Joe Carey (Clare, Fine Gael)
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I thank the Ceann Comhairle for allowing me the opportunity to raise this serious issue on the Adjournment. I discovered yesterday that the HSE intends to change its policy in the mid-west such that all major trauma cases presenting in County Clare will be sent to Limerick Regional Hospital, thereby bypassing Ennis General Hospital. This proposed change, which is to come into effect next April, ignores the standard international maximum time limit to treat accident victims, commonly known as the golden hour. This is a high risk strategy. At the centre of this decision is cost-cutting and not patient care. It is a matter of cuts before care, theory without practice. The Government, the Minister for Health and Children and the HSE are determined to implement the Hanly report by stealth and this move is another step on the way.

This decision ignores the unique geographical nature of County Clare and, in particular, the west Clare peninsula. It ignores the fact that some patients in west and north Clare will have to travel up to 70 miles to Limerick on roads that are among the worst in the country. I refer in particular to the Kilrush and Ennistymon roads. This decision was made without any upgrading in ambulance cover in County Clare and without any upgrading of the accident and emergency facility at Limerick Regional Hospital to cater for the greater workload.

Furthermore, there was no consultation with the ambulance personnel who attend these scenes and have practical knowledge of the matter. I spoke with one of them yesterday. Frank O'Malley works at Ennis General Hospital and has 35 years' experience. He is outraged by this decision which he described as "totally ludicrous". Mr. O Malley informed me it could take patients three hours to get to Limerick Regional Hospital from areas like Kilbaha and Carrigaholt. A seriously ill person, he remarked, would not have a prayer of surviving this journey on such poor roads.

In recent weeks, there have been three separate incidents where expectant mothers in west Clare have had their babies without medical care because the ambulance service is so badly resourced and understaffed. Thankfully, all three mothers and their babies are doing well. This proposed move will stretch our faulty ambulance service even further. It is unacceptable that people's lives should be put at risk in this way. The Minister for Health and Children and her advisers must ensure an immediate review of ambulance cover in County Clare. She must ensure there is 24-hour cover in Kilrush, Ennistymon and Scariff, which only has 19 hours' daily cover.

It is an absolute disgrace that successive Fianna Fáil-led Governments have ignored the need for serious investment in Ennis General Hospital. The Government has ignored the county hospital because it wants to run it into the ground and erode people's confidence in it. It is doing a great job in that regard. We in County Clare demand and deserve a world class health service, not a system that is thrown together and with major shortcomings and repeated cuts in services. I strongly believe we need to bring hospital services closer to people, rather than moving them further away. I do not advocate that we should have every discipline in every hospital. However, a fully functioning accident and emergency unit should be available 24 hours a day, seven days a week to protect the 110,000 people who live in County Clare. The service should be supported by a properly staffed and well resourced ambulance service. Far too many promises have been made about the upgrading of Ennis General Hospital, but no work has taken place. I ask the Minister for Health and Children to get on with it. She should spend the money that is needed to upgrade Ennis General Hospital. It has been proven that longer journey distances to hospitals lead to increased mortality rates. They also affect recovery times and the type of recovery a patient can expect. In the interests of public health, I respectfully ask the Minister to intervene to ensure the plan to stop using Ennis General Hospital for major trauma cases does not proceed.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I will respond on behalf of my colleague, the Minister for Health and Children, Deputy Harney. As Deputy Carey is aware, the provision of services at Ennis General Hospital and the mid-west in general is the responsibility of the Health Service Executive. One of the priorities of the Government and the HSE is to improve the delivery of accident and emergency services. Considerable improvements in the delivery of such services have been made over the last two years. Medical and paramedical experts consistently advise that all major trauma cases should be transported to regional trauma centres. International and national evidence has shown that trauma victims have a better chance of survival and recovery when they are treated at specialist centres. Over the years, many senior consultants in Ennis, Limerick and Nenagh have expressed their desire for best international practice in this regard to be introduced in the mid-west.

Joe Carey (Clare, Fine Gael)
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What about the golden hour?

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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Consultants have expressed concern about the policy of taking major trauma cases to Ennis and Nenagh before transferring them to Limerick. Many years ago, the Medical Council advocated the introduction of what is known as the "trauma bypass". The HSE has informed me that from April 2008, six trained advanced paramedics will be qualified to intubate and cannulate patients in County Clare.

Joe Carey (Clare, Fine Gael)
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That is not enough.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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The Government is committed to the continued development of appropriate services at Ennis General Hospital. It has provided for developments at the hospital in the past. It will continue to invest in services at the hospital.

Joe Carey (Clare, Fine Gael)
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The Government has done absolutely nothing.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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Ennis General Hospital will continue to play a vital role in providing services for the people of County Clare.