A number of Fianna Fáil backbenchers have indicated their opposition to the potential effects of the Hanly report on hospitals in their constituencies.
During a Dáil debate on the recommendations of the report on medical staffing in hospitals, TDs welcomed some of its proposals but at the same time insisted there should be no downgrading of their local hospital either in the pilot regions and Ennis or Nenagh.
Others warned of their opposition should "Hanly 2" be visited on their constituency.
Ms Maire Hoctor, North Tipperary Fianna Fáil TD told the Dáil that "we need to retain our accident and emergency services as we know them and enhance our ambulance service by providing it with upgraded equipment. We want to keep our services in Nenagh".
Ms Hoctor backed the report at the public meeting in Nenagh at which her constituency colleague the Minister for Defence, Mr Smith, subsequently voiced his first criticism of it and of the downgrading of Nenagh hospital.
Ms Hoctor said that following the meeting "concerns have emerged regarding not so much about what is said in the Hanly report as what is not said in it". From the beginning she "recognised the benefits for Nenagh hospital" in the report's recommendations but "I share the concerns of GPs and the public about the provision of a doctor for 24 hours a day, seven days a week.
"It is unthinkable and unacceptable that in the long-term, a doctor would not be on duty at Nenagh hospital between 9 p.m. and 8 a.m.
"The current provision of an anaesthetist on call overnight for accident and emergency in Nenagh is paramount and must stay."
Mr Tony Killeen (FF, Clare) said there was much in the report that was positive but "there are grave concerns at Ennis Hospital, and in the area, about the proposals for accident and emergency services, which I share".
It was "not at all clear what criteria were used in designating whether hospitals should be general or local". That "is a sticking point for Ennis because on further examination of the report it does seem that Ennis meets the criteria for a general hospital".
Mr Michael Finneran (FF, Longford-Roscommon) warned that if the second Hanly report made recommendations about downgrading Roscommon County Hospital "this deputy and the advocates of that report will be on a collision course".
He said that "I will oppose it and I will oppose anybody in this House who attempts such action".
However, another Government backbencher, Ms Fiona O'Malley (PD, Dún Laoghaire) believed that with the publication of the report "we have crossed a Rubicon on health reform and there is no turning back".
She said that "Government policy must never be sacrificed on the altar of the parish pump".
Ms Marian Harkin (Ind, Sligo-Leitrim) said the casualty unit in Manorhamilton hospital in Leitrim closed two years ago, but the ambulance service has not been upgraded, nor have the roads and infrastructure been improved to facilitate better access to Sligo General Hospital.
She asked: "Is Manorhamilton hospital to be a blueprint for what we can expect?"