Brian Stanley (Laois, Sinn Fein) | Oireachtas source

I welcome the opportunity to speak on the Sláintecare report. We are all agreed that our health care system is in some disarray and that we need to address the problem. I want to deal, in particular, with the emergency services in the Dublin Midlands hospital group as an example of what needs to be done. I will approach this in a constructive way.

Ministers often shout at us about not having solutions. We produced a plan for universal health care two years ago, when Deputy Ó Caoláin was Sinn Féin spokesperson on health. Much of what was in that document is now in the Sláintecare report. The Social Democrats and people from other parties also had a major input to the report. There is broad agreement on that. I raise this issue in a constructive way because we put a great deal of effort into our plan at the time. Deputy Ó Caoláin consulted widely and met people in the sector.

An issue raised by the public, and one that I have come across when interfacing with the health service, is that consultants and specialists are two-timing. The Minister of State knows what two-timing means when people are having love affairs - they are deceiving both parties. In this case, consultants and specialists are running private practices within the public system and are taking patients out of the public system. For example, a person employed by local government told me yesterday that he brought his child to hospital to have a procedure and was put on a waiting list for a year or more. However, the child could not wait. He and his wife pay a lot of income tax but he happened to mention that he had private health insurance with an excess of €500. They were in Slane clinic within a day. They paid the €500, the insurance company paid the rest and the procedure was carried out in a couple of days. Senior staff whisper in patients' ears - sometimes they do not even bother to whisper - that if they pay privately, the procedure can be carried out. I have had that experience. It has to stop. If people want to take out private health insurance, that is grand but the private system has to operate separately from the public system.

When Fianna Fáil was in government in the noughties, and Deputy Micheál Martin was Minister for Health, it wanted to have co-location. I am glad that we have moved away from that insanity. We have to build a new system around the proposal in the Sláintecare report. Deputy O'Reilly has said that we agree with 95% of it, including the need for a single-tier system, recognition of the role socioeconomic background plays in the quality of people's health, the "carta sláinte", a universal card for access, etc., employing extra staff and single waiting lists to avoid queue skipping.

On page 78 of the Sláintecare report, it is set out clearly that "concrete measures to improve access to Emergency Departments and manage waiting lists [properly]" must be put in place. On page 110, there is a recommendation to "Introduce a maximum wait time in EDs, working towards a four hour target". We all agree with that and we understand this cannot be done in an hour or a week but that it will take time. Deputy O'Reilly has articulated much better than I the detail of what needs to be done there.

Side by side with this report, the Dublin Midlands Hospital Group produced a report that was leaked to me three weeks ago. Since then, the top tier of the HSE - which is feeding information to a Sunday newspaper - has put in place a news management strategy. It is a case of shock horror one week and the following week it leaks a report similar to this one, specifically dealing with areas of care in Portlaoise. The Minister of State knows, as do I, that the 24-hour emergency department in Portlaoise is in danger of being closed. The report I received sets out what is to replace it, namely, a minor injury unit and medical assessment unit operating between the hours of 12 noon and 7 p.m.. There will be nothing after 8 p.m. I have spoken many times about the effect that this will have and the crisis it will create. In the first six months of this year, 20,000 people presented at the emergency department in Portlaoise. There is nowhere else in the system to put the emergency department. According to the leaks to The Sunday Business Postfrom by those in the top echelons of the HSE last weekend, it will cost €100 million to provide the extra capacity in other hospitals such as Tallaght. If the emergency department at Portlaoise hospital is removed, according to the plan leaked to The Sunday Business Post, serious paediatric services, maternity services and the intensive care unit will go. It is widely acknowledged on the Government benches, and on this side of the House, that since the improvements were made in staffing levels in the maternity unit in Portlaoise, services have improved dramatically. They are now linked to the Coombe, which provides an excellent service. Investment has been made in that service and I welcomed that publicly at the time.

While the services have been brought up to a high standard, the proposal is that emergency services will now be removed and shifted to the Coombe.

Has the Minister of State, Deputy Jim Daly, ever tried to get from Portlaoise to Dublin during the three hours of rush hour in the morning or the three hours of rush hour in the evening? How will the patients be transported? They cannot be transported by road because apart from the gridlocked traffic, outside of those six hours the ambulances are not available to do that.

I listened carefully to the views of local consultants and GPs about what needs to be done in terms of critical care provision in the midlands, in particular with regard to Portlaoise. They produced a strategy for the future of services at the Midland Regional Hospital, Portlaoise and a copy was sent to the Department for information. They set out clearly what needs to be done. They say the same thing needs to happen with emergency care as has happened with maternity services in terms of being linked in with units in Dublin hospitals with the sharing of consultants and expertise. That is what we need to do. That will not cost €100 million, which is what the HSE intends to spend if it gets it way to beef up Dublin hospitals to take the supply from the midlands when it closes down the emergency services in Portlaoise.

We heard much talk in the past about the golden hour but the health experts who are pushing the agenda have stopped talking about it. We all know that the first hour after a serious accident or health incident where a person has a heart attack, for example, is key. If Dr. Susan O'Reilly, who is leading the drive to close the emergency services at Portlaoise, is allowed to have her way, based on the fantasy of the Dublin Midlands hospital group, we will not be able to get people to hospital through the gridlock and because the ambulances are not available. The critical golden hour will be lost. If the proposed change is allowed to happen, people will hold Fine Gael to account. Dr. O'Reilly sent a letter to staff this week to inform them that a decision to that effect has been made. I have a copy of the memo with me. She said the issue is now in the hands of the Minister. If that happens it will come down on Fine Gael's head, and the party that is propping it up in government, namely, Fianna Fáil. If anybody dies in the back of an ambulance either travelling to Tullamore across very bad roads or to Dublin it will come down on the Minister's head. The issue is on the desk of the senior Minister. If he signs off on it he is signing the death warrant of people in Laois and the surrounding counties. He is also signing the death warrant of Fine Gael and there will be political consequences for the party that is propping it up in government if it goes ahead with the proposal.

The Minister should push ahead with the Sláintecare report. The report from Dr. Susan O'Reilly and her team should be put in the shredder. The Minister should talk to the GPs and hospital consultants and make the necessary investment in Portlaoise hospital. It will not amount to €100 million or even €20 million. The Minister should shred the fantasy plan of Dr. Susan O'Reilly and push on with Sláintecare.

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