Pat Breen (Clare, Fine Gael)
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I thank the Ceann Comhairle for allowing me to raise this important issue, namely, the Teamwork report for the north east and whether it will be applicable to services in the mid-west, specifically Ennis General Hospital, and the future of 24-hour accident and emergency services.

The report to which I refer is entitled Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North East, which was produced last August by Teamwork Management Services on behalf of the Health Service Executive. I agree with a recent statement by my party colleague, Deputy Twomey, that there is a major gap between proposals made in the report and the experience of those on the front line trenches of the health service.

The report recommends the development of one regional hospital for the north east and changes in care at local level. The proposals include changing the status of five acute hospitals in the area to local hospitals which would perform a wide range of day surgery and outpatient procedures. While we all recognise that centres of excellence must be based at major hospitals and some services are not suitable for county hospitals, a growing body of evidence in the United Kingdom indicates that the trend towards developing super-regional hospitals and downgrading acute hospitals to local hospitals is an inappropriate model.

One of the reasons for this conclusion is the emergence of hospital superbugs and life-threatening illnesses such as MRSA, which are spread much more easily in large hospitals with high volumes of patient turnover. This trend also discriminates against people living in remote areas with poor transport infrastructure, which greatly reduces the chances of having timely and appropriate treatment. In this context, I refer to people in villages in west Clare such as Carrigaholt, Cross and Kilbaha, who are more than one hour's journey by car from Ennis General Hospital and face considerable disadvantage when compared to their counterparts in urban areas.

It is a pity the Government does not recognise this problem. The Minister believes the issue relates solely to Ennis General Hospital, but I am extremely disappointed at the news that Galway will not receive a neurosurgical unit. The review of neurosurgical services has advised against establishing such a unit in Galway. People in the west have died from head injuries due to the lack of speedy access to a neurosurgical unit. The units in Dublin and Cork are too far away for people in counties Clare and Galway and other counties in the west to access them quickly. Health services in the west are the poor relation of those in the east and when one considers the outcome of the Comhairle na n-Ospidéal review of neurosurgical services, those in the south are also in dire need of improvement.

I raise the Teamwork report because of concerns raised over how its conclusions might apply to Ennis General Hospital. These concerns have been passed on to me by members of the Ennis General Hospital development committee who have done trojan work on behalf of the hospital in recent years. The committee is concerned that accident and emergency services at the hospital could be cut in line with proposed changes at Monaghan and Cavan hospitals and other hospitals in the north east, with the result that the hospital will essentially become a nurse led clinic.

We have had these arguments in County Clare before. When Kilrush Community Hospital was closed in the early 1970s we were assured that the moving of maternity services and other hospital functions to Ennis General Hospital would enhance overall health services for the county. Maternity services have long since decamped to Limerick and the threat of a reduction in current accident and emergency and acute services is ever present.

It has been reported to me that a HSE official informed a delegation from Monaghan, in the presence of the Minister for Health and Children, Deputy Harney, and the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, that the conclusions of the Teamwork report would be applied to the rest of the country. Neither Minister has contradicted this statement. In addition, I have been informed that the value for money audit of hospital and health services in the mid-west, due to be completed before the end of the year, will oppose retention of the consultant led accident and emergency service at Ennis General Hospital.

Not only are our services under threat but our speedy access to centres of excellence is denied. When a patient in the Clare area suffers serious head injuries which necessitate removal to the Cork neurosurgical unit, no helipad is available at Ennis General Hospital to facilitate transportation. The Minister and the Taoiseach have sent conflicting signals on their intentions for Ennis. The Taoiseach has disowned the Hanly report conclusions without indicating what would replace them, while the Minister chooses her words carefully. For example, she recently stated:

There is no question of downgrading. We want to make sure that wherever patients are treated they get appropriate care and that their lives are not being put at risk or in danger by being taken to the wrong hospital.

The point is that Ennis will only become the "wrong" hospital if it is stripped of its accident and emergency and acute services. The Minister in her statement seems to be endorsing the centralisation of all critical services to Limerick.

There have been other incidents which have rung alarm bells in County Clare. Last May the HSE, after delaying for six months, responded to the Ennis General Hospital development committee with an assurance on the future of accident and emergency services. Within hours of that letter arriving, it was withdrawn and replaced by another with the all-important assurances on accident and emergency services removed.

I would appreciate tonight a clear commitment on the part of the Minister on the future of accident and emergency and acute services in Ennis General Hospital.

Tim O'Malley (Limerick East, Progressive Democrats)
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I will be taking the matter on behalf of my colleague, the Minister for Health and Children.

The Deputy's motion tonight refers to the Teamwork report on the acute hospital services in the north east and its relevance to the mid-west. Accordingly I would like to address the Teamwork report first.

The HSE commissioned Teamwork Management Services to undertake a review of hospital services in the north east and to provide an action plan for achieving the best possible acute care for patients in the region. The report, Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North-East, was presented to the board of the Health Service Executive in June 2006.

The report concludes that the present system, where five local hospitals in the north east deliver acute care to relatively small populations, is exposing patients to increased risks and creating additional professional risks for staff. This does not serve patients well, is not sustainable and must change. The report highlights the need to develop a high quality, responsive emergency and planned service, in line with international standards, by developing local services within existing hospitals and other local centres supported by a new regional hospital to be provided in the region.

The HSE has established a steering group and a project group to oversee the implementation of the recommendations of the report with a view to improving safety and standards across the acute hospital network in the north-east region.

With regard to the mid-west region, the Health Service Executive has initiated an independent review of acute hospital services in the region. The aim is to determine the optimum configuration of acute hospital services in the mid-west. The HSE is currently in the process of selecting an external consultancy to undertake the review, with a view to work commencing early in 2007.

The configuration of acute hospital services is a complex and difficult issue. Government policy is to build up health services in all regions of the country to provide safe, high-quality services that achieve the best possible outcomes for patients. Quality care and patient safety come first. No matter what county or region they come from, all patients should receive the same standard of quality assured care. This will mean that those services that can be safely delivered locally are delivered locally and the more complex services that require specialist input are concentrated at regional centres, or in national centres of excellence. Every report that has been produced in the past number of years has highlighted this requirement.