John Moloney (Laois-Offaly, Fianna Fail)

I apologise on behalf of my colleague, the Minister for Health and Children, who could not be present. I thank the Deputy for raising this matter.

The transformation programme for the north east involves widespread and fundamental change. It is designed to build a health system that is in line with the model of care emerging internationally. This can be achieved by centralising acute and complex care in order that clinical skill levels are safeguarded by ensuring access to a sufficient throughput of cases. The need to reconfigure health services in the north east was highlighted, along with identified patient safety and quality of care issues, in the 2006 teamwork report to the HSE: Improving Safety and Achieving Better Standards - An Action Plan for Health Services in the North East. This report demonstrated that the service configuration in the region was unsustainable.

This report demonstrated that the service configuration in the region was unsustainable.

The first step in transforming services in the north east is to develop a fully integrated regional health service to ensure that people in the north east have local access to both routine planned care and immediate life saving emergency care. The HSE began this process with the transfer of acute inpatient services from Monaghan Hospital to Cavan General Hospital on 22 July 2009, which was supported by the opening of the medical assessment unit, MAU, in Cavan General Hospital in March 2009, the development and implementation of an enhanced ambulance and pre-hospital thrombolysis service, together with enhanced primary care services.

The immediate focus is now on service reconfiguration in the Louth and Meath area, which involves transferring acute services to Drogheda, strengthening existing medical services, enhancing emergency department capacity, developing appropriate ambulance protocols, completing surgical reconfiguration and providing additional community packages of care. The new emergency department at Our Lady of Lourdes Hospital Drogheda will provide an improved service to both patients and staff within the Dublin north east region. This new department, which encompasses best design principles, is approximately 1,300 m2 in size, and represents a 300% increase in size from the existing department in use today. The increased size of the department and the specific entrance points will allow patients access the department in a more timely manner by segregating patients at first point of contact with a separate entrance for ambulance and stretcher-borne trauma and another separate entrance for the walking wounded, as it were.

Once the department opens, all paediatric patients presenting to it will be assessed and treated in a designated paediatric area. Adult patients will be allocated to one of three distinct assessment and treatment areas; the minor injuries department, the major treatment department and the resuscitation area. Patients will have more immediate access to diagnostics with an on-site emergency department, dedicated X-ray facility and staff. Patients will benefit from more immediate treatment, enhanced outcomes and a more patient-focused environment. Staff will benefit as the new infrastructure and design of the department will facilitate easier access to patients and ultimately earlier admission or discharge.

The increase in size of the emergency department means that staffing levels must be examined. That is the nub of the issue. Under the 2010 employment control framework the filling of posts is in the first instance to be by redeployment from within current services. Once redeployment options have been explored, external recruitment may then proceed in line with this framework. The HSE is committed to opening the new emergency department at Our Lady of Lourdes Hospital in Drogheda at the earliest possible date. Negotiations are in progress between the HSE and unions in order to agree a mechanism to redeploy staff at all grades and in some instances to consider outsourcing or contracting. Unfortunately, it has not been possible to reach agreement on these matters to date but the HSE will continue to try to achieve an agreement as quickly as possible in order to open the facility.

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