Dáil Éireann díospóireacht -
Tuesday, 21 Oct 2003

Vol. 572 No. 6

Hanly Report.

Mr. P. Breen

I wish to share my time with Deputy James Breen. I thank the Leas-Cheann Comhairle for the opportunity to speak on this important issue and welcome the Minister for Health and Children to the House to listen to my concerns and those of Deputy James Breen.

Over the past 20 years, there has been a huge erosion in funding of health services in County Clare. At Ennis General Hospital, this has resulted in the loss of 30 bed numbers, maternity services, funding for vital equipment in the general hospital, such as cat scanners and ultra sound machines. There have also been cutbacks that have affected ward upgrades, general infrastructure upgrades and, above all else, accident and emergency facilities, where much life-saving work was carried out by a dedicated team of doctors and nurses. Many promises were made by the Government before and after the last general election regarding the provision of €15 million to upgrade these facilities.

Last week, I put down a parliamentary question on the same issue. The reply stated that a briefing document was approved and endorsed by the Mid-Western Health Board and a request for approval to appoint a select and design team was under review by the Department of Health and Children. It also stated that it was expected that the review would be completed shortly. That reply, together with many announcements by local Oireachtas Members to the media, led many to believe that the work was going ahead.

Was the decision on the upgrading put off to await the publication of the Hanly report? Will the Government use the Hanly report as a justification for not proceeding with the above promised improvements to the general hospital?

The Hanly report is a dangerous experiment. The pilot project proposed for the Mid-Western Health Board region will result in the deaths of many Clare people if accident and emergency services are downgraded in Ennis General Hospital. This has been confirmed by an experienced consultant working in the accident and emergency unit. Some 90% of admissions come through this unit with 4,500 admissions each year.

I represent the Kilrush electoral area on Clare County Council. Many of my constituents have to travel to Ennis General Hospital and the journey can take one and a half hours. There are villages like Cross and Kilbaha and towns like Kilkee with a population of up to 25,000 in the summer and Carrigaholt where there was a tragedy last weekend. If the Hanly report was to be implemented, emergency cases would have to pass Ennis General Hospital and make a journey of up to two and a half hours to Limerick Regional Hospital to get accident and emergency assistance.

Since the Hanly report was published, my constituency office has been inundated with callers relating their experience of Ennis General Hospital stating that, were it not for the accident and emergency unit there, they would not be alive today. How many of the consultants who contributed to the report ever stood in Ennis General Hospital? How many have worked in the accident and emergency unit of a rural hospital? The report has been prepared by consultants in an urban centre of excellence environment. It will not work in a county like Clare. I, therefore, ask the Minister to reconsider the proposals. This is the 148th report and its findings cannot be delivered. I suggest the Minister should leave it on the shelf to gather dust like the others before it.

Mr. J. Breen

This afternoon I asked the Tánaiste how she would get rid of the Hanly report – by recycling, incineration or sending it to a landfill site, as that is all it is good for. When I entered Clare County Council 18 years ago, a former Minister for Health from the Labour Party decided that the hospitals at Ennis and Nenagh should close down. There was an outcry from my party at the time, which is still the Minister's party. Then along came a new Minister – the present Ceann Comhairle. A march was due to be held to protest at the downgrading of Ennis General Hospital. We were advised to stay away and everything would subsequently be rosy in the garden for the hospital. There were 120 beds, which were reduced to 80.

The present Minister for Health and Children visited the county three years ago. I visited Ennis General Hospital two days before him and was afraid to stand still for fear of being painted. He announced the provision of £15 million for upgrading the hospital but has reneged on his promise and has no intention of spending this money. He said consultants would be employed but then sat back. Fianna Fáil thought it had three handy seats in Clare and that it could con the people of the county and win them back. However, they gave Fianna Fáil its answer and returned me to watch the Government.

The Minister now has the Hanly report recommending that Ennis General Hospital become a local hospital with the loss of our accident and emergency unit. This will mean Clare people going to Limerick and having to wait five or six hours to be seen in its accident and emergency unit. What about people in places in west Clare like Loop Head, Carrigaholt, Miltown Malbay and Spanish Point who might have heart attacks? Must they choose their time for getting a heart attack? Must we choose the time when chemicals pass through the town of Ennis? The Roche chemical plant is located in Clarecastle and there are others in Shannon. What would happen if there was a major accident in those plants or at the international airport? Where would the casualties be catered for?

The Minister has failed to bring forward a proper package of reform for the health service. He is now hiding behind the Hanly report which should be marked in red and placed in the dustbin where it belongs. I call on the Minister to provide for proper health reform or else I will ask the Taoiseach to have him removed to the backbenches.

Mr. Martin

I welcome the opportunity to respond to the concerns raised by the Deputies. I established the national task force on medical staffing in February 2002. I asked it, among other tasks, to devise an implementation plan for reducing average working hours of junior doctors in line with the European working time directive. At present, most front-line medical care in our hospitals is delivered by junior doctors, most of whom work excessively long hours. The task force set out to answer a key question. How do we safely provide hospital services, 24 hours a day, seven days a week, as the working hours of our junior doctors reduce in line with EU law?

The task force responded by setting out a new way of organising hospital services. Its proposals mean that no hospitals will close. Instead of supposedly "downgrading" hospitals such as Ennis General Hospital, the report proposes to bring services closer to patients while ensuring services are both safe and sustainable. The task force has recommended that a full range of acute hospital services be available in each region, including the mid-west, in order that patients should not have to travel beyond it other than for services best provided at supra-regional or national level. It also recommends investment in local hospitals such as Ennis General Hospital in order to provide more services for patients, including elective medical and surgical procedures, out-patient services, pre and post-natal maternity services and better access to diagnostic facilities.

Contrary to some claims, hospitals such as Ennis General Hospital will not lose their ability to treat all patients presenting with illness or injury. Instead, the task force report recommends that emergency or life-threatening conditions should be treated in multi-specialist hospitals which have all of the staff and expertise required.

Dr. Cowley

They will not get that far; they will be dead before they get there.

Mr. Martin

This policy offers the best outcome for patients. The report recommends that all minor injuries and illnesses which do not require complex or multi-specialist support services should continue to be treated in hospitals such as Ennis General Hospital. This means that local hospitals such as Ennis General Hospital will continue to treat around 70% of all the patients they currently see in accident and emergency departments.

Mr. P. Breen

What happens at night?

Mr. Martin

In the case of emergency, the best way to meet patients' needs quickly is through immediate intervention by trained ambulance personnel at the scene.

Mr. P. Breen

Where is the funding for the ambulance service?

Mr. Martin

The Hanly report stresses the importance of well-trained emergency medical technicians who can provide immediate life-saving treatment. The concern is not over taking the patient to the nearest hospital but over providing on-the-scene treatment speedily and then bringing the patient to the hospital best equipped for his or her condition.

A key step in the forthcoming reform process is capital development of facilities at hospitals such as Ennis General Hospital. A briefing docu ment has been prepared by the project team for the hospital. This followed my announcement some time ago. While it has taken some time, it must be remembered it was a two way process. It sets out the broad scope of proposed future development and will be considered in the preparation of an outline development control plan for the hospital.

The Mid-Western Health Board has endorsed the briefing document and identified a number of elements, including ward upgrade, radiology, out-patients and a general infrastructure upgrade as priority areas for development.

Mr. P. Breen

It also included an accident and emergency upgrade.

Mr. Martin

General infrastructure covers a considerable amount. The project is being considered by my Department in the context of both an ongoing review of capital projects under the national development plan and the health services reform programme, including the Hanly report. The Deputies should watch this space.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Wednesday, 22 October 2003.