Denis Naughten (Roscommon-South Leitrim, Fine Gael)

I thank the Ceann Comhairle for giving me the opportunity to raise this issue on the Adjournment. I am extremely disappointed that the Minister for Health and Children walked out of the Chamber approximately ten minutes ago and did not think it worth her while to be present for this debate. Sadly, neither she nor a representative of her Department considered it worthwhile to hear my contribution this evening.

I wish to raise the attempts by the Health Service Executive to downgrade Portiuncula Hospital and Roscommon Hospital by instructing them to report directly to the general manager at University College Hospital, rather than to their own managers who operate the hospitals on a daily basis. The HSE claims the objective is to expand the scope of the Galway general manager, which is the start of the restructuring of hospitals in the region and which will result in the downgrading of the skill mix and services available to the people of counties Roscommon and Galway who avail of services at both Roscommon and Portiuncula hospitals. The proposal to introduce a new reporting structure will mean that the hospitals will be managed from Galway and this is the thin end of the wedge. Professor Brendan Drumm has made it clear in the past that he wants accident and emergency departments and surgical services transferred from both hospitals to Galway and this change to the management structure is the first step in that process.

The HSE has continuously misrepresented its intentions regarding Roscommon and Portiuncula hospitals and there is no doubt that if the executive gets away with this change further, more significant transfers of medical capabilities will take place. The hidden agenda behind this process is to move accident and emergency and surgery departments from both hospitals to Galway. Currently Galway hospitals are struggling to discharge patients and under the new management structure the patients will be operated on in Galway and then transferred back for respite care to either Portiuncula or Roscommon hospitals. This will dramatically reduce the capacity of both local hospitals to deal with emergencies and ongoing surgical procedures. This modus operandi was used in respect of both Ennis and Monaghan hospitals where the management structure was downgraded initially followed by services.

The HSE has issued weasel words in response to concerns raised locally and it stated:

In the course of recruiting a new general manager for Galway University Hospitals, a national decision was taken to expand the role to include Portiuncula Hospital and Roscommon County Hospital. There is no question of the downgrading of any hospital as a result of this expanded role.

This is a blatant lie on the part of the HSE. In the final quarter of 2009, a report on a review of surgical specialties in the western region to identified realistic solutions for the medium term that would take five years to implement. The report states the only value of conducting such reviews is they would act as a guide to the decision-making process. Regarding the HSE strategy for acute services, it states: "The national strategy to reconfigure acute services with a smaller number of large hospitals providing the full range of acute care and all emergency services, with smaller hospitals providing elective procedures ... raises particular issues" in the western region.

The report further states regarding emergency services that "Portiuncula, being closer to Galway, and with the completion of the M6 motorway to Galway and Dublin, could conceivably transfer its emergency services to Galway in the nearer future" but there are issues relating to the planning timescale and capacity to deal with the additional demand following the closure of the accident and emergency department in Portiuncula Hospital. It is reasonable to assume acute services will remain in the hospital for the a period of five years while the HSE has to time to upscale its capacity in Galway University Hospitals. The report goes on to state Roscommon County Hospital

...will be reconfigured in the nearer term to provide only non-emergency services, following the process now underway or completed in Monaghan, Louth, Nenagh and Ennis. The medical and surgical emergencies which currently present there will need to be dealt with elsewhere, and this must be planned for.

The report was produced within the HSE and it has not been published. However, it clearly identifies the executive's intention and the proposed change in the management structure is the first step in implementing this plan. In addition, the executive received a report 12 months ago from Prospectus Consultants, which reviewed the critical care services in all the acute hospitals in the State, including the intensive care service at Portiuncula Hospital and the coronary care service at Roscommon County Hospital. For some unknown reason, neither the HSE nor the Minister for Health and Children is prepared to publish the report, even though taxpayer's money was used to compile it. The report copperfastens the ethos outlined in the review of acute services and it is the sole purpose of the HSE to put the new structure in place and to transfer both surgical and accident and emergency services from the two local hospitals to Galway University Hospitals. That is unacceptable to the people of counties Galway and Roscommon and we will oppose it tooth and nail.

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