Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

I move:

That Dáil Éireann calls on the Government to stand by its commitments and ensure:

— the continuation of all existing accident and emergency services at hospitals across the State as promised by candidates of the Fine Gael and Labour parties in advance of the general election, including Roscommon, Navan, Letterkenny, Portlaoise, St. Columcille's (Loughlinstown), Portiuncula (Ballinasloe), the Mid-Western (Limerick), Clonmel, Mallow and Bantry;

— the retention of key services such as orthopaedic services at St. Mary's Hospital, Cork and the return of comprehensive breast cancer services to Sligo, also as committed by candidates of the parties now in government; and

— equal access to safe and efficient hospital services for all, without discrimination based on income or geographic location.

I think the Leas-Cheann Comhairle has the list of those with whom I am sharing time. I move the motion on behalf of Sinn Féin Teachtaí Dála and urge all Deputies to support it.

There is grave concern and growing anger among communities across the State at the prospect of the closure of accident and emergency departments in a range of hospitals. The level of that concern and anger has been increased because of the total lack of clarity on the part of the Minister for Health, Deputy Reilly, the Government and the HSE on exactly what is planned for these hospitals. This is in the context of the shortage of junior doctors and the imminent turnaround date of 11 July and, importantly, what is to happen in the medium to long term.

What we know for definite because the Minister and the Taoiseach have told us is that the 24-hour accident and emergency service at Roscommon County Hospital is to be axed. This has been confirmed this evening by the Health Service Executive. The accident and emergency service at Roscommon County Hospital is to be no more and replaced with a medical assessment unit-urgent care centre. This is an absolutely disgraceful decision. This action is in flagrant violation of the clear and unambiguous commitments given by Fine Gael Deputies in advance of the general election. Deputy Naughten, now chairperson of the Joint Committee on Health and Children, stated:

... a clear commitment on the hospital's future has been provided by Fine Gael's Health Spokesperson, Dr. James Reilly. Not only will Fine Gael retain all existing services at the hospital but we will also enhance and develop services ... Under our proposals the future of services at Roscommon Hospital will be determined locally. We want to have a local board appointed by staff, patients and the community to run the hospital in conjunction with local management and not have it run by faceless bureaucrats within the HSE ... The reality is that Fine Gael is the only party which has delivered a written commitment on the future of Roscommon Hospital and is the only party with a plan to reform the health service as a whole.

These commitments can still be read today on his website. Interviewed for the Roscommon People newspaper he stated, "I made it clear that if, down the road, those commitments were not delivered upon, then yes, I would be prepared to resign the party whip."

Deputy Feighan stated, "... Fine Gael is determined that its plan to retain and enhance services at hospitals like Roscommon will finally put a halt to this much-touted reconfiguration plan of hospitals in the west which essentially amounts to downgrading by stealth." Labour Party candidate Senator Kelly stated, "The future of the hospital is very safe in Labour hands."

Even more significant than these clear commitments was the commitment made by the then Fine Gael spokesperson on health, Deputy Reilly, now Minister for Health, who, in an open letter to the people of Roscommon published in the local press prior to the general election, wrote:

I would like to confirm that Fine Gael undertakes, in accordance with the Fine Gael Policy on Local Hospitals, to retain the Emergency, Surgical, Medical and other health services at Roscommon Hospital which are present on the formation of the 31st Dáil ... Furthermore, in the event of the A&E being downgraded, we are committed to reinstating a 24/7 service, where feasible.

When replying to health questions last week in the Dáil the Minister tried to sow confusion about this letter. The only meaning - make no mistake about this - that can be taken from it is that, in the event of accident and emergency services at Roscommon County Hospital being downgraded prior to Fine Gael entering government, it would reinstate a 24/7 service, where feasible. That is what the Minister intended; that is what he meant and any twisting of words will not alter this one iota. The accident and emergency service in Roscommon County Hospital was not downgraded prior to the general election but is to be under a Fine Gael-Labour Party Government. Without question, the Minister, his party and coalition partners collectively are breaking their commitment to retain at the hospital the services which were present on the formation of the 31st Dáil.

The Minister claims the accident and emergency service at Roscommon County Hospital is not safe but also claims that he was not aware of this at the time he made his pre-election commitment. However, I put it to him that it was well known all along that the accident and emergency service was under threat in the so-called reconfiguration plans for hospitals so ardently pursued by then Minister for Health and Children, Mary Harney, and the former HSE chief, Professor Brendan Drumm. Otherwise, why would the Minister and his party colleagues have felt it necessary to make these commitments to, in the words of Deputy Feighan, "finally put a halt to this much-touted reconfiguration plan of hospitals in the west which," he correctly indicated, "essentially amounts to downgrading [of services at Roscommon County Hospital] by stealth"? This Sinn Féin motion is not only about Roscommon County Hospital. If the axe falls on its accident and emergency department, as indicated, it will surely fall elsewhere also.

