James Reilly (Dublin North, Fine Gael)

Smaller hospitals now treat small numbers of patients with complex or acutely life-threatening conditions. It is not easy for clinical staff to maintain their skill levels in these complex cases. As such, small hospitals have difficulties in ensuring best outcomes. However, where it is necessary to transfer more complex services from smaller to larger hospitals, the transition must be managed. We want to improve the quality of the service. Key to quality will be the HSE clinical programmes, HIQA small hospital framework recommendations and the programme for Government policy on acute hospital services, including independent hospital trusts licensed by a patient safety authority and a universal health insurance health system. Under the framework, growth in local hospitals will be in ambulatory care, including chronic disease management and day surgery, diagnostics and rehabilitation, with close links to primary health care for the local population.

Smaller hospitals can deliver faster access for patients by increasing elective services in selected specialties. In turn, larger hospitals need to utilise smaller hospitals to meet access requirements for the more complex care only they can provide. We can and will expand the services safely delivered in smaller hospitals, in particular in day surgery, ambulatory care, medical services and diagnostics. It makes little sense to retain all of these services and in so doing clog up larger hospitals. This framework is the first of its kind to describe a genuine and positive role for smaller hospitals. It will be developed further as our reforms take hold and local communities, health professionals and other stakeholders will continue to be consulted as it develops.

The transformation will not be easy and will not happen overnight. It requires good planning and positive engagement with communities. Successful implementation of this approach means we must also transfer the right services to smaller hospitals. Thus far, there has been the transfer of services to larger centres for reasons of safety. We must rebalance this approach in order that smaller hospitals can develop confidence about their future roles. The flow of activity needs to reverse for less complex workI have in the past drawn the analogy of sending one's ten year old Volkswagen to a Ferrari testing centre which, while it will do a great job, is hardly necessary when the local garage would do the job just as effectively and a lot more conveniently. It is important that smaller hospitals continue to provide immediate and urgent treatment in less complex, non life-threatening cases. The expert advice available emphasises that urgent care centres can manage typical presentations to emergency departments, most of which are not complex or life-threatening.

In line with HIQA and international evidence, we are implementing the best care model for complex and emergency cases, to transport seriously ill or injured patients to the centre best equipped to treat them. Ambulance personnel are highly trained and skilled clinical staff. They treat patients immediately at the scene and get them to the most appropriate, not necessarily the nearest, hospital as quickly as possible. Putting in place urgent care centres with ambulance bypass protocols to bring seriously ill patients to larger hospitals is not about closing emergency services, rather it is about making services safe. I am committed to this approach so as to ensure very ill patients have the greatest chance of survival.

Emergency ambulance services are not being diminished. Traditional work practices within the national ambulance service are changing as stations move from on-call to on-duty status. This move to on-duty status means highly trained paramedic crews will be in the stations or their vehicles to respond to calls rather than having to be called out to the station, which is inevitably slower when responding to emergency calls. This is a better way to provide the service and better for patients. On-duty status allows a modern emergency response service to be provided, including paramedics, advanced paramedics, community first responders and GP out-of-hours services, working together to respond to emergencies. This approach is consistent with international best practice and will ensure compliance with HIQA response times and quality standards.

Apart from the strategic initiatives I have addressed, there is a series of positive developments to which I can point. The new unit at St. Vincent's University Hospital, comprising 100 single rooms and provision for cystic fibrosis patients, is on target to open in April next year. A few days ago I opened the new colposcopy unit at the Coombe Women's Hospital. Also, resources have been made available to upgrade the hospital's theatre and labour suite to bring it up to international standards. As I mentioned, Tallaght hospital is now operating within its monthly budget, with reduced numbers waiting in its emergency department. Management enhancements will shortly be put in place at Limerick and Galway hospitals. Much improved, more up-to-date information is available on waiting lists, with weekly reporting in most hospitals to the special delivery unit enabling the addressing of individuals waiting more than 12 months for procedures. As I said previously, we are for the first time driving not in the dark but with full headlights on. Before the introduction at Our Lady's Hospital, Navan of a money follows the patient system initiative, no patients were admitted on the day of procedure. Currently, 80% are admitted on the day of procedure, providing for much greater efficiency. Cappagh National Orthopaedic Hospital, in which much greater numbers are being seen, has increased its day of admission figures by 45%.

On Deputy Healy's contention about smaller hospitals, I ask him to consider Louth County Hospital as a case in point. While in 2009 there were no care of the elderly cases at the hospital, thus far in 2011 there have been 388. The figure for haemochromatosis patients treated with phlebotomy was 535 in 2009; thus far this year it is 1,783. In respect of colposcopy, the figure in 2009 was nil; in 2010 it was 2,083. The number of surgery cases is up from 3,400 to 3,600; in respect of radiology, it is up from 534 to 3,000 plus, while the number of outpatient assessments is up from 933 to 974. This is the future for the small hospital, namely, appropriate work carried out safely, rather than trying to be all things to all men, with dire consequences.

Regulations to allow pharmacists to deliver the flu vaccine at much reduced cost and with increased accessibility are now in place. Also, later this week I will sign regulations to provide for a fall in fees to GPs from €42 to €28.50. On the catch-up programme for HPV, the cervical cancer vaccine, all girls in secondary school will be vaccinated during the next three years.

The choice for the Opposition is simple: swim against the tide or join us in making the health service a place wherein patients feel safe and those who work in it can feel proud.

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