Brendan Howlin (Wexford, Labour)
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I am grateful for the opportunity to raise an important issue for the constituency of Wexford, that is, the future of accident and emergency services at Wexford General Hospital.

I do not often seek to raise matters on the Adjournment. I do it only when matters are of critical importance to my constituency. I welcome the Minister of State, Deputy Áine Brady, but I regret that the Minister for Health and Children, Deputy Harney, is not here to answer a simple and straightforward question.

First, let me give some background to Wexford General Hospital. Wexford General Hospital is one of the busiest hospitals in the country. It has a broad range of specialties, including one of the busiest maternity units in the country. It caters for a population in County Wexford of 140,000 permanent residents and perhaps double that number during the summer months. It is an unusual hospital in that its peak activity is in the summer.

It is the only acute accident and emergency 24-hour service geographically between Loughlinstown in south County Dublin near Bray and Waterford General Hospital. That swathe of population between south Dublin and Waterford, the populous counties of Wicklow and Wexford, are serviced by Wexford General Hospital.

I have repeatedly asked about the future of the accident and emergency services in Wexford General Hospital because I have been informed directly by the staff involved that preparations are far advanced for the termination of the 24-hour accident and emergency service by the end of this year. Nurses have been told not to look for night time rostering at the end of this year and emergency ambulance personnel are being added to and upskilled to provide a different type of service.

When I have asked the HSE directly - I am fearful that the Minister of State has been provided with the same script to deliver to this House tonight - it states that there are no plans yet agreed or drawn up on any service or hospital in the south east. I simply do not believe that because the facts on the ground are quite different.

The people of Wexford deserve to know whether plans are being put in train by this expert group that is looking at the realignment of services across the south east, and whether a decision has already been made to end the permanent 24-hour accident and emergency cover operated by Wexford General Hospital. If that is happening, it is the beginning of the end of the full facilities to be provided by this essential and critical hospital.

I want a clear and unambiguous answer from the Minister tonight. The HSE, overblown and all as it is, is still subject to the Department of Health and Children and policy is ultimately determined by the Minister. The simple question to which I want an answer tonight is this. What is the future for 24-hour, 365-day accident and emergency cover in Wexford General Hospital? Please, do not give me obscurantist answers about surveys, analyses, committees or commissions. What is happening and what is the Department of Health and Children's policy?

Áine Brady (Kildare North, Fianna Fail)
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I thank Deputy Howlin and I will be taking this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

Wexford General Hospital provides comprehensive acute services to the local population of 130,000 and to the thousands of tourists who visit Wexford each year. The hospital benefits from a committed workforce that, during 2009, will treat an estimated 63,900 patients. More than half of these will present as emergency department attendances. In addition, an estimated 56,730 will attend the hospital on an outpatient basis.

Wexford General Hospital has strong partnerships with colleagues working in primary, community and continuing care sectors and aims to provide patients with fully integrated services. In line with the National Service Plan 2009 and in accordance with the HSE transformation programme, the HSE will be reviewing the current configuration of acute hospital services in the south east. A steering group has been put in place to this end and is tasked with developing a plan for hospital reconfiguration that will deliver optimal, cost effective, easily and readily accessible and high quality services through centres of excellence. The membership of the steering group comprises the four clinical directors, one from each hospital, and the hospital network manager.

All hospitals in the south eastern hospital group, consisting of Wexford General Hospital, Waterford Regional Hospital, South Tipperary General Hospital and St. Luke's Hospital, Kilkenny, will be included in the plan for the revised model of care. In this regard, no decisions regarding the roles of services in any hospitals will be taken until this plan has been completed through a process of broad based consultation within the services.

Brendan Howlin (Wexford, Labour)
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Then why is it being implemented?

Áine Brady (Kildare North, Fianna Fail)
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It is likely to be the end of 2009 or early 2010 before the review is completed and a plan put in place.

