Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

The Kildare Nationalist, reporting on the Minister's visit to Naas, mentioned that she spoke of the importance of investment in health care. It went on to state: "However, she was not able to comment on the current beds crisis at Naas General Hospital." I bet she was not.

Hand in hand with privatisation goes the disastrous centralisation of our public hospitals. Monaghan has been the blueprint for the centralisation of hospital services in this State. We now face the threat of the axing in 2009 of all inpatient acute care in Monaghan General Hospital. Monaghan's average of 3,000 acute medical admissions per year will have to be catered for predominantly by Cavan General Hospital, which is already severely overstretched. The outlook for Ennis, Nenagh and other smaller hospitals is similar if the plans of the Government and the HSE go ahead. It will mean loss of services, long distances to travel for patients and further pressure on other hospitals without the provision of additional beds and staff to meet the need.

Nenagh hospital has set a high standard of service for smaller hospitals, and its close relationship with local GPs in terms of access and admission is an example that should be followed. A report on Nenagh hospital in 2006 found that 97% of cases sent to the hospital were safely treated and only 3% required transfer to Limerick. GPs in Clare, north Tipperary, Cavan and Monaghan have all come out strongly against the HSE plans in recent weeks. However, the Government and the HSE, as I had occasion to hear clearly only last Thursday when I met the Minister and Professor Drumm, in pursuing their centralisation and privatisation agenda, are working against the interests of patients and against the advice of front line health care providers.

The HSE report on accident and emergency services in the mid-west was jointly authored by Teamwork, the British-based management consultants whose recommendations form the basis for the current policy of slashing services at local hospitals and over-centralising services in already overstretched regional hospitals. The report on the mid-west is no different and would see accident and emergency services taken from Ennis and Nenagh, leading to the downgrading of those hospitals and their eventual conversion to glorified day care centres. Make no mistake about it, that is exactly what will happen. We are almost at that stage at Monaghan General Hospital, as the Minister knows too well, where the HSE and Government propose to end all acute inpatient services in the early part of this year.

In speaking on this motion and against the Government amendment I wish to make it very clear that I am opposed to the plans arising from the Teamwork-Howarth report, Review of Acute Hospital Services in HSE Mid-west, which provide for centralisation in Limerick. Lest there be any misunderstanding, Sinn Féin does not support a position which says that if all these contingencies are put in place then centralisation will be acceptable. It will not be acceptable, full stop and end of story. Among the recommendations of the Teamwork-Howarth report are, lest we forget, no provision of critical care at the local centre; the removal of acute services in small and medium-sized hospitals; all inpatient beds in Ennis, Nenagh, St. John's, St. Munchin's and St. Nessan's hospitals to close; and asset-stripping, namely the potential sell-off of St. Munchin's maternity hospital and St. Nessan's orthopaedic hospital, Croom. These plans are not acceptable. They are clearly running in parallel with similar plans in my own region and are equally against the interests of patients and of our public health service in general.

The Ennis General Hospital Development Committee has stated that the removal of acute surgical facilities from Ennis, as opposed to the proper resourcing of the casualty unit and associated services, will increase the risk to lives in Clare. They point out that the danger is further heightened for the 44,000 people who will have to undertake a journey to Limerick of between one hour and one hour 45 minutes from the scene of an accident, after a possible 45 minute ambulance response time. The Clare Champion reported on 6 February that it had obtained a HSE document showing there are an average of 50 medical patients occupying surgical beds in Limerick Regional Hospital every day, resulting in cancellations of planned surgery, overcrowding in the accident and emergency unit and longer hospital stays for certain patients. This is the hospital into which the Government and the HSE wish to centralise all emergency patients from Clare and north Tipperary. It just will not fit, exactly as the situation in Monaghan and Cavan will not fit. No matter how often we try to impress that on the Minister, she remains dogged in her determination to move ahead with her foolhardy plans.

It is grimly appropriate, while we make mention of foolhardiness, that April fools' day is the target date for the closure of the accident and emergency units in Ennis and Nenagh. Surgery is to follow some three months later. GPs in both Clare and north Tipperary are opposing plans for them to provide out-of-hours casualty services in both hospitals. Consultant geriatrician Dr. Christine O'Malley has expressed her serious concern about the prospect of losing the services of general surgeons from Nenagh. She said:

I have never worked without having surgeons on stand-by in the hospital. I am concerned that GPs are being asked to work above their level of competence. Every health professional has to be confident they are working within their level of competence when it comes to the treatment of patients.

Limerick Regional Hospital can't meet its own requirements at the moment. The HSE is devising a plan without looking at the situation on the ground. Consultants refer patients who need a bed in Limerick on a daily basis and are regularly told there is no bed for them due to overcrowding and the fact that there can be up to 30 people on trolleys.

We are determined in Monaghan, and, I hope, in Cavan, to resist the plan to effectively close Monaghan General Hospital — certainly to remove acute medical services from that hospital to Cavan — over the next number of weeks. I commend the people of Clare and north Tipperary on their support for their local hospitals and their determination to sustain the vital services they provide. That, at the end of the day, is the most important element in terms of health care provision and the provision of acute hospital services, not only when we need it but — make no mistake about it — even when we do not, for the peace of mind, assurance and confidence to face what each day brings.

See this speech in context