Tá straitéis ann le fada chun seirbhísí in ospidéil timpeall na tíre seo a ghearradh siar. Ní rud nua é seo. Bhí sé mar príomh-aidhm ag iar-Aire Sláinte agus Leanaí Harney, le tacaíocht ó Fhianna Fáil i rialtas ó 1997. As a Deputy representing counties Monaghan and Cavan, I can speak from long and bitter experience. The words we are hearing from the Minister and the HSE were the words used to justify the downgrading of Monaghan General Hospital which was downgraded and dismantled service by service, beginning with maternity services and the removal of the accident and emergency unit. The strategy was to starve the hospital of resources up to the point where it was deemed unsafe.

There is an interesting parallel between the removal of all acute services from Monaghan General Hospital just under two years ago, on 22 July 2009, and what is happening now. Both scenarios involved an election. In July 2009 I was reliably informed from within the HSE that then Taoiseach, Brian Cowen, and the then Minister for Health and Children, Mary Harney, were closely involved in the decision to axe these services. It was signalled by the HSE that the services were to go in November 2008, then at the start of 2009 and then in the early summer. Of course, the local and European elections followed and the axe was hidden until polling day had passed. It was merely being sharpened and two days before the Dáil went into summer recess until September 2009 we had the announcement that the axe would fall on 22 July. It flew in the face of all appeals from front-line healthcare workers, including nurses, general practitioners, consultants and support staff, and the community across all political affiliations, including, strongly, colleagues of the Minister.

As happened in Monaghan, lives will be put at risk day and night if more communities lose vital hospital services, including emergency and inpatient medical care services. Lives were lost when Monaghan General Hospital was off-call for emergencies in the past, as we pointed out in July 2009. As the Minister is aware, there are approximately 1,600 public hospital beds closed due to cutbacks. Today on "Morning Ireland" on RTE the former HSE chief, Professor Brendan Drumm, was still maintaining that we had too many hospital beds, this at a time when accident and emergency units are overflowing and waiting lists for acute hospital beds are growing. When Monaghan General Hospital was downgraded and acute care services ended, not one additional inpatient bed was provided at either Cavan General Hospital or Our Lady of Lourdes Hospital, Drogheda to which patients formerly treated in Monaghan must go. These hospitals continue to be over-stretched and under-resourced. All of the promised support services due to be put in place before the axing of acute care services in Monaghan General Hospital were not put in place. In the HSE's confidential so-called transformation planning document of April 2008 which I revealed at the time rehabilitation, respite and step-down facilities are described as "alternatives to acute inpatient care". The Minister is a general practitioner and knows they are no such thing. They are distinct from acute inpatient care services. Their availability may free up some beds inappropriately occupied, but they are not alternatives to acute inpatient care for those who require it. However, not one additional inpatient bed was provided.

This is the type of scenario other hospitals face if they are given what I can only describe as "the Monaghan treatment". The emergency department at Navan hospital is hanging by a thread. No ambulances are accepted there and those who present are assessed and diverted to Our Lady of Lourdes Hospital, Drogheda. In 2010 Deputy English of Fine Gael stated:

The news that all trauma cases will drive by Our Lady's Hospital Navan is a terrible blow to Meath and all its residents. The HSE has clearly deliberately downgraded Navan Hospital to pave the way for this decision ... The Lourdes Hospital will not be able to cope with the increased numbers coming from Meath, which means lives will be put at risk.

Deputy McEntee of Fine Gael stated:

This moves make no sense at all. Navan is located at the heart of Meath and is easily accessible from all parts of the county, but most of the roads to Drogheda are of a poor standard. The main road to Slane is currently closed and the diversion via back roads is barely suitable for ambulances.

The downgrading of Navan hospital was also criticised by the then Labour Party health spokesperson, Deputy O'Sullivan. There are real and well grounded fears that the Midland Regional Hospital, Portlaoise could share the same fate. It may be that the emergency measures being introduced to address the junior doctors issue will prevent the downgrading of the accident and emergency department at Portlaoise for now, but I urge those campaigning on the issue not to desist. Almost 42,000 people attended the accident and emergency unit there last year and there must be no question of the department being closed or services being reduced there.

In Letterkenny hospital senior clinicians are seriously concerned about what will transpire there from 11 July. Any diminution of accident and emergency services there would be a disaster for the people of the north west. In the case of St.Columcille's Hospital, Loughlinstown, the proposed downgrading of accident and emergency services would deprive the people of County Wicklow of a vital service and place further pressure on St. Vincent's University Hospital, Dublin.

