Timmy Dooley (Clare, Fianna Fail)

I welcome the opportunity to speak to this Bill and commend the Minister for introducing it. It deals with an important issue which has been a feature of medical staffing for several years. The crisis with which it deals recurs twice a year and needs to be resolved. While the legislation is a stop-gap measure to deal with the immediate problems presented, we need to take a radically different approach to hospital staffing. I look forward to hearing the Minister's proposals for the putting in place of a comprehensive strategy to address the issue. It is not acceptable that the problem recurs on such a regular basis and it throws the management of hospitals into confusion. We regularly criticise the management structures of the HSE and the management initiatives taken by hospitals, but dealing with this issue puts extraordinary pressure on hospital management.

I ask for the Minister's assurance that what will happen on 11 July will not impact on the mid-west region. He will be aware that it was one of the first regions in the country to embrace the process of reconfiguration. From the point of view of hospital management, staff and patients, great leadership was shown in this regard. A previous Minister provided an assurance that the appropriate level of staffing and investment would be provided for to ensure the success of the reconfiguration process. It would be a retrograde step, therefore, if those who jumped on the bandwagon of reconfiguration were told service provision would have to change once more because it was not possible to employ the necessary staff. I urge the Minister to use his good offices in order that the people concerned will not be penalised for having agreed to difficult decisions.

Reconfiguration in the mid-west region was vigorously opposed by both Fine Gael and the Labour Party every step of the way. They were scaremongering in regard to the number of people who would be negatively affected. I have always believed reconfiguration is the appropriate solution from the perspective of patient safety and care. Although it was a difficult concept to sell to the public, it was in the best interests of patients in the long-term. For some reason, the Government backbenchers who made inflammatory statements on the potential numbers of deaths that could ensue are the same people who last night trooped through the lobby to inflict the same level of service on the people of County Roscommon. Either the Minister has succeeded in educating them on the benefits of reconfiguration or their statements were disingenuous.

The policy of reconfiguration is progressing in County Roscommon as it did in the mid-west. I supported the policy in the mid-west region and Ennis, in particular, while I was in government and continue to believe the Minister is correct to follow the approach adopted by the last Administration. However, he needs to provide for an appropriate level of resources if he is to assure people it is not solely intended as a cost saving measure. In addition to the potential cost benefits, patients will have better outcomes because they will be treated in the appropriate hospitals. Investment in the ambulance service will also be required if we are to ensure a positive outcome. In this regard, it is welcome that Dr. Cathal O'Donnell who, with Mr. Paul Burke and others in the mid-west region, was a champion of the reconfiguration process has been promoted to the position of clinical director of the ambulance service.

Having accepted reconfiguration in respect of acute surgery, we should not rush to judgment on the delivery of acute medicine. I recognise that certain aspects require centralisation but others should be provided in smaller hospitals to reduce pressure and demand on the system. I refer, in particular, to the cohort of older patients who suffer from pneumonia and other conditions. They have no business being in centralised hospitals because they can access an appropriate level of care in smaller units. There was an acknowledgment that certain services should be moved to smaller hospitals, but, sadly, this has not happened at the rate one might have expected. This can partially be explained by staffing and personnel issues, but the Minister needs to ensure services are delivered in the appropriate settings. That will mean decentralisation of certain services.

If the Minister is to be successful in what he is attempting to do in Roscommon and other hospitals, he must look at the pilot project that took place in the mid-west. He will be required to ensure the services which can be delivered in places such as Ennis and Nenagh are decentralised quickly in order that he will have a benchmark to be used in other areas. To that end, there is a necessity to ensure a coronary care unit, currently in place at both Nenagh and Ennis, will be retained. These services are a fundamental part of ensuring we can continue to deliver a safe medical service and not having a coronary care unit in these hospitals will impact on the capacity to deliver the medical services that can be delivered in smaller hospitals. I, therefore, urge the Minister to ensure some of the views maintained in the HSE will not be allowed to be realised. Everyone accepts acute surgery must be carried out in the appropriate hospital with 24-hour accident and emergency facilities. There was potential for people in smaller hospitals to have less than adequate outcomes based on the service delivered. However, from a medical perspective, there is a necessity to retain coronary care units in order that smaller hospitals will have the capacity to deliver those services which can be delivered.

In respect of the air ambulance service, the western seaboard of County Clare is a considerable distance from Limerick. There were discussions between the previous Ministers for Transport and Minister and a body of work has been done by Mr. Cathal O'Donnell and the Irish Coast Guard on the provision of a service. I know there is a difficulty with funding, but I call on the Minister to support the work done and ensure the project which was identified a long way back reaches fruition, as it is unusual to have an opportunity to provide for a greater level of service at no additional cost to the State. This would be of benefit to the Irish Coast Guard in maintaining the proficiency of EMTs and ensuring there was the required level of activity in order to maintain their professional standards while availing of the downtime in their schedules. If a service can be provided as part of a pilot project, there would be an opportunity to overlay it across the country using the Irish Coast Guard. There should not be an air ambulance service available to cover every event, only where it is a matter of life or death and there is an absolute necessity to get the patient to hospital on time. I would appreciate it if the Minister put some effort into dealing with this issue.

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