Leaders’ Questions

Before beginning Leaders' Questions, I reiterate the rules governing this. Two minutes are allocated to the presentation of the question, three minutes are allocated to the reply and there is one minute each for the supplementary question and answer. I must stick rigidly to these times and I ask for the co-operation of Members.

Every time the Taoiseach gets asked a tough question, he attacks the person asking the question and avoids answering it. He did the same last week when he described it as pathetic that his broken promise to Roscommon hospital was raised. He said: "I am getting a little fed up of the Deputy putting words in my mouth". The Taoiseach demanded that we show him the quotes. What he did not count on was that Niamh Connolly ofThe Sunday Business Post had a recording of the exact words spoken by the Taoiseach on this issue. The Taoiseach was caught out. As reminder he said: “And I don’t come down here lightly to say these words”. The Taoiseach said to the people of Roscommon that the accident and emergency services would be maintained and he attacked what he called “decisions made for Roscommon Hospital by bureaucratic people in a room far away from here”. With solemn flourish, the Taoiseach said: “And I want you to understand this: I have defended the nurses and the doctors and the workers and the people of Roscommon over the years about this hospital, and will do so again”. Not only this, the deputy leader promised he had the answer to doctor shortages and safety issues. Nothing new has been raised by HIQA since February.

It emerged today that HIQA has never set foot in Roscommon hospital. The idea that the view of HIQA on Roscommon hospital suddenly changes everything is ludicrous. Will the Taoiseach finally take this opportunity to come clean and admit that he and his party promised to keep the services open in full knowledge of the issues the hospital faced in a crass but effective effort to take two seats for the Fine Gael Party in Roscommon? Will the Taoiseach correct the public record as per a statement on RTE on Sunday? Will he correct the record of this House, which was misled last week?

Unlike Deputy Martin, this Government will face tough questions and make tough decisions. Deputy Martin was the collator of over 100 reports which cost millions of euro and which were never acted upon, be that as it may.

A Deputy

What about keeping your promises?

The statement Deputy Martin refers to in respect ofThe Sunday Business Post was a public address on the street in Roscommon——

——and an interview afterwards in which I as leader of the Fine Gael Party enunciated what Fine Gael policy was at that time.

So it is the Labour Party's fault.

Part of the duty and the responsibility of any leader of any party is to enunciate party policy. The party policy in respect of Roscommon hospital was published in the local papers and publicly known before I arrived in Roscommon. The first mention of the situation being unsafe in Roscommon hospital arose in the Mallow report, which as the Deputy is aware was published after the general election.

The position is that were I not to accept the clinical evidence of the independent health regulator and say that everything was fine in Roscommon hospital and in a number of other small hospitals around the country where similar issues arose and something were to happen in that accident and emergency department, I would have neither conscience nor cover. The position is that when it became clear to me and to the Minister for Health that the situation in Roscommon hospital is not as it should be the decision was made to redesign and restructure the services for Roscommon hospital. From that point of view I continued to reiterate Fine Gael Party policy around the country and espoused it in Roscommon the same as anywhere else. It is not by some surreptitious means that a public address and an interview suddenly become known. I reiterated and enunciated our party position, given in good faith at that time in Roscommon——

And then denied it.

——as I did in other locations about other issues around the country.

What did the Taoiseach say last Saturday?

Unlike Deputy Martin, prior to the 2002 election when he said he would end waiting lists for once and for all and when he was asked if he would accept responsibility for that he laughed into the microphone.

Deputies

Hear, hear.

It was the Taoiseach who personally promised to tell it straight. It was the Taoiseach who denied to RTE and to this House that he made any promise regarding Roscommon hospital, and he was caught out. I find it incredible that he cannot face up to that in the House today and put the record straight.

Deputies

Hear, hear.

After three days of ducking the media the best the Taoiseach can come up with is that——

The Deputy is good at ducking himself.

——others are confused. Everybody else is confused except the Taoiseach. The Taoiseach reaffirming Fine Gael policy is not the same as him personally committing to that policy. A journalist this morning——

Could we have a supplementary question?

