town. There have been far too many missed opportunities where primary care facilities have become glorified places in which general practitioners have rooms. They need to be much more than that, a desire which I know the Minister shares.

Deputy Crowe made a valid point in regard to after hour general practitioner services. This issue needs to be examined and I urge the Minister to do so in consultation with general practitioners in Wicklow and south Dublin in regard to St. Columcille's Hospital, Loughlinstown. Reforms at St. Columcille's Hospital are needed but no change should take place in isolation. It should happen as part of an overall package to co-ordinate services between St. Columcille's Hospital, St. Vincent's University Hospital and St. Michael's Hospital in Dún Laoghaire. St. Columcille's Hospital should be mandated to take the clinical lead in some areas of medical speciality. Reconfiguration equals change but must not equal downgrade. I welcome the Minister's comments in that regard.

I will continue to pursue these issues with the Minister over the coming weeks and months. I will support whatever service is deemed best not by my political opponents but by those with the qualifications and know-how to serve my constituents. I need to hear about how my constituents in County Wicklow, a county abandoned from a health point of view during the boom years, will fit into the roll out of primary care centres and indeed improved access to an ambulance service. It is extremely important, as we in this House wrestle control from an unaccountable HSE and restore accountability to this House, that the message goes out to the HSE tonight from all sides of this House that the leaking of information and the deciding of HSE proposals without consultation is not on.

There is a new sheriff in town. It is important that message is heard loudly and clearly by the HSE.

There has been a sustained attack on the safety of small or local hospitals, facilitated and promoted by the last Government. All of the medical professionals say their practises are not safe and that their emergency departments should be closed. Surely then the solution is to make them safe and keep them open. Instead, we are faced with a one size fits all approach from medics based a few minutes away from the major regional centres. This is unacceptable. There are clear exceptions where this type of approach simply cannot work.

We should and must look at the unique geographic problems facing communities such as that serviced by Roscommon County Hospital and come up with a tailored solution that takes this and other factors into account and acknowledges that the one size fits all approach simply will not work. Commentators and so-called medical experts say that Roscommon County Hospital has no future yet none of these people is prepared to acknowledge that many parts of the hospital's catchment area are two hours from the so-called centre of excellence. These geographical issues are being completely ignored by the setting of standards by the Health Information and Quality Authority, HIQA, which seem to be solely focused on standards applicable when people come to the door of a hospital or are placed in an ambulance rather than on the transportation of inadequately resuscitated and unstable patients over large distances. This must change.

Door to door, via the motorway, Roscommon County Hospital is one hour and 21 minutes from Galway University Hospital. This does not include call-out time, assessment and stabilisation of the patient by a paramedic and return journey from the scene of the emergency. I am not a medical expert. However, the total disregard for these facts does not make sense to me. I invite all of the local medical professions in Roscommon, including the consultants and general practitioners, to meet directly with the Minister and his medical advisers and to thrash out once and for all the so-called safety issues at Roscommon County Hospital.

The proposed complete closure of the accident and emergency department at Roscommon County Hospital came not from outside but from the hospital and its consultants. I believe the consultants proposed the closure of accident and emergency in good faith as a last resort. The fact is that this is now being used as an implementation plan. The HSE is saying this is what the people working in the hospital have put forward. I urge the consultants to revise their plans and to work with the Minister to ensure Roscommon County Hospital can provide additional services locally to individuals who should not have to travel significant distances to access treatment.

The urgent care centre proposed by the Minister is the first of its kind in the country. It is a blank canvas. I urge the consultants and general practitioners to work with the Minister to create a unique centre of excellence that can become the benchmark for other geographically isolated communities. I reject utterly the proposal for the complete closure of the accident and emergency department at Roscommon County Hospital. The people of Roscommon need a 24 hour-seven day a week service. We have some of the best nurses and support staff in the country working in and supporting our emergency department. We should be using these professionals to develop services not undermining their role. I have not thrown in the towel. I am committed to working in the best interests of the hospital, its patients and staff in providing the best possible safe service long into the future.

In the brief time available to me I would like to address the situation in my constituency, with particular reference to the Midland Regional Hospital, Portlaoise which is not a district, county or general hospital but a regional hospital that over the past 12 months carried out 41,825 accident and emergency procedures. This to my mind places the Midland Regional Hospital, Portlaoise in a most different place to those hospitals referred to in the debate thus far this evening.

