John Crown (Independent)

I did not have an opportunity to consult HIQA on the mortality figures in local hospitals, but the closure of services in Roscommon is a critical issue. I am not an instinctive "save our hospital" type of person because calm, rational and systematic decisions need to be made about the configuration of hospital services. However, these decisions must keep in mind two key variables. The first is that larger centres with a higher throughput will generally have better outcomes than smaller centres dealing sporadically with the same health problems. The second is that local people will enjoy some improvements in the quality of their care if they have local access. A balance has to be struck between these variables. For that reason, I will not state whether services in Roscommon should be closed or remain open.

I have strong opinions about where cancer care services should be provided, but I am not as certain about the emergency department at Roscommon County Hospital. However, the decision-making process which apparently led to the precipitous decision to discontinue emergency services at Roscommon County Hospital leaves something to be desired. I ask the Leader to arrange for the Minister for Health to come to the House with the figures and, if necessary, a good old-fashioned US Congress-style board because I, for one, want to understand the numbers which led to the statement that the mortality rate in Galway was 5% compared to 20% in Roscommon. As a professional, there are not many areas of my speciality in which two treatments gives rise to a 200% difference in outcome. As I thought there was something odd in the figures, I sought information from the folks in Roscommon and the figures they supplied indicate that there were approximately 430 admissions to the coronary care and cardiac unit last year in Roscommon, with a mortality rate of approximately 5%. I have also seen the figures for the patients who died while in the care of Roscommon County Hospital in 2011 and believe most of those who died could not have been saved in Mayo Clinic, Massachusetts General Hospital or anywhere else. They included patients who had had devastating strokes complicated by pneumonia and elderly people with multi-system complications and no chance of recovery.

When I heard the suggestion that matters were so bad in Roscommon that not only was it necessary to close the service but that it had to be done as an emergency, I was discomfited on behalf of my good colleagues working at the hospital who for many years had provided a service on a shoestring budget and, in some cases, built modern cardiac services with limited or no support from successive Governments. They have managed to achieve and deliver a reasonably good service for the people of County Roscommon. The argument may be made in favour of centralising cardiac and other emergency services in Galway and this should be part of the national debate. However, promising in advance of an election that -----