John Kelly (Labour)

I welcome the Minister of State, Deputy Róisín Shortall. My only regret is that the Minister for Health, Deputy James Reilly, is not present, as he is the man to whom I should be addressing all my concerns about the health service.

This legislation, while welcome, is eleventh hour stuff. It has come too late for the accident and emergency department in Roscommon County Hospital. Most people in County Roscommon are asking where it has all gone wrong. Somebody famous once said that to solve the problems of the future, one had to look to the past. During the 1960s, 1970s and 1980s a matron ran Roscommon County Hospital. That was the only system people knew. There was one matron; the floors and walls were scrubbed and there were no infections, including MRSA, in the hospital. There were nurses and a consultant. Today there are consultants, directors of nursing, assistant directors of nursing, clinical nurse managers, grade 3, clinical nurse managers, grade 2, night duty administrators, night superintendents, clinical directors, etc. There were 11 grade 8 personnel in the country in the period to which I referred; there are 717 today. That is where it has all gone wrong and why we do not have an accident and emergency service. It is not a question of patient care but of the fact that we have no money. We have wasted money on the HSE. Since it was established, we have wasted taxpayers' money in the delivery of a second-rate hospital service and health service generally.

I totally agree with Senator John Crown. What we are engaging in is a Band-Aid exercise. However, I would accept a Band-Aid to fix the problems in Roscommon County Hospital in the short term in order that in the longer term it would be possible to deliver the service the people who live its isolated, rural catchment area deserve.

With regard to the word "reconfiguration" which the HSE has been using for the past seven years, no one from it has explained its meaning. No one knows what it means, although I have my own ideas as to what it might mean. The people are afraid. We are suddenly hearing the word "reconfiguration" again, but, unfortunately for the people of County Roscommon, it is when we are being told for the first time that their accident and emergency department is to be closed down. In spite of this, to date no one has explained the meaning of the word "reconfiguration".

I have said to Senator John Crown that if he has a better vision for the delivery of accident and emergency services, let him put it in place before removing other services. Let him deploy advanced paramedics and let us prove to the people that, as soon as one has a heart attack, there will be somebody on a motorbike or in an ambulance to ensure one survives. We should prove this service works in tandem with an accident and emergency department before proceeding further. If it works, the accident and emergency department could be downgraded. However, one should not take away a department and say something else will be put in its place.

I attended a meeting last Friday week in Hawkins House. I guarantee the Minister of State that no one from HIQA or the Department of Health had a plan for the provision of an advanced paramedic team when talking about shutting down the accident and emergency service in Roscommon. They had no plan but will look at it.

Another point being bandied about by the Minister at present concerns mortality rates in Roscommon hospital being five times higher than is the case in Galway hospital. While that may be the case, I genuinely believe these figures are based on the fact that people in County Roscommon are so distant from an accident and emergency unit in Galway that could save some of these lives. It is that people are dying on the way to Galway and not that they are dying in the hospitals. All people in my situation want their local hospital to be up and running for their safety and that of their families.

I have a question for the Minister of State in respect of HIQA, which was set up by the last Government via the HSE. Who directed HIQA to set the bar so high that hospitals, such as Roscommon hospital, cannot survive or did it do so itself? Such hospitals cannot deliver the service that will deliver patient safety. Who set that bar so high? Was this done under the previous Government or did HIQA itself do so? If hospitals such as Roscommon hospital are unable to reach that bar, it simply is because of lack of funding and resources within the health service.