Micheál Martin (Cork South Central, Fianna Fail)
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At the weekend, The Sunday Business Post, in particular, reported leaks from the recommendations of the trauma steering group that was established by the then Minister for Health, Deputy Varadkar, last year. It essentially identified nine accident and emergency departments that are under threat of being downgraded, being open for shorter periods or closure of some kind and the removal of trauma facilities from them. Obviously, this has caused concern across the country, including in Cavan, Naas, at Portiuncula Hospital in Ballinasloe, Mullingar, at St. Luke's in Kilkenny, Clonmel, at Mercy Hospital in Cork and Portlaoise. At all emergency departments across the country there is incredible overcrowding. Even today, more than 400 people are on trolleys. There was a time when the rows were about whether there would be an emergency department in a county. Based on this report, there will be regions without emergency departments if this trend continues. In the east, there is the potential for nothing in between Waterford and Dublin, with Kilkenny and Wexford taken out. In the midlands, there will be nothing between Tullamore and Tallaght in Dublin. The problem is that emergency departments in Dublin simply cannot cope and are bursting at the seams. In Cork, there have been closures in the South Infirmary, Mallow and Bantry down through the years.

The point I am making is that there has been significant reconfiguration already. Some medics will say that politicians will oppose this and oppose that.

There needs to be a re-evaluation of all of this, and of the trend, because by the time we are finished everybody will be going to Dublin for an emergency facility or a department. While there must be professional medical input, there must also be balance, common sense and an evaluation of what has happened already because there is incredible overcrowding. Last year, I visited Galway University Hospital, where there is an appalling vista. As it has just two cubicles for paediatric patients, it is completely incapable of dealing with what it has already been asked to deal with as part of the reconfiguration along the western seaboard, with the hospital in Letterkenny in Donegal having to shift people down to Galway University Hospital, which simply cannot cope. The major refurbishment it requires is not even in the capital programme that runs up to 2021. It cannot possibly cope.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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A question, Deputy, please.

Micheál Martin (Cork South Central, Fianna Fail)
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I put it to the Tánaiste that the bottom line is that there needs to be a fundamental rethink of where we are going. Common sense and a bit of balance need to be brought into this equation in terms of best outcomes because best outcomes also mean morbidity and fatality because of overcrowding itself. Doctors have estimated that people are dying because of overcrowding in our emergency hospitals. Will the Tánaiste confirm when the steering group report will be published? Will she confirm that the leaks are accurate? I refer to what has been revealed so far. Will she confirm that the accident and emergency departments in question will not be downgraded or affected?

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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It is important to reassure people that the work which is under way to develop a national trauma policy is about getting the best outcomes for a particular small category of patients who sustain traumatic injuries. The Minister has not yet received that report. It is probable that he will not get it until towards the end of the year. There is no question of closing accident and emergency departments.

I will respond to the broader points made by the Deputy. Attendances in our health service have increased by 6%. For example, the number of elective procedures done this year has increased by 13,500 when compared with last year. The Government has just invested €500 million, or 90% of available resources, in our health services to deal with the pressures outlined by the Deputy. There is no question of focusing emergency care in Dublin. Clearly, we are establishing the hospital groups to ensure appropriate care is provided throughout the country. As the Deputy knows, there are very large demands on our health services. That is why an additional €500 million has been invested this year. Some €15 million has been allocated to the National Treatment Purchase Fund to deal with those who have been on the waiting lists for the longest period of time. All of those initiatives are targeted at dealing with and improving our waiting lists and making sure people get these services. The throughput in our health services is up. Attendances are up 6%.

The Government is responding to the high demand that exists by investing further and making sure we have the appropriate services around the country. The hospital groups have been given responsibility for developing local services. I repeat that there is no intention to close down accident and emergency departments. That is not the Minister's intention. This is about trauma care. It is a question of how to get those who suffer traumatic injuries in road accidents to the best centre in the appropriate place. The Royal College of Surgeons has been working on that and has made a recommendation. The Minister has agreed that this area should be examined to give the very best care to people who have suffered traumatic injuries.

