Séamus Healy (Tipperary South, Workers and Unemployed Action Group)

Any reasonable person looking at the health service will know and appreciate it is in crisis, particularly the hospital services. My colleague has just outlined the reasons for that. What we have is the implementation by the Government of the policies of the previous Government. The three key areas creating that crisis in our hospitals and health services are bed closures, of which there were 1,700 in the past 12 months - 5,000 since 1980 - and the moratorium through which we have lost 6,000 staff since 2008. Another 7,000 will be lost between now and 2014, giving a total of 13,000 staff gone from the system. The third element, as the Minister is aware and which is clearly shown in the case of Blanchardstown hospital, is a budget reduction from €104 million to €84 million. That is a huge reduction but there is an expectation that the same number, if not more, patients will be treated. The throughput is higher, staff are under enormous pressure and the consequences for patients are huge. We know the consequences because we see them every day. Today, there are 344 patients on trolleys and that is happening in every acute hospital throughout the country.

Yesterday, an individual came to my clinic who was unwell and has been waiting for a barium meal for six months. It is unfair that any person should have to wait that length of time for a procedure which is crucial for that person's health. That is not an isolated case; it is happening in every acute hospital. Despite the best efforts of staff from the top to the bottom, who work above and beyond the call of duty on a daily basis, they simply cannot cope because those three elements are putting the health services in crisis.

The Minister is the political head of the health services. His amendment to the motion refers to the delivery of safe care closer to local communities and freeing up capacity in larger hospitals. I agree 100% with that statement. All international research and professional evidence suggests and proves that is the way to go, that health services should be delivered locally. The same independent international research proves that 95% of all health treatments can be provided locally in safety, as the Minister has described in his amendment. Is it not time the Minister instructed the HSE to implement that policy throughout the health services because it is doing the exact opposite? The Health Service Executive is implementing, by any other name, the Hanley report. It is implementing centralisation and specialisation on a daily basis.

It is time the political head of the health services instructed the HSE to follow the policy he claims to espouse in his amendment which states that it supports the Government's policy of developing the role of smaller hospitals to their full potential rather than closing or downgrading them; welcomes the Minister's intention to publish a framework for smaller hospitals which will include plans to transfer appropriate services from larger hospitals to smaller facilities; and supports the process of local consultation that will help inform future decisions on the organisation of acute hospital services. That is the kind of language we have been listening to from the Health Service Executive for years. What it means is the downgrading and closure of local hospitals, more Nenaghs, Ennis', Monaghans and Cavans.

The Minister speaks about the transfer of appropriate services from larger hospitals to smaller facilities but he has to transfer some services from those hospitals to do so. That is the key. What happened in respect of Monaghan, Cavan, Nenagh and Ennis is what this paragraph means and it is totally at variance with the proper delivery of safe services locally. I would be absolutely delighted if he was supporting the process of local consultation to help inform future decisions. However, we all know, including the Minister, that is not happening, that the Health Service Executive is a bully boy and makes the decision first without any consultation. After the event, to try to pull the wool over people's eyes, it involves itself in discussion with some stakeholders not about the decision or the service, but how its decision is to be implemented so there is no local consultation. There should be a real process of local consultation with stakeholders, whether staff, members of the public, service users or patients, before decisions are made. There is no point in having consultation after a decision has been made because the HSE will only have consultation on the basis that it wants to implement the decisions made.

I know that is the case because I have seen it at first hand in south Tipperary where the Health Service Executive made the decision to close the acute inpatient psychiatric unit at South Tipperary General Hospital without any consultation whatsoever. The decision was announced overnight and the first staff knew about it was on the local radio the following morning. Now, after the event, the Health Service Executive will discuss the issue, but it will not discuss the appropriateness of the decision. It will not discuss having a proper options appraisal nor will it discuss a proper cost-benefit analysis of the decision. It will only discuss the implementation of the decision. That will not work.

The policy being pursued by the Health Service Executive is the policy of the Hanly report. It is a policy of centralisation and specialisation. It is a flawed and misguided policy that is not providing a good service to patients in this country. We have seen that at first hand. What else is the reconfiguration of hospital services in Monaghan and Cavan into the hospital in Drogheda? What else is the reconfiguration of hospital services in Ennis and Nenagh into Limerick hospital only the implementation of the Hanly report? That has been an absolute disaster in both cases.

International, independent, professional research shows that medium-sized hospitals of approximately 200 to 300 beds provide the best quality of care, good value and proper access. The suggestion that biggest is best is simply wrong. It is leading to a situation where we have a major crisis in the health service, in particular in hospital services in this country. I support the motion.

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