Dáil Éireann debate -
Wednesday, 6 Jul 2011

Vol. 737 No. 4

Hospital Services: Motion (Resumed)

The following motion was moved by Deputy Caoimhghín Ó Caoláin on Tuesday, 5 July 2011:

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.

Debate resumed on 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 inpatient, day case and outpatient 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."

—(Minister for Health, Deputy James Reilly).

Deputy Luke ‘Ming’ Flanagan

First I wish to say, "Well done to the Rossies, ye turned out in good numbers today, I am proud of you".

After the election I was asked by the media whether I would vote for Fine Gael in order to put them into government. I said, I might because they actually agree with quite a lot of my policies. I agreed with their policy on health care and the future of Roscommon hospital; I agreed with their policy on turf-cutting; I agreed with burning the bondholders. As a result, I was asked by RTE why did I not join Fine Gael if that was the case. My answer was, "I don't think Fine Gael actually believes in those policies". Unfortunately, I have been proven to be correct.

Fine Gael's policy in advance of this election from the now Minister was as follows: "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". However, one does not have to lie to get into this House. I did not lie. I could have gone down the same route at the general election. I could have lied to people about my views on the legalisation of cannabis because there are no votes in Roscommon on that issue. I could have lied to people on the fact that I do not have a problem with a mobile phone mast beside my house. That certainly did not get me any votes but that was my opinion. Unfortunately, that cannot be said for Deputy Denis Naughten and Deputy Frank Feighan, unless today they vote with the people of Roscommon and south Leitrim rather than voting with Fine Gael.

The spin in the past few days has been very hard to take. Even our own elected representatives have attempted to convince us that we will be better off without our accident and emergency department. The reason given is that they cannot argue with medical evidence being presented to them. Well, the medical evidence has been made quite clear today in The Irish Times and the GPs in our area have said the following: “We are in no doubt that lives will be lost and patient outcomes will be adversely affected”. General practitioners in the county’s catchment area have warned of serious consequences and they have said: “Every GP in the catchment area of County Roscommon, Leitrim, Longford, Mayo, Galway, Westmeath and Sligo, is appalled at the proposed downgrading of the hospital and the effect it will have on patient care and safety.” The former head of the IMO, Dr. Martin Daly, stated: “My colleagues are very angry that they should be asked to provide a service which facilitates the downgrading of the hospital, given their concerns about the capacity of other hospitals to cope with the extra load and safety issues associated with that”.

I looked at the Fine Gael website and I discovered that Fine Gael is a Christian Democrat party. I also checked out the Ten Commandments which Christians are meant to follow. The ninth commandment is, "Thou shalt not lie". If Fine Gael does not do as it promised in advance of the election, I challenge its members that they are not Christian nor are they democrats.

Ultimately, this is down to money. The IMF and the EU will make a profit of €9 billion over the lifetime of the bailout. We require 0.5% of that sum to keep our hospital open this year. The question is who is more important, the bankers or the people of Roscommon and south Leitrim and surrounding areas who will die if we let this happen.

As for the Fine Gael amendment to the motion, the people of my constituency are on the ball and if the local Fine Gael Deputies vote for the amendment, then they will be seen to be voting for the closure of our hospital. The amendment proposes the deletion of the fact that the Minister said he would stand by his commitments.

Deputy Denis Naughten and Deputy Frank Feighan promised the people they would stand by them. Today they must vote in favour of this motion otherwise they will be classified as traitors until kingdom come. The Deputies from the surrounding counties, from Longford, Westmeath, Mayo and east Galway, must do the same thing; they must choose between the bankers or their constituents. Let them die but the Deputies will pay the price if they do.

Deputy Richard Boyd Barrett

I commend the people of Roscommon for coming out and protesting to defend their hospital. I commend the people of Portlaoise who are mobilising to defend their accident and emergency services. I want to encourage the people of Shankill and Wicklow and Loughlinstown to join the people of Roscommon and Portlaoise in protesting to defend their hospital's accident and emergency service which is coming under attack. They will have the opportunity to do so this Saturday at 2 p.m. in Shankill.

We all need to stand together against this madness. The attacks on our hospital services are falsely being presented as something to do with health and safety. This is nothing but a lie to cover up a brutal agenda of cutbacks and downgradings of public services and of vital hospital services in order to satisfy the greed of bankers and bondholders and to do the bidding of the IMF and their EU masters who are dictating to this Government that the lives of ordinary people and the services for ordinary people in this country should be sacrificed in order to ensure the EU, the IMF, the bankers, the bondholders and speculators in Europe, can make €9 billion profit out of the lives and services of people in this country. The logic that this Government is applying to justify what it is doing to hospital services in Roscommon, Portlaoise and Loughlinstown, is like the logic the US applied in the Vietnam war when they said, "We are going to save your village by destroying it". It is the same logic that is being applied here — "we are going to save your health service by closing your accident and emergency service; we are going to save your health service by closing and downgrading your hospitals". It is nothing but nonsense and lies to cover up brutal and unjust cutbacks. People will die as a result of this. There is a choice and the choice is to make the bondholders and speculators who caused this crisis pay for it, not the ordinary citizens of Roscommon, Portlaoise, Loughlinstown, Shankill, Wicklow and the other places around the country whose hospital services are being attacked.

I appeal to people that this is part of a bigger agenda. We need to mobilise now against this mad, IMF-EU austerity package. People will have the opportunity to do so on Saturday, 16 July, at 2 p.m., at the Garden of Remembrance, Parnell Square. I hope the whole country comes out to stop this madness and these unjust cutbacks.

Deputy Stephen Donnelly

This debate must be about survival, not of any particular accident and emergency service but survival of patients. We all want equal access to safe and efficient medical services. If one has a stroke, a heart attack or a serious accident, one's chances of survival should not depend on where one is in Ireland. For this to work, our hospital system must use its resources smartly. There is no point going to Loughlinstown if the skills one requires are in St. Vincent's. There is no point going straight to St. Vincent's if one is going to spend half an hour in an ambulance in the car park waiting for a trolley.

It would be easy for me, as the only Opposition and Independent TD for Wicklow and east Carlow, to say that I will fight to retain a full, 24-hour accident and emergency department at Loughlinstown, but I do not believe this would be the safest outcome for the people of Wicklow and east Carlow. The medical experts I have spoken to also are of this view. The accident and emergency department at Loughlinstown is routinely bypassed by the ambulance services in serious cases. Loughlinstown accident and emergency department does not have sufficient patient numbers to be at the cutting edge. If one has a serious injury one is told to go to St. Vincent's Hospital because the extra seven or eight minutes travel will radically increase one's chances of survival.

In recent years I have spent a lot of time working on improving health care systems abroad and I promise to bring that experience to the Dáil. My experience tells me that Loughlinstown is being run down year after year by cutbacks and a lack of vision and leadership from politicians and the HSE. It does not stop at Loughlinstown. Wicklow and east Carlow have suffered from years of under-investment. There are not enough ambulances and the ones we have are getting old. The primary care strategy has disappeared. Where are the primary care centres? The doctor on call service is a joke; people are left waiting for hours at night for a GP to arrive.

If the Government is to change the accident and emergency service at Loughlinstown, it must not be a cost-cutting measure, but rather part of improving the entire health care system for Wicklow and east Carlow. It is not acceptable that someone in Carnew must drive more than 60 miles to have a minor injury treated. It is not acceptable for a parent in Arklow with a sick child to wait for hours at night for a GP to arrive. It is not acceptable for a heart attack victim in Blessington to have to hope that an ambulance will be ready to bring him or her to hospital.

We must have primary care centres in Arklow, Wicklow town, Blessington, Greystones and Bray, doctor on call services, a modern ambulance service and fully functional accident and emergency capacity at St. Vincent's Hospital. If the minor injury unit is to be closed at night in Loughlinstown, one should be opened in Arklow during the day. We have to invest in Loughlinstown hospital. It needs a vision. It should not cling to an outdated and potentially dangerous idea of what a hospital needs but become a truly excellent hospital serving our community as part of a comprehensive, modern and responsive health care system for Wicklow and east Carlow. That is a vision for which I will fight.