——talked about the danger of the Taoiseach spoofing. He described it well. The Taoiseach has a chance to set the record straight. Is he telling us now he had no knowledge of any previous HIQA statements about Roscommon hospital? Is he saying he did not know that his deputy claimed to have the answer to Roscommon hospital's safety issue? Was he aware when he told the country last week that he had no option but to downgrade Roscommon hospital that HIQA had not set foot in Roscommon hospital?

The Deputy is slightly confused. The enunciation of party policy is made by any leader of any party, including the Deputy.

As he is aware, party policy is put together by the Front Bench, the members of the party and the different organs within the party——

By the opinion polls.

——and from that point of view I enunciated what party policy was on a range of issues during the course of the general election.

The issue of a personal commitment is something above and beyond what party policy might be and from that point of view, to say that one has gone around the country giving personal commitments outside of what party policy was is a nonsense.

This situation is not about party politics, as Deputy Martin said. It is about patient safety.

I cannot stand over a position where the independent health regulator says that the situation in the Roscommon hospital accident and emergency department was unsafe.

What stance did the Taoiseach take on Ennis when the HIQA report called into question patient safety?

Deputy, please.

The Taoiseach is grossly misleading us.

The Mallow report made it very clear that 24-7 emergency department services should only be maintained in hospitals that had a full range of clinical resuscitation and diagnostic services on site——

HIQA said the same about Ennis hospital and the Taoiseach took a different position.

——with full-time clinical decision makers on site and where that did not apply, the appropriate arrangements to discontinue the emergency services should apply. In that case the Minister for Health, HIQA, the Health Service Executive and local representatives met in Roscommon to discuss that, and the position was made clear. When I travelled to Athlone for another purpose I made it clear to people who were concerned and anxious about it that changes would occur——

We are over time, Taoiseach.

——and that the situation that applied in Roscommon hospital——

That does not stand up to scrutiny.

——emergency department would not continue in the fashion it did previously.

That is not the position the Taoiseach took in regard to Ennis hospital or Nenagh hospital where there were people——

I call Deputy Gerry Adams.

On a point of order, the Taoiseach has refused to correct the record——

I call Deputy Gerry Adams.

He personally made a——

Resume your seat.

The record was misled.

(Interruptions).

Deputy Martin, will you resume your seat?

The Taoiseach has refused to correct the record.

(Interruptions).

Deputy Adams, without interruption.

A point of order was raised.

When the Taoiseach took up office he told the Dáil——

Do not fall off the bridge.

——that the old ways of politics damaged us, and he said his Government would tell the people the truth. The Taoiseach's handling of this Roscommon hospital crisis, even here today, is an example of the old ways of politics at their very worst. Caithfidh an Taoiseach a leithscéal a ghabháil, go háirithe le muintir Ros Comáin. During the election both the Taoiseach and the Labour leader, Deputy Eamon Gilmore, promised to maintain services at Roscommon hospital. By claiming today, and since he reversed that commitment, that the 2011 HIQA report means that he has no option but to close accident and emergency services at Roscommon hospital, he compounds the offence because he knew the HIQA position before that.

In 2009, it recommended that smaller "hospitals ... [be] redesignated for minor injuries and non-acute care". Fine Gael set its face against that recommendation and, in my view, opposed it correctly and trenchantly. It is in that context that the Taoiseach made the pre-election commitment on Roscommon hospital in the full knowledge of the HIQA position. The Taoiseach and Labour are now doing——

Could we have a question please, Deputy?

——exactly what they accused Fianna Fáil of having done. To add insult to injury, the HSE today admitted that there had not been an inspection of Roscommon hospital. The important issue is that the Taoiseach would honour his commitment to restore accident and emergency services because his promise was the right thing to do and reverse his decision to withdraw acute services from Roscommon hospital.

The position I enunciated when I visited Roscommon was strictly in accordance with Fine Gael policies at that time——

To gain two seats.

