James Reilly (Dublin North, Fine Gael)

This motion is self-explanatory and much of the rationale behind it is laid out clearly. While all that remains for me to do is to expand on the motion, I will first address the Government rebuttal, which "welcomes the conviction of the Royal College of Surgeons in Ireland that the reforms should continue in the Mid-West and elsewhere". This reference is very selective, however. In reply, the RCSI president stated, "While supporting this programme, this college remains extremely concerned about the provision of services in the major hospitals where accident and emergency departments continue to be overwhelmed on an ongoing basis and where patients who require elective surgical operations cannot be adequately managed within the health service in a timely and predictable manner". Clearly, the accident and emergency unit in Limerick falls into this category.

Furthermore, the Government rebuttal refers to CT scanners which have been present but not operational in Ennis and Nenagh hospitals for well over a year. The rest of the rebuttal welcomes and supports various intentions but does not provide timelines, which is at the core of our problem.

Yet again, the HSE and the Minister for Health and Children, backed up by a Fianna Fáil and Green Party Government, are ignoring their own report, the Howarth-Teamwork report, Review of Acute Hospital Services in HSE Mid-West. The report identified a number of issues that had to be addressed in order to achieve their end goal, which is the reconfiguration of the hospitals, with the centralisation of surgery and acute medical services in Limerick Regional Hospital.

The first area they examined was the accident and emergency department of Limerick Regional Hospital. A number of issues arose out of this. First, they acknowledged the unit needs serious upgrading as it is regularly overcrowded, with as many as 15 to 30 people lying on trolleys for longer than 24 hours and a mean waiting time of somewhere between seven and eight hours for all patients. Into this cocktail, the Minister will add the patients of north Tipperary and Clare, which will result in further chaos and reduction of services, and is grossly unfair on the people of Clare, north Tipperary and Limerick.

Another facet of the accident and emergency unit is the staffing levels, particularly in regard to consultants. Currently, there are three very hard-working consultants in the accident and emergency department but this number does not allow for a consultant-delivered service so it remains a consultant-led service. To achieve the former and to achieve best practice, the report recommends that eight consultants in total be employed in accident and emergency.

Not one of these additional five consultants has been appointed. In fact, only two of the five posts have been approved. Although none of the jobs has been advertised, the word "approved" gives the impression that the posts will be filled imminently but this could not be further from being the case. There first must be approval of a post, then advertisement, the drawing up a panel, the interviewing of applicants and then, ultimately, the making of an appointment. It is then necessary to wait for the successful applicant to become available. The process can take anything up to 18 months.

One of the main reasons for the congestion in accident and emergency in Limerick is lack of capacity within the regional hospital. The Teamwork report recognises this and recommends 135 additional beds prior to the reconfiguration of the service. Not one of these beds is in place. Instead, we are given a sop, with talk of reducing the average bed stay from 6.5 to 3.5 days, which will result in additional capacity. Yet, where is the evidence to support the suggestion this can happen? In order for this to be achieved, practices have to change within the hospital and the community, and there needs to be much greater support for the patient in the community. None of this has happened. I emphasise that none of the recommended 135 beds is in place.

Another area of concern in the Teamwork report is the necessity for further ambulances to service north Tipperary and the Clare region, including Ennis. None of these ambulances is in place. Furthermore, these ambulances are to be supplemented by emergency medical technicians or paramedics who will be able to give certain drugs at the roadside but will not be able to administer life-saving blood transfusions. The paramedic will travel in the ambulance with the patient if there is a serious life-threatening condition but with the current proposed spread of paramedics, there would not be somebody to take up the slack or to drive the paramedic's car from the scene of the accident.

The bottom line for patients in areas like Carrigaholt and Lorrha in Clare and north Tipperary is that they will be well outside the "golden hour" in terms of accessing the necessary life-saving treatment which has been proven in the past to have a major influence on outcome. There is a real need to supplement this until the road system is properly finished. The report referred to a helicopter but I have not heard mention of it since.

Another integral part of this plan is for a high-dependency unit of 40 beds to be built at Limerick Regional Hospital. Again, there is no sign of this. Planning permission has not even been applied for and from talking to the hospital doctors at Limerick Regional Hospital and St. John's, they feel there is a need for at least another 40 beds to which to transfer those patients.