The Government is committed to ensuring the delivery of the best quality health services possible in an effective and efficient way. Ensuring patient safety is of paramount importance so that people can have confidence in the services and the best possible patient outcomes can be achieved.

Seán Sherlock (Cork East, Labour)
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We have had reports from Horwath, Wrixon, Teamwork and Professor John Higgins and today's Irish Examiner claims that all acute services other than those provided at Cork University Hospital, CUH, will be done away with. Subsequently, a HSE press release stated that Kerry General Hospital will be excluded from the process. What will be the position of acute services in hospitals other than Kerry General Hospital and CUH from 9 June?

The people of the region have been through the mill, given the obfuscation on simple questions on the future locations of acute services for the countless thousands served by hospitals in, for example, Mallow, Bantry and Cork. We want a little bit of decency and for people to tell us their intentions with regard to acute services. Mallow General Hospital is efficient and at the top of its league in terms of cleanliness and the other HIQA statistics. It needs its acute services, given its catchment area of more than 150,000 people.

Bernard Allen (Cork North Central, Fine Gael)
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I congratulate the Irish Examiner on publishing the details of a report that effectively downgrades all of our acute hospitals and enhances the role of CUH. The report, prepared by faceless consultants of whose credentials I am not aware, raises many challenges to the future viability of a number of Cork hospitals, including three in Cork city, namely, Mercy University Hospital, South Infirmary Victoria University Hospital and St. Mary's Orthopaedic Hospital.

I have managed to get a copy of the report, which starts by stating that it, as an independent report, identifies the optimum configuration of hospital-based services. Has this report cost as much as others? The McKinsey report cost €1 million and one consultant charged €10,000 per day to prepare it. As Chairman of the Committee of Public Accounts, I looked for a copy of it recently, but I have not received it yet.

In response to questions put to Professor Brendan Drumm at a meeting of the Committee of Public Accounts, he said: "The truth is that one could write an awful lot of them oneself" - by which he meant reports. He went on to say: "They are not rocket science but the problem is that it is hard to get buy-in to the proposed change unless there is independent validation of it." Basically, he said that he was prepared to give a significant amount of taxpayers' money to external private consultants to produce reports that recommended what he wanted. He then claimed that they were independent and that he was required to implement them without any real internal or public debate, no matter how good or bad the recommendations. Is this a failure of leadership or Machiavelli at his most devious?

I question the ability of some of the consultants in question. Those who penned their names to the most recent report under discussion are Horwath Consulting Ireland Limited of Clanwilliam Court, Dublin 2, and its partner, Teamwork Management Services Limited from the top floor of some office block in Bolton. I have served the people of Cork city for almost 30 years in the House and I can table proposals that will protect the best interests of the members of the public who I represent instead of the vested interests that are trying to change the face of acute hospital services in the southern region and to override the public's needs and wishes.

I assure the Acting Chairman and the Minister of State that these proposals to downgrade hospitals that have served generations will be fought tooth and nail. Will the Minister of State assure the House that the Government and its Deputies who represent Cork will not stand over these types of proposal to victimise the members of the public who are dependent on these hospitals, which have given so much service?

Áine Brady (Kildare North, Fianna Fail)
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I will reply to this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The HSE southern area commissioned Horwath Consulting Ireland Limited and Teamwork Management Services Limited to review the current configuration of acute hospital services in the region, which encompasses counties Cork and Kerry. The HSE southern area is considering the outcome of this review and the recommendations made with the objective of securing clinically safe and sustainable acute hospital services for the region.

It is important to emphasise that the Teamwork report represents an input into decisions about the future service arrangements and it will not be the only means by which decisions about reorganisation are informed. Patient safety considerations will be paramount in determining the future configuration of services, especially where complex care is concerned. It is widely recognised that treating a low volume of cases in higher volume specialties is not conducive to optimal patient care. To ensure the best possible outcomes for patients, clinicians must be able to maintain their specialist skills by treating a sufficient number of cases. It is more difficult for specialists to maintain their skills in smaller hospitals when treating a low volume of patients. This has implications for how we organise acute services generally.

