Barry Andrews (Dún Laoghaire, Fianna Fail)

I welcome the opportunity to speak on this important matter, which is one of the issues to arise in the context of the challenges posed by the national restructuring of the HSE. Many Deputies have highlighted the danger of politicising certain issues, such as health and crime. It is a common theme. I am a great defender of politics as a profession. The influence of politics in the health system is a positive one. However, there comes a time when we have to acknowledge that the overwhelming weight of clinical evidence and opinion is pointing us in a certain direction. We should be honest enough to accept that our narrow self-interest needs to be put to one side in favour of a greater interest. In this case, a greater interest has been identified by clinical leaders in this area. A similar approach should be taken in other areas of public policy if a clear and strong professional opinion is pointing in a specific direction. It may not suit our personal interests, but greater interests have to be borne in mind. Acknowledging the obligation to show moral leadership on certain issues is at the core of politics.

All of us have been affected in one way or another by this issue. In recent years, we have all seen reconfigurations of hospital services in our local areas It is painful, difficult and hard to put self-interest to one side, but it is necessitated by the greater interests I have mentioned. Reference has been made to the overwhelming professional opinion in this area. I would like to refer specifically to the comments made by a consultant surgeon in Limerick, Dr. Burke, on "Prime Time" last Thursday night. He agreed with the other 12 surgeons in the area that all acute and emergency surgery should be centralised because that would lead to the provision of a safer and better service. It is clear that Dr. Burke's comments, along with all the other evidence that has been furnished over recent weeks, point us in one direction only — the configuration of services in this area, as suggested by the HSE. We all have a duty to convince our natural constituencies to follow us on that road.

The Minister, Deputy Harney, reminded the House last night that these proposals were first ventilated almost 40 years ago. The difference now is that we have a Minister who is prepared to tackle the vested interests and face down the narrow self-interest that has unfortunately dogged this country's health policy for too long. Professor Tom Keane has demonstrated the benefits of centralisation and specialisation. Anybody who has had to avail of this country's paediatric services will agree that there is no debate in this respect when it comes to paediatric oncology, for example. We all agree that the centralisation of paediatric services is working. People do not mind having to travel to Dublin because they know that one of the best paediatric services in Europe is available at a single location there. That argument has been proven for some time. We now have the political will to match the strong professional opinion that has prevailed for many years.

The Teamwork-Horwath report states that "the core specialties of general medicine, general surgery, A&E and critical care are too fragmented, carry increased risks for patients and staff, and are not sustainable in their present form". Dr. O'Donnell has said that the extra time taken to get to a specialist service improves survival rates by 25%. As the Minister of State, Deputy Moloney, pointed out, the president of the Royal College of Surgeons in Ireland has added his weight to the argument that substantial reform has to be continued in this area. It has been suggested that the accident and emergency department in Limerick will be unable to cope with the additional demand on it. Statistics show that, in January 2009, the number of people who had to wait for long periods of time in the unit was quite small. They indicate that the department has the capacity to absorb any extra demand that may result from the changes that are being proposed.

In regard to the mid-west, an examination of the number of cases presenting in general reveals that in a six-month period Ennis General Hospital had 28 surgical cases and St. John's Hospital had only 21. Of the 105 emergency cases requiring treatment in one month in Nenagh, only 12 involved a general anaesthetic. It is clear there is a need for us to change the way we think about these issues. This debate presents an opportunity for a bipartisan approach to these issues to ensure we have better patient safety and better outcomes for patients.

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