It is totally unacceptable to have to highlight again in this House the total breakdown of trust between the people of County Laois and the Health Service Executive. The Midland Regional Hospital, Portlaoise was consistently bled of funds by the previous Administration. Rumour and counter rumour are swirling about that accident and emergency services at the hospital are to be terminated as and from next week. I would like clarification on this issue as soon as possible to allay the genuine fears of the people in my constituency concerned about their health services.

Last week, the Central Statistics Office released under Census 2011 figures in respect of County Louth which, unlike in any other county in the country, has experienced a population growth of unprecedented levels, an increase of 20% in population over the past five years. Portlaoise is unique in that on any given day up to 800 prisoners may require emergency treatment given the nature of our prison system. Good quality health care and a service that people in my constituency can have confidence in is absolutely paramount.

I do not have any medical expertise. I was elected by the people as a public representative. I confess that medical specialty is not among my talents. I will never profess to be an expert on medical issues. I will be guided by what the clinical practitioners say, both locally and nationally. However, I will require best practice for my constituents and will fight to ensure the health service be quantifiable in terms of service. I would like the Minister, whom I congratulate on his efforts in difficult circumstances, to facilitate the recruitment of the non-consultant hospital doctor team for the next six months. I understand that great progress has been made at the Midlands Regional Hospital, Portlaoise and I am confident the team in white coats will be in place for Monday next. However, I want to see additional matters at the hospital addressed, including the availability of a 24 hour CT scan. I want clarification in regard to the health service delivery plan for the people of County Laois which I have sought from the HSE over the past 12 months, to no avail.

I refer again to the total breakdown of trust which will require the Minister's personal intervention and leadership, which I look forward to. The ambulance service was mentioned. This, too, is a serious issue in Portlaoise. I thank the Deputies opposite for facilitating this debate, to which we will have to return. I make no apology for fighting for my constituents, albeit as a layman in terms of medical expertise and clinical diagnosis. However, like every other Deputy in the House, I hope we can have a service in all our areas in which the people can have a fair degree of confidence.

When in opposition, during a debate on a cancer services motion on 20 May 2008, the Minister, Deputy Reilly, said:

The motion is self-explanatory but the rationale behind it requires further elucidation. At the core of it is the question of trust. What is at issue is whether the people of the north west and west can trust the Government, the Minister for Health and Children and the monolithic Health Service Executive to deliver the services they have promised.

Certainly the issue of trust has been shattered for many people in the mid-west, north west and west given the commitments made by the Minister when he was in opposition on the provision of services in Roscommon, Sligo and elsewhere in the north west and west. Our party, when in government, was involved in a reconfiguration programme and the HSE was the organisation carrying it out in conjunction with waiting for reports from HIQA. However, we did not hide behind any reports. We were upfront and honest with the people in every constituency on the provision of services and what reconfiguration might mean for some services in certain areas.

The motion before the House comes about as a result of deceit and cynicism at its highest level perpetrated on many people with breaches of promises made prior to this year's general election. In the same debate in 2008 the now Taoiseach, Deputy Enda Kenny, said:

We should not be obliged and restricted by the acceptance of independent reports. He said we should have the courage to change them if we believe they are not correct... This is an opportunity for the Government to show the courage he speaks of because this is not only a medical position but a political decision and the Minister knows it.

He went on to state:

I am appalled at the attitude of Government Deputies who said this fight was lost when statements were issued by management. Members of hospital management do the jobs they are supposed to; politicians reflect the views of the people and make political decisions in the best interests of the community. I inform the Minister, Deputy Harney, that I would not stand here and defend this motion in the name of Fine Gael if I did not believe that the standards of surgery, clinical outcome and survival stand up. The Minister has not proven anything in this debate to date to demonstrate that the service in Sligo or in Mayo General Hospital should not continue.

The issue of hospitals is very emotive, a point Fine Gael and the Labour Party played on when in opposition. I often sat on the other side of the House listening to the issue being raised continually as is the right and duty of every Opposition Deputy. However, equally every political party has an obligation at least not to sow seeds of deceit and cynicism as perpetrated on the people of the west, north west and mid-west.