It is important to note that the total spend on health care in counties Cork and Kerry is approximately €1.4 billion. The HSE is conscious of the need to ensure that these resources are spent in the most effective and efficient way. In addition to the need to ensure patient safety, the need to ensure efficiency will also inform the reconfiguration exercise.

John Higgins, professor of obstetrics and gynaecology at University College Cork, has been appointed by the HSE as director of the reconfiguration of acute services in the Cork and Kerry region. Professor Higgins has commenced a comprehensive consultation plan with the counties' people. This process involves face-to-face meetings in various locations across both counties, with hospital staff and management, clinicians, patient groups, hospital representative and fundraiser groups and public representatives. A particular focus of the consultation process has been engagement with general practitioners across the Cork and Kerry region.

Following the consultation process, the HSE expects to be in a position by mid-June to indicate the general terms of its proposals for the future configuration of the services in the region, with the objective of putting in place a single health care system for counties Cork and Kerry and the development of a new governance structure for the hospitals and community services. The consultants' report will be published at the same time. The HSE will then commence a detailed planning process leading to the implementation phase beginning in the autumn of this year. It has emphasised that no hospital will close, but that every hospital must fundamentally change how and what services it delivers. The precise details of the changes to existing arrangements and the timetable for these will be developed in consultation with all the relevant interests in due course.

Cork and Kerry present specific demographic and geographic challenges in delivering safe health care. However, the HSE has clearly indicated with regard to Kerry General Hospital that the key current acute services, including accident and emergency, obstetrics, intensive care, acute surgery and acute medicine, will be maintained.

The Government is committed to ensuring the delivery of the best quality health services possible, in the safest, most efficient and effective way. The reconfiguration of the acute hospital services in the HSE south region which is being planned at present will be progressed in accordance with these principles.

Seán Sherlock (Cork East, Labour)
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On a point of order-----

Brendan Howlin (Wexford, Labour)
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There are no points of order on the Adjournment.

Seán Sherlock (Cork East, Labour)
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We were told it was 9 June. The Minister of State's reply states it is mid June. I would like to seek a clarification on that.

Lucinda Creighton (Dublin South East, Fine Gael)
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I listened with interest to the pervious comments, which I assume are those of the Minister for Health and Children, Deputy Mary Harney, regarding the Government being committed to ensuring the best quality health services possible are delivered in the most efficient and effective way possible. I find it quite extraordinary, in the context of those comments, that it is proposed to scrap proposals to redevelop the old Meath Hospital, which would have made provision for adequate and suitable primary care facilities for the Dublin 8 and Dublin 2 areas.

I find it extraordinary because, as I am sure the Minister of State, Deputy Brady, and I know, the future of health services in this country is through primary care. We have an acute system which is creaking. Every political party agrees with the paramount need for the delivery of primary care services. We have been promised this since well before 2002. In fact, this was one of the key promises of Fianna Fáil in the run-up to the 2002 general election and many votes were garnered in the Dublin 8 area on foot of such promises. The same promises were made in 2007 and, yet again, are not being delivered on.

There is now an official decision from the HSE not to deliver on the funding that was committed, earmarked and ring-fenced specifically for the Meath Hospital. To give a picture of the current level of primary care, to say it is inadequate would be an understatement. There are two small teams providing primary care services in the south inner city area, comprising a community nursing unit with 54 beds, which is inadequate, and the Irish Wheelchair Association, which also operates from the Meath Hospital. There is also a social inclusion service. It is a very modest level of primary care.

What has been promised, and what the funding was earmarked for, were an additional 100 beds for a community nursing unit on the site of the Meath Hospital, at a cost of €20 million, a new mental health day care facility, which would have made a tremendous difference to the people in the area who are crying out for any form of mental health services, new disability services, in particular respite apartments for family care, which would be very far-reaching but, unfortunately, will not be delivered, and a new primary care network with a new primary care team and a purpose-built facility.