An indicator of the doubts and concerns raised by the junior doctors shortage was the fact that the board of the Mid-Western Regional Hospital in Limerick had indicated that its complement of non-consultant doctors had been halved and that it would be obliged to close the accident and emergency service, the second busiest in the country, for 12 hours duration overnight. HSE West regional director, Mr. John Hennessy, has since stated no decision had been taken to close or curtail the emergency service. I call on the Minister to confirm that this is the case and give a clear commitment that definite action will be taken to ensure nothing of the kind will be allowed to occur and that this will apply to all of the other hospitals mentioned in the motion, as well as the accident and emergency unit at Clonmel.

In the case of the other hospitals referred to in the motion, those in Mallow and Bantry, the downgrading plans are being implemented. If Fine Gael and the Labour Party were sincere in their claimed commitment to these smaller hospitals, they would reverse the cuts. The parties now in government also made commitments to the retention of key services such as orthopaedic services at St. Mary's Orthopaedic Hospital, Cork, as well as to the return of comprehensive breast cancer services to Sligo. Rightly, the people are demanding that these commitments are kept also. We make the same call again on the floor of the House in our motion.

The context for the hospitals crisis is the regime of savage cuts to public health services imposed as a result of the continuation by the Fine Gael and Labour Party Government of the Fianna Fáil and Green Party Government's disastrous economic policies. The Minister and the Taoiseach have stated the over-spend in hospitals this year is €99 million. However, on 29 June the Government paid out €12 million to senior Anglo Irish Bank bondholders with unguaranteed bonds. On 20 June it paid out €20 million. By the end of the year it will have paid €779 million to the same cohort of gamblers. Apparently, seriously ill patients must wait but bondholders cannot.

The latest cuts in my region, the north east, are to services for sick children. In the Louth Meath Hospital Group the HSE has reduced the number of paediatric outpatient department clinics and increased waiting times for routine outpatient department appointments from approximately 16 weeks to 32. Children with cancer previously admitted to Our Lady of Lourdes Hospital, Drogheda will not now be admitted but transferred to Our Lady's Children's Hospital, Crumlin.

The other aspect of the current context is the the non-consultant hospital doctor issue. The Government is undertaking stop-gap measures to meet the shortage of junior doctors from the turnaround date of next Monday, 11 July. These measures, including the Medical Practitioners (Amendment) Bill, are necessary, but we are unclear as to how far they will go. They may avert full or partial closure of accident and emergency services at some hospitals such as at Portlaoise General Hospital. However, what is to happen in the medium to longer term? As I pointed out, there is a long-standing strategy of downgrading hospitals and centralising services in a handful of regional hospitals. The junior doctor issue is being used as a smokescreen to implement the policy of the Minister's predecessor in government, whom he berated here day after day for the same pursuit. The non-consultant hospital doctor issue is not a new problem. It has been known and widely recognised for years that the hospital system is totally over-reliant on junior doctors. Successive Governments have failed to address the issue and now it is looming again, worse than ever. Recruiting sufficient additional junior doctors will be required in the short term, but this is not enough. Nurses should be freed up to fulfil more responsibilities in accident and emergency departments, as they are qualified and willing to this work. Hospital consultants should be required to fulfil their contracts to serve the public hospital system, contracts which continue to be widely breached. More consultants are required in the public hospital system. The current excessive remuneration for consultants must also be reduced to facilitate the employment of more consultants.

I urge all Deputies to support the motion. Let us make no mistake about it: the immediate backdrop to our meeting in the Chamber is the announcement by the HSE this evening that accident and emergency services at Roscommon County Hospital are to cease as we have known them.

The right to access to safe and efficient health care should not be conditional on one's postal address. There can be no discrimination on the basis of geographic location or the size of one's bank account. Tragically, that all too often is the reality in Ireland today and will become the reality for many more thousands of Irish citizens. The people were led to believe by the parties now in government that change was coming and that in the health service, above all, a new chapter would be written. It is time these elected representatives, as well as the Minister and his Cabinet colleagues, listened to the people again. They have a duty to keep the commitments they have given. I commend all those who have been campaigning in defence of hospital services and for health care justice. They are courageous people of all political views and none and I urge them not to give up but to keep on campaigning, to unite with other communities nationwide and avoid approaching the problem as individual communities with a sole hospital focus. Instead, they should merge into a single strong campaign and stand together in demanding the protection of and a guarantee in respect of the continuation of accident and emergency and all other essential services currently in place across the network of local hospitals across the State. The destruction of the public health services must be prevented. Therefore, I urge all Members to support the motion.

See this speech in context