Minister of State at the Department of Jobs, Enterprise and Innovation (Deputy Sean Sherlock)

I wish to share time with Deputies Regina Doherty and Buttimer.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Deputy Sean Sherlock

I wish to speak specifically on Mallow. I am not aware of any commitment that was given on Mallow General Hospital regarding accident and emergency services but I am open to correction. I am a member of the Mallow Hospital Action Committee since I entered public life. In Mallow and north Cork we have been through a very difficult and dramatic time, especially when on Tuesday, 19 April, it was announced by the Health Information and Quality Authority, HIQA, that it would investigate the services at Mallow General Hospital. At the time it was purported that the investigation was on foot of a complaint, which turned out not to be the case. When HIQA visited the hospital, it found the staff, clinicians and physicians were absolutely and utterly beyond reproach.

I note the comments of Deputy Donnelly. In parallel with the investigative process, there was a roadmap for the reconfiguration of Cork and Kerry hospitals whereby the designation of Mallow would evolve or change to reflect the concerns that arose in the HIQA report. All the stakeholders, including the hospital action committee of which I am a member, physicians, GPs and those who were referred to the hospital were part of the process. The endgame was to ensure we could maintain the capacity of the hospital to deliver in order that more services would be taken out of Cork University Hospital on an elective basis, acute surgical services could be maintained and an urgent care centre or medical assessment unit established which would allow for the vast bulk of cases that present on an emergency basis to continue to be dealt with in Mallow. We were on that route map until I discovered this week that certain forces within the HSE wanted to derail it and go way beyond the HIQA recommendations to reduce the capacity of the hospital to deliver.

I am encouraged by a meeting I had with the Minister for Health, Deputy James Reilly. He reflected a statement he made when the HIQA report was issued, namely, that he was strongly committed to the role of smaller hospitals. I can only speak for Mallow with any great authority. We now need to get the roadmap back on track so that if we have to go through change management, it will reflect HIQA. However, it must not be solely for budgetary reasons. It has to allow for a situation to arise whereby we can take more of the elective procedures that can be done in Mallow and have a short stay surgical unit in order that we can continue to have an emergency department facility and begin to facilitate the structures around CUH.

If we proceed along a pathway that seeks to excise acute surgery or the acute medicine programme from Mallow in a short space of time, I have no doubt it will contribute to the risk profile of larger hospitals like CUH. We must be cognisant and very wary of the need to ensure hospitals such as Mallow have a role. We need to consider in a more lateral way how the role can proceed. Mallow differs from other hospitals in that HIQA has examined it and provided recommendations. The issue of licensing is coming down the track. No matter what one's political hue is — I accepted this a long time ago — one has to take the view that one does not reduce the capacity. The HIQA requirements should be met, we should ensure that a hospital has a license to practice and that services can be delivered, albeit possibly in a different way.

Deputy Regina Doherty

I am a resident of Ratoath in County Meath. My local hospital is Navan and I have been supportive of the Save Navan Hospital Committee for the past number of years and will continue to be so, not just because I am on this side of the House. It is fundamental to Government policy to provide quality health services in this country.

The concern about the state of the health care system has reached a slow bowling point in the country over recent days. The delivery of health care consistently ranks among the top three issues the electorate want policymakers and politicians to address. Lately, it is increasingly intertwined with the growing worries about Ireland's economic insecurities. High costs, gap ridden coverage and sporadic quality are the health care problems that most Irish citizens talk about, yet Sinn Féin wants to keep all the policy discussions focused on coverage, which is disingenuous.

To ensure the other problems are not forgotten and that delivering system reform is central to his plans, the Minister, Deputy Reilly, set up the special delivery unit. It is charged with promoting quality, efficiency and patient centredness in a high performing health system that the people of this country have been promised and are waiting on for many years. Reconfiguration and the old HSE plans for hospitals are null and void. They are definitely not our plans.

The long-term plans for our smaller hospitals will deliver extended day surgery, expertise in particular areas, much-needed capacity and doctor-led services. We need our smaller hospitals now more than ever. We need patient-led services, more capacity and the expertise that we get in our smaller regional hospitals, but most of all we need them to be safe. Let us be very clear about that.

We are currently experiencing, as we have for many years in the past, a non-consultant hospital doctor shortage. I welcome the Minister's recent move to address this issue to ensure it does not keep cropping up time and again. Temporary registration, the new two-year contract term, the new training programmes and the new supervisory roles are all very welcome and show the Minister's intelligent approach to dealing with the issue.

Deputy Ó Caoláin said yesterday that the right to access safe health care should not be reliant on one's purse or geographical position. To an extent I agree with him, but I am very happy that the priority and concern of the Government is to defend patients and ensure their safety when they are most vulnerable.

Deputy Jerry Buttimer

I am pleased to support the Minister for Health and his Government colleagues who are committed to ensuring that hospital services are of the highest quality, centred on patient safety and focused on successful treatment. When Fine Gael and Labour went before the people we did so on the basis of a vision for a reformed health service. Those comprehensive proposals have been amalgamated to form a policy for a successful Government. That policy will have the patient at its core.

To the dismay of most people, we have now had a dramatic change in the situation concerning junior doctors. Without these doctors it would be impossible to deliver a service of the highest quality. The Minister, the Department and the HSE have ensured that a recruitment drive will be undertaken to overcome the difficulties that have arisen in recent years. The decision of previous Administrations not to include training for junior doctors as part of their contracts has resulted in this mess. In addition, these roles were not sufficiently attractive. We cannot expect to retain high quality doctors if we do not provide sufficient training for their professional development. There must be a clear path of advancement.

Recently, the quality of nursing home care has rightly been a matter of concern to Members of this House, to the public and, most importantly, to the patients receiving such care and their families. In discussing these matters, everyone in the House relied upon HIQA's reports which were acted upon to ensure patient safety. Now that we have received HIQA reports on certain hospital services that do not suit the short-term political gain or motivations of certain TDs, they choose to ignore them and HIQA is cast to one side. When nursing homes are closed, based on a HIQA report, the actions are applauded, yet the Government has been, and is being, criticised when it acts on HIQA reports regarding hospitals. The hypocrisy would be laughable if it was not such a serious issue.

In the North of our country, Sinn Féin has held the Ministry of Health under Bairbre de Brún. She commissioned a report that recommended "emergency services should be phased out at Whiteabbey Hospital, Lagan Valley Hospital and the Mid-Ulster Hospital". The report went on to recommend that Mid-Ulster Hospital should be replaced with "a local nurse-led emergency unit providing a comprehensive minor injury and illness service". Since then, of course, Sinn Féin has refused to take on the Ministry of Health in the North, thus abdicating its responsibilities. It has avoided the difficult decisions necessary to deliver improved services for all our citizens. Sinn Féin prefers, as it has done here, to stand on the sidelines, shouting and roaring, and playing on people's fears for political gain.

Deputy Caoimhghín Ó Caoláin

That is the Deputy's own game. He is the author of it.

Deputy Jerry Buttimer

People are rightly concerned about health. They deserve the collective, non-partisan support of all Members of this House. Public apprehension has been caused by all politicians who have used health as a political football, and never more so than inside and outside this House today and yesterday. When it comes to reforming the health service, patient care must be to the fore. It should be our only concern because we cannot allow health to be used as a political football by vested interests.

The reform of our health service must not be based on ad hoc decisions, but be part of a vision for change which will deliver improved services to patients who are our fellow citizens. Those of us who profess to be republicans must look inside our hearts and do what is best for our people. We must do what is best for all our citizens, not just for the ballot box or cheap headlines. We should not cast slurs on Members of the House by making disparaging remarks about them.

Deputy Caoimhghín Ó Caoláin

The Deputy has just done that. He should practice what he preaches.

Deputy Jerry Buttimer

The Sinn Féin motion is a cheap political ploy which does not deserve support.

Deputy Damien English

I am glad of the chance to speak on this important issue. I thank Deputy Ó Caoláin for quoting last night what I said a couple of years ago.

Deputy Caoimhghín Ó Caoláin

Accurately.

Deputy Damien English

I stand over those quotes absolutely and will not change my views because it is still a capacity issue. People may talk about trying to close Navan accident and emergency unit and putting those patients into Drogheda instead, but it cannot happen. It should not happen and it is wrong. I stand over what I said because Drogheda cannot cope. We were told for a long time in Meath that Fianna Fáil and the HSE planned to close the accident and emergency unit at Navan eventually or to reduce the opening hours. We were also told that would only happen if there was capacity elsewhere, but there is none. As a GP in that area in his previous occupation, the Minister for Health, Deputy Reilly, knows exactly what the capacity issue is in the north east. It cannot cope.

