Paudge Connolly (Cavan-Monaghan, Independent)

I wish to share my time with Deputies Gormley and Ó Caoláin.

I welcome the opportunity to speak on this Bill. It signals the biggest shake up in the health services in 43 years. The establishment of the Health Service Executive will transform the administrative function of the health boards with the effect of centralising services. Effectively, we will move from 11 health boards to four nationally. Health board members, the democratic voice of the people, were the people's watchdog in regard to services at local level. There was a myth that health board members cost the health boards a fortune. If one looks at what they cost, it was in the region of .003% of the total budget. Before it reached health boards, 97% of health board funding was predetermined so the influence health board members had was negligible. The benefit was that the people felt they had a voice. There was also the voice of the professionals representing professions in the health services.

As Deputy McManus said, rather than abolishing health boards, we should have looked at ways of tweaking the system and of re-examining what we had. I have no doubt it needed to be changed and that there was a need for accountability in the way services were delivered. However, I am not particularly happy with the way we are moving in terms of ministerial nominees and so on. These people do not have to go back to the electorate. Effectively, there will be a bunch of head nodders on this board and there will be a lack of accessibility for the press and so on. It is an issue of major concern.

The abolition of these health boards and the establishment of the HSE is clearing the way for implementation of the recommendations in the Hanly report. There will be no democratic objections and no voice for the people. Given the changes to the health services which were signalled, health board members were a thorn in the side of the Department, the Executive and the professional bodies. The easy option was to get rid of health boards so there would be no objectors.

There has been a number of reports on the health services recently. I believe the cost of those reports totals approximately €40 million. I wish to refer to the health strategy and the Hanly report. The health strategy refers to services being accessible to all. Under the Hanly report, I do not see how that can happen because the Hanly report, irrespective of what people say, is about removing services from the smaller hospitals. There will be a withdrawal of services from hospitals such as Monaghan General Hospital and Ennis, Nenagh and Loughlinstown hospitals. In particular, services are being withdrawn from accident and emergency units. That is the big threat hanging over each of these hospitals. Looking at the situation in Monaghan General Hospital, lives have been lost. The North Eastern Health Board is a prototype of what the Hanly report is about. If one reads that report and supplants the North Eastern Health Board, that is what it is and what it has given us. The mid-west region has been described as the pilot project but we are a step ahead of it. The north east is never out of the news and always for the wrong reasons. Much of this is accounted for by the fact that the region has the most underfunded health board in the country.

The rush to implement the Hanly report relates to the requirement to satisfy the EU working time directive which was to be implemented on 1 July this year. The report considered many options but only certain of those options are being taken. These are the cheap options. Smaller hospitals have been robbed of their staff to accommodate a reduction in staff hours in the larger hospitals in line with the EU directive. The Hanly report also referred to the need for beds. More than 2,000 beds are required in the system. The report also referred to regional centres of excellence. I would be very happy to be shown these centres.

The changes are more hospital-focused than patient-focused. We are familiar with environmental impact studies. A patient-impact study of the changes proposed in the Hanly report should have been undertaken. The major question is how to marry the requirements in terms of local services with the changes proposed with regard to the establishment of regional centres of excellence. This will be the acid test. There is a perception that my Independent colleagues and I are opposed to such regional centres. This is grossly unfair. We are pro-people, pro-services and pro-local hospitals.

However, I do not know how these centres will cope with the additional volume of patients that will be transferred from smaller hospitals. If regional centres of excellence include such facilities as Beaumont and Tallaght Hospitals, the reality is that they cannot cope with the current volume of patients. Cavan General Hospital cannot cope with the overflow of patients from Monaghan General Hospital. This problem will be magnified in larger hospitals. The notion of regional centres of excellence with spare capacity is an excellent prospect. However, where are we to accommodates patients? They are being put on trolleys in corridors and in dental rooms. There was a case last year where patients were put in a hospital carpark.

Are the regional centres going to adopt a system similar to that initiated by Holles Street Hospital whereby notice will be given that only a certain number of patients will be treated at a particular time? The precedent has been set in this regard. The situation will arise whereby we simply cannot handle the volume of patients presenting for treatment. Hospitals may effectively put themselves off call in such cases.

My colleagues and I have been accused of wanting all-singing, all-dancing hospitals at every crossroads or in every county. We know this will not happen. We do not expect that heart or brain surgery, renal operations and orthopaedic units can be provided in small hospitals. That is not what people want. The key issue is the provision of well functioning accident and emergency units at all these small hospitals. Other services must be provided also if the accident and emergency services are to be sustainable, to have the volume and mix of staff necessary in smaller hospitals. This issue must be considered. There is no point in people being told at Monaghan General Hospital, for instance, that they should hold on for another hour and they will brought to a regional centre of excellence. People have died on the way to other hospitals and this will continue to happen.

The priority must be to save lives. People's concerns regarding their local hospitals is to have faith that their lives will be saved rather than endangered. They are willing to undertake journeys for elective treatment. Patients have travelled to Cork, Waterford, England and elsewhere to receive elective treatment under the national treatment purchase fund. There is no objection to such travel because it is not a matter of emergency and their lives are not under threat at that time.

A significant issue is consultant numbers and I wish to offer some comparative figures in this regard. The average EU figure is 139 surgeons per 100,000 population while the corresponding figure here is 31. The EU average for gynaecologists and obstetricians is 131 as compared to Ireland's figure of 23. The EU figure for paediatricians is 146 while in Ireland it is 22. There are on average 98 radiotherapists per 100,000 population in the EU but only 39 in this country. We must begin to employ more consultants, professionals and hands-on people in the service.

Last week, the Tánaiste and Minister for Health and Children sent her adviser to the Cavan-Monaghan area. When she receives the report of this visit, I hope she will listen to the concerns expressed by the Monaghan Hospital alliance, the Monaghan Hospital development group and the staff in both hospitals in the area. This will allow the Tánaiste to gain a better enlightenment as to the services required.

There has been talk of providing clinical nurse practitioners in hospital units. This sounds like a good idea. However, the training period for clinical nurse practitioners is some seven years and there are five such qualified people currently employed in the health service. Moreover, clinical nurse practitioners must have a consultant in the room with them. Allocating such a practitioner to a hospital, therefore, necessitates the co-operation of a consultant surgeon. They are not stand-alone staff and the Tánaiste should take this into consideration.

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