Micheál Martin (Cork South Central, Fianna Fail)
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I asked about the emergency departments, rather than the waiting lists. I asked about the waiting lists last week and they have got far worse since then.

Simon Harris (Wicklow, Fine Gael)
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Not since last week.

Micheál Martin (Cork South Central, Fianna Fail)
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Some of the waiting times are very poor. The Tánaiste has said that accident and emergency departments might not be closed down but I believe it is possible that there could be a dramatic change in the nature of what happens in them. The point I am making to the Tánaiste is that there has been no re-evaluation of the trend, or the model that is being driven incessantly by the medics. There has been no evaluation of what has actually happened. That is my point. The tertiary centres cannot cope. When will someone cop on to the huge problems that have arisen since we centralised everything? I have been in the key tertiary models. There is no way they can cope with report after report without a proper overarching model being put in place. It needs intervention. I expect that the Minister is well briefed on this. He is nodding his head. I know he has not got the report formally but he will have been briefed on this by his officials.

Simon Harris (Wicklow, Fine Gael)
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I have not been.

Micheál Martin (Cork South Central, Fianna Fail)
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The Minister should brief himself on it.

Brendan Howlin (Wexford, Labour)
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Of course the Minister has been briefed.

Micheál Martin (Cork South Central, Fianna Fail)
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Tomorrow morning he will be told what is in the pipeline. That is what happens normally. The bottom line is that somebody here must push back. Tallaght hospital will not be able to take everything; the hospital in Galway cannot cope with what it has to deal with, not to mind close down another facility, while Cork University Hospital cannot take any more, given the numbers who are attending. There is now talk of having one for the entire county and city. It is just not doable.

Does the Tánaiste accept the need for new thinking, to balance what medical personnel are bringing to the table with other studies and analyses of what has happened so far? Let us take the example of what is happening in Limerick and Ennis. Politicians went along with it-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I am sorry, but the Deputy's time is up.

Micheál Martin (Cork South Central, Fianna Fail)
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-----but the experience of the acute hospital in Limerick has been very difficult and challenging for all concerned.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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The Deputy is a former Minister for Health and knows that we must examine how trauma patients can best be dealt with. That is what the study is about. It is important not to raise unnecessary anxiety. I have outlined the position in emergency departments. It is not about closing them or diminishing services. Currently, there are no plans to close or remove trauma services from hospitals. However, it is extremely important to examine this very small percentage of patients, obtain the report and discuss in a rational way the best way to deal with people suffering from a particular type of trauma and where is the best place to bring a person with, for example, a head injury after a car accident. It might not be the nearest emergency department but a specialist trauma centre.

Micheál Martin (Cork South Central, Fianna Fail)
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I know that.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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That is what we are talking about; that is what the Deputy raised. He then proceeded to talk about the possible closure of other departments, which is not on the agenda, as I have repeatedly said. What is on the agenda is a discussion about the best care to be provided. The report has not yet been received by the Minister. When it is, it will be considered.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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On the same matter raised by Deputy Micheál Martin, it is incredible that members of the Government have managed to avoid much of the commentary on and discussion about the report of the trauma steering group. I will outline what it contains. In short, it proposes the redirecting of trauma patients to the supposed centres of excellence. However, we have seen all of this previously, with the scaling back of services in Nenagh, Ennis and the mid-west, the reduction in services in Roscommon and Tipperary and the concentration of services in Clonmel, Our Lady of Lourdes Hospital in the north east, St. Vincent's University Hospital and the Mid-Western Regional Hospital in Limerick. We do not need a commission report to know that these measures have utterly failed. The recommendations made in the report pertain to both serious and moderate trauma cases. That is the difference. Previously, patients with serious trauma injuries were sent to so-called centres of excellence, but now they will receive both serious and moderate trauma cases. This will mean that the scale of downgrading will be even greater and it will put pressure on hospitals that are already at breaking point. It means that many more people will be affected and that there will be more overcrowding and chaos in already over-worked emergency departments.

