Kieran O'Donnell (Limerick East, Fine Gael)

I support the motion proposed by our health spokesman, Deputy Reilly. The cart is being put before the horse. The Minister is introducing changes to accident and emergency services on 1 April and to surgical services on 1 July, although the approved services are not available in Limerick Regional Hospital.

St. John's Hospital is in my constituency, in the heart of the city. It is the only accident and emergency service based in the city. Barrington's was the main provider of accident and emergency services in Limerick until a Fianna Fáil Government closed it in 1988. St. John's took on that role and has done a terrific job. The report mentions that the service in St. John's, along with those in Nenagh and Ennis, will be nurse-led. I welcome the commitment by Mr. Paul Burke, who is co-ordinating the reorganisation of the acute service in the mid-west, that it will continue to be doctor-led. That is critical for St. John's. I hope the Minister will give that commitment in writing to Mr. Burke. There are three doctors in the accident and emergency unit in St. John's, four nurses and two administrators. I am worried that if the service is doctor-led, the medical skills will be lacking to assess a patient with an acute difficulty.

The Teamwork-Howarth report mentions increasing the throughput of patients in the accident and emergency unit of St. John's hospital from 19,000 to 30,000 annually. St. John's is open five days a week from 8 a.m. to 8 p.m. Does the Minister propose to make that a seven-day a week service? She proposes sending patients directly to the accident and emergency services in Limerick Regional, where the service is already overstretched. The average waiting time for a patient in the accident and emergency unit in Limerick Regional is seven to eight hours. I cannot understand how bringing in extra patients will improve the quality of care. That is why it is critical that the accident and emergency services are maintained in Ennis, Nenagh and St. John's and that the hospitals are upgraded.

According to the original Teamwork-Howarth report, €47 million would be spent in St. John's. That reference has disappeared from the published version of the report. Will that €47 million investment be honoured? The hospital needs new buildings and upgrading. Will the Minister provide the staffing resources to activate the much-needed CT scanner that has sat idle in the hospital for the past two years? The ground floor of St. John's has been closed for a long time. It was traditionally closed for the summer months for budgetary reasons but it has remained closed for a longer period. Does the Minister propose to provide funding to open it?

There are excellent medical and consultant staff in St. John's and Limerick Regional and in the hospitals in Nenagh and Ennis. St. John's and Limerick Regional interact in respect of consultants and appointments. I would not like to see the elective surgical work that can be carried out in St. John's moved automatically to Limerick Regional. That would worry medical staff and needs to be clarified.

Staff in St. John's say they were not properly consulted in the preparation of the Teamwork-Howarth report. The consultants visited them for a few hours. These people are at the coalface and should have been consulted. Furthermore, they were not consulted before the report was published. We met many of these people during Deputy Reilly's recent visit to St. John's and Limerick Regional. It is critical that the HSE engage in meaningful discussions with the staff and management of St. John's. We want to retain a functioning service and accident and emergency unit.

Will the Minister say whether she will give a commitment in writing to providing a doctor-led accident and emergency service in St. John's? Will she say whether in increasing the throughput of patients from 19,000 to 30,000 patients, the service will increase from five to seven days? Will she say whether she is providing the resources to operate the CT scanner in St. John's? Will she put resources in place to enable the ground floor in St. John's to be opened? Will she put in place the €47 million proposed in the original report for St. John's? Will she set a timescale for the provision of the extra facilities, staff and resources in Limerick Regional, for example, that the number of accident and emergency consultants increase to eight, the addition of 135 new acute beds, the increase in the number of ambulances, the high dependency unit and the upgrade of the accident and emergency unit in Limerick regional? I also call on her to ensure that the accident and emergency departments in St. John's Hospital, Nenagh General Hospital and Ennis General Hospital are left as they are, and that nothing happens until the services in the Mid-Western Regional Hospital in Limerick are upgraded.

See this speech in context