Deputy Ó Caoláin is also familiar with the position and I am glad he quoted me last night, thus giving me a chance to clarify the matter because it is wrong. People need access to accident and emergency services, without standing in a queue of 50 other patients or lying on a trolley, as is happening in Drogheda now. I want to clarify one thing Deputy Ó Caoláin said last night which was wrong. It is important to get it right because in arguing with the HSE and Ministers to keep services open, they must know that they are open. Last night, the Deputy said no ambulances are accepted in Navan at the moment and those that are presented are assessed and diverted, but that is not true. All medical cases are accepted in Navan except those involving trauma. That amounts to about 80% of those who would attend Navan accident and emergency unit or 17,000 people annually. It is important to clarify that because if people think it has already gone we will certainly not get it back.

The fight here is to ensure we keep the service in Navan. I am glad to be part of a cross-community, cross-party group which is fighting for such services at Navan hospital. It is a good group comprising TDs from all parties, as well as consultants, GPs and other health staff.

Medical staff must be involved in and consulted on any changes in any of our hospitals, although it has not happened to date. It is lunacy to withdraw services from, or even add services to, hospitals without asking those who work there about it. I am glad we will have a meeting next week with the action group, and the consultants and staff of Navan hospital, to put their case to the Minister and thus be involved in any future plans.

Deputy Ó Caoláin specifically mentioned Navan accident and emergency unit last night but there is no reason why it should close next week, or have its hours reduced, because the same staff who are operating there today will be there next week and the week after. There is no change so there is no excuse for anybody to try to reduce services there.

We must end this stupid way of doing business whereby every six months we must check to see if there are enough junior doctors in place. It has been the same since I started in politics over ten years ago, but it is not the way to run a service. I am glad the Minister for Health has plans to change that. Hopefully the bands can be addressed and adjusted to suit various areas. At least he is going to try to tackle it and not let it drag on for ten or 15 years, which happened in the past. It was not good enough, so we must fix this once and for all.

Deputy Caoimhghín Ó Caoláin

Equally, there is no excuse for closing Roscommon.

Deputy Colm Keaveney

I thank you, a Leas-Cheann Comhairle, for the opportunity to speak on this matter. As always, it is a great honour to speak in the House. Before getting to my primary point, however, what really galled me today was to see the Fianna Fáil backbenchers laughing at the notion that they had handed over a destroyed economy to the new Government and the people of Ireland. There is nothing less amusing than what they have left the people of this country with and that is their legacy.

The Government's only option is to do the best it can with the disastrous situation that has been left by Fianna Fáil and its neo-liberal friends in the last Administration. It is important to make this point regarding Roscommon. We are all aware that the Roscommon accident and emergency department will be replaced by an emergency care centre, which will operate between 8 a.m. and 8 p.m., seven days a week.

In recent weeks, we have heard a lot of scaremongering about the delivery of emergency medical care in Roscommon and the safety of patients. Anyone taking part in such scaremongering is doing a great disservice to the people of Roscommon, as well as a disservice to the people of my own County Galway, who are being led to believe these decisions concerning Roscommon are being made to save money. The reality, however, is that the decisions are being taken to save lives.

We should ask ourselves what really lies behind the term "accident and emergency". What is in a name? It does not take too much research to uncover the fact that many of the multidisciplinary services that fall under what we understand to be an accident and emergency term, do not actually exist in Roscommon and never did. There are no orthopaedic, obstetric or paediatric facilities there. One simply does not go to Roscommon hospital for those medical services. If someone was to fall and break a leg, they would not go to Roscommon. If I were in Roscommon and had a sick child, I would not take him or her to Roscommon County Hospital because it does not have a paediatric unit. I would go to where the services were. We are fighting here over a title. Let us be clear: this is not a downgrading because the accident and emergency department at Roscommon County Hospital is not and never was a fully functional unit. The notion of having no accident and emergency department gives the impression that the service was available in the first instance. As I stated, in this instance the term "accident and emergency" does not honestly reflect the services available at Roscommon County Hospital.

This initiative is about patient outcomes and the necessity to streamline and modernise services to make the Roscommon County Hospital more efficient and effective. General practitioners will be available from 6 p.m. to 8 a.m., while a medical emergency unit will be operational between 8 p.m. and 8 a.m. There will be four full-time ambulances and an advanced paramedic medical team based in Roscommon on a 24-7 basis, which I envy. These will deal not with patient transfers but with emergency medical calls. Roscommon County Hospital is and will remain safe if this is done in the correct manner. The goal is to match patient needs with appropriate services. The decision of an emergency medical technician on the side of the road in the event of a road traffic accident is best in terms of patient need. Case by case judgment by emergency service workers will always be required. Twelve additional emergency medical technicians appointed to assess patients in the event of unforeseen circumstances will decide what service a person requires, consider the specialties, supply all of the information to the necessary medical facility and make a decision based on the best possible outcome for the person concerned.

The population of Roscommon is more than 63,000. According to the Western Regional Authority, the population will grow by approximately 10,000 over the course of the next ten years, bringing it to approximately 73,000. This will, no doubt, put extra pressure on Roscommon County Hospital and surrounding medical facilities, which is all the more reason to commence modernisation and ensure emergency service operations in Roscommon and the surrounding region will be maintained. Protesting will not save lives in Roscommon. It will not result in medical solutions to the problem. Having said that, I completely understand the reason people are angry, but this problem was caused by the previous Administration. We have limited resources and must do the best with what we have. The Government is making the best decisions to ensure the best outcomes for the people of Roscommon in the context of the future of Roscommon County Hospital.

Deputy Frank Feighan

I wish to share one minute of my time with Deputy McLoughlin.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Deputy Frank Feighan

I welcome the motion, many aspects of which I agree with. I thank Sinn Féin for bringing forward its argument in a measured and cohesive manner, which is how it should be done. Anger will not get us out of the situation in which we find ourselves. I fully understand the concerns and anger of the people of counties Roscommon and Leitrim and other parts of the country who like me are proud of their hospital and the important role it continues to play in the community. The confusion and uncertainty about services, primarily created by the Health Service Executive, have not been helpful.

My family, friends and others I know have relied on Roscommon County Hospital in time of need. I assure the people of counties Roscommon and Leitrim that will not change. Like my constituency colleague, Deputy Naughten, I gave a commitment in good faith before the general election that I would stand by the hospital and safeguard its services. However, events have overtaken that commitment, including the Health Information and Quality Authority report, the Mallow report and the position on junior hospital doctors. I am sincerely sorry that I cannot stand by that commitment. However, I am doing everything possible to live up to my commitment.

The changes being made at Roscommon County Hospital are not ideal for local people. The vast majority want the services currently available at the hospital to continue. I am sure everyone in Roscommon wants to ensure the safest levels of health care are provided at the hospital.

Deputy Colm Keaveney

Hear, hear.

Deputy Frank Feighan

Patient care is paramount. I attended the meeting last Friday week with members of the Health Information and Quality Authority, the Health Service Executive and other Members from across the political spectrum. HIQA opened my eyes to exactly the standards we need to comply with patient safety. I wish everything could remain the same but it cannot.

I looked at what happened over the years and in the last week. I took a position that I would be measured and try to take on board the views of the HSE and the people who wanted the hospital to be maintained and that is what I have done. I want to say one thing to Dr. Ming. His behaviour during the past week has not helped this situation. He has acted like a political thug. He has a responsibility to tell the people the truth.

Deputy Luke ‘Ming’ Flanagan

Do I have a right of reply?

Deputy Frank Feighan

What he has done has shamed politics. I will tell people the truth. I come from a position of telling people the truth, and if they do not like this, that is fine. The Deputy is a political opportunist who is more worried about his re-election than about the innocent people in Roscommon.

Deputy Luke ‘Ming’ Flanagan

Do I have the right of reply?

An Leas-Cheann Comhairle

No.

Deputy Tony McLoughlin

I welcome the opportunity to speak to the motion. Following a meeting of Oireachtas Members with the Minister for Health, Deputy Reilly, organised by Senator Henry and me, I welcome the Minister's commitment to the provision of a screening centre for colon cancer, will full colonoscopy services. Furthermore, the Minister has announced that a second oncologist will be appointed at Sligo General Hospital in the autumn. He has stated the matter of breast cancer surgery remains under review. Members will be aware that the previous Government put in place a national cancer strategy under the direction of Ms Susan O'Reilly, with whom the Minister must work hand in hand on this review.

During the general election I gave no commitment to a timeframe for the reinstatement of cancer services. It is my firm belief the Minister must be given the time and space to do his job. I am prepared to afford him that time and space. The original decision by the Fianna Fáil-Green Party Government not to select Sligo General Hospital as one of the centre of excellence cancer hospitals was catastrophic for people in the wider region. I have no intention of resigning my seat as the people of Sligo-North Leitrim democratically elected me. Since being elected to the House, I have worked hard on the issue of cancer services at Sligo General Hospital.