——which was public knowledge.

It was about internal party policy.

It was referred to on the local radio station and was given in good faith based on the information and the knowledge we had.

You saw your opinion poll.

The situation, as the Deputy is aware, following the Ennis report was that a review——

He rubbished the Ennis report.

——was to be carried out in respect of hospitals that were similar to Ennis hospital. That was never done. Roscommon was identified specifically in respect of the Mallow report.

What stance did the Taoiseach take on Ennis and Nenagh hospitals?

That is the independent health regulator——

You made a promise before the election.

The Taoiseach, without interruption.

——pointing out that a situation was unsafe. The politically expedient thing to do would have been to continue on——

You made a promise before the election.

——until something serious happened.

It did in Ennis and Nenagh hospitals, and the Taoiseach still rubbished the proposal.

The Government, the Department of Health and the Minister would have been in possession of information from an independent body stating that the——

Two people had died at Ennis and the Taoiseach still did not ——

Would you stay quiet please?

I cannot take it, a Cheann Comhairle.

——emergency department was unsafe from that point of view. We cannot do that and unlike Deputy Martin, we will face the tough questions in respect of dealing with patient safety and sorting out the endless litany of problems that have been left to us. I point out to the Deputy that when I said things will change in Roscommon——

——and they will change, I checked the position. I even got the registration numbers of the five ambulance vehicles. There are four crews.

(Interruptions).

Deputy Ó Caoláin may well laugh but the fact is that the rapid response vehicles, of which there are now two with a full-time crew available 24 hours per day, seven days per week, are part of the changes the Government will prove are for the betterment of services for patients and people in general.

The Taoiseach should check the record on what he said about reconfiguration.

We will now move on and demonstrate that Roscommon hospital——

It is outrageous.

Deputies

What about Loughlinstown?

——has a real future in terms of health service delivery, is secure and will not be closed down, as happened other hospitals.

The Taoiseach should get his researchers to go back over what he said about reconfiguration. This is pretty hard to take.

The fact that a stream of invective comes my way from the decent people of Roscommon is an indication of anxiety and concern.

The Taoiseach lied.

The Taoiseach sent a fair bit of invective our way for doing exactly the same thing.

I understand that is the case in public life. Deputy Feighan raised with me yesterday his concerns over palliative care patients.

I ask the Deputies to stay quiet.

Patients regarded by the palliative care nurses as requiring some treatment in hospital can have their transfer to Roscommon hospital effected by ambulance. This would not be constituted as an emergency because it would not be an accident and emergency case. It is common sense that elderly people in receipt of palliative care should be, on the determination of the palliative care nurse, doctor and a consultant, enabled to be transported to Roscommon hospital by ambulance. That will apply.

I remind Deputies that this is Deputy Adams's question. I ask Deputies to give him an opportunity to ask his question and to listen to the reply.

Deputy Adams has one minute.

When Fianna Fáil used the 2009 HIQA report to justify the withdrawal of emergency services from Ennis hospital, the current Minister for Health, Deputy James Reilly, rightly accused the then Government of starving smaller hospitals of resources to make them unsafe and of then producing reports to prove this and justify their closure. This is precisely what the current Government has just done.

The solution to a hospital that is unsafe is to make it safe. To decide there are no alternatives just shows a complete lack of vision and imagination. I spoke to the Roscommon hospital action group. I do not have time to tell Members what it told me; suffice it to say it challenged in great detail the figures put forward by the Minister for Health on various claims he made in the past week or so. I am sure Sinn Féin's health spokesperson, Deputy Ó Caoláin, will raise these issues again.

I want to follow the logic of what the Taoiseach is saying today. He says he accepts the HIQA recommendation in respect of Roscommon hospital. HIQA has recommended that nine other hospitals be downgraded and lose essential services. Can the Taoiseach confirm this? In the interest of telling the people the truth, can he tell us which hospitals will lose emergency services and when those services will be withdrawn? Does he not accept that what he is doing in Roscommon is what Fianna Fáil did in Louth, Ennis, Nenagh and Monaghan?

