Michael Noonan (Limerick East, Fine Gael)

I support the motion and I wish to be associated with the arguments put forward by Deputy Reilly. The people of the mid-west are very fortunate to have such excellent medical practitioners, including consultants, doctors, nurses and paramedical staff. The service they provide is tremendous. I visited Limerick Regional Hospital this morning at 8.30 a.m. Everyone there went about their business, happily working and setting about the tasks of the day. They were able to separate their personal traumas, pension levies and family concerns from their day's work. They were up at work early in the morning and quite cheerful about it. I held a brief conversation with a consultant. He remarked on the uncertainty of the times and that the only remaining certainties concerning this Government were death and taxes, which is as good an epithet as one is likely to hear. I compliment the staff who provide a great service in the hospital in Limerick. Even if they are reconfigured, they will continue to do so.

It is very easy to agree with the objectives of this report. Who would disagree with a report which is supposed to deliver on improved patient safety? Who would disagree with maximising clinical outputs, a programme to deliver better value for money, or an objective which purports to provide a high-quality service close to all patients' homes? It is not the objectives of this report with which one would disagree but its implementation, measured against the past experience of the Minister and the Department of Health and Children.

The modus operandi does not meet the needs of the region. It is planned to centralise emergency services at the Mid-Western Regional Hospital in Limerick and to transfer to there all trauma cases from Ennis General Hospital, Nenagh General Hospital and St. John's Hospital. It is planned to turn these hospitals into minor ailment facilities operating from 8 a.m. to 8 p.m. The theory and practice very quickly go their separate ways. They do so because the facilities are not in place in Limerick regional hospital to take the existing workload and certainly the facilities are not in place to take the workload which would arise from the transfer of cases from Ennis, Nenagh and St. John's hospitals.

The Minister promised that the necessary facilities would be put in place. However, nobody believes the Minister and with good reason. The Minister has previously made promises on innumerable occasions concerning different aspects of the health service and its delivery throughout the country. However, the promises have not been fulfilled. Deputy Seymour Crawford will again illustrate the difficulties in the north east and Cavan-Monaghan. We will hear of the litany of pathetic cases, whereby some people we obliged to drive past Monaghan General Hospital to access the services required, but did not arrive on time. That is the experience of people in the regions when it comes to the integration of services. It is not a very attractive blueprint for the people of the mid-west who can see what occurred in the north east.

In these times of devastating cutbacks, when the pay and conditions of people in the public service are being trashed and when the fiscal situation continues to deteriorate, does anyone believe the Minister will produce €300 million to put the necessary programme in place to facilitate the new workload at Limerick regional hospital? It is not long ago since, for the sake €8 million, that the Minister reneged on a promise to vaccinate 12 year old girls, so that their lives would be saved at the age of 75 to 80. The Minister could not deliver on a promise of €8 million. Does anyone believe it is credible that she will now deliver on a promise to the people of the mid-west, to the people of Ennis and Nenagh, and to the many people in downtown Limerick who use the facilities at St. John's? Does anyone believe the Minister will deliver?

The only relevant figure in the Estimates for 2009 for this programme is a figure of approximately €6 million, but €300 million is required. I do not understand how this is supposed to add up, which is the problem we face. The report lists the necessary services, including an emergency operating theatre in Dooradoyle, of which there is no sign, the extension of the ambulance service and the deployment of advanced paramedics in the region. According to the report this service is under way. If the ambulances have been ordered, they certainly have not yet been delivered. The human resources situation involving ambulance drivers is not yet resolved. They have not even applied for planning permission for a new critical care block in Dooradoyle with ICU, HTU and CCU, although this is an essential component of the reconfiguration. New facilities in Ennis and Nenagh, a new theatre block in Nenagh, expansion of radiology services in Ennis, Nenagh and St. John's, upgrade facilities in Nenagh — these are dreams over the silvermines. This is not reality. Nobody believes the Minister will deliver them. That is the problem she faces with this programme.

In debating this issue over the past few weeks, Deputy Reilly has put forward a simple but profound proposition, that the Minister put the new facilities in place before closing the old ones. If she does that, people will vote with their feet and buy into them straightaway because the facilities outlined here would enhance patient safety and give better clinical outputs.

Various case assessments have been made, and an assessment of outputs of patients who went through accident and emergency services in Nenagh and Ennis. In some cases the outcomes could have been better but there is no guarantee that the outcomes will improve by taking the patients into Limerick in an ambulance, to lie in the accident and emergency unit for five or six hours before receiving attention.

There is a sting in the tail of this report because we have highlighted accident and emergency services but, on the first page of the statement I received, the HSE states accident and emergency surgery and critical care services need to be reconfigured as soon as possible, followed by medicine in the longer term. If one has the patience to read to the end of the report, one can see many plans for the reconfiguration of medical facilities which turn Ennis and Nenagh into medical outposts.

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