Following the decision by the last Government to remove breast surgery services from Sligo General Hospital, like many others, I joined the campaign to seek the return of these services and attended many meetings of protest in Sligo and Dublin. As a candidate in the last general election, I sought commitments from my party on this issue and gave no more assurances than I had received. As a member of the Fine Gael Parliamentary Party, I continue to lobby the Taoiseach and his team of Ministers, in particular the Minister for Health, on behalf of the people of Sligo-North Leitrim on issues of importance, including Sligo General Hospital, against the backdrop of the presence of IMF and European Union officials in this country.

I urge the Minister to work with Ms O'Reilly to explore all avenues to ensure full cancer care services are returned to Sligo General Hospital. The recent positive announcements made by the Minister which I restated are to be welcomed and illustrate that the Government is committed to Sligo General Hospital. There is still time to study the review together with the national cancer strategy. I urge the Minister to review the merits of having services based in Sligo and the past surgical success of Mr. Tim Hanrahan and his team at the hospital. The absence of a centre of excellence north of the line between Galway and Sligo is a tragic legacy of the last Government. The north-west region must not be forgotten when it comes to cancer care services. I will continue to work with the Save our Cancer Care Service committee to achieve our common goal, namely, the return of full cancer services to Sligo General Hospital.

Deputy Gerry Adams

Tá mé ag caint i bhfábhar an rún a mhol Sinn Féin aréir. Iarraim ar na Teachtaí eile vótáil linn ar an ábhar tábhachtach seo. I call on all Deputies, but especially those from constituencies that will lose health services and accident and emergency units and those who made election commitments, to stand with their constituents and support the Sinn Féin motion. I commend all those who are campaigning to save their accident and emergency units and commend the people who are outside in the rain calling on their Teachtaí Dála anseo to stand with them. Thaistil gnáthdhaoine ó Ros Comáin inniu ag impí ar an Rialtas gan leanúint leis na ciorruithe seo agus gan airgead á bhaint ó othair faoi chúram chroí.

The scale of the crisis in the health service and the refusal by Fine Gael and Labour to stand by communities is staggering. I offer some fraternal advice to colleagues opposite. As people are now too wise, they should be careful about the old trick of pretending to be in government and opposition at the same time. They are part of government and they cannot defend, argue and place themselves on action committees locally and then be part of decisions that, for example, result in the closure of the accident and emergency unit in Roscommon. This is especially true of Labour Deputies who are acting in total contradiction to the general election commitment of their leader to reverse any cuts in Roscommon County Hospital.

The previous Government oversaw local hospital services bring stripped from local communities. Tallaght Hospital, which has the largest accident and emergency unit in the State, was described recently by the Dublin city coroner as a dangerous place. The hospitals in Monaghan, Nenagh, Ennis and Dundalk were decimated by Fianna Fáil. Louth County Hospital is an example how this operated. The children's ward was the first to go, followed by the maternity unit and then the gynaecological unit. As these services were reduced and undermined, it impacted on Our Lady of Lourdes Hospital in Drogheda. Despite the efforts of a wonderful staff, that hospital cannot cope with the demands being made of it. This tactic of removing one medical service and then using the absence of that to justify the closure of other services is being cynically used by the HSE and Government.

Roscommon is the focal point today. Where will it be next week, next month or the following month? The Government seeks to excuse all this by claiming there is no money. However, today the Government handed €10 million to unguaranteed bondholders in a busted bank, Anglo Irish Bank. The money is there and it cannot blame Fianna Fáil for that; it is a Government decision. Politics is a matter of political choices and today the Government chose to give away €10 million of taxpayers' money instead of investing it in these threatened hospital services. Tá an Rialtas ag tabhairt airgead na gcáiníocóirí do bhaincéirí dona nach bhfuil fiú aithne againn orthu. I still find it hard to absorb this. On 2 November the Government will hand €703 million to senior unguaranteed bondholders in the same bank. This is not part of the bank guarantee, any deal or the bailout. The money is being given by the Government out of charity while we have this ongoing crisis in our public services.

I am asking Deputies to stop playing politics with this issue and make a stand. The Minister for Finance has said the next budget will introduce €4 billion in cuts. Will we see health targeted again? Whatever else is happening in the State, citizens need to have some certainty that they will have basic rights upheld by people in this institution. Citizens are making a stand and Deputies need to make a stand with them. I ask the Dáil to back this motion and oppose the cutbacks.

Deputy Brian Stanley

I welcome the people from Portlaoise and Roscommon some of whom are in the Gallery and more of whom are outside protesting. I heard a Government Deputy describe one of them as a political thug. I was outside with him on a few occasions this afternoon and this evening and I did not see any political thuggery. The protest was noisy but was certainly good humoured. People were there to make a point and if we do not allow that in our democracy, we are on the road to nothing.

Sinn Féin believes it is essential that emergency services are retained in regional hospitals. We are all aware that there are serious threats to Portlaoise hospital because of the crisis with NCHDs. Following the meeting with the Minister for Health on Monday — I welcome that he met us quickly — it could be said that there appears to be a slightly more optimistic outlook for the moment. As the Minister has said that he does not want to see a closure and reduction in emergency services in Portlaoise, we appear to have a stay of execution. Sinn Féin will be supporting the emergency legislation on Thursday to facilitate the registration of new junior doctors in the State. These doctors are badly needed to alleviate a crisis, but it is just short-term crisis management.

In the medium term, the Minister may be trying to say that things will be resolved at Portlaoise hospital, but this does not take from the serious concerns for the long-term future of regional hospitals in general. If Portlaoise is to continue as a major regional hospital, there needs to be a significant increase in the hospital's budget as well as the number of consultants attached to it. This was confirmed by senior Department of Health officials when we met them on Monday. The hospital cannot continue to operate on a budget of only €42 million. It is a hospital that provides major services, including maternity, paediatric, medical and psychiatric service, and a very busy accident and emergency unit that served more than 41,000 patients last year. Some of the services need to be upgraded, not ended. In particular, the maternity and accident and emergency units in Portlaoise are operating under severe pressure.

On Sunday more than 5,000 people turned out in Portlaoise to protest against the original plans to downgrade the hospital. I welcome the HSE statement following those protests that it will be able to maintain 24-hour emergency services from 11 July pending the remaining number of junior doctor posts being filled. However, following yesterday's meeting of the Dublin mid-Leinster regional health forum, a Fine Gael member of the forum stated that the position for accident and emergency services and acute surgery is only secured for six months.

I commend the 5,000 people who came out to show their support for the retention of hospital services in their town, but I also want commitment from the Government that at some point down the road it will not suddenly decide to end certain services there because it reckons it is cheaper to do that than to address a health system that is broken. I heard my constituency colleague, Deputy Charles Flanagan, say on Midlands 103 radio that the HSE must tackle the lack of trust people have in the organisation. Does he not realise that his party colleague, the Minister, Deputy Reilly, now has his hands on the reins and that his party and Labour now control the health service directly? The Minister stood down the board of the HSE and has told us that he and his Department officials now run the health services, so this is a red herring. I welcome that the board has been stood down but the Minister needs to introduce the necessary reforms.

The Minister is asking the people to trust the HSE days after this same organisation failed to co-ordinate air transport for Meadhbh McGivern on Saturday night in order that she could have the long-awaited liver transplant she needs. That did not happen ten years ago; it happened last weekend. These are life and death matters and we are placing them in the hands of the HSE. Deputy Charles Flanagan said that before he was in government he regarded the HSE as dysfunctional, and went on to say that nothing has changed since his party went into government. I agree with him on those two matters. However, Deputy Flanagan's party and Labour are now in Government and it is his Government's responsibility to create trust by fixing the health service.

Only a couple of weeks ago, it was being reported that outpatient clinics in Portlaoise hospital would not be in operation for July and August with the exception of maternity and the warfarin clinic, with corresponding reductions in accident and emergency services, and at that point the HSE was apparently in talks to put together a contingency plan, but no public decision had been made on what has to be done. If it has been made, we have not been made aware of it. I ask the Minister when exactly we will see a health service that does not continually operate on the basis of lurching from one crisis to another.

Health care is a fundamental human right. If this Government had the capacity and the political will to manage the economy effectively and fairly, it would realise it is a right for everyone. Giving people equal access to proper health services and tackling the social and economic inequalities that lead to poor health for many would go a large way to saving money in the long term. I ask the other Members of the House to support the motion.

