James Reilly (Dublin North, Fine Gael)

I accept the Chair's correction and will rephrase by saying they have been exposed as misleading statements.

The Minister for Health and Children has refused to accept that patient services will be affected by the cutbacks but who can believe her, particularly when one of her own Ministers of State expresses concern? It is glaringly obvious that patients will be affected by the loss of 30 nurses and four consultants from Sligo General Hospital; the cancellation of dental services for children in Dublin; the dismantling of accident and emergency services in Ennis; the immediate closure of breast cancer services at 13 hospitals nationally without alternative services being available; the closure of a 24 bed unit for the rehabilitation of elderly patients at Merlin Park Hospital, Galway; the disuse of a 17 bed surgical ward in Limerick; the cancellation of essential suicide prevention training courses, known as applied suicide intervention skills training, ASIST; the closing of the rehabilitation ward in St. Luke's, Kilkenny; and the deferral of 184 posts in the western HSE, 169 of which are medical, mainly nurses.

In setting up the HSE the Minister promised it would deliver efficiencies and value for taxpayers' money but instead she has allowed bureaucracy to spiral out of control. The Minister's reaction has been to introduce cutbacks and to stop the recruitment of essential health specialists instead of targeting the expensive administrative and bureaucratic overload. The Minister's spending cuts cannot be described as a drive to efficiency, as stated by the CEO of the HSE, because they are more likely to drive services into the ground.

This is more than apparent in Sligo General Hospital where, in recent weeks, drastic cost-cutting measures have been introduced. Despite Government promises immediately before the general election that there would be no cutbacks at Sligo, management at the hospital has been directed by the HSE to cut upwards of 30 nurses and four consultant posts. The four consultants to lose their jobs are an orthopaedic surgeon, an obstetrician gynaecologist, a general surgeon with special interest in breast surgery and an ear, nose and throat surgeon.

It is inexplicable how the Minister and Professor Drumm believe that patient care will not be affected by these drastic cutbacks, which will see a 25% reduction in overall services and a 50% cut in breast surgery. It is likely that household staff will also be affected. Where does this leave women of the north west in need of breast surgery or the 365 adults and 27 children who have been waiting for surgery in Sligo for more than 12 months? These cutbacks are inexplicable and will undoubtedly affect patient care. Under the Minister for Health and Children patients are punished for health service over-spending.

At the same time, down the road at the Radisson Hotel in Sligo, the HSE conducted interviews for up to 200 middle management posts when these cuts were being announced. The HSE spent €3.5 million on hotel hire for meeting rooms which, added to the €4.5 million unauthorised overspend on information technology, totals €8 million, a damning indictment of the attitude of management in the HSE. Information technology and interviews are more important than patient care.

Not only are acute services being affected, so are community services. Schoolchildren in Inchicore and Bluebell were notified that their dentist appointments had been cancelled when a dentist who had just left the Inchicore dental service could not be replaced as a result of the HSE employment freeze. The Inchicore dental team was given no notice of the ban on employment and as a result cannot recruit a replacement dentist. If it had been given notice, it could have brought forward the start date of the new dentist so patient care would not have suffered. Again, balancing the HSE books has been allowed to take priority over patient care, leaving adults and children without essential services and treatment.

People are so angered at the recent cutbacks that they have taken to the streets in protest. On Saturday, Deputies Pat Breen and Joe Carey, together with 5,000 people, took to the streets of Ennis, County Clare in protest at the Minister's cutbacks in Ennis General Hospital. True to form, the Minister for Health and Children waited until after the general election before rubbishing the promises of local Fianna Fáil TDs. Now, Ennis General Hospital will not only see the closure of its 24 hour accident and emergency service but the mammography unit, shut down in July, will not be reinstated. I saw it last week, an empty room full of pristine equipment waiting to be used.

This is a dark hour for the health service in Clare and these measures will undoubtedly lead to unnecessary deaths as nearly half of the 100,000 people living in the county live more than an hour away from vital accident and emergency services at the Mid-western Regional Hospital in Limerick. While the Minister might argue that this move is part of a plan to improve the excellence of services I do not believe her. Regionalisation and concentration of services may be desirable in some specialties but, as the Minister well knows in the case of maternity and, particularly, accident and emergency services, proximity to emergency care can be critical not just to patient welfare but to actual survival. What about the golden hour? People in west of Clare, in places such as Carrickagholt, Kilmihil, Kilkee and Kilrush, are well over an hour from Mid-western Regional Hospital and will not get attention within the golden hour that so influences outcomes for those who are seriously ill. This emphasises the geographical location of Ennis.

In recent months a series of cancer misdiagnoses and unreliable treatment practices have exposed the frightening reality of our cancer services. Inquiries into practices at Barrington's Hospital in Limerick, along with the review of thousands of mammograms and breast ultrasounds at the Midlands Regional Hospital, Port Laoise, have led to a crisis of confidence in our cancer services. This crisis of confidence is compounded by the fact that the Department of Health and Children was aware of seven separate issues concerning the quality of breast cancer services at Barrington's Hospital 19 months ago but did nothing about it and allowed these questionable practices to continue until August of this year.

People feel isolated by the public health service and, if they can afford it at all, they are turning to private health care in the hope of a better service. If we have a free hospital service, why do more than 50% of citizens opt to pay for health insurance at considerable cost to themselves? As we now know, private patients will not always be guaranteed a better or more reliable service.

Last week the HSE displayed how little has been achieved in the delivery of cancer services by announcing the supposed details of its national cancer control programme. This implementation programme contains gaping holes and does not explain how or when the cancer centres will be operational or how much the plan will cost. In addition, 13 hospitals have been ordered to stop providing care to breast cancer patients immediately at Naas, Tullamore, Mallow, Cavan, Ennis, Nenagh, Loughlinstown, Dundalk, Navan, Roscommon, Portiuncula, Mercy Hospital in Cork and St. Michael's Hospital in Dún Laoghaire. We know some of these centres ceased service some time ago but when asked at last week's conference which ones, the HSE spokesperson did not know. Such is the HSE's grasp of the health service.

While we all want excellence in the delivery of cancer treatment, how can we seriously believe this is the motivation for those cuts when a letter from the board of Galway University Hospital outlines what the deferral of 184 posts in the region will mean? It will result in fewer beds being available and therefore more people on trolleys in accident and emergency units, and this will be the position with the winter approaching. Here is the really damning part: the letter states that deferrals will also result in the need to reduce breast cancer services in Galway from five to three days a week. This was to be the centre of excellence in the cancer strategy for HSE west. It is just one week old and already in tatters.

The hospital's second CT scanner will now lie idle most of the time because there are insufficient staff to operate it. Coming into the winter there will be no serology testing for atypical pneumonia, which affects many old people and is much more prevalent in winter time. It beggars belief that if these cuts go ahead, Galway will not have the facilities to test for atypical pneumonia.

Critically ill patients should not be left in a position where treatment services are withdrawn without adequate replacement services being put in place first. Under the Government's policy it is the patient who is punished and who suffers as a result.

Drastic cutbacks are affecting not only cancer patients but stroke patients also. A 24-bed unit for elderly patients is to close at Merlin Park Regional Hospital in Galway as part of the HSE's ongoing drive to cut costs.

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