James Reilly (Dublin North, Fine Gael)

I remember the meetings to which the Deputy refers. I certainly know that at no time did I promise to keep the accident and emergency department in Navan open indefinitely. I have made it clear, however, since becoming Minister for Health, that with accident and emergency departments in Cavan, Navan and Blanchardstown, all on the M3, and another in Drogheda, in the longer term the position at the accident and emergency department in Navan must be reviewed. As the Deputy rightly points out, in the current situation where there is such a capacity issue, there is no question of a reduction in the service provided in the accident and emergency department in Navan hospital.

I acknowledge the hard work and dedication of the accident and emergency services at Our Lady's Hospital, Navan. Staff ensure patients are treated in a dignified and respectful manner, even when they might have to wait for treatment or admission.

The Government is committed to securing and developing smaller hospitals to provide more services, not fewer. However, these services, including emergency care, must be right and safely delivered. HIQA has pointed to the type of patient who can be safely treated in different hospitals, depending, in particular, on the volumes of patients seen with each condition. Smaller hospitals treat only small numbers of patients with complex or acutely life-threatening conditions in scheduled and emergency care. This means clinical staff do not treat certain conditions frequently enough to ensure their skill levels. These patients may also require specialised resources, including advanced life-support machines and complex surgical facilities which it is not feasible to provide in many small hospitals. Accordingly, for certain conditions, small hospitals cannot ensure the best care and patients need to be directed to the care pathway appropriate to their needs.

The HSE clinical programmes delineate acute hospital services, based on the safe provision of patient care for given facilities, staff resources and local factors. Under this framework, the future growth in health care for local populations is firmly in local hospitals for ambulatory care, diagnostics and rehabilitation and with close links with primary health care. Suitable services for expansion in smaller hospitals include minor injury units and urgent care centres; day surgery, including cataracts, hernia and other surgery safe for day provision; ambulatory care, including chronic disease management and assessment for older persons; medical services, including cardiac failure clinics, cardiac rehabilitation and chronic obstructive pulmonary disease outreach clinics; rheumatology, dermatology, diabetic day centres and rehabilitation; and diagnostics, including blood tests, X-rays, endoscopy and bronchoscopy.

The HSE is reviewing all services against its cost containment plans and a number of proposals are being considered for Navan. The HSE is focusing on improving accident and emergency department and related services at Drogheda. The HSE has been engaging with Navan Hospital Alliance and will continue to do so. Under the public service agreement, there will also be engagement with staff and staff representatives. However, the HSE has informed my Department that there will be no significant service changes in Navan or Dundalk pending the outcome of the discussions. We must ensure hospitals deliver on the SDU's access requirements, within Government budgets and HIQA's safety and quality requirements. The best way forward for smaller hospitals is to operate initially within hospital groups and ultimately within the proposed independent hospital trusts. Consultations on these groups will commence this week with hospitals and other key stakeholders.

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