Kathleen O'Meara (Labour)

I move:

That Seanad Éireann:

—noting the emerging crisis in the delivery of our maternity services all over the country;

—noting the recent unnecessary death of a person in Monaghan due to the downgrading of the accident and emergency service in Monaghan;

—noting the 33 hour wait by an ill woman on a trolley in Limerick Regional Hospital recently;

—noting the determination of the Minister for Health and Children to implement the disastrous recommendations of the Hanly report;

calls on the Government to drop the Hanly report and to upgrade the accident and emergency service currently available in general hospitals all around the country in order to ensure that every patient in need of a service gets the service they need when they need it, and to further ensure that the crisis in the maternity service is not allowed to deteriorate further.

I am happy to move this motion on behalf of the Labour Party group. The reason for tabling it — we appear to debate health a great deal in this House — is that the issue cannot be ignored. The state of our health services is one of the major preoccupations and concerns of the public. That is not the main reason one would table a motion, although it is a good one. It is because our role as an Opposition group, particularly in Private Members' time, is to seek to make the Government accountable for its actions and also to engender public debate about Government policy, Government decisions and to raise in a public arena matters of major concern.

Last week when I considered what we should discuss in Private Members' time it appeared that issues around health were at the top of the agenda, particularly the delivery of maternity services, the crisis in acute services in the Monaghan area, due directly to Government policy in regard to Monaghan General Hospital, the 33 hour wait by an ill woman on a trolley in Limerick Regional Hospital, which was highlighted in the media last week, and the determination by the Minister for Health and Children to implement the disastrous Hanly report, which is the area on which I wish to concentrate. My colleague, Senator Tuffy, who will second the motion, will speak on the issue of maternity services, which is appropriate considering that she is the most recent mother in the House.

I shall speak about the position in Monaghan and the situation in Limerick, with which I am quite familiar, given that I live near Limerick. The Minister of State at the Department of Health and Children, Deputy Tim O'Malley, whom I welcome to the House, may be aware, as I am from staff in Nenagh General Hospital and people I have met, that people from Limerick and its environs are using the accident and emergency service in Nenagh because they cannot get into Limerick Regional Hospital. If they go to Limerick to access the accident and emergency service they have to wait hours and sometimes two days. I know of people who were sent to Limerick Regional Hospital from Nenagh hospital with fractures and were there for almost two days. I spoke to a lady recently who spent almost an entire weekend in the hospital's accident and emergency unit despite it being a so-called designated hospital under the Hanly recommendations. People from the Limerick area are travelling to Nenagh hospital to use its accident and emergency service because of the horrendous delays in Limerick Regional Hospital.

A debate took place in the other House last week on the position in the north east. I have read that debate. I specifically wish to raise one comment made by the Tánaiste and Minster for Health and Children, Deputy Harney. In her remarks the Tánaiste made it clear she is determined to implement the Hanly reforms. That was the first time she made it clear she would do so and it is one of the reasons the motion is before the House. The Minister of State, Deputy Tim O'Malley, contributed to the debate. The Tánaiste stated: "The board proposes to recruit five additional non-consultant hospital doctors to facilitate the early restoration of 24 hour, seven-day medical cover to Monaghan General Hospital, at an estimated additional revenue cost of €500,000 a year." She went on to say that revenue funding for ten additional beds has been approved.

The language used by the Tánaiste is the same language that is used in regard to Nenagh hospital — the notion of 24 hour, seven-day medical cover by non-consultant hospital doctors. Non-consultant hospital doctors have also been recruited for Nenagh hospital. This is a clever play on words and it raises the question as to when an accident and emergency service is not an accident and emergency service. It is not an accident and emergency service when surgical services are removed. It is notable that in Monaghan General Hospital surgical services are being removed, therefore reducing Monaghan to what the other hospitals in the Hanly recommendations should provide, namely, 24 hour, seven-day medical cover.

