Jan O'Sullivan (Limerick East, Labour)
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I raise the issue of services in St. John's Hospital in Limerick and seek clarity on it in the context of the proposed so-called reconfiguration of acute hospital services in the mid-west. There are a number of concerns.

There is an accident and emergency department which is open from 8 a.m. until 8 p.m. and there have been suggestions this could be under threat. I do not believe it is but I would like confirmation that the department will continue to operate between 8 a.m. and 8 p.m. Will it operate five days or seven days per week? The facilities in Ennis and Nenagh are different because they are in operation 24 hours a day. The proposal is that they will lose hours but I believe this will not be the case with St. John's Hospital. Will the Minister of State clarify that?

According to the Teamwork-Horwath report, the suggestion is that the accident and emergency department in the hospital be a nurse-led facility. In the press statement by the Health Service Executive on the publication of the report, it was stated the department would be doctor-led, and I seek confirmation on this. This is in no way to show disrespect to nurses. What is the future of surgery in the hospital? There were questions raised over the possible removal of surgery facilities from the three smaller hospitals in the region but I understand that may not happen and St. John's Hospital may keep its surgery.

Almost all the ground floor of the hospital is closed for money saving reasons. It is a popular hospital in the centre of the city and there is great loyalty to it and fondness for it. Many people choose to go there if possible rather than going to the larger regional hospital. Will the Minister of State confirm that there will be full bed availability in the hospital and that cutbacks will not lead to bed closures? It is ironic that the Minister is talking about trying to provide more beds while beds are closed.

I visited the hospital some months ago and they showed me plans for an extension. There is space for this. The hospital is very efficient and there are plans for further services if they get permission for the extension. I seek clarification on this issue. St. John's Hospital is complementary to the Mid Western Regional Hospital in what it does. It has a very good minor injuries clinic which takes the pressure off the accident and emergency department in the regional hospital. This is recognised as being very efficient.

I hope the Minister of State's response will be positive. My understanding is that many of the issues I have raised will have a positive response. There is much uncertainty in the mid west and concern about the configuration of hospitals but today I seek a clear response on St. John's Hospital.

Mary Wallace (Meath East, Fianna Fail)
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I thank Deputy Jan O'Sullivan for raising this important issue. The HSE is engaged in an important process of reorganising acute hospital services. The first and utmost concern is patient safety so that people can have confidence in the services and the best possible patient outcomes can be achieved.

The HSE has commissioned a number of reviews on how acute hospital services should be organised, including the Teamwork-Horwath report on the mid-west which the executive has published recently. The report highlights the need for changes to be made in the provision and organisation of acute hospital services in the region. It is widely acknowledged that the current delivery of these services is too fragmented, carries increased risks for patients and staff and is not sustainable in the future.

The HSE has indicated that certain changes to the present arrangements for the provision of some acute services, including accident and emergency services, must be made in the interests of patient safety and also to make best use of the clinical resources available in the mid-west. The HSE has been engaged in a consultation process with key stakeholders as it formulates detailed plans relating to emergency care, critical care and surgical services in the region.

The HSE plans will involve the reconfiguration of acute hospital services into a network and their better integration with primary care services in the region, with a regional centre at the regional hospital in Limerick that will deal with complex and specialist cases. Health service delivery is changing and smaller hospitals can now meet much of the demand for less complex services, especially those that are done increasingly on a day case basis.

St. John's Hospital has played a prominent role for some time in the provision of health services in the mid-west. For example, consultant appointments to the hospital over recent years have been on a shared commitment basis with the regional hospital in Dooradoyle. In addition, the hospital has participated in joint ventures such as the development of a minor injuries service in Limerick, as mentioned by Deputy O'Sullivan, and the co-ordination of pathology and radiology services.

St. John's Hospital is well placed strategically to play a prominent role in future services. Initial discussions have commenced with the management of the hospital on its future contribution, with initial discussions concentrated on providing increased consultant input at accident and emergency consultant level and the possibility of expanding the scope of the minor injuries service in St. John's to cover the weekends. Additional requirements in relation to acute surgical beds are also being discussed.

The programme of change also includes expansion in the range of diagnostic facilities and expansion of outpatient and day surgery capacity in the smaller hospitals in the mid-west, which include St John's Hospital. The issue of capital developments at St. John's Hospital is being discussed in the context of the future role of the hospital in the regional structures.

The utilization of acute beds at St John's Hospital is being discussed by the HSE and the hospital in the context of the arrangements for the provision of services by the hospital in line with the overall HSE service plan and the resources available. An important factor to be borne in mind is that the HSE has identified the need to increase the proportion of treatment provided on a day basis and its 2009 national service plan contains a number of specific objectives in this regard

The Minister is satisfied that the measures being taken by the HSE are necessary and appropriate to ensure the provision of safe and effective health services to the people of the mid-west region.