Sandra McLellan (Cork East, Sinn Fein)

At the outset, I echo the comments of a number of previous speakers that health care is a fundamental right. Sinn Féin has proposed a health service based on universal public provision, one that provides full equality of access and is free at the point of delivery. Access should be based on need and paid for through progressive taxation. Instead, we have a rotten system which is driven by the three Gs of health care - genes, giros and geography. The other G, genius, is certainly not running the health service.

Those with chronic illnesses, earning just above the medical card threshold and living in rural Ireland, are worst affected. The Minister, the Department and the HSE would do well to recognise that Ireland is not the Netherlands, or anywhere else for that matter. The subtleties of this country, its demographics, landscape, transport infrastructure, and where and how people choose to live, need to be reflected in a health service which caters for the needs of all of the people equally. Instead, we have listened to consecutive Ministers talk about the transformation and reconfiguration agenda. Political decisions are cloaked in carefully selected, so-called expert opinions. Unfortunately, the actions which follow that talk consistently amount to major downgrading and reduction of services, and the lives of ordinary people are being put at risk.

The latest push to close accident and emergency services is happening despite the fact that a number of medical professionals have expressed their strong opposition. This includes doctors, nurses and other health care workers, as well as general practitioners, who are expected to pick up the pieces.

The Minister and gurus in the HSE have to be aware of the most comprehensive study carried out investigating the relationship between distance to hospital and patient mortality in emergencies which was conducted at the University of Sheffield in Britain. After analysing data from 10,315 cases, the research showed that increased distance was, in fact, associated with increased mortality. Every 10 km increase in straight-line distance was associated with approximately a 1% absolute increase in mortality. One might have thought such a study would be relevant, given the implications of the decisions being made in regard to Mallow, Bantry, Roscommon and other at-risk emergency departments.

This is the essence of the argument people in those affected areas want to make. It is what brought people onto the streets today and over the past number of weeks and, indeed, years. People instinctively know the downgrading of emergency departments will endanger lives and cost lives. The Minister knows this too. There is real evidence to prove it, not only from researchers in Sheffield but from families in this State who have already been affected by this change agenda in Monaghan, the mid-west and elsewhere.

We cannot forget that these decisions are being made in the shadow of a legacy of poor planning and a complete lack of foresight within health service delivery in Ireland. This Government seems intent on continuing in the same vein as the last Government.

Once again services are being cut back and downgraded, while the necessary provisions are not being put in place elsewhere. I have seen this happen in my own local hospital in Mallow where the accident and emergency department is on the Government's radar, but at the same time paramedic and primary care cover is also being downgraded. Crucial ambulance services are being replaced with first responder cars, while the number of SouthDoc out of hours cars is being reduced.

The people of Roscommon realised their worst fears when they heard the news yesterday that their accident and emergency department was to be demoted to being little more than a medical sorting office. They made their opinion about this decision known outside Leinster House and now inside this House their elected representatives and the representatives of all areas affected, including my constituency of Cork East, have a clear choice between supporting the Sinn Féin motion and retaining essential services or doing otherwise and guaranteeing the opposite. The decision is theirs.

See this speech in context