Joe O'Reilly (Fine Gael)

I wish to share time with Senators Twomey and Doherty.

I also welcome the Minister to the House. Contrary to what she just stated, health services should be delivered locally, where possible. This is critically important, as people want to remain in their locality because they respond best in that environment. That should be our guiding principle and we should only opt for an alternative when the evidence is compelling. The burden of proof should be to establish a patient should not be cared for locally rather than the reverse. The Minister has made a compelling case for centres of excellence and empirical evidence suggests they should be provided but it is not right that, north of a line between Dublin and Galway, a centre of excellence will not be provided. That is active discrimination against a significant proportion of our population and it is unacceptable.

I am not convinced and I do not have sufficient evidence that there is budgetary provision for the centres of excellence and the necessary ancillary facilities. How will next week's announcements impinge on resources? We were told in 2007 there would be no cutbacks but there has been a plethora of cutbacks since then. How do we know the resources will be available to provide the centres of excellence? If we are not convinced of that now, why proceed with dismantling existing facilities before the centres of excellence are in place?

Take the example of primary care. There are not enough general practitioners to implement primary care. The concept of primary care is great but there are no resources. There is also the example of Monaghan hospital, which is now effectively closed. There were 3,000 admissions per year to that hospital while Cavan hospital has 5,000 admissions per year. The total is 8,000 and that number will now be loaded onto Cavan hospital, but there is no evidence that it has adequate resources to cope with it. In fact, one of the wards in Cavan hospital has no staff resources. While the philosophy and the grand statements are fine, there is no evidence of resources to support them. That has been the case with primary care and in a range of services and hospitals throughout the country.