James Reilly (Dublin North, Fine Gael)

I thank all my colleagues who have taken part in this debate from all sides of the House.

The motion is clear in its intent. It does not seek to block progress. It seeks to ensure that all necessary arrangements are put in place, as recommended by the HSE's own Teamwork Management Services report, before any decision is made on the downgrading of the accident and emergency departments at hospitals at Nenagh or Ennis. It further calls for the immediate provision upgrades at both hospitals. The report specifically refers to 135 additional new acute inpatient beds, but the Minister last night told us because we are not moving services from Macroom or the services from the maternity hospitals that this will not be necessary.

This is the Minister being selective in her use of quotations. I first refer to the selective quote she takes from the Royal College of Surgeons, whose president favours this plan but who states clearly that it will be dangerous if they are put into overloaded accident and emergency departments. In other words, they do not want it implemented piecemeal fashion, and that is what is happening here.

I have a copy of the Teamwork Management Services report before me and I will quote from selected sections. It states:

However, consideration must be given to the economies of scale in developing the existing site to provide a modern, 'fit for purpose' facility, or whether a new purpose-built regional 'centre of excellence' should be developed. The list of reconfiguration/refurbishment . . . is substantial and includes:

New obstetrics, midwifery and neonatal unit;

New elective orthopaedics unit;

New or refurbished A&E;

New or refurbished critical care unit [the high dependency unit];

Complete ward refurbishment to infection control standards; and [not instead of]

New additional in-patient beds, totalling 135.

It will be seen from this that the 135 beds are in addition to obstetrics and orthopaedics, therefore, the Minister is disingenuous in what she stated last night.

While on the subject of maternity and this report, I refer to page 22 of the report where it states:

However, there are well recognised residual risks to mothers as the hospital [St. Munchin's] is not co-located with adult critical care support services. Furthermore, there is no on-site paediatric cover for babies which poses further risks. Plans are now agreed for a final move of the service to the Regional Hospital Dooradoyle.

However, the Minister told us last night that those plans will not be implemented.

Moving to page 36 of the report, the last paragraph states:

In the meantime [this is critical] until implementation of the new service configuration is completed, put in place transitional support arrangements, in the form of additional temporary medical staffing for Ennis and Nenagh in particular to improve the quality of current services.

Finally, lest there be any doubt about what this report contains, in heightened blue it states:

The over-riding principle is that no acute services will be withdrawn from the current general hospitals until the regional 'centre of excellence' is resourced and ready to deliver that service with reference to international quality standards.

I am afraid the Minister, yet again, — as is her wont so often to selectively quote from various documents, reframe the truth and present it as something entirely different — has failed. These are additional beds and they need to be put in place.

The report further recommends an increase in the number of ambulances, which the Minister has not been able to guarantee. In fact, on "Prime Time" last week, the cock crowed three times and still she could not give an undertaking that these ambulances would be in place, because there were industrial relations and human resources issues. That is not good enough for the people of north Tipperary, I say to the Minister of State, Deputy Hoctor, and not good enough for the people of Clare, I say to the Minister of State, Deputy Killeen.

The report demands that a high dependency unit, consisting of 40 beds, be built at Limerick Regional Hospital. Planning permission is not even sought. It calls for an upgrade of the accident and emergency unit at Limerick Regional Hospital, and that has not taken place. It calls for additional accident and emergency consultant staff, to bring the number up from three to eight, yet not a single job has been advertised. It will take from 12 to 18 months to fill those posts. The general practitioners of the region are against it. Each one of them met with Mr. Burke, and not one voted for it. All voted against it because they had no confidence in it, as it is currently being implemented.

The consultants, as referred to last night by the Minister, are becoming increasingly alarmed, particularly at the manner in which this is being implemented. The core of the matter is that the Minister is putting the cart before the horse yet again. The Government wants the people of north Tipperary and Ennis to forego their current service because it believes it is not safe, in favour of a nirvana which has not been put in place. Time and again the Minister has people giving up their current service for a promise of something wonderful to come, and in the gap that ensues people die.

The bottom line here is trust. I said this before and I shall say it again. The people do not trust this Minister, Fianna Fáil, the Government or the HSE to deliver the promises they make. They said there would not be cutbacks and there were. They said they would not hurt patients and they did. This Government promised it would vaccinate our children against cancer, and three months later turned its back on this. In finishing, I ask the Minister to do the right thing.

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