Willie Penrose (Longford-Westmeath, Labour)

I am pleased to have an opportunity to contribute to the debate which allows for discussion of subjects beyond the scope of the Bill which provides for the dissolution of St. Luke's Hospital and other significant amendments to various Acts within the health area.

Professor Keane has done extremely good work in this area. We should accept that the identification of the eight centres of excellence predated his arrival. If one is seriously ill, one wishes to get the best treatment. Centres of excellence allow for a significant throughput of people, the upgrading of skills on a regular basis and the availability of multidisciplinary teams to ensure that patients get the most appropriate and best treatment. One only gets one opportunity to address a health issue and it is important that one is treated in the quickest, most efficient and effective way by those who have the required professional skills and equipment available.

County Westmeath is above the Dublin to Galway axis but we have a good road infrastructure to bring patients to Dublin and Tullamore. In the same way as the Minister of State, Deputy Moloney, I have no qualms about travelling to Tullamore if that is designated as the centre of excellence for the people of Westmeath. What is important is to get the best and most effective services for patients in the area. However, an issue arises in the north west and it would be churlish not to admit it. The road infrastructure and transport networks are not up to standard. Centres of excellence are a great idea if the infrastructure is in place but it is not feasible for people from the north west to travel to Galway and other places that are already under significant pressure in terms of admissions. Infrastructure must be put in place in order for the proposals to work and if that is not done then difficulties will arise for patients in Donegal and Sligo in particular.

One could ask why this country has been loath to take up services available elsewhere such as air ambulances to ensure that patients are transported quickly and get the appropriate treatment as soon as possible. Surely it is not beyond the bounds of possibility to have such services based around the country. They are important in the context of ensuring people suffering from neurological complaints or difficulties get to Beaumont Hospital where the top neurosurgeons are available to look after them as soon as possible or to facilitate the transfer of cancer patients for treatment. We must try to broaden our horizons in this regard in that we must ensure people are not isolated from centres of excellence. This area should have been examined far more assiduously to ensure the needs of people in the north west would be catered for much more comprehensively than they have been.

It will be no surprise to the Minister of State, Deputy Moloney, to know I will refer to the debacle on the Midlands Regional Hospital, Mullingar, an extremely important hospital in terms of the treatment of a significant population, amounting to 120,000. It serves the expanding population in Longford and Westmeath. A commitment was made in the mid-1980s that when Longford hospital closed, the one in Mullingar would become the focal point for this very significant geographical area. It has grown.

In 1993, the then Minister for Health, Deputy Howlin, commenced phase 2A, and Deputy Noonan was Minister for Health and Children when it was completed in May 1997. Something happened thereafter that has never been explained and it has caused great concern and wonderment among the populations of Longford and Westmeath. They wonder why the phase 2B process, which had already been costed and taken on board in terms of value for money, which issue has been addressed in various reports issued today, was not completed and why the four-storey building built under phase 2A was left unused and covered in the droppings of crows and blackbirds for many years. It had almost become defaced. People were wondering for many years why it was built and left there, particularly because significant public moneys were invested therein. The people's expectations were legitimate in all respects due to the fact that they are entitled to the best facilities available. The people of Longford and Westmeath also pay their taxes and were entitled to the best facilities. The project was left on the back burner and subject to snail's-pace development. There was a degree of tardiness.

There was always suspicion over why the project was slowed down. People asked whether there was a political spoke put in the wheel that slowed it down. It did not progress with the rapidity it warranted, particularly because a significant element of the building had already been put in place. From a value-for-money perspective, it should have proceeded apace and should not have been sidelined. There should not have been obfuscation or delaying.

I have no qualms about other hospitals receiving their fair share. Like the Minister of State, Deputy Moloney, we are very proud to see the orthopaedic and ear, nose and throat facilities in Tullamore hospital. There are excellent consultants, nurses and other staff in that hospital doing excellent work. The hospital covers the Minister of State's area. He is probably a bit closer to it than I am. It is excellent and we accept and applaud it. The hospital needed modernisation also and it is not begrudged that. The politics of begrudgery does not come into play and has no place in respect of health; however, the politics of ensuring we get our fair share comes into play. I was sent here to articulate that view on behalf of the people of the Longford-Westmeath and make no apology for doing so. This is the people's forum in which I can make their case.

The snail became slower in respect of phase 2B. The phase was divided into stages, with phase one involving a rescheduling that was to be completed in 2008, having commenced in October 2006. The completion was to result in an increase in the bed complement from 215 to 244 beds. I acknowledge that there were additional moneys for the refurbishment of the existing wards, the medical surgical ward at level 0 and a delivery-gynaecology ward at level 2. Wards were to be fitted out, including a new paediatric ward on level 0, a new day surgery-gynaecology ward on level 1, a new obstetric ward on level 2 and a new medical ward, incorporating an acute stroke unit, on level 3. Stage one was to see "the existing paediatric and obstetric wards in line with SARI guidelines to provide a surgical ward on level 1 and a medical ward and palliative care unit on level 3". That was excellent.