Deputy Aengus Ó Snodaigh

Cuirim fáilte roimh an deis labhairt ar an rún rí-thábhachtach seo. Gabhaim comhghairdeas leo siúd ar fad atá lasmuigh. Chuala mé go bhfuil siad ag éisteacht leis an díospóireacht seo. Tá súil agam go n-éiroidh leis an rún, nó ar a laghad leis an bhfeachtas. Thaistil na daoine sin ó Ros Comáin chun agóid a dhéanamh i gcoinne an cinneadh atá déanta ag an Rialtas an aonad timpistí agus éigeandála san ospidéal sa bhaile sin a dhúnadh. Ní hiad amháin a bheidh síos leis má leanann an Rialtas seo ar an mbealach atá siad ag tabhairt faoi cheana féin.

The Government amendment to the Sinn Féin motion is a sick joke. The second paragraph refers to "the Government's approach to ensuring that all patients have access to timely, high quality emergency services". What is timely about adding hours to people's journey to hospital in emergency situations, as happens when emergency departments are closed, such as is happening in Roscommon? What is timely about sitting in accident and emergency for hours on end, as happens in most big hospitals in this city every day, particularly at weekends?

The Government amendment makes no reference to any of the specific hospitals mentioned in the Sinn Féin motion. This is no wonder as the pre-election commitments of both Fine Gael and the Labour Party in regard to these hospitals, such as Roscommon, Navan, Letterkenny, Portlaoise, Loughlinstown, Portiuncula, Limerick, Clonmel, Mallow, Bantry and others, have all now been exposed for what they were, namely, attempts to deceive the people and to buy votes.

Recently, the Minister for Health, Deputy James Reilly, stated that the Government would be accepting the Trolley Watch figures of the INMO rather than the doctored figures we have seen and still see from the HSE and the national treatment purchase fund. This is a welcome move, and it is about time it happened. The Minister should also take heed of the INMO statement of this week, which reads: "The INMO...reaffirms its absolute conviction that the current policy of the HSE and Government, to reduce services in some hospitals and to centralise them in major centres, is ill-timed, will not succeed and will simply result in further misery for patients requiring inpatient care in a hospital bed in a proper ward". The INMO statement was based on its six-month comparative study, just published, which shows the disgraceful level of accident department overcrowding taking place in 2011 as compared to the same period in years since 2006.

With regard to 2011, the survey confirms over 46,000 people were on trolleys, having been admitted to a hospital, in the first six months of this year. This marks a 20% increase on the same period in 2010 and a 37% increase since 2006, when it was declared "a national emergency". There has been a dramatic increase in overcrowding in hospitals in the north-east region, where other services have been curtailed and centralised into the already crowded two main centres. A significant deterioration is also happening in a number of other hospitals outside of Dublin and there has been a further deterioration in the greater Dublin area, which includes the major hospital in my constituency, St. James's Hospital, where numbers on trolleys and chairs in accident and emergency have risen continuously.

Little attention is being paid to the maternity hospitals. One of the largest is the Coombe hospital in my area, where there is the highest birth rate in the EU. Our maternity hospitals are struggling to cope, resulting in higher numbers of caesarean births but also in less time being spent in hospital by mothers who have given birth because they are literally being pushed out the door to make room for other expectant mothers.

I have spoken many times in the House about the situation in Crumlin children's hospital. The Government amendment refers to providing high quality diagnostic services. With regard to vital diagnostic services for children, what will the Government do about the 12 to 18 month waiting time for endoscopy for children at the only national centre, Crumlin children's hospital? All that is on the cards for that hospital this year is that it will have to curtail its services, close its operating theatre and restrict outpatient services because of a shortfall in funding, despite taking on extra patients and being more efficient and effective in the use of consultants, time and money. It is being punished, as it was in the past under the previous Government.

The Government has a choice, as do its Ministers and backbenchers. They should support the local and national hospitals, make a change and vote against the Government amendment.

Deputy Sandra McLellan

At the outset, I echo the comments of a number of previous speakers that health care is a fundamental right. Sinn Féin has proposed a health service based on universal public provision, one that provides full equality of access and is free at the point of delivery. Access should be based on need and paid for through progressive taxation. Instead, we have a rotten system which is driven by the three Gs of health care — genes, giros and geography. The other G, genius, is certainly not running the health service.

Those with chronic illnesses, earning just above the medical card threshold and living in rural Ireland, are worst affected. The Minister, the Department and the HSE would do well to recognise that Ireland is not the Netherlands, or anywhere else for that matter. The subtleties of this country, its demographics, landscape, transport infrastructure, and where and how people choose to live, need to be reflected in a health service which caters for the needs of all of the people equally. Instead, we have listened to consecutive Ministers talk about the transformation and reconfiguration agenda. Political decisions are cloaked in carefully selected, so-called expert opinions. Unfortunately, the actions which follow that talk consistently amount to major downgrading and reduction of services, and the lives of ordinary people are being put at risk.

The latest push to close accident and emergency services is happening despite the fact that a number of medical professionals have expressed their strong opposition. This includes doctors, nurses and other health care workers, as well as general practitioners, who are expected to pick up the pieces.

The Minister and gurus in the HSE have to be aware of the most comprehensive study carried out investigating the relationship between distance to hospital and patient mortality in emergencies which was conducted at the University of Sheffield in Britain. After analysing data from 10,315 cases, the research showed that increased distance was, in fact, associated with increased mortality. Every 10 km increase in straight-line distance was associated with approximately a 1% absolute increase in mortality. One might have thought such a study would be relevant, given the implications of the decisions being made in regard to Mallow, Bantry, Roscommon and other at-risk emergency departments.

This is the essence of the argument people in those affected areas want to make. It is what brought people onto the streets today and over the past number of weeks and, indeed, years. People instinctively know the downgrading of emergency departments will endanger lives and cost lives. The Minister knows this too. There is real evidence to prove it, not only from researchers in Sheffield but from families in this State who have already been affected by this change agenda in Monaghan, the mid-west and elsewhere.

We cannot forget that these decisions are being made in the shadow of a legacy of poor planning and a complete lack of foresight within health service delivery in Ireland. This Government seems intent on continuing in the same vein as the last Government.

Once again services are being cut back and downgraded, while the necessary provisions are not being put in place elsewhere. I have seen this happen in my own local hospital in Mallow where the accident and emergency department is on the Government's radar, but at the same time paramedic and primary care cover is also being downgraded. Crucial ambulance services are being replaced with first responder cars, while the number of SouthDoc out of hours cars is being reduced.

The people of Roscommon realised their worst fears when they heard the news yesterday that their accident and emergency department was to be demoted to being little more than a medical sorting office. They made their opinion about this decision known outside Leinster House and now inside this House their elected representatives and the representatives of all areas affected, including my constituency of Cork East, have a clear choice between supporting the Sinn Féin motion and retaining essential services or doing otherwise and guaranteeing the opposite. The decision is theirs.

Deputy Dessie Ellis

I dtús báire, ba mhaith liom buíochas a ghabháil le gach éinne a tháinig amach ar an agóid inniu, go háirithe iad siúd ó Laois agus Ros Comáin. Tá ár gcóras sláinte ag dul in olcas mar gheall ar na ciorruithe atá curtha i bhfeidhm ag an Rialtas seo agus an Rialtas a chuaigh thart. Caithfimid stad a chur leo. Tá na daoine ag fulaingt agus níl gá leis.

Article 12 of the International Covenant on Economic, Social and Cultural Rights which the State has signed calls for the creation of conditions which ensure everyone medical services and attention in the event of sickness. Can we say with honesty that the State is fulfilling this basic right? Can we say that, regardless of wealth or geography, we are guaranteed adequate medical services and attention to ensure the highest level of attainable health, as is strived for in the covenant and demanded by those who pay their taxes every week? I am not alone in believing we cannot say this, certainly in this House. I hope the Government Members who have attempted to neuter our motion with their amendment will take the time to speak to the ordinary people who have rallied outside Leinster House in support of the principle of the motion. They have come from as far away as Roscommon and other places similarly affected by the Government's policy of treating the rights of the people as an afterthought with deference afforded to bankers, developers, judges and highly paid consultants.

