Joe Carey (Clare, Fine Gael)

Tonight we are at a crossroads. The signposts are clear. One path leads us to the continuation of 24-hour accident and emergency services at Ennis General Hospital together with the upgrade of that hospital. The other path leads us to the dismantling of County Clare's accident and emergency services and their replacement with an eight-to-eight nurse-led minor injuries clinic, relying on two paramedics in one car to cover the whole of County Clare and protect the 110,000 people who live there.

Last night I listened to the Minister, Deputy Harney, saying this issue should be removed from politics and be above politics. This is a political decision. We are public representatives, elected by the people to articulate their views and represent them to the best of our ability. I make no apology for that. Since the year 2000, successive Ministers for Health and Children have made political commitments to the people of Clare. These political promises have been made by Deputies Martin, Cowen, Bertie Ahern and every Fianna Fáil Deputy in County Clare. Fianna Fáil political figures from the very top gave commitments that 24-hour accident and emergency services would remain at Ennis General Hospital and that the hospital will receive a €39 million upgrade. This is a political decision.

The Teamwork report does not move Loop Head any closer to Limerick Regional Hospital. It is still 74 miles. The Teamwork report ignores the "golden hour" principle. This is the standard international maximum time limit to treat anyone who has suffered a stroke, a heart attack or who has had an accident. Some 44,000 Clare people will be left outside the golden hour cover if the Minister's plans go ahead. There are alternative models of providing accident and emergency care to dispersed populations, such as that delivered in the highlands and islands of Scotland. The British NHS was moving to centralise services in Scotland but their Minister for Health recognised that it would not work because it was not safe or right to ask people to travel extreme distances. That Minister had the courage to ignore and reject a centralisation policy and adopted a more appropriate model. The same model operates in Cornwall on the south-west coast of England and closer to home at Downpatrick Hospital.

The shared factor in each of these examples is that since the year 2003, the NHS has been legally required to consult with patients and the public when any change in health care is proposed. The Minister and the HSE have done their best to conceal the HSE report from the people. GPs in County Clare and Nenagh were not consulted. Nurses were not consulted; nor were the people of County Clare. It is obvious the Minister is determined to provide accident and emergency services on the cheap while dressing them up as a standard of international excellence. This is being done with no consultation and little regard for the people on the ground who so desperately need, want and deserve speedy access to an accident and emergency unit.

Leaving aside the issue of the golden hour, nobody is convinced that any of these improvements can be delivered in Limerick Regional Hospital in such a short space of time. For example, six years ago the Hanly report promised a dramatic improvement in ambulance services, but nothing has happened. In fact, the service has disimproved. We have less capacity now than we did six years ago because an ambulance can carry only one person, and extra ambulances have not been provided. The HSE has failed to address this issue, and it continues to ignore the ambulance crew based in Ennis, who have campaigned for a year to be provided with a simple washing facility. They must clean the ambulances with a bucket and mop, using a tap in the public car park, with people walking in and out through it. The HSE has done nothing about this. How are we expected to believe the Minister will improve ambulance services? The Minister's plans are simply unrealistic. Will the 135 beds promised for Limerick Regional Hospital appear from the sky on 1 April? Will the five additional accident and emergency consultants required wander in off the streets and arrive in a new accident and emergency theatre?

Behind all these reports and planned cuts are real people with real lives and real stories to tell. About a year and a half ago, a good friend of mine — a young man from Ruan — was involved in a farm accident on the outskirts of Ennis, in a place called Larchill. When agitating slurry, he came in contact with the gas and inhaled it. He collapsed, but fortunately there was a man there to raise the alarm. He called the ambulance service and the young man was admitted to Ennis General Hospital. People in the area found out about this accident, concern was expressed, and a mass was held in Ruan. All the people of the area came, and I was there myself. We all prayed for that young fellow. Because of the intervention at Ennis General Hospital, that young man has made a full recovery. He is 100% better. If he had to travel to Limerick by ambulance, that man would be brain-damaged today. That is the real benefit of having an accident and emergency unit in one's locality. It saves lives and improves recovery. With that vital intervention, the young man was saved.

I ask the Minister, Deputy Harney, if she would ask any of her constituents to travel from Dublin to Roscrea for accident and emergency services. That sounds ridiculous, but it is the same distance as that from Loop Head to Limerick Regional Hospital. In recent weeks, sick people have been lying on trolleys for three days in Our Lady of Lourdes Hospital in Drogheda. Surgery has been cancelled as there have been insufficient beds. I ask the Minister not to make the same mistake in the mid-west. I demand the best hospital service for the people of County Clare. That will not be delivered by closing an accident and emergency unit or by transforming Ennis General Hospital into a glorified nursing home. Tonight I appeal to all Members of the House, of every political persuasion, to join in supporting this Fine Gael motion to preserve the vital 24-hour accident and emergency services in Ennis hospital and support its redevelopment.

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