Mary Harney (Dublin Mid West, Independent)

I thank Deputy O'Dowd for raising this issue. It is ironic that we are discussing this issue some 90 minutes after discussing patient safety. I assure the Deputy that everything being done in this regard is being done on the basis of the best clinical advice available to me and the HSE. I am conscious there are concerns and worries among the population of north Louth; that is to be expected. However, I am equally aware that the most senior clinicians in this country, led by Dr. Michael Power, who leads for the HSE in regard to critical care and is based in the Mater Hospital, a man with enormous experience and expertise and a leader among his peers, have strongly recommended that this transfer should take place now rather than in the autumn.

As the Deputy is aware, it was intended that this transfer would take place in October, in line with the reconfiguration. The new accident and emergency department has opened in Drogheda and is four times bigger than the previous such department. The minor injuries unit will operate from 9 a.m. until 8.pm. in Drogheda. There is an additional 24 hour seven day week ambulance, to be based in north Louth. When patients are seriously ill and must be taken to a hospital the critical factor is the advanced paramedics who arrive on the site. The Deputy is right to emphasise the significance of the ambulance and paramedic support. In every system throughout the world at which we looked, pre-hospital care and first point of care is often the most significant intervention, especially when a person experiences a heart attack. He or she can be brought to a place and be offered the best possible chance of recovery. We know that some people with heart conditions who reach the appropriate place within two hours and have stenting can effectively reverse a heart attack.

In the first place, the pre-hospital service is important and that has been strengthened in the area. The ambulance service has assured us it is taking measures to strengthen and increase the resources available. Second, there is an additional 24-7 ambulance to be based in north Louth. The ambulance service took the view that the current service in Monaghan should be switched to Carrickmacross to provide better cover for the catchment. In addition, Daisy Hill Hospital will be available. There are protocols for patients to be taken to the hospital if that is appropriate.

Louth County Hospital has a good future. Its future will be in doing different things, such as more elective work and more diagnostics. My colleague, the Minister, Deputy Dermot Ahern, has strongly made the case for a colonoscopy service to be provided there. From 1 January we will be providing a national colorectal screening programme. The Minister, Deputy Ahern, asked that the colonoscopy service for the north east be based in at Louth County Hospital and I strongly support that. I see no reason that we cannot make that happen. I know it is the view of the clinical director, Dr. Ó Branagáin, and through discussions with the cancer control programme, I will ensure that Louth County Hospital is where this service will be provided in the region, rather than at Our Lady of Lourdes Hospital, which will always be under pressure as one of the main hospitals in the north east.

Reconfiguration of hospital services is always challenging and worrying for the public because people become very reassured by having a hospital in their midst. However, we all want the best possible care for members of our families if they are sick. We want them to be taken to the most appropriate place, wherever that is. As they say in the medical world, the right people in the right place at the right time provide the best possible result. The north east has five acute hospitals for a population of 300,000. We are moving into a licensing regime for acute hospitals, probably beginning in 2012 or 2013. The legislation will be published by the end of this year or the start of 2011. We want public consultation on that. The standards that will have to be met by the hospitals will be published next month in draft form by HIQA, and again will be subject to public consultation. These will form the basis of the new law, which has been recommended by most people, including medics, nurses and doctors, as well as the patient safety commission.

At a time when we are talking about licensing kennels and looking after dogs, it is ironic that we still do not have a licensing system for hospitals in this country. It is long overdue and it is going to happen. Everything we are doing is in preparation for that licensing regime. If the system was in operation today, we know that many of the services in some of our hospitals would not be sustainable and would have to be moved.

We are aware of the need to strengthen the ambulance service in the region. In particular, we are aware of the need to make sure that more things are diverted to hospitals such as Louth County Hospital, so that the community will know that the majority of their health needs can be met in the region. It is only when we are acutely ill or have a complex health problem that we will need to go to Drogheda or Cavan. Up to 95% of our health requirements can be dealt with at primary care or in hospitals such as Louth County Hospital.

I thank the Deputy for raising this issue and I assure him we are mindful of the challenges. Change is never easy. I accept what the 24 GPs have said, but I assure him that these decisions are being based on the best clinical evidence available to us. That is not to suggest that the general practitioners do not provide good clinical evidence, but in this case moving critical care and acute care is based on the advice of the experts in that field. This is why it is happening now rather than in October, for when it was originally planned.

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