I have spoken to nurses and doctors in my constituency who have told me horror stories about the way cuts, embargoes and other pressures are seriously damaging their ability to provide care. One nurse has told me that she feels she is merely going through the motions in providing a service because there are insufficient staff to provide real long-term benefits for patients who are struggling to keep their heads above water. I was told that it was not possible to provide cover for two staff who were injured for more than two months, with the result that nurses had to work additional overtime shifts, even though this required them to work beyond the limits of what was safe in providing patient care. Students have told me that their preceptors have no time to teach them. The most they can do is contribute to the most basic of work in the hope of lightening the load of overburdened staff members who are already stressed by the damage the crisis is doing to patient care. One evening last week only two porters were on duty in one hospital in my constituency, which meant delays in the provision of X-rays, blood, urine and stool samples and two blood transfusions. Thankfully, the latter were not as urgent as was usually the case. In one hospital the number of intern doctors has been cut by one third for night shifts from midnight, placing further burdens on already overworked interns who are often dangerously tired in carrying out their vital duties. The stories of wards being used as excess accommodation for accident and emergency departments and rotating staff to make up for short-falls, even in specialised areas, were shocking to me, but for anyone professionally concerned with infection control and quality of care, they are heartbreaking and soul shattering. I feel for the people who have studied long and hard and dedicated themselves to the provision of care because they have been failed by this system.

We are also faced with reduced hours for home help services. My area of Dublin North West has a large population of older people, many of whom require help in order to retain their independence at home, but their independence is becoming more difficult to preserve because the amount of care they are receiving is decreasing. For several years I have heard, as I am sure have other Members, stories I have found to be unacceptable. People who need assistance are facing cuts in care hours from eight and ten hours per week to two or as little as one. For these reasons, I ask Deputies to support our motion.

Deputy Martin Ferris

While today's protests and the anger of people in Roscommon have brought the issue to a head, there has been mounting evidence of a crisis in accident and emergency departments. The problems have persisted for many years and they will not be solved by subjecting health services to more cutbacks.

Research published late last year found that only 13 of the 31 accident and emergency departments in the State were properly staffed because vacancies had not been filled. Enormous pressure was put on junior doctors to fill the gap. The long hours many of them had to work endangered their health as well as the health of their patients. While guarantees had been given that the accident and emergency department at Kerry General Hospital would be secure, the research found that its vacancy rate of 66% was the second highest in the State. The failure to fill necessary posts is imposing massive pressures on staff and impacts on the level of care provided for patients.

A report published by the Irish Association for Emergency Medicine criticised the dependence on junior doctors to staff accident and emergency wards and stated full-time staff needed to be appointed in order to ensure the efficient operation of the system. Instead, however, we are seeing a programme of cuts which will further impact on accident and emergency departments and, as we have seen, is already leading to closures. The cuts in the health service do not only impact on accident and emergency departments. For example, it is now common practice at Kerry General Hospital to discharge patients at weekends in order to free up beds. Staff are being forced to do this in order to cope with the pressure exerted, but patients who are discharged in this way often have to be readmitted. One individual who was terminally ill was discharged on a Friday, readmitted on a Sunday and died on a Monday. This is not the fault of the staff concerned who are working under enormous constraints and the problem is wider than the financial aspects. However, it is certain that closures and cuts as part of a money saving exercise are not going to provide the solution to the crisis.

The biggest problem with the accident and emergency departments at Kerry General Hospital and other locations is that the lack of beds prolongs the waiting time for treatment. As of 29 June, 29 surgical beds were closed at Kerry General Hospital. This means that patients in severe discomfort often have to spend long hours waiting before being seen. I received one report on a woman who had to wait almost 36 hours in the accident and emergency department before being given a bed.

The continued failure to open the much needed Tralee community hospital is also a huge issue locally. Millions of euro were spent on the construction of that hospital, but it lies idle.

Concerns have been expressed in Limerick about the future of accident and emergency services at the Mid Western Regional Hospital. It is feared that services may have to be curtailed from next week owing to a shortage of doctors. The chairperson of the hospital board has stated patients may have to be sent to Cork or Galway because the hospital may not be able to ensure full cover during night time hours.

I commend the hundreds of people from Roscommon and Portlaoise who stood outside Leinster House in the pouring rain to show their determination to prevent this from happening to them. They are prepared to fight back. People who are threatened with the removal of their rights and the closure of their accident and emergency departments need to tell the Labour Party which was so loud in opposition and its partner in government that they will not tolerate this without a fight. The Government will have to start listening to them.

Minister of State at the Department of Health (Deputy Róisín Shortall)

This Government's prime concern is the safety of patients. We will not stand over unsafe services. No one here would agree that an unsafe service should continue. We need the best possible service for patients in our emergency departments, inpatient services, day cases and outpatient departments. We want to achieve what is best for patients, and as quickly as possible.

While there is much analysis remaining, the picture so far shows that for stroke, cancer and heart attacks, in-hospital mortality rates vary widely. Some smaller hospitals have noticeably poorer mortality rates than larger hospitals. This supports the international evidence that smaller hospitals, with lower volumes and fewer support services, have poorer patient outcomes than larger hospitals with appropriate resources and patient volume.

The Minister has repeatedly stated that smaller hospitals should provide as wide a range of services to their local communities as possible. Smaller hospitals should be the cornerstone of local health care provision, with clear links to other services. They should provide a range of diagnostics and expanded elective day surgery and medical procedures. These should transfer from the larger hospitals, freeing these facilities up for more complex work. In addition, smaller hospitals should provide locally accessible outpatient care as well as access for GPs to services and diagnostics. That is the direction in which we are going.

We are implementing the best care model for complex and emergency cases. Highly trained ambulance personnel treat patients immediately at the scene and get them to the most appropriate — not necessarily the nearest — hospital as quickly as possible, giving a greater chance of survival. That is the key. Smaller hospitals should continue immediate and urgent treatment for less complex, non life-threatening cases, through urgent care centres which can manage most typical emergency presentations. This approach is endorsed 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.

Our immediate problem is the world-wide NCHD shortage. The Minister intends to reintroduce temporary registration for overseas doctors, giving secure tenure for up to two years. Likewise, we will be sure they are here for two years. There are currently around 180 HSE vacancies. While some will be filled before 11 July, the HSE and hospitals are working on contingency arrangements, if required, to minimise any impact and to ensure safe delivery of hospital services. I welcome Sinn Féin's support of the legislation that will be taken tomorrow and Friday to address that urgent matter.

It is unacceptable that some patients wait so long to be assessed and treated. This cannot be resolved in emergency departments or hospitals alone but must be done on a system-wide basis. The special delivery unit will unblock obstacles that stop patients being seen and treated quickly. It has started work already on emergency department issues and will also concentrate on inpatient and outpatient waiting times and access to diagnostics.

We intend to provide equal access to health services through a single-tier system supported by universal health insurance. Among the steps needed, the special delivery unit has already been mentioned. We must also reform primary care, with phased removal of cost barriers. We must move to integrated care in the primary and community sector. This work is under way. It has been accepted for many years that we should have the vast bulk of health care provided at primary level. This has not happened until now, and we are determined to make it happen.

If we want the best health system with the best outcomes for our patients, we must work together. We must deliver services at the right time, in the right place, to the right people. We cannot safely provide all services from all hospitals at all times. We can provide safe services across our whole system through larger and smaller hospitals, community and primary care. We are committed to driving the changes needed. Those changes are long overdue and, regrettably, they were not implemented by the previous Government. It will not be easy and not everyone will be happy, but it has to be done and this Government will see it through, because patient safety is our absolute priority.

Deputy Peadar Tóibín

Meath has had a hospital since 1767. For nearly 250 years, the people of Meath have been served by a local hospital. This hospital survived the 1798 rising, the disaster of the famine, two world wars, the Black and Tan war and the civil war. The hospital in Meath survived the hungry 30s and every recession since. In the 1960s, the population of Meath was about 100,000, yet the county had a fully functioning hospital. Today, the population of Meath is now 184,000, which is the highest population ever achieved in the county, yet services there are being slashed. Paediatric services have been lost, orthopaedic services have been reduced and suspended for months on end, and D-dimer blood testing is now outsourced. Interns have been removed from the hospital, surgeons have been removed and, indeed, suspended on the basis of evidence-free allegations. Training recognition has been withdrawn, leading to reductions in the number of junior doctors. Keyhole surgery has been cancelled and doctor on call services have been cut by two thirds. Psychiatric services are to go before 2012, and since September all acute surgical services have been cancelled. Nearby alternative hospitals are not funded to accept the overflow and cannot cope. The cuts have been chaotic and if, God forbid, a miner were to suffer an accident in Tara Mines, there is a good chance he would not able to survive, given how far he is underground.