In addition, there was a commitment for 50 units of sheltered housing on the site, which would have had a tremendous impact on the local community but this has also now been scrapped by Dublin City Council. There is a requirement for €40 million. As I said, €30 million was earmarked by the HSE, but a number of local Deputies and councillors were called to a meeting recently and told it would not be available.

This issue is very important for this area, for a number of reasons. Day care services in this area would have allowed local residents to get treatment locally, without having to travel and, very importantly, without clogging up major hospitals, such as St. James's Hospital, which are already under tremendous pressure. We know the difficulties that exist with acute beds in such hospitals. They are being occupied by people who do not require acute treatment.

This development would certainly have eased the pressure in the south east inner city area. A community nursing unit would have taken a significant amount of pressure off acute beds in hospitals such as St. James's Hospital. Sheltered housing would have allowed elderly people in the area to remain in their community when they have reached a stage in their lives when they deserve to be in care near their families, with the support of their families around them. It would have allowed people to get treatment locally and would have been an important signal to the people of the inner city that they are not being forgotten or neglected and are not bottom of the list of priorities, which is how they often feel. It is myopic to sacrifice this type of investment.

Everybody is talking about cuts in the HSE and health services and they are required, although we argue they should be found in other areas, particularly in administration in the HSE. However, this short-term saving will have long-term consequences because it will put increasing pressure on our major hospitals and acute beds, and will not do anything to serve the long-term interests of these communities.

I urge the Minister of State, Deputy Brady, to take that message back to the Department of Health and Children and the Minister for Health and Children, Deputy Harney.

Áine Brady (Kildare North, Fianna Fail)
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I thank the Deputy for raising this issue as it provides me with an opportunity to reaffirm the Government's commitment to developing community-based services at local level. Government policy on older people is to support people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care where this is appropriate. This policy approach is renewed and developed in the current partnership agreement, Towards 2016.

The Government's objective of continued development of community-based services for older persons is reflected in the funding given to the system in recent times. Since 2006, more than €500 million in additional funding has been invested in long-term care supports for older people. This includes the largest ever investment of more than €200 million to develop community care services.

As the Deputy is aware the Health Act 2004 provides the Health Service Executive with responsibility for the management and delivery of health and personal social services. As a statutory body, the provision of these services, including progressing community services at local level, is therefore an operational matter for the executive.

The HSE is committed, through its national service and capital plans, to deliver services within its Vote provided by the Oireachtas. The HSE at present provides or supports the following services on the Meath Hospital site, including two primary care teams, the south inner city partnership, a community nursing unit, comprising 54 beds and day care, the Irish Wheelchair Association and a social inclusion service.

When the Meath Hospital moved to Tallaght, various proposals were evolved and considered for the Meath Hospital site. However, none of these proposals ever proceeded beyond initial consideration and this is still the position. No decision, therefore, has been taken to either allocate to or withdraw funding from the old Meath Hospital site.

Lucinda Creighton (Dublin South East, Fine Gael)
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That is not true.

Áine Brady (Kildare North, Fianna Fail)
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Any proposals on the infrastructural development on this site would, in the first instance, have to be put forward by the HSE as part of its agreed capital programme for 2009 or beyond. This would have to take account of priorities determined nationally by the executive, including decisions regarding new community facilities coming on stream or the replacement or up-grading of long-term residential facilities generally.

Such initiatives have to be in line with agreed capital envelopes and identify any additional revenue or staffing implications arising from this particular project. It is only in this context that the proposed re-development of the Meath Hospital site, whether on a phased basis or otherwise, can be progressed. I understand that officials from the HSE local health office and HSE estates met local public representatives on 21 April last and apprised them of the situation on this issue.