Mary Harney (Dublin Mid West, Progressive Democrats)

In regard to trauma cases, protocols are already in place in Ennis and Nenagh general hospitals to take those patients to Limerick Regional Hospital. That is the current arrangement. Those patients are supposed to be taken to Limerick and are not supposed to be taken to either Nenagh or Ennis.

Hospital services and the re-organisation of them have always been a challenge for us in this country. If we were starting to put in place a hospital infrastructure today, we would never build 35 acute hospitals around the country. We know that trying to get specialists, not only domestically but internationally, is a challenge. Those specialists work in a an extraordinary fragmented fashion. We have 4,800 junior hospital doctors and 2,100 consultants, therefore, we have many doctors working in hospitals. Many of them deal with very low numbers of patients. To allocate more staff to a system that is not properly organised around patient safety in order to deliver good outcomes would not make any sense, no matter who writes the letters.

I met a group of people from Ennis. The HIQA report will be published soon and we will see what it has to say about how we organise services. We live in an environment where we have a new organisation independent of the provider of services, funded by the taxpayer to set and monitor standards and to carry out inquires where it is considered there is a risk to the patient's care or welfare. That is what that organisation has been doing. For the first time in the past few years, we have had inquiries into wrongdoings, which have been very revealing. We can either bury those reports or pretend more of the same will get us over the findings of a report or we can change things. That is what we are seeking to do.

The president of the Royal College of Surgeons in Ireland was clear when he said we want critically ill surgical patients to be brought to centres that are appropriately equipped and staffed where there is a sufficient volume of this kind of activity to sustain the necessary levels of skills. He went on to say, it is precisely at these times that changes can be made with sensible costings rather than the over-exuberant plans and unrealistic budgeting that is sometimes mentioned. He clearly indicated, contrary to Deputy Reilly's speech, that, as president of the Royal College of Surgeons in Ireland, the training body for surgeons in Ireland, the reforms in the mid-west are appropriate as far as he is concerned.

Patient safety is not only about organising services differently in our hospitals, it also involves how we regulate professions working in the health care area. We recently modernised how we regulate medical practitioners. We have a lay majority in that respect. We have a different procedure as far as fitness to practice is concerned where hearings can be held in public other than on an exceptional basis, where doctors are mandated by law to maintain their competence. Many of those provisions, particularly the lay majority one, was opposed by the Opposition.

The same position applies to the Pharmaceutical Society of Ireland where there is also a lay majority. For the first time in more than 100 years we have an appropriate regime in regard to the regulation of the pharmacy profession. Shortly we will have a new nurses Bill, subsequently a dentists Bill and so on.

Patient safety is about the organisation of services, but it also about the regulation of the professions. In particular, it is about ensuring that those who work in medicine maintain their skill base. We know in our heart — Deputy Reilly, as a doctor, in particular, knows this — that one cannot maintain one's skill in an accident and emergency department, particularly if one is not a consultant with specialty training, and certainly if one is only dealing with six, eight or nine patients a night. Nobody can maintain or even acquire a skill in that kind of environment. We must learn from the evidence and be courageous enough to act on it. The Government knows this and that is why it is so enthusiastic for the reform. It also knows reform will be difficult and many people will be worried. The reason they will be worried is that politicians are telling them that they are going to die.

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