Michael Lowry (Tipperary North, Independent)

During my political career I always have been committed to addressing the many and varied problems at Nenagh General Hospital. With others, I have battled long and hard to preserve and protect it over the years. My only motivation and objective was to ensure the provision of the best possible health service for the people of north Tipperary. Health care must be outside politics. It should not be used solely to win votes and enhance reputations. For as long as I can remember, Nenagh General Hospital has struggled to survive.

Health care is an emotive issue and affects people in a deeply personal way. Personal health and well-being is the key priority. What we need is a quality of care that is community focused, addresses the needs of everyone equally and locates the most intensive services in locations where they will be most valuable and widely available.

We have confronted many challenges facing Nenagh General Hospital over the years arising from policy decisions initiated by different Governments under former Ministers for Health such as Barry Desmond, Deputy Hanlon and Deputy Noonan. Nenagh General Hospital has again reached a critical juncture. The decisions we take now will determine whether it has a future.

As a politician, I feel obliged to listen and take notice of the professional medical advice on the structures and procedures that are considered to give the best possible patient care. I have consulted widely with all the important stakeholders. I believe that consultation with senior and experienced medical professionals is the correct way to make informed judgments. The surgeons in the front line, including the head of the Royal College of Surgeons in Ireland, Professor Frank Keane, support the reform of surgical facilities in the mid-west. Senior accident and emergency consultants, such as Cathal O'Donnell and Paul Burke currently working at the coalface in the mid-west, say that the current system operating in small hospitals is costing lives. How can any politician ignore those statements?

Listening to the one-sided debate about Nenagh General Hospital, it would be easy to get the impression that everything is perfect at present. Let me put on record that Nenagh General Hospital in its current configuration has significant problems. Its surgical unit is inadequate for major elective surgery, as it does not have the adequate recovery rooms, intensive care unit and anaesthetic systems required by modern-day medical practice.

The Health Information Quality Authority was established in response to malpractice and systems failure in other hospitals that had disastrous consequences for unsuspecting patients. This same quality authority conducted a hospital-wide audit of Nenagh General Hospital in 2007. The quality authority put Nenagh's management on notice that patient safety and infection prevention standards were not up to an acceptable level within the sterile services structure of the hospital. The sterile services are located within the operating theatre. These operating theatres are in place since 1954. They are outdated as well as structurally and clinically redundant. If they are not demolished and replaced, we will face an order for closure of the current surgical theatres.

Also in 2007, it was recognised at clinical level that Nenagh General Hospital did not have the range or diversity of clinical skills to cope effectively with or manage major trauma. In reaction to this reality a trauma bypass protocol was put in place at the beginning of 2008. Nenagh General Hospital is now bypassed in the case of events such as major car crashes because it is deemed the existing surgical and back-up facilities cannot cope. Under this protocol the paramedics at the scene of an accident or emergency situation were given the discretion to determine the extent of injuries or condition of the patient and make an instant decision as to which hospital would best meet the medical requirements of that patient.

We hear much talk about the golden hour concept and in that context it also should be realised that under the present system between the hours of 5 p.m. and 8 a.m. radiographers and laboratory technicians are not in the hospital and are only on call. This means there is an inevitable delay of up to one hour when a critically ill patient arrives at the hospital. At present one has to wait for the radiographer or the laboratory technician to be called and arrive at the hospital before an X-ray can be completed or a blood analysis conducted.

In short, I am saying those leading the agitation for the existing system to be retained at Nenagh are misinformed, misguided and putting patient care in jeopardy and the future of the hospital at risk. Retaining the status quo at Nenagh without capital investment will lead to stagnation, unsafe standards and ultimate closure.

Nenagh General Hospital needs investment to survive. Without a multimillion euro upgrade of outdated facilities, the hospital has no future in any capacity. If we do not have capital investment, it will close. As a way forward Nenagh hospital needs to assert itself to the extent of its ability as a centre of excellence in its own right. To this end, it needs a cash injection of millions. When I committed to the support of this Government, I placed priority on the provision of funds for capital projects at Nenagh General Hospital. I sought and received verbal and written commitments from then Taoiseach, Deputy Ahern, later endorsed by the current Taoiseach, Deputy Cowen. These included the provision of two new surgical theatres, a new endoscopy unit and diagnostic centre, together with ancillary facilities and accommodation.

Since the publication of the Teamwork report I have had extensive discussions with the Minister, Deputy Harney. I advised her that the reform suggested to improve the delivery of health services to the people of north Tipperary must be predicated on fully operational and functioning alternative structures being in place. It became apparent during those discussions that there was in existence three separate development plans for Limerick, Ennis and Nenagh. I was understandably concerned that Limerick Regional Hospital's proposed development would be funded, progressed and completed. We could then have a nightmare scenario for north Tipperary whereby the HSE might say that Limerick had the capacity to meet all needs, Nenagh was surplus to requirements and a doomsday decision would be made not to proceed with investment in Nenagh.

To avoid that possibility I secured from the Minister a commitment to commission one overall integrated plan for the mid-west. The Minister gave me a further guarantee that the development of Limerick and Nenagh would take place in conjunction with each other. She also gave a commitment that the capital projects for Nenagh, included in my agreement with the Taoiseach, would be delivered. These multimillion projects such as the new surgical theatres, the endoscopy and diagnostic units will be included for funding under the multiannual capital programme of the Department of Health and Children to be announced in the coming weeks.

The Minister has undertaken to ensure the existing CAT scanner at Nenagh General Hospital will be fully commissioned and staffed. She has committed to a significant enhancement of the ambulance service in the mid-west through an increased out-of-hours ambulance cover. She fully appreciates the crucial role of advanced paramedics in the new structures and has committed to the provision of an adequate number to cover north Tipperary. Day surgery and diagnostic facilities are to be extensively developed and easily accessible.

The Minister has also committed to appoint eight additional hospital consultants to enable the delivery of these new services and specialties in Nenagh and Ennis hospitals. She has made a commitment to me that primary care teams will also play a major part in the proposed reform of health services in north Tipperary. Currently, two teams are successfully up and running in Roscrea, Borrisokane and Cloughjordan. In Thurles, the development of two primary care teams is well under way. The process will be expedited to provide care teams in Templemore, Nenagh, Ballina and Newport. These are critical to ensure the success of any local health reform and will ensure the people of north Tipperary are treated effectively in their own localities.

A new medical assessment unit will be provided at Nenagh General Hospital. This will be accessible by a GP referral system. What this means in effect is that most of the patients currently treated at Nenagh will continue to be treated there. There will be no reduction in the services provided to the public of north Tipperary requiring medical care. The staff at Nenagh General Hospital are professional, dedicated, caring and committed. I have been assured that under the new proposed reconfiguration all permanent nursing, attendant, porter, cleaning, catering and clerical officer staff will retain their jobs.

The Teamwork report set out to put in place upgraded services to improve patient care and to treat the patient in the most appropriate setting based on the recommendations of medical staff, that is, doctors, nurses, consultants and general practitioners. I am of the firm belief that if the components of this report are not implemented in their totality, there is no future for Nenagh General Hospital and it will be allowed to whittle away and die. The people of north Tipperary know the extent of my commitment to them and to what is in their best interests. In that respect, this is the correct decision to best serve the interests of the people of my community.

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