Let us be under no illusions about the commitment made on Roscommon hospital. Deputies were arriving home like Neville Chamberlain in 1938 with a letter declaring peace in our time, except it was accident and emergency units and retention of hospital services in our time. Clearly Fine Gael did a poll in the Roscommon-South Leitrim constituency, which showed that Fine Gael was close to winning two seats and also indicated that Roscommon General Hospital was the biggest issue for voters in the constituency. Contact was made, and the party's deputy leader arrived and gave his cast-iron guarantee to the people of Roscommon. I get no joy from saying this. The Taoiseach said we should respect the Minister's opinion because he takes into account HIQA reports, the advice from clinicians and from the HSE and equally because he is a medical practitioner himself. At the time he made that commitment I do not believe that the Minister did not know there were some difficulties with accident and emergency services in Roscommon General Hospital. This commitment was made solely to con the people of Roscommon and get two seats for Fine Gael in the process.

Deputy Naughten was quoted in the Roscommon Herald on 22 March 2011 as saying:

Fine Gael has already committed to retaining services at the hospital and as a party we have outlined our plans to not only protect but also to enhance and develop those services. This decision by Minister Reilly is the first step in securing the future of services at smaller hospitals such as Roscommon and Portiuncula.

On 5 October 2010 Fine Gael tabled a Private Members' motion on health services calling on the Government to:

ensure that there are no further reductions to front line staff or services;

suspend the loss of front line health services and capacity at hospitals, for example, at Clonmel, Merlin Park, Nenagh, Roscommon, Navan, Sligo, Letterkenny, Portiuncula, Wexford, Monaghan, Ennis and Louth county.

During the debate, the Minister, Deputy Reilly, stated:

This motion is about protecting patients from cutbacks necessitated by mismanagement and waste in the HSE, presided over by this Minister [Mary Harney]. It intends to demonstrate clearly that there is a third way by changing the bizarre working practices and bloated bureaucracy at the root of the waste in our service. The Government, through a series of policy failures, continues to undermine the provision of fair and equitable health services to our citizens. Current health policy, particularly as outlined in the amendment to the motion, sends a clear statement that the Government does not view health as a priority. [This is the cracker in it all.] It has consistently ignored the concerns of local people, medical professionals and service users when stripping hospitals of their services. Nobody in the House opposes excellence in clinical care or denies the need for change in the provision of hospital services but when the Government's immediate reaction is to close theatres and wards or to withdraw front line services to save money, we do have a problem, as this is a lazy way to attack our difficult situation.

If it was a lazy way then it is damn well a lazy way now.

Nobody is withdrawing front-line staff.

Not only is it a lazy way, it is also dishonest in the way it was perpetrated.

It is not saving money; it will save lives.

Deputy Kelleher, without interruption.

In that debate the Minister, Deputy Reilly, went on to say:

People are feeling pain but HSE administrators have taken the soft option of cutting front line staff and services. Navan hospital is a case in point. The Minister alluded to it being shut because of economic considerations, given all hospitals must stay within budget, but Navan hospital is operating within budget.

We had a statement the other day from the Minister, Deputy Reilly, quite clearly directed to all hospitals and the HSE. I remind the House that the HSE is now governed by the Minister. He has assumed sole responsibility for the provision of health care in the State. He waltzed into HSE headquarters, sacked its independent board, and appointed people from the Department of Health and the HSE who are to work under his guidance with his hand always on the tiller when it comes to decision making. On any decision made from now on, Government backbenchers cannot blame us or the HSE. They can look to their own Minister, the man who decided to take in charge all issues on the provision of health care.

Following the recommendations in the HIQA report, I accept nobody in this House would stand over putting patients at risk. However, there are two ways to address the issue. There is the lazy and deceitful option the Minister has taken of withdrawing the services or——

Not withdrawing chairs.

——alternatively he could address the deficiencies impacting the safe delivery of services in the areas HIQA highlighted. To date the Minister has not done that in Roscommon, Sligo, Letterkenny, Castlebar, Galway and many of the hospitals highlighted in the HIQA report on Ennis hospital. The report is being used by the Minister to breach all the promises made during the general election campaign.