Work was proceeding very well and phase 2B2 was brought into play. Then the whole project became subject to independent cost-benefit analyses. We all knew the analyses should recommend that the work proceed. The project, which was the most over-analysed, over-evaluated and over-scrutinised project ever to take place in Ireland, was then referred to the hospital capital steering committee, and formal confirmation was awaited from the committee concerning the status of this development. How many times did a project that had been in the pipeline for 12 or 13 years have to be subject to analysis and evaluation? Does the HSE keep evaluating in the hope it will produce a negative analysis? That is what always made me very suspicious about the HSE. I knew it could never get a negative analysis in regard to the hospital because the project was vital to the people of Longford-Westmeath.

In the past five years, Mullingar hospital has become one of the top three in the country for efficiency and effectiveness. Last week it was second. What is the hosptial to do to secure its future and ensure it is in a position to provide vital services and utilities for the people of Longford and Westmeath?

We are unsure of the current position. The surgical service is only to deal with emergencies for the next two months. The surgical facilities are very fine and the consultants are excellent. The nurses and ambulance and paramedical services are wonderful. One could not have better staff. They work way beyond the call of duty and at 125% efficiency. The people of the region wonder why what I describe is happening. Why does the Minister have to try to save money? One only gets one run at health. It is the one area in which money must be spent.

People ask why the surgical service is being abandoned for two and a half months. Is it feared that it may be shifted altogether, despite the efficiency and effectiveness highlighted in all the various reports? The people will be asking this in their thousands next Saturday on the streets of Mullingar as part of a march commencing at 2 p.m. at the hospital. This will send a clear message to the HSE, the Government and anybody else in the corridors of power that we expect that all our facilities will be maintained and enhanced, and that additional facilities will be put in place.

I do not want to bore the House with figures as this is not the appropriate forum; suffice it to say that Mullingar hospital has 185 acute beds, despite being promised up to 300. It got €64 million or €65 million last year and €59 million this year. There are 14 day beds. The average length of stay in the hospital is three days, the best in the country. The number of inpatient discharges in 2009 was 18,866, the day cases outturn was 7,235, and the number of attendances at the accident and emergency unit, which is one of the best, was 32,841. The number in Tullamore was 5,000 fewer, at 28,241, yet there are fewer staff and beds at Mullingar hospital.

The staff in the Mullingar accident and emergency unit, where I attended as a patient, are doing great work. The nurses react to emergencies and work extremely hard to put people into beds, only to find the beds are non-existent, thus requiring them to put patients on trolleys. The nursing staff do not want to be doing this; they want some of the 41 acute beds that were closed last November reopened.

While the Minister must come into the House and give me the HSE answer, I believe what Deputy Rabbitte said some days ago, namely, that it is about time those who make the decisions should be answerable. The buck should not always stop with the Minister, I do not subscribe to that. Ministers come in here for me to rant at them, and I do not like doing that. The people who make the decisions are the people who should answer.

I do not believe a single word that comes from the HSE. If it wrote to me today, I would throw the letter in the fire because I have no faith in it. If it fools me once, I am the fool; if it tries to fool me twice I am not going to buy it. The HSE tells me it can get 14 day beds in Mullingar but 41 acute beds are closed. The 14 day beds are for people who need a minor surgical procedure. Mullingar is most efficient at turning people out so the 41 beds are vital. The nurses in accident and emergency, who are working competently and professionally as a unit, would love to see some of those beds opened. They want additional staff. Why should they, in spite of their efficiency, have fewer staff than comparable hospitals that do not handle as many patients? There were 33,000 admissions to the accident and emergency department and they all received the best care and attention from expert staff. We are concerned about these developments and we are sending a signal that we will not accept any attempt to downgrade the Midland Regional Hospital in Mullingar.

There is talk of reconfiguration and reviews. Do they want to waste more money reconfiguring? We have spent millions of euro on a hospital and all we need is to put the additional staff in place and open the beds. People do not want to go hospital, they have to go there. That is why those facilities are important to the area. The road structure in Mullingar is reasonable but those from north County Longford, where the road infrastructure is not as good and there is no public transport, would have to travel to Tullamore, an additional 39 kilometres. We will not accept that when there is already an effective, efficient unit in Mullingar. Time is of the essence when someone needs urgent treatment. There is no reason why anyone would ever contemplate interfering with any of the hospital's facilities.

Almost 3,000 children were born in the maternity unit in the hospital in 2009, with less than 23% of those by Caesarian section, one of the top results in the country. There are excellent maternity, obstetric and paediatric facilities in the hospital, with wonderful consultants, doctors, nurses and attendants. People work as a team providing a great service, making sure patients get the best treatment.

The Midland Regional Hospital in Mullingar is the only major hospital between Dublin and Sligo. It is an important facility and it is ready to be a centre of excellence in maternity care. There is no better place. It could accommodate up to 5,000 children being born. If we are going to talk about centres of excellence, Mullingar should be in the vanguard. We should enhance the facilities there and I appeal to the Minister of State, who is doing his best in his portfolio and who is fighting his corner, to remember that the Midland Regional Hospital is one of the most effective and efficient hospitals in the country. Services must be retained there and we are ready for enhanced additional facilities.

See this speech in context