Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I thank the Deputies for giving me the opportunity to again update the House or plans for Portlaoise hospital. The Government is committed to securing and further developing the role of Portlaoise hospital as a constituent hospital within the Dublin Midlands Hospital Group, which also includes St James's, Tallaght, Tullamore, Naas and the Coombe hospitals.

Any change to services at Portlaoise hospital will be undertaken in a planned and orderly manner and will take account of existing patient flows, demands in other hospitals and the need to develop particular services at Portlaoise hospital in the context of overall service reorganisation in the Dublin Midlands Hospital Group. Decisions will be made on the basis of maximising patient safety and patient outcomes, not financial considerations, and that is the only guarantee I can give.

In recent months, substantial investment and enhancement measures have been put in place to ensure a safer level of service at the hospital. Maternity services will be upgraded following a memo of understanding between the HSE and the Coombe hospital to provide a managed clinical maternity network within the Dublin Midlands Hospital Group. Furthermore, improvements in Portlaoise hospital generally include a number of additional consultants posts in anaesthetics, surgery, emergency medicine, paediatrics, obstetrics and medicine, and an additional 16 midwifery posts. It is also intended to provide a new acute medical admissions unit and to expand day surgery, and a new paediatric emergency triage unit is being developed.

The group CEO has set out clearly what is being proposed for Portlaoise hospital and has made it clear that maternity, acute medical and paediatric services will continue, as will 24/7 anaesthetics, and that elective day surgery is likely to be expanded. Patient safety and best clinical outcomes for patients must come first and, as Deputies are aware, last week the HSE advised that complex surgery, such as bowel surgery, in Portlaoise hospital will be transferred to St. James's Hospital or Tullamore hospital as the volumes are too low to maintain the requisite expertise of clinical staff.

Indeed, the HIQA report specifically criticises the HSE for recruiting additional consultant surgeons at Portlaoise hospital when patient numbers were not sufficient to allow them to maintain their skills. Anyone who is perpetrating the nonsense that this is about resources needs to read and understand that report. The HSE was criticised for hiring more consultants and overstaffing a service, thereby making it unsafe because the patient load was not adequate.

Currently, all categories of surgical patients can arrive at the emergency department at Portlaoise hospital. The hospital group, in collaboration with Portlaoise hospital and other hospitals in the group, need to plan for how some of these patients can be transferred and cared for in the most appropriate high volume surgical services within the group.

Deputy Stanley referred to the golden hour. It is important to understand to what that applies and means. It is particularly relevant for something like an ST elevation MI, STEMI, where ideally one needs to be in a cath lab within 90 minutes of diagnosis. Going to Portlaoise hospital now is not a good idea if one has a STEMI because it does not have a 24/7 cath lab. People with STEMIs are not taken to Portlaoise hospital because they will not be treated within the golden hour. The same applies to major trauma orthopaedics. Such patients are not and should not be taken to Portlaoise hospital, because they need to be taken to a major trauma centre. That is why they are taken to Tullamore hospital.

The important point to understand here is that work is being done to strengthen services in Portlaoise hospital from a patient safety and quality perspective and to ensure that services currently provided by the hospital that are not viable are discontinued and those that are, are safety assured and adequately resourced.

This is also in keeping with the recommendations of the report by HIQA into services at the hospital and indeed other hospitals.

The emergency department at Portlaoise hospital has between 30,000 and 40,000 attendances per year. Its patient experience times are the best in the country. There is no question, therefore, of it being closed. The only question that has emerged, as raised by the chief executive officer, is whether 24-hour services are sustainable. No decision in this regard has been made or can yet be made. In the case of Navan, for example, surgical services are no longer provided but the hospital continues a 24-hour emergency department for medical patients and those with minor injuries.

I strongly agree that any proposal to end 24-hour services at Portlaoise could not be advanced without a clear and credible plan to provide additional capacity at Tullamore, Naas and Tallaght hospitals, which are already overstretched. At the same time, I hope Deputies understand that a hospital that does not and cannot do complex surgery is not the best place to take a patient who needs complex surgery in an emergency, for the obvious reason that it cannot be done there.

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