I was a member of the accident and emergency forum for many years and have seen at first hand the impact reports such as this have. The Tánaiste has made the point that it is important not to cause panic. However, that is exactly what will happen. People driving past their local hospitals tonight on their way home from work will wonder if their hospital will survive the Government's term of office. That is what is on their minds. The Minister says he has not seen the report and claims not to have been briefed on it. That is utterly incredible. There were senior members of the Department of Health involved in the production of the report and it is incredible that they would not have seen fit to provide a briefing.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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A question please, Deputy.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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There is an all-party committee on the future of health care. There is substantial evidence that the report will be material to the work of that committee. Will the Tánaiste ensure every report that is vital to the business of that committee will be laid before it? Otherwise, what will happen is that it will report and immediately afterwards another report will issue.

Given that we are reading about this in the press, we do not know how many reports will inform the work of this vital committee.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Thank you.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Every party here bought into the establishment of the committee and we are hopeful it will be able to conduct its business. However, we cannot work in a vacuum and it is unfair to expect that we will. Will the Tánaiste insist that any and all available reports, including those in draft form, are laid before the committee?

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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The first point I have to repeat is that there is no completed report at this point. The Minister has not received a report, so the Deputy is operating on the basis of a report in regard to the committee's work, which is not finished. Of course, it will go to the all-party committee on health for discussion when it is available. The Minister has been very keen to show that he wants to work comprehensively with the committee and this is clearly a report that will go there. It is a joint initiative from the Department of Health and the HSE. As I have already said to Deputy Martin, it has been developed in recognition of the fact we do not have a co-ordinated trauma network structure in Ireland. This is about doing the best for patients-----

Micheál Martin (Cork South Central, Fianna Fail)
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We do have a major trauma network.

Simon Harris (Wicklow, Fine Gael)
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There is only the RCSI.

Micheál Martin (Cork South Central, Fianna Fail)
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There is Beaumont and Cork, as the Minister knows.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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One speaker, please.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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We do not have a national policy in regard to trauma and the management of patients who suffer in this way. This is about giving excellent care to people who find themselves in these circumstances. The report is examining how best to do that.

The implementation of the hospital groups provides an opportunity for hospitals to work together to develop an optimal configuration of trauma services. There is no need for people going past their hospital emergency department tonight to have the kind of concern the Deputy is outlining-----

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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There is.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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-----unless by statements in here that raise anxiety unnecessarily.

Micheál Martin (Cork South Central, Fianna Fail)
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That is unfair. This is in the public domain.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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The work is ongoing and it will be received. I would also put on the record of the House that the current fragmented arrangements for dealing with trauma in hospitals in Ireland have long been a point of discussion, and trauma services are one of those service areas that require a national policy direction. That is what is being worked on at present. To say anything else, or to say that emergency departments are now under threat because we are discussing how best to deal with patients who suffer traumatic injuries, is incorrect.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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It is correct to say that people are concerned. While I respect what the Tánaiste has said, it might be that she and her colleagues have given over their weekend to speculating about internal party matters. Perhaps if she had been talking to people who are concerned about this, she would know that the concerns that are being raised are not raised in order to frighten people unnecessarily but because they are being raised directly with us. People know the record of this Government. They know it will lead with cuts, they know that it will cut first and ask questions later, and they are concerned.

I asked the Tánaiste to give a commitment that any and all information, be it in draft form or otherwise, be given to the committee, of which I and others in the Chamber are members, so we might have all of the information in order to make up our minds and issue our own reports. She has not given that commitment and I want to press her on that. Can I have her assurance that any and all available information, be it in draft form or otherwise, will be given to the committee?

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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There is no draft report that is at present available to the Department. What I can give the Deputy a reassurance about, of course, is that once the report is available, the Minister will make it available to the health committee. It should rightly form part of the discussions at the health committee. In the meantime, as I said, there is no threat to emergency departments. In fact, what the Government is doing is investing in the health service, with 90% of the resources that were available going into the health services to deal with the ever-increasing demands on the services. Recently, €500 million was allocated to deal with the issues we are concerned with here.

The purpose of this report is to ensure we do the best for patients who suffer traumatic injuries and make sure they go to the right place, where they will get the best health care. It is not about closing or changing the arrangements in regard to emergency departments.