In my constituency of Cork North-Central there was an issue with St. Mary's Orthopaedic Hospital. At the time I was honest with the people and informed them that the reconfiguration was taking place and the recommendation was for a transfer of orthopaedic services to the South Infirmary-Victoria University Hospital. A campaign was rightly waged. However, we had cast-iron guarantees from the Minister, Deputy Reilly, that there would be no movement of orthopaedic services. He then carried out a brief review, the details of which we did not see. Lo and behold, at the end of the day we discovered that services are being moved from St. Mary's Orthopaedic Hospital to the South Infirmary-Victoria University Hospital. He has stated that he hopes some services might move up to St. Mary's on the north side of the city. I do not mind the cut and thrust of politics, but this is a case of playing on people's fears and concerns prior to a general election and then doing a complete U-turn on the provision of services. I thought the Minister was about to quote Winston Churchill referring to the end of the beginning and the beginning of the end. Winston Churchill also said that men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened. In this context, the Minister is picking himself up and hurrying off as if nothing happened.

We are not hurrying anywhere. The Deputy can be assured of that.

I had the joy of reading the Minister, Deputy Reilly's website today. To be fair, it is a very active website and it is clear the Minister is very active working hard as a TD, as is the right and duty of everybody in the House. However, I then found a statement on the website with regard to the national children's hospital from which I must quote as it raises grave concerns in the context of the provision of care in such a hospital. The statement refers to the resignation of Mr. Philip Lynch, the chair of national paediatric hospital project team, and reads:

This must lead to a re-think. There is an offer on the table from Noel Smyth which deserves consideration. We don't serve our children well by telling them fairy tales about a hospital that may never be built. Our sick children have a window of opportunity for optimum outcome that closes quickly and when they miss it they could be damaged for life. We must ensure that our sick children get care when they need it.

There is a worrying arrogance about this Minister and Government [Deputy Reilly is referring to the previous Government] that they refused to entertain a different view, from their own appointed chairman, especially when that view could be the difference between a realistic plan and a plan based in never never land.

This has been an ongoing saga for many years. There is almost a duty on everyone in the House to fully support the provision of a national children's hospital on the Mater site. There have been reports, reviews and recommendations. The Minister was obviously playing local politics with this press release, which makes no sense from any other angle. The Taoiseach regularly points out that the Minister, Deputy Reilly, is a general practitioner but to call the plan "never never land" is to downgrade the efforts of the previous Government and many previous Administrations to facilitate the building of a national children's hospital next to a hospital that has all the other tertiary services and is in line with the recommendation that it should be next to a university hospital.

With €200 million from philanthropy. That is never never land.

The Mater is that hospital. I urge the Minster to ensure he brings clarity to this issue and that he states that he is fully committed to the development of the children's hospital so that it moves to the planning stage as soon as possible.

There is a shortage of funding and we do rely on philanthropy and support from the private sector to develop the hospital. If there is uncertainty in the context of the commitment from the Government to the development of a national children's hospital, it will undermine confidence in those who may want to assist the State in developing a children's hospital. The timeline is in place but it is tight. We expect that the Minister will give full support to the children's hospital.

While I do not want to play politics with the case of Maeve McGivern, can I have clarity that protocols will be put in place as quickly as possible to make sure that what happened recently in the context of a transfer to Britain for a transplant will not happen again?

I support my party colleague, Deputy Kelleher's amendment as well as the broad thrust of the motion put forward by Sinn Féin. I have been very disappointed at what we have seen from the Government to date, which was essentially that the current Government parties made grand promises to get into Government only for them to turn around afterwards and renege on those promises. I saw at first hand the situation in the north west during the general election, where Labour Party and Fine Gael candidates gave cast-iron guarantees that services would be returned to Sligo hospital within 100 days of the election, only for those election promises to be shown up for what they were.

In the short time available to me, I will concentrate on Letterkenny General Hospital, with which I am most familiar and which counts most to the constituents of Donegal North-East. The Minister, Deputy Reilly, in recent days issued a diktat that there is no way he will consider hospitals running over budget. When one considers this, it can only mean one thing, namely, treatments which otherwise would have been carried out will not be carried out.