There is no danger of closing down Roscommon hospital. There is every potential for it to play a fundamental part in the delivery of an effective health service that regards patient care as central.

The Taoiseach said that at the time of the general election.

The GPs do not even believe that. It is the ambulance drivers he is looking to.

Sinn Féin's Minister in Northern Ireland recommended the closure of three emergency departments in favour of a nurse-led service. In Roscommon, there is a doctor-led service, including a GP-led out-of-hours service.

The HIQA report stated there are risks associated with a number of hospitals and that these must be addressed. If the Deputy follows his own logic, he will note that even if one deployed in Roscommon hospital tomorrow all the medical personnel who have not been there for quite some time, the throughput in the accident and emergency unit would be such that those specialists would become de-skilled in a very short period. That would not be acceptable in any circumstances.

I have outlined that change will occur in Roscommon and that it will be effected with the consequent introduction of other services in the hospital over a certain period. This will be dealt with by the Minister for Health in due course. I agree with the Deputy that it is necessary to have absolute clarity in terms of the effecting of the strategy for change. People are entitled to know what happens. There should not be any confusion over these matters. One of the issues that arises in respect of the HSE is that it is often difficult to obtain the required clarity. The Minister for Health will now see to it that the strategy applies in all cases so people will be informed irrespective of how difficult the change might be.

Does the Taoiseach realise what a contemptible figure he cuts today coming into the Dáil and using the most pathetic excuses to cover up what is a cynical betrayal of the people of Roscommon, in whose hospital he pledged to protect the emergency services? How pathetic is it to use HIQA as an alibi? It makes the young fellow who offers the excuse of the dog having chewed his homework positively credible by contrast.

Using Fine Gael policy, as it was before the election——

Should HIQA be ignored?

No, but Deputy Shatter should be.

(Interruptions).

Fine Gael policy is one's new flexible friend to fit all occasions. It is the new Fine Gael brand of pantyhose to cover every possible emergency of every size and form. This is absolutely pathetic stuff considering that the Taoiseach should come into the House to give a simple apology.

The Deputy should audition for a pantomime next Christmas.

The Taoiseach and his Deputy Prime Minister and Minister for Health, who are beside him, solemnly pledged to secure the accident and emergency services for the people of Roscommon and the greater district. It is a sorry set of circumstances in which three of the most senior members of the Government are shamelessly prepared to resign from their solemn pledge and pretend it is excusable to do so. They should be referred to as the "Roscommon Three" from now on, or perhaps "the troika".

Could the Deputy ask his question?

The first demand made of the Roscommon Three should be that they honour the pledge they gave to the people of Roscommon. The second demand, which would be of the third member of the troika, the Minister for Health, would be for him to apologise for and withdraw the absolute falsehood he propagated in the Dáil, namely, that the mortality rate in Roscommon was 21% by contrast with 5% in other hospitals. That is a palpable falsehood. It has been demonstrated as such and it is another alibi to cover up the betrayal——

The Deputy fails to listen when it suits him. Rhetoric will only carry him so far.

——of the people of Roscommon.

(Interruptions).

The Deputy has exceeded his time.

I invite the Taoiseach to reclaim some modicum of dignity by admitting how he gave false promises and that he is now prepared to make good.

I do not know what the question is but the Taoiseach will try to answer it.

I have never heard such a political rant from the leader of the Socialist Party before——

The Taoiseach is good at ranting when it comes to it.

——Dingle 2 or whatever he wants to talk about. My first duty is to the people and the country, not to any individual location in the country. I made it perfectly clear that the evidence and advice from the independent health regulator, with whose findings the Deputy seems to want to interfere in respect of its findings, demonstrate beyond "yea" or "nay" that the situation in Roscommon is unsafe. I cannot accept that we should continue with such a situation. At a meeting between HIQA, the HSE, the Minister for Health and local representatives, this matter was discussed quite clearly. The decision to effect change and to reconfigure and redesign the services for the people of Roscommon was entered into.