Another area of deep concern relates to the local general practitioners, who were unanimously opposed to this move at a major meeting with the HSE. Not one GP out of 81 at that meeting was prepared to vote in favour of this plan as currently implemented. These are the doctors on the ground, in the community, who know the people and the real, practical difficulties they suffer. They are at one with their community in opposing this, not least because they have been in touch with their colleagues in the north east — in counties Monaghan, Cavan and Louth — where reconfiguration also took place and where a fiasco resulted. I am told this situation resulted in 17 people passing by Monaghan Hospital in an ambulance only to arrive too late at Cavan. To quote one of the participants in the recent "Prime Time" programme, a Clare man, "There is no point in having utopia if it is a corpse that arrives".

We have been accused of scaremongering but the facts are the facts. We have seen the extraordinary situation of Drogheda hospital having to close for seven hours because it just could not cope. We have seen the additional load on accident and emergency units in the region, including Beaumont Hospital, which had up to 50 people on trolleys a few weeks ago. We have heard one of the accident and emergency consultants talk of a 25% improvement when a patient is brought to a centre of excellence for multiple trauma. However, these studies relate in the main to helicopter medevac on the roadside to bring the patient to the centre. First, we do not have the helicopter and, second, will we seriously describe an overcrowded accident and emergency unit at Limerick Regional Hospital as a centre of excellence when it will have to deal with 54,000 more patients per year arriving from Nenagh, Ennis and St. John's hospitals?

This is just another instance of putting the cart before the horse. What really upsets people is that, underlying this, they see a trend — anything that will save money is implemented post haste but anything that will save lives or cost money will be put on the long finger into the distant future. That has been the history of this Government and this Minister.

In the original draft of this report, the cost of implementation was put at €380 million yet we are told there is only approximately €6 million to make it happen. Further, we have been advised by the Minister that the doctors in the hospital have been all bought into this and are enthusiastically supporting it. I have met all of those doctors. The two lead surgeons believe they will get the funding and trust the HSE to deliver but I am afraid nobody else does. Many of their colleagues are becoming increasingly concerned. At the outset, they were concerned by the lack of consultation on the Teamwork report but they are becoming more concerned with each passing day given the way it has been implemented and the ongoing lack of consultation.

Having taken all of the above into consideration, this comes down to an issue of trust of the people of Ireland, in particular the people of the mid-west, in our current Minister, the Government and their much-discredited agency, the HSE. We cannot trust a Minister and a Government which told us in January 2007 there would be no cutbacks, when they knew full well there would be. We cannot trust a Government and Minister which told us cutbacks would not hurt patients, when they clearly did. We cannot trust the Minister or the Government who promised the wonder of a vaccine against cancer for our children in August 2008 and which, three months later, turned their backs on those same children.

The Minister for Health and Children has displayed a pattern of behaviour which is very worrying. My words may seem harsh, but what else can one say when the Minister received letters from concerned doctors in Portlaoise dating back to 2002, and which were re-addressed to her in 2005, yet she did not take any appropriate actions. We saw what occurred as a consequence. There were 11 misdiagnoses of breast cancer. The files of 97 women were thrown into the corner of an office until a cohort was reached. That horrible ethos led to the same situation arising in the north east. In September 2007 the HSE knew a problem existed there and yet took no action until May 2008. It knew it was possible there were people walking around with lung tumours growing. In that instance, letters were written to the Minister complaining about the service, the lack of staff and the over-use of locums. However, nothing was done about it.

An article was published in The Sunday Times last weekend by Mr. Paul Gallagher who, through a freedom of information request, discovered that the consultants in Ennis General Hospital also wrote to the Minister highlighting deficiencies in the radiology service and stating it was not safe. Yet again, nothing was done. We are all familiar with the consequences in that case, which is now the subject of a HIQA inquiry following much public outcry, including comments from the family concerned. The Minister eventually agreed to the inquiry. What is emerging is a recurring pattern that borders on criminal negligence. There appears to be a refusal to listen to professionals in the field who have put their concerns in writing, a refusal to act in any appropriate fashion, and a refusal to address these issues.

Here we are again. Another report is before us, the thrust and principle of which have much merit, including the principle of centralising facilitates and trying to get the best for patients. However, the manner in which it is being implemented has no such merit. Everything this report seeks to do, including to improve safety and to reach goals, is being ignored and put on the long finger. This is not the way to proceed. The report does not have the support of the people or the professionals.

I appeal to the Minister, Deputy Harney, her Government colleagues, the Deputies who support her, especially the Ministers of State, Deputies Máire Hoctor and Tony Killeen, and Deputies Timmy Dooley and Michael Lowry to step up to the plate, to protect the people of the mid-west and to insist that the full recommendations of the report are implemented. Only then should the House consider the future of Nenagh General Hospital and Ennis General Hospital. I commend the motion to the House.

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