As an example, Letterkenny General Hospital had a budget last year of €103 million compared to a budget of €95 million this year. This, coupled with the fact that it last year ran €4.5 million over budget, shows the strain being put on the hospital to deliver the service expected of it. Given the service it is operating at present, the hospital is facing an overrun of more than €6 million this year. For this to be addressed, the only option is that the hospital stops providing some of the services it currently provides and cuts back on other services. Letterkenny General Hospital is different from other hospitals in that 90% of the treatments carried out there are non-elective, which means cases come through the door on a day-to-day basis and are not scheduled, which does not allow the hospital the same measure of control.

I urge the Minister, with the representatives of the hospitals which are currently finding difficulty in providing services, and before he issues a diktat stating they cannot run over their budgets, to ascertain what exactly this would mean for the individual hospitals. We cannot have a situation where people are left in pain and waiting months for treatment and operations to be carried out because we cannot afford to do them. We must give the No. 1 priority to health.

I call Deputy Healy, who has two and a half minutes.

While I cannot deal with the issue in two and a half minutes, I will simply say I am concerned by what I have heard today. I have dealt with the HSE and the previous Fianna Fáil-Green Party Government in recent years in regard to hospital reconfiguration. The terminology, phrases, sentences and words I have heard here today, such as "a new lease of life for local hospitals" and "no hospital will be closed but the services will change", are reminiscent of the Fianna Fáil-Green Government. It appears this represents the old centralisation and specialisation policy of the previous Government, and, although I hope I am proved wrong, I am concerned with what I have heard.

I agree with Deputies Charles Flanagan and Simon Harris, who said earlier that we should take on board the views of clinicians. In south Tipperary at present, the HSE and, it would appear, the Minister of State, Deputy Kathleen Lynch, proposes to close the acute psychiatric unit. To a man and woman, each clinician in the hospital, each GP in the county and each of the clinicians in the hospital to which the beds are supposed to be transferred, St. Luke's hospital in Kilkenny, are opposed to the closure of that acute psychiatric unit. I agree with the Deputies to whom I referred that we should take this on board.

I hope we are not going back to the centralisation and specialisation policy of the previous Government, which is not a soundly based, evidence based or patient centred policy. There is clear international, independent professional evidence which confirms that medium sized hospitals in the 200-bed to 400-bed range provide much better quality of service, value for money and access for patients and their families. General hospital services should be provided on that basis as close as possible to local communities.

While I do not have as much speaking time as I would like, I thank the Minister for coming to visit South Tipperary General Hospital in Clonmel. The Minister made great promises as to what he would do with the HSE and while he has removed the board, little other change has taken place, although I do not blame him for all of that as he inherited many of the problems.

I ask the Minister to give a commitment that the reconfiguration of South Tipperary General Hospital has been abandoned. Thankfully, the hospital has a full complement of staff, unlike some other hospitals where shortage of staff or inability to get staff is being blamed. I note that a team of accountants is involved and that this is the only hospital in the country being singled out in this way. It is an attack by the HSE on the services provided by South Tipperary General Hospital and it is being carried out under the Minister's watch but I will take him at his word. Clonmel is the base for a large number of high technology and pharmaceutical industries and it has an extensive catchment area. We saw what happened to north Tipperary when Nenagh hospital closed and transferred to Limerick. Patients and staff are frightened by what they see happening elsewhere. Any man is as good as his word and I will await the fulfilment of the Minister's commitment.

We are being blackguarded with our acute psychiatric hospital, which the HSE wants to close. The Hillery report revealed that the HSE and health board officials mismanaged the situation and rode roughshod over staff, consultants and everybody else. We are not opposed to A Vision for Change but we cannot be accused of saying we do not need acute psychiatric beds in the case of psychotic attacks and everything else. The psychiatric unit is located on the campus of the general hospital. These services have to be maintained.

I ask the Minister to speak to his Minister of State, who made a fly-by-night visit to the hospital. I welcome the fact that she visited it but she ran in and ran out when we demanded that she come to see the problems for herself. I ask that a deputation of Oireachtas Members from south Tipperary be facilitated in meeting her because she is avoiding the issue and will not meet us. It is a far cry from where she stood in the last Dáil. I supported her on many issues in committee and elsewhere. As the elected representatives of the area, we need to know what is happening.

Debate adjourned.
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