James Reilly (Dublin North, Fine Gael)

I move amendment No. 2:

To delete all words after "Dáil Éireann" and substitute the following:

"— recognises that the first and over-riding priority for all hospital services must be the safety of patients;

— supports the Government's approach to ensuring that all patients have access to timely, high quality emergency services;

— notes the growing evidence that larger hospitals with a higher volume of patients treated by appropriately trained health professionals have significantly better

outcomes for patients with complex or life-threatening conditions;

— endorses the recommendations of the independent Health Information and Quality Authority on this issue and welcomes the Government's commitment to implementing the approach advocated by the Authority;

— strongly supports the Minister for Health's establishment of the Special Delivery Unit within his Department, which has already started its work to reduce unacceptable waiting times in emergency departments, and will also address lengthy waiting times for in-patient, day case and out-patient treatments;

— supports the Government's continuing emphasis on providing high-quality diagnostic and treatment services for patients with cancer irrespective of where they live;

— commends the Minister for Health's work to ensure that there is a sufficient number of non-consultant hospital doctors to provide high quality acute hospital services throughout the country; and

— endorses the Government's intention to introduce a system of Universal Health Insurance, which is based on fair access to healthcare for all, irrespective of income or geographic location; and

resolves that no hospital will close but that some services will change."

I start by responding to some of the issues raised by Deputy Ó Caoláin. While it might have been known that Roscommon's emergency department, which is still referred to as an accident and emergency department, was under threat it was not known that it was unsafe. The Mallow HIQA report had not been released at that point and was not published until April. It was the first report to identify clearly the hospitals about which it was concerned. Nobody has raised this issue with me more and shown more concern about this than Deputies Naughten and Feighan. Senator John Kelly has been at my door on numerous occasions in regard to his concerns.

I want to touch on one or two things that were said about Tallaght and Fettercairn. I met the Tallaght Hospital Action Group today and we had a good conversation. It raised its concerns about staffing levels and the budget and I have taken that on board. I am equally aware and concerned about the fact that a place like Fettercairn has no GP service. It is an area to which I refer when I talk about the right of my Department to implement our social policy when it comes to supporting practices. If we open the GMS to all GPs I have no issue with that, but we will not support five practices on Grafton St. when there is none in Fettercairn.

In regard to the national paediatric hospital, the ambulatory care unit in Tallaght will be open first and the report alludes to the need for some overnight beds there, something which will certainly be considered. On the comments on Loughlinstown, the hospital is seven minutes from St. Vincent's Hospital. Therefore, what can be carried out safely there is obviously a matter of consideration and what can be achieved by moving a patient seven minutes down the road also has to be considered.

I made it clear before the last general election that if the cancer services in Sligo General Hospital were out of operation for more than a year it would be very difficult to reinstate them, but we have not closed the door to that possibility and are still in discussions. Deputy Doherty mentioned that money follows the patient but that the money has left the country. If we were to follow his advice and debunk on everything we would have to make an adjustment of €19 billion or €20 billion in one year. How many salaries and cuts would that cost? The system could not withstand the shock.

In regard to Roscommon in particular, I understand the fear of local communities. In the past it often meant death by stealth. That is not the case here and it is not the agenda of this Government. The Government is very clear that the future of smaller hospitals is bright. It is not the beginning of the end. In fact it is the beginning of a new lease of life, but in a much safer way by doing a lot of different work from what they did hitherto. We need our local hospitals and their capacity and expertise.

As the Taoiseach said, in regard to Roscommon we also need to be truthful. Not enough non-consultant hospital doctors will be available to us, something which I will outline in more detail. Smaller hospitals are not as safe as bigger ones in key areas. There is a wealth of international research to back this up. When it comes to multiple traumas, strokes and heart attacks, it has been proven internationally that one has a 25% better survival rate at a larger hospital which has a higher volume even if one is more than one hour away. In this context paramedics are very important.

What has happened in this country over the past couple of years is something which has now been highlighted by HIQA We all thought if there was an accident and emergency department with a doctor and X-ray machine the service was safe and could look after us if we were acutely ill, and that the skill set was available to deal with multiple traumas, double fractures, heart attacks or profuse bleeding. We have to realise that behind many of these hospitals the skill set is not there and there is no vascular surgeon, orthopaedic surgeon, anaesthetic consultant on-site at night or a person to carry out intubation. If a person has to wait 15 minutes for someone to come from down the road to intubate him or her, he or she will be dead.

We have to look at what constitutes safe practice and be honest with people. People are starting to vote with their feet. It is important to point out the attendance rates at smaller hospitals. In Roscommon 30 people attend on a daily basis on average, a total of up to 14,000 per year. Fewer than one person a day, or 360 patients a year, is transferred from the accident and emergency department to Galway, rather than the 14,000 some would have us believe.

The golden hour has been much talked about but has been superseded in recent years by a wealth of international experience that shows that a high-volume unit is where the best outcomes are achieved, even if it is well in excess of an hour away. This view was formally endorsed in Ireland by the Irish Association of Emergency Medicine, the medical director of the National Ambulance Service and the national programme director of the HSE's clinical programme on emergency medicine. Dr. Una Geary, the clinical leader in emergency medicine in this country, said at a press conference the other day, "There is not a single serving emergency department consultant in Ireland who believes different." That is the reality.

The Deputies opposite referred to the statement I made during the election on Roscommon hospital. Any statement I made was made in good faith. Any utterance I made was born out of a strong conviction that all hospitals have a future with integrity in their communities. Anything I said was in defence of hospitals and out of a determination that no hospital should be downgraded out of existence. My priority is to defend patients and above all else ensure their safety when they are at their most vulnerable, when they are acutely ill and when they are utterly reliant on the skills of those around them to save their lives and ensure the best outcome for them.

The Opposition wants to sustain what is unsustainable and keep unsafe that which must be made safe.

See this speech in context