It will be a Band-Aid station. That is all.

The restructuring and redesign are now being given effect. What I outlined to Deputies Martin and Adams now applies. We now want to demonstrate that these changes work in the interest of all the people of Roscommon and anybody passing through that county who happens to require medical treatment or a health service.

What the people of Roscommon want is to maintain the accident and emergency department which has served them well for decades and which they feel safe having there and quite correctly so. What the people in the other nine threatened hospitals want is similar, including in Loughlinstown which the Tánaiste promised he would protect. Is this another promise that will be broken?

The evidence is that the mortality rate was grievously misrepresented by the Minister, Deputy Reilly.

A consultant who was 30 years in the hospital did a painstaking study which found it was approximately the same as other hospitals. Senator John Crown, also a hospital consultant, has confirmed this and stated it brings into question the research on which Dr. Reilly is basing the entire hospital reconfiguration programme. At worst, Roscommon had the same coronary death rate as Galway hospital. This is the reality of the situation.

A supplementary question please.

The Taoiseach should call on the Minister to come in and correct this.

It is correct.

Your time is up, Joe.

In a more general way, is not all this another poisonous outcome of the treacherous policy the Taoiseach has continued of——

Poisonous hyperbole I would say.

A question please.

——sacrificing the health care of our people to the vampires and financial institutions in Europe which are getting the resources——

The Deputy is over time.

——that should be going into our hospitals?

I could not catch the final comment because of the confusion on the far side of the House.

Confusion is the new byword.

It was the noise level of the Taoiseach's colleagues.

The situation about the mortality rate is as follows. With regard to mortality rates, Ireland performs well compared to other countries with an in-hospital mortality rate within 30 days of 7.2 per 100 admissions. What the Deputy neglected to say is that the analysis finds the in-hospital mortality rate from heart attack in Roscommon County Hospital is 21.3 per 100 admissions compared to a national average of 7.2 per 100 admissions.

It is the same as Galway.

No, it is 5.8.

You forget that bit, Joe.

The point made by the Minister, Deputy Reilly, is that survival rate from heart attack is much higher with transfer to a higher volume hospital.

The Minister would want to check his research.

Does the CMO stand over those figures?

So Fine Gael had no research done on the development of its policy prior to the election.

It is the same rate as Galway.

Fine Gael made up its policy on the fly. It is not based on any research.

These statistics are very clear. Deputy Higgins spoke about mortality rates in general. With regard to his comment that what people want is to keep everything open, that may well be so——

It is what you promised.

And you fed them that diet.

——but the requirement here is to have patient safety as the first priority——

Health and safety is the oldest excuse in the book.

You have not put in the resources.

——and that cannot apply in a case like Roscommon. As I stated to Deputy Adams, if one put every facility into that accident and emergency department——

That is what you promised.

——the throughput is so low that deskilling would occur in those specialist areas very quickly and we would be faced with the same problem.

It is amazing what the Minister, Deputy Reilly, has learned in the past two months. He has been a GP for the past 25 years.

When you made your commitment.

The situation now is that, following the independent regulator's health advice on the basis of this being unsafe, the decision made between HIQA, the HSE and the Minister, together with the local residents being informed, is for change and that change is keeping patient safety central to the focus of what we have to do. I have never made any suggestion other than that there are deep and difficult decisions and reforms to be made and we will face them in as fair and balanced fashion as we can.

Deputies

Hear, hear.

If you have a pain in your chest do not go to Roscommon.

On a point of order, the Taoiseach has treated the House with contempt today.

What you did for 14 years.

Sorry Deputy——

The record was misled——

Look up at the press gallery.

Will you please resume your seat? It is not a point of order.

(Interruptions).

We are dealing with questions. Will Members please stop shouting?

Will the Ceann Comhairle advise the House on how to get the record corrected? It is very important to the House. The House is in disrepute.

Look up again at the press gallery.

Resume your seat.