We have had a massive campaign in response to this. Fifteen thousand people have signed the Save Navan Hospital petition, 8,000 people signed up to the Facebook page, while more than 10,000 people marched in Navan last October in support of the hospital. We invited Deputy James Reilly, then Opposition spokesperson on health, to address that march, an invite he speedily accepted. He promised a return of surgery services and a new regional hospital to be built within five years in Navan. Surgery services have not been returned and in recent weeks senior medical professionals in Meath have stated to me that the situation in our accident and emergency department is under serious threat. If these cuts go ahead, it will be clear that the promises made four months ago by Fine Gael and Labour will have been replaced by the continuation of normal HSE strategy.

That HSE strategy has been simple. The HSE reduces funding. This leads to the HSE making allegations of a reduction in patient safety. This in turn leads to service being closed down. If patient safety were at the heart of these decisions, this would not happen. Money is at the heart of these decisions. A recent INMO survey stated that more than 46,000 people were on trolleys in the first six months of this year. This marks a 37% increase since 2006 when it was declared a national emergency. An organisation that allows this to continue is not prioritising patient safety and is effectively prioritising the payment of private debt. If this Government accepts the straitjacket of the EU and the IMF, patients will die and people in provincial towns throughout the State will see a real reduction in their own life expectancy. Each individual Fine Gael and Labour Deputy is at a crossroads. Either they bunker down behind the EU and IMF plan and slash services, or they stand up for their local constituents and the people of Ireland, grow a backbone and support our motion.

Deputy Jonathan O’Brien

We have heard much about Roscommon, Sligo and Portlaoise, but I wish to talk about St. Mary's Orthopaedic Hospital which is in the heart of my constituency of Cork North-Central. I acknowledge the presence in the Chamber of the other three Deputies from the constituency, Deputies Dara Murphy and Billy Kelleher and the Minister of State, Deputy Kathleen Lynch.

As many Deputies will not be too familiar with the orthopaedic hospital, I will put on record some points in regard to it. It is sited on the north side of Cork city, has one of the lowest infection rates of any hospital in this State, is located on 30 acres of land, more than half of which is green open space that can be developed, and has all the ancillary services one would expect of a local hospital. Despite all these positives, someone somewhere in the HSE came up with the bright idea that we should transfer the orthopaedic services from the hospital. As people can imagine, this proposal was met with bewilderment and outrage by the local community and, as a result, the proposal to transfer all orthopaedic services from the hospital was a very contentious election issue.

On 4 February of this year, the then Fine Gael candidate and now Fine Gael Deputy, Dara Murphy, issued a press release on the future of the orthopaedic hospital. In the statement he said Fine Gael would stop the transfer of orthopaedic services from St. Mary's hospital if it got into power the following month, that he had received a cast iron guarantee from the Fine Gael deputy leader and spokesperson on health, Deputy James Reilly, that the transfer would be stopped, that this was a commitment it would absolutely deliver on and that it was an absolute cast iron guarantee.

Naturally enough this statement raised a few eyebrows in the media in Cork so they went looking for Deputy Reilly to get his views. Subsequent quotes attributed to him in response to the press release issued by Deputy Murphy were as follows. He said he supported the call by the now Deputy Dara Murphy in regard to the retention of orthopaedic services at St. Mary's hospital and that the proposal to transfer services made no sense for four reasons. He said clinical outcomes would be better at St. Mary's owing to the low infection rate at the hospital, the move to the South Infirmary-Victoria Hospital would reduce the number of available beds from 125 to 80, which is a 36% reduction, that the South Infirmary-Victoria Hospital was on a cramped city centre site while St. Mary's had 30 acres of space on which to expand, and that instead of downsizing St. Mary's, child and family services, ambulance services and community health services should be there.

This statement begs the question about what has changed. When Deputy Reilly found himself in the position of Minister for Health, instead of standing over what he said before the election, he decided to change his mind and hold a review on the future of orthopaedic services at St. Mary's. This was despite everything he said only a few weeks previously about the proposal not making any sense whatsoever. The review was conducted by officials from the Department and we now know they reported back to the Minister in the past fortnight. The contents of the review have not been published so I can only guess as to what was contained in it. However, whatever it was, it must have been damning because the Minister has now done a complete U-turn and agreed to the transfer of orthopaedic services. As a result of this U-turn, I call on the Minister to publish in full the results of the review as well as all correspondence received by his Department in regard to the orthopaedic hospital while this review was being undertaken.

This is important not only because of the obvious U-turn but because the Minister stated in this House on 28 June in response to a question tabled by Deputy Kelleher that he consulted local representatives as part of the review. I am not sure who these representatives were but I can say who they were not. They were not the elected Members for the area nor were they representatives of the staff or the patients.

The Minister might think this issue has been put to bed with the decision he announced last week but the campaign to retain the orthopaedic services at St. Mary's hospital continues and is far from finished. In fact, this Friday, campaigners will hold another rally at the hospital. We will fight tooth and nail to force the Minister to stand by his pre-election commitments. That is all we want. We are not looking for the impossible. We are not asking the Minister to fly a rocket to the moon or rush a beach head during wartime. We are just asking him to stand by what he said a few short weeks ago. What he said does not make sense.

Deputy Michael Colreavy

I applaud all the people from Sligo, Leitrim, Roscommon and elsewhere who are in the Visitors Gallery and who are standing in the rain outside the gates of the House. If I might use Deputy Ó Caoláin's words, they are the eyes and ears of their community and they have come here to see how Sinn Féin debates to safeguard our health services. I hope they will go back to those communities and report fully on the debate and on its outcome.

I thank all those who took part in the debate, in particular those opposite who might do the courageous and right thing and oppose the Government and Fianna Fáil amendments and support the Sinn Féin motion. This motion offers Deputies of all parties an opportunity to vote in favour of accessible, quality hospital care for our people, but it does something more than that. It also offers all of us an opportunity to demonstrate that politics can work and that politicians can be trusted.

The three most scary words in Ireland currently are "health services reform". People are scared for very good reason. They saw the Minister's predecessor, Mary Harney, in a Fianna Fáil-led government, talk about health services reform. What did she do? She dismantled a relatively good service and left us with the shambles we now have. Is it any wonder that people are scared when they hear the words "health services reform" spoken by a politician?

Tonight every Deputy has an opportunity to stand up and be counted. Some will have to decide whether they are here under false pretences and will have to deal with their consciences. Others will consider doing the honourable and honest thing and will consider voting against the Government and Fianna Fáil amendments and voting in favour of the Sinn Féin motion.

The Fianna Fáil amendment means nothing but then how could it? Its members are the very people who started this. Fianna Fáil closed the accident and emergency departments in Monaghan, Dundalk, Nenagh and Ennis and took cancer services from Sligo General Hospital. Now Roscommon County Hospital's accident and emergency department is the first of a batch of hospital accident and emergency departments to be closed under a Fine Gael-Labour Party Government.

The Minister for Health and the Taoiseach have repeated the mantra, "Big hospital safe, small hospital unsafe". That is a mantra for taking services from small hospitals. Small hospitals is a misnomer. We are not only talking about accident and emergency services. It will start with accident and emergency services but it will move on to other services very quickly. We are talking about centralising everything in a handful of regional centres. If, as the Minister said yesterday, patient throughput is a key determinant in regard to the quality and outcome of care, how come small private hospitals can and are allowed to run cancer services? If the hospital is private, it does not matter but if it is public, we must centralise and regionalise.

Hospitals are not doctor fattening units. They are places to which ill and injured people go. How safe are the overcrowded units in our large regional hospitals? What risk assessment has the Minister or any agency done on whether the hospitals adjoining Roscommon can carry the additional burden that will be placed on them because of the closure of accident and emergency services in Roscommon?

As the Minister will know, prior to the last general election, Fine Gael and Labour Party candidates promised unconditionally that Sligo General Hospital would have full breast cancer services restored within 100 days of them taking office or they would resign their seats. The Minister knows that promise was made and there is plenty of evidence of same. It is also probable that those Deputies would not be here if they had not made that unconditional promise. Are they here under false pretences? It is now very clear that they have a choice. They can vote against the Fianna Fáil and Government amendments and in favour of the Sinn Féin motion. Otherwise, they will be voting to support their party and against the interests and wishes of those they pretend to represent. I call on them to do the right thing or resign.

Amendment put.

The Dáil divided: Tá, 96; Níl, 47.