The provision of medical cover effectively amounts to a minor injuries clinic. Without the backup of consultants on site and surgical services it cannot be said to be an accident and emergency service. We can see from the Monaghan area what are the implications. The family of Mr. Benny McCullagh know them. He was a man who lived very close to Monaghan General Hospital and who died because the hospital could not treat him as it did not have the acute service required. That is the consequence that will follow the implementation of the Hanly report. I have no doubt that what is happening in Monaghan is a test case in this regard. If it can be implemented in Monaghan and in the mid-west, Hanly II will be rolled out and the reform will be in place. I also do not doubt the total determination of the Minister to do that. I ask her to come into the House and state that in clear terms. If she does not attend the House this week I ask the Minister of State to state clearly that it is the Government's intention to implement the Hanly reforms because it believes that is what is best for the patient. There is a body of opinion that believes that.

However, the fundamental basis on which Hanly is positioned is totally flawed. In that regard I refer not only to the report itself but to an analysis of it prepared by Ms Catherine McNamara, a health economist, on behalf of the hospital services action group. Ms McNamara is not the only person to have pointed this out. In this widely available document, which was published some months ago, she points out that the evidence for the basic proposition in the Hanly report, namely that higher volume hospitals produce better outcomes, is flawed. The statistics and evidence to which the report refers are misinterpreted.

The Hanly report states that larger volume hospitals produce better patient outcomes. It refers to the York report in that regard, yet the latter report came to the exact opposite conclusion. The members of the National Task Force on Medical Staffing did not read the York report or, if they did, they chose to interpret it in a different way. Therefore, criticisms of the Hanly report are not the wild rantings of culchies from the regions, whether it be Monaghan or north Tipperary, as one would have it from certain urban commentators, particularly those from Dublin. They are not the mad rantings of country people who allegedly want a hospital at every crossroads. The fact is that the very foundation of the Hanly report is totally different from what the task force says it is and therefore the policy is flawed. However, the Government, by way of its single-minded, "must be right" approach, is determined to wreck the health service of communities throughout the country with its disastrous policies. An example is the downgrading of Nenagh accident and emergency unit, which would result in thousands more using an already overcrowded facility in Limerick.

If one asks why the Government wants to do this, one will start to see clues. Obviously there is another agenda, which in turn is one of a series of agendas. An article in The Irish Times from Saturday, 13 November 2004 offers a clue to the nature of the real agenda: "The Tánaiste and Minister for Health, Ms Harney, will signal next week [presumably this week] that she wants public hospitals to enter into agreements with the private sector to develop additional medical facilities on their campuses." Of course this is happening already. The Minister will know that there were recent tenders for the building of a private hospital close to the existing public facility in Limerick. This indicates that the real agenda is to build private facilities and to have a system in which one buys one's health care. This is the bottom line.

We see evidence of this approach in many areas, particularly in the tax breaks for capital funding for facilities for the care of the elderly. Such facilities are not capable of taking and do not want to take elderly people with medical conditions who cannot leave hospitals because they have nowhere to go. Such people are, according to a horrendous phrase, the "bed blockers". Nursing homes can only take relatively healthy old people. Hospitals have to take the medical patients because the nursing homes cannot afford highly qualified nurses and medical personnel to care for them.

It is clear that the PD agenda of the Government, which is accepted by Fianna Fáil, is to have private facilities in public hospital premises. This, on its own, is not necessarily bad, except that underlying the agenda is the principle that we should be buying our health care. The national treatment purchase fund is another example of this. I fundamentally object to the idea that one should have to purchase health care in a private market. Under this British system this would be called Thatcherism.

If one cannot afford to buy health care, where will one get it? The public system is being run down and the idea is to force people to use the private system. There is considerable evidence of this, which, unfortunately, I do not have time to set out this evening. I hope we will have a comprehensive debate on the Hanly report in particular. I call on the Minister to think again. It is not too late to reverse this disastrous health policy and to realise that the circumstances in Monaghan will replicate themselves around the country. Is that what the Government intends to achieve?