Timmy Dooley (Clare, Fianna Fail)

I welcome the opportunity to contribute to the debate. We have had an opportunity to discuss the issue on a number of occasions recently and it is always important that we continue to discuss the various changes that are taking place. Health is an extremely emotive issue. As a result, the notion of change within the system as it is delivered generates a considerable amount of fear. Some of that fear is clearly well founded but more of it is unnecessary. The difficulty is who decides what is well founded and what is not. Therefore, it is important that people set out their views and proposals clearly on the delivery of health services.

I am reminded of an issue that developed in the area with which I am most familiar, namely, the mid-west, and the changes that were brought about to Shannondoc some time ago, which allowed GPs to facilitate their normal existence by putting in place a centralised out-of-hours service. At that time people in rural and isolated areas had real concerns and fears that a doctor would no longer be available on-call. Their fears were proven to be largely unfounded when the centralised service took up office and the necessary facilities were put in place. The GP who is on-call is provided with a base, a driver and nursing backup. That assisted to a considerable degree in allaying people's concerns out of hours.

I am somewhat concerned that, in their desire to have that service rolled out, GPs are now seeking to involve themselves in a debate that is largely to do with hospital consultants. That is not to take from the work GPs will have to do to provide an ongoing out-of-hours service that will be affected by the reconfiguration proposals. However, I appeal to GPs, the HSE and hospital consultants to come together to begin a dialogue for the sake of patients and the people who are perhaps unnecessarily concerned. Given that there is a level of discord among all those involved, it is not clear to patients that there has been joined-up thinking. I would welcome those three parties coming together to put in place the necessary solution to the problem. There are always solutions to the kinds of problems that arise. I hope the Minister might be able to facilitate that. Clearly, there are industrial relations issues and financial implications for any agreement that might be reached. However, I believe a resolution can be found. Some GPs to whom I have spoken believe a solution exists to the concerns that have been expressed.

Particular concern has been expressed about accident and emergency services in Ennis General Hospital. Much of it is unfair and unnecessary as a result of a number of cases that were highlighted. Those cases have occurred in all smaller hospitals and it is unfair that the focus has been unnecessarily visited upon Ennis hospital. We have to move beyond that because there is a fantastic team of very well qualified people there who have worked very hard in difficult circumstances to deliver a very good level of patient care over the years. I hope that can continue.

Notwithstanding that, we must be open to change. The system has let down many people. I do not refer to the mid-west. People have been let down from a patient safety point of view and from the perspective of outcomes throughout the country. It is incumbent on all of us to listen to the advice of senior clinicians who have put forward a different model and methodology to deliver a service that will save lives. It is easy to get tied up to some extent in the political debate and point scoring and to rely on what I believe is an outdated principle, the notion of the "golden hour", because the advent of advanced paramedics has enabled that to be overcome in terms of stabilisation on the roadside or other site. For that reason we must listen to the people who are putting forward a better level of service.

I appeal to the Minister to continue with the transformation she has started and to back it up, as she has indicated she will, with a level of investment. Regarding the reconfiguration of the mid-west, there is a requirement for a considerable amount of funding to upgrade the ambulance service and the facilities at Ennis General Hospital. Based on the various discussions I have had with the Minister, I know she is committed to that.

This is a political Chamber and we have political debate in it. People on the other side have put forward various different points of view. They have asked pertinent questions. I wish to pose some questions to the other side through the Acting Chairman, Deputy Kathleen Lynch.

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