Tá

• Bannon, James.
• Breen, Pat.
• Broughan, Thomas P.
• Bruton, Richard.
• Burton, Joan.
• Butler, Ray.
• Buttimer, Jerry.
• Byrne, Catherine.
• Byrne, Eric.
• Cannon, Ciarán.
• Carey, Joe.
• Coffey, Paudie.
• Collins, Áine.
• Conaghan, Michael.
• Conlan, Seán.
• Connaughton, Paul J.
• Conway, Ciara.
• Coonan, Noel.
• Corcoran Kennedy, Marcella.
• Costello, Joe.
• Coveney, Simon.
• Creed, Michael.
• Creighton, Lucinda.
• Daly, Jim.
• Deasy, John.
• Deering, Pat.
• Doherty, Regina.
• Donohoe, Paschal.
• Dowds, Robert.
• Doyle, Andrew.
• Durkan, Bernard J.
• English, Damien.
• Feighan, Frank.
• Fitzpatrick, Peter.
• Flanagan, Charles.
• Flanagan, Terence.
• Griffin, Brendan.
• Hannigan, Dominic.
• Harrington, Noel.
• Harris, Simon.
• Hayes, Brian.
• Hayes, Tom.
• Heydon, Martin.
• Hogan, Phil.
• Howlin, Brendan.
• Humphreys, Kevin.
• Keating, Derek.
• Keaveney, Colm.
• Kehoe, Paul.
• Kelly, Alan.
• Kenny, Seán.
• Kyne, Seán.
• Lawlor, Anthony.
• Lynch, Ciarán.
• Lynch, Kathleen.
• Lyons, John.
• McCarthy, Michael.
• McEntee, Shane.
• McFadden, Nicky.
• McGinley, Dinny.
• McHugh, Joe.
• McLoughlin, Tony.
• McNamara, Michael.
• Maloney, Eamonn.
• Mathews, Peter.
• Mitchell, Olivia.
• Mitchell O’Connor, Mary.
• Mulherin, Michelle.
• Murphy, Dara.
• Nash, Gerald.
• Neville, Dan.
• Nolan, Derek.
• Noonan, Michael.
• Ó Ríordáin, Aodhán.
• O’Donnell, Kieran.
• O’Donovan, Patrick.
• O’Dowd, Fergus.
• O’Mahony, John.
• O’Reilly, Joe.
• O’Sullivan, Jan.
• Penrose, Willie.
• Phelan, John Paul.
• Rabbitte, Pat.
• Reilly, James.
• Ring, Michael.
• Ryan, Brendan.
• Shatter, Alan.
• Sherlock, Sean.
• Stagg, Emmet.
• Stanton, David.
• Timmins, Billy.
• Tuffy, Joanna.
• Twomey, Liam.
• Varadkar, Leo.
• Walsh, Brian.
• White, Alex.

Níl

• Adams, Gerry.
• Boyd Barrett, Richard.
• Browne, John.
• Calleary, Dara.
• Collins, Joan.
• Collins, Niall.
• Colreavy, Michael.
• Cowen, Barry.
• Crowe, Seán.
• Daly, Clare.
• Doherty, Pearse.
• Donnelly, Stephen.
• Dooley, Timmy.
• Ellis, Dessie.
• Ferris, Martin.
• Flanagan, Luke ‘Ming’.
• Grealish, Noel.
• Halligan, John.
• Healy, Seamus.
• Healy-Rae, Michael.
• Higgins, Joe.
• Kelleher, Billy.
• Kirk, Seamus.
• Kitt, Michael P.
• Lowry, Michael.
• Mac Lochlainn, Pádraig.
• McConalogue, Charlie.
• McDonald, Mary Lou.
• McGrath, Finian.
• McGrath, Mattie.
• McGrath, Michael.
• McGuinness, John.
• McLellan, Sandra.
• Moynihan, Michael.
• Murphy, Catherine.
• Naughten, Denis.
• Ó Caoláin, Caoimhghín.
• Ó Cuív, Éamon.
• Ó Fearghaíl, Seán.
• Ó Snodaigh, Aengus.
• O’Brien, Jonathan.
• Pringle, Thomas.
• Ross, Shane.
• Smith, Brendan.
• Stanley, Brian.
• Tóibín, Peadar.
• Wallace, Mick.

Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Seán Ó Fearghaíl.

Amendment declared carried.

Question put: "That the motion, as amended, be agreed to."

The Dáil divided: Tá, 96; Níl, 46.

Tá

• Bannon, James.
• Breen, Pat.
• Broughan, Thomas P.
• Bruton, Richard.
• Burton, Joan.
• Butler, Ray.
• Buttimer, Jerry.
• Byrne, Catherine.
• Byrne, Eric.
• Cannon, Ciarán.
• Carey, Joe.
• Coffey, Paudie.
• Collins, Áine.
• Conaghan, Michael.
• Conlan, Seán.
• Connaughton, Paul J.
• Conway, Ciara.
• Coonan, Noel.
• Corcoran Kennedy, Marcella.
• Costello, Joe.
• Coveney, Simon.
• Creed, Michael.
• Creighton, Lucinda.
• Daly, Jim.
• Deasy, John.
• Deering, Pat.
• Doherty, Regina.
• Donohoe, Paschal.
• Dowds, Robert.
• Doyle, Andrew.
• Durkan, Bernard J.
• English, Damien.
• Feighan, Frank.
• Fitzpatrick, Peter.
• Flanagan, Charles.
• Flanagan, Terence.
• Griffin, Brendan.
• Hannigan, Dominic.
• Harrington, Noel.
• Harris, Simon.
• Hayes, Brian.
• Hayes, Tom.
• Heydon, Martin.
• Hogan, Phil.
• Howlin, Brendan.
• Humphreys, Kevin.
• Keating, Derek.
• Keaveney, Colm.
• Kehoe, Paul.
• Kelly, Alan.
• Kenny, Seán.
• Kyne, Seán.
• Lawlor, Anthony.
• Lynch, Ciarán.
• Lynch, Kathleen.
• Lyons, John.
• McCarthy, Michael.
• McEntee, Shane.
• McFadden, Nicky.
• McGinley, Dinny.
• McHugh, Joe.
• McLoughlin, Tony.
• McNamara, Michael.
• Maloney, Eamonn.
• Mathews, Peter.
• Mitchell, Olivia.
• Mitchell O’Connor, Mary.
• Mulherin, Michelle.
• Murphy, Dara.
• Nash, Gerald.
• Neville, Dan.
• Nolan, Derek.
• Noonan, Michael.
• Ó Ríordáin, Aodhán.
• O’Donnell, Kieran.
• O’Donovan, Patrick.
• O’Dowd, Fergus.
• O’Mahony, John.
• O’Reilly, Joe.
• O’Sullivan, Jan.
• Penrose, Willie.
• Phelan, John Paul.
• Rabbitte, Pat.
• Reilly, James.
• Ring, Michael.
• Ryan, Brendan.
• Shatter, Alan.
• Sherlock, Sean.
• Stagg, Emmet.
• Stanton, David.
• Timmins, Billy.
• Tuffy, Joanna.
• Twomey, Liam.
• Varadkar, Leo.
• Walsh, Brian.
• White, Alex.

Níl

• Adams, Gerry.
• Boyd Barrett, Richard.
• Browne, John.
• Calleary, Dara.
• Collins, Joan.
• Collins, Niall.
• Colreavy, Michael.
• Cowen, Barry.
• Crowe, Seán.
• Daly, Clare.
• Doherty, Pearse.
• Donnelly, Stephen.
• Dooley, Timmy.
• Ellis, Dessie.
• Ferris, Martin.
• Flanagan, Luke ‘Ming’.
• Grealish, Noel.
• Halligan, John.
• Healy, Seamus.
• Healy-Rae, Michael.
• Higgins, Joe.
• Kelleher, Billy.
• Kirk, Seamus.
• Kitt, Michael P.
• Lowry, Michael.
• Mac Lochlainn, Pádraig.
• McConalogue, Charlie.
• McDonald, Mary Lou.
• McGrath, Finian.
• McGrath, Mattie.
• McGrath, Michael.
• McGuinness, John.
• McLellan, Sandra.
• Moynihan, Michael.
• Murphy, Catherine.
• Ó Caoláin, Caoimhghín.
• Ó Cuív, Éamon.
• Ó Fearghaíl, Seán.
• Ó Snodaigh, Aengus.
• O’Brien, Jonathan.
• Pringle, Thomas.
• Ross, Shane.
• Smith, Brendan.
• Stanley, Brian.
• Tóibín, Peadar.
• Wallace, Mick.

Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Seán Ó Fearghaíl.

Question declared carried.