Willie Penrose (Longford-Westmeath, Labour)
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I thank the Ceann Comhairle for allowing me to raise this important matter in the Adjournment debate on the floor of the Dáil tonight on behalf of the people of Longford-Westmeath. I am flabbergasted and frustrated that, once again, I find myself compelled to stand in this forum of the people this evening on behalf of up to 120,000 people throughout Longford and Westmeath to reflect the fears, concerns and apprehensions which they have raised over future developments at this important regional hospital in Mullingar. I do so in the context of speculation or rumours that there is a plan afoot to move general surgery of an elective nature from the very fine operational and surgical facilities available in Mullingar to Tullamore General Hospital as and from 15 June. I am unsure whether this is a done deal or a concluded plan or if it is simply speculation but, as a Labour Party representative of the people who has continually championed the cause of this important hospital in every forum available to me and at every opportunity, I make no apologies to the Government and the HSE for doing so again this evening and for seeking straight answers to the queries raised.

I seek an assurance that there are no plans to remove the important service of general surgery from this hospital for any period, no matter how short, because we have had a bad experience already with the HSE in respect of how it operates services at our hospital. Generally, we wake up and find that they are gone, moved by stealth, notwithstanding numerous assurances that no such move was planned or contemplated.

I refer to the speculation concerning our general surgery facilities. Even if it is planned to move them to Tullamore for the summer period or another short period, I hereby launch a pre-emptive strike on behalf of the people. We in Longford-Westmeath want no diminution or dilution of the excellent service we have in the hospital, provided by excellent and competent staff and professionals who work remarkably hard to ensure we are well looked after. Let us consider what the position would be were there any truth to the speculation or any basis in fact. There is no direct public transport service for the people of Mullingar to Tullamore, but that pales into insignificance when one considers the distance a patient who might require surgery would have to travel from north Longford if the surgery service was relocated to Tullamore. Certain people in the Government might reply that we are over-reacting but we have been burned too often in the past.

I refer to some illustrative examples to set out the situation. This hospital should have had phase 2A completed in 1997 and was to have phase 2B completed at various times in the past decade. The shell of phase 2B was completed in 1997. Then, for the purposes of delay and obfuscation, phase 2B was subdivided into stages 1 and 2, with stage 2 to include a new, acute psychiatric department or unit to be built as part of the phase 2B capital programme for Mullingar Regional Hospital. This has been scrapped and reneged upon by the HSE without batting an eyelid, despite the solemn commitment given that the plan would proceed. Stage 2 of phase 2B also had as a target that the bed compliment would increase to 313 beds. Despite this being clearly set out in the original plan, it was subject to a further independent cost benefit analysis by the national hospital capital steering committee in November and December of 2008. This is another objective or target which has not been met and which, in fact, has been widely missed.

I refer to the question the people of Longford-Westmeath repeatedly ask me and my Labour Party colleagues. Why are we being treated as second class citizens by this Government, which has been in power continuously since 1997, despite the consistent performance of the Midlands Regional Hospital, Mullingar as one of the top three hospitals in this country? Whenever a decision is made, the Government and the HSE in the midlands always seem to favour Tullamore or some other place which has ministerial influence in preference to Mullingar. I will always argue for resources and support expenditure for other midland hospitals, especially in Tullamore, where the residents avail of the excellent orthopaedic and ear, nose and throat facilities at that hospital. However, the people of Mullingar and Longford seek to ensure we get our fair share. We are suspicious that the aim of the HSE is to regionalise services and to engage in grandiose reconfiguration. If the HSE wishes to reconfigure then, in the words of Dr. Ron Charles, clinical director, Midlands Regional Hospital, Mullingar, "Mullingar should be in the driving seat, as the figures for Mullingar hospital speak for themselves". Mullingar Regional Hospital sees more than 92,000 patients for scans and X-rays, thanks to the excellent team of three consultant radiologists and one locum, led by Dr. Hugh Logan. We have one of the best paediatric and maternity facilities in the country, with almost 3,000 babies delivered in 2009 and a rate of Caesarean section of less than 23%. There is the potential to develop this into a maternity centre of excellence which could deliver up to 5,000 babies per year.

The general surgery services, to which I have referred previously, are excellent and the hospital has the potential to become a major centre for day surgery, with the potential to take patients from Dublin. The hospital is located on the N4 and is only major hospital facility between Dublin and Sligo. The hospital operates very efficiently. However, it is being deliberately starved of resources. For example, some 41 acute beds were taken our of service late last year, a matter I raised in the Dáil, and have never been restored. Why did that happen considering the accident and emergency department is continuously overcrowded and the excellent staff working flat out, beyond the call of duty at all times, and having to contend with people placed on trolleys while these beds lie idle and unused? What sort of mindset in the HSE or the Government would allow such a situation to develop and not take appropriate action to remedy it?

The Minister of State should examine the 2009 figures which are very revealing. The number of acute hospital beds in Mullingar was 185, the total of day beds was 14, the total inpatient and day care capacity was 199 beds, the average length of stay was 3 days, the number of in-patient discharges was 18,866, the day cases outturn was 7,235, the number of accident and emergency attendances was 32,841, the number of outpatient attendances was 74,053 and there was a budget of €64.66 million, which has been reduced to €59 million this year, including €2.9 million for casemix adjustment.

We will be protesting on Saturday, 12 June 2010 in Mullingar. We seek to protect, enhance and maintain the facilities we have in place. We demand that the Minister and the HSE make no attempt to downgrade the Midlands Regional Hospital, Mullingar; that the 24 hour accident and emergency facility should be retained and enhanced with the extra beds provided to accommodate the numbers of people requiring admission thereto; that all existing services at the Midlands Regional Hospital, Mullingar be retained and enhanced; and that this important hospital should get its appropriate and fair share of resources including additional staff and money. This is what we deserve and we will accept no less.

Michael Finneran (Roscommon-South Leitrim, Fianna Fail)
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I take this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The Deputy's question assumes that there is to be a withdrawal of surgical services at Mullingar hospital. The Minister has been advised by the HSE that at present there are no plans to relocate surgical services from Mullingar hospital to Tullamore hospital. Decisions on the allocation of resources and the prioritisation of service provision at regional level are a matter for the HSE.

The Midland Regional Hospital in Mullingar is part of the Dublin-midlands hospital group. The aim of the hospital is to deliver a quality driven, people centred service to the population of Dublin and the midlands and in particular the Longford-Westmeath area. The hospital in Mullingar operates on a 24 hour, seven day week basis.

Mullingar hospital, in common with all other agencies, is required to manage its services within the approved allocation and to run its services within the approved employment ceiling. The hospital has been recognised as being one of the most efficient in the country in the context of the annual case mix adjustment.

Patient safety is of paramount concern to the HSE across the hospital system. An issue which is currently being addressed by the HSE which is relevant to this situation is a shortage of junior doctors, or non-consultant hospital doctors, that exists in some parts of the country. This situation may become more acute in some areas from early July. A recruitment drive for a new intake of non-consultant hospital doctors is under way and a number of other initiatives are being considered so as to ensure that hospitals continue to offer a high level of care to all patients. Given that this recruitment process is still ongoing, it is too early to say which hospitals and what parts of the country might be affected and to what degree.

However, local management are working with clinical directors in a planned way to devise contingency arrangements which can be implemented in hospitals if and as required. The HSE is also putting in place a number of processes to address the issues contributing to this difficulty on a short, medium and long-term basis.

The Minister remains confident that the issues referred to above will be addressed by the HSE and that services at the Midland Regional Hospital in Mullingar will continue to be designed to deliver the best and most appropriate services to all of its patients.