James Reilly (Dublin North, Fine Gael)
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Question 10: To ask the Minister for Health and Children the basis of the Health Service Executive decision to cease surgery, particularly elective surgery, at Navan Hospital, County Meath; the clinical reasons behind this decision; the details of the HSE review into this matter; and if she will make a statement on the matter. [35141/10]

Mary Harney (Dublin Mid West, Independent)
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In its role as patient advocate for high quality, safe, surgical care and practice, the Royal College of Surgeons of Ireland supported the decision of the HSE's director of quality and clinical control, Dr. White, to cease emergency acute surgical services at Our Lady's Hospital in Navan with effect from 1 September. Earlier this year, the HSE north east identified two general surgery cases with poor clinical outcomes. It later identified four laparoscopic surgery cases where outcomes were also poor. The HSE has asked the RCSI to nominate two senior clinicians to review the two general surgery cases. The precise format of this review will be finalised shortly and the review will be concluded as soon as possible.

The HSE has appointed a review team of three senior surgeons with appropriate experience and standing to undertake a review of the four laparoscopic cases. This review is expected to take approximately two months. Four reviews have been conducted into the department of surgery in Navan since 2005. The HSE has accepted all the recommendations of these reviews and is committed to their ongoing implementation. All decisions regarding the location of services will be taken with patient safety as the priority. Minor elective surgery and endoscopy will remain in Navan. The hospital continues to be the regional centre for elective orthopaedic surgery.

James Reilly (Dublin North, Fine Gael)
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I thank the Minister for her reply. I will point out a number of issues. The Minister mentioned two cases, one of which involved the mother of a general practitioner who asked that his mother's case be removed because he has no issue concerning the manner of treatment given.

The surgery facilities at Navan have been cancelled for elective surgery too. Some 1,800 cases are performed there every year. At a professional level I am aware there is no capacity within Dublin and the north east, including Cavan, Drogheda, Beaumont, Blanchardstown and the Mater hospitals, to take on those 1,800 cases. Patients of mine have had to wait four days on trolleys and have had their operations cancelled as a consequence of the downflow from the other end of the north east. The patients in Navan will not be accommodated within the system and waiting lists will grow. People are being deprived of the rightful service they now have. Where are they supposed to go? There was a preliminary investigation by the RCSI. When will there be a full investigation? Will the Minister explain to the House why elective surgery been cancelled at that centre when the RCSI did not allude to elective surgery?

Mary Harney (Dublin Mid West, Independent)
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The question relates to emergencies. There are six cases involved and one surgeon was put on temporary leave while being subject to investigation. As to emergency surgery there was one such procedure in every 24 hours and the decision was made to move that to a safe environment. There are reviews pending which involve the Royal College of Surgeons.

Regarding elective surgery, financial pressure points exist in that hospital and in other regions of the country, as the Deputy is well aware. We shall be debating that tonight, and I do not believe that hospital is mentioned. However, there are pressures and the HSE has to live within its budget. Deputy Reilly is the deputy leader of his party and I understand is committed to fiscal rectitude.

James Reilly (Dublin North, Fine Gael)
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I thank the Minister for orientating me.

Mary Harney (Dublin Mid West, Independent)
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I believe that at the very minimum he would expect units of the HSE in every part of the country to live within the budgets allocated for the year.

James Reilly (Dublin North, Fine Gael)
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At least the Minister clarified one thing for the people of the north-east. It is all about money and not patient safety. As the Minister well knows, the reason we are not mentioning Navan hospital in tonight's motion is that any question in regard to it would probably be disallowed if it influenced the motion. To get back to the real question, the Minister has acknowledged that it is a matter of money, not quality of care in regard to elective surgery. She also mentioned that a consultant was placed on administrative leave. That consultant has since been cleared and is off that leave, so I do not get any sense from her of any real patient safety issue as regards her decision, through the HSE, to close Navan hospital. Having mentioned earlier the shortage of anaesthetists at Drogheda, it is difficult to see how the greater area can cope. Clearly, we are going to see a deterioration in patient services in the north-east.

Mary Harney (Dublin Mid West, Independent)
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To cite the advice of the Royal College of Surgeons in Ireland in regard to this matter, it is to the effect that we cease all emergency surgery, all emergency surgery admissions, examine patients in the emergency department and transfer any patient needing a surgical admission - this accounts for four admissions a day, approximately two of which would require a surgical procedure - and so on.

Damien English (Meath West, Fine Gael)
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We know all that.

Brendan Howlin (Wexford, Labour)
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Allow the Minister to reply. She may well reach the point the Deputy wants.

Mary Harney (Dublin Mid West, Independent)
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It was on the basis of that advice and the number of reports that have been conducted into these procedures, that the decision was made. With regard to elective procedures there and elsewhere, hospitals have to live within the budgets allocated to them, and that includes Navan Hospital.

James Reilly (Dublin North, Fine Gael)
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The Minister says that to live within the budget they must cancel the entire service. That is not funny for the people who must use that service.

Mary Harney (Dublin Mid West, Independent)
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I believe I have dealt with the issue. The Deputy is raising two separate issues. One is the matter of safety and the transfer of acute surgery from Navan to Drogheda hospitals.

Damien English (Meath West, Fine Gael)
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Which we all accept.

Mary Harney (Dublin Mid West, Independent)
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I am delighted to hear the Deputy does, since he opposed it when it was announced.

Damien English (Meath West, Fine Gael)
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We did not, but we opposed the cancellation of elective surgery. The Minister should get her facts right.

Brendan Howlin (Wexford, Labour)
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References should be made through the Chair. This is a priority question. Other Members should not be encouraged to enter into the debate.

Mary Harney (Dublin Mid West, Independent)
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I do not want to provoke the Deputy but was not cancelled in August when he was speaking on this matter, because I have some of his quotes here.

Damien English (Meath West, Fine Gael)
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It was cancelled on 31 August.

Mary Harney (Dublin Mid West, Independent)
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Navan hospital in the north-east, Galway University Hospital and every other hospital and region in the country have to live with the budget allocation for health services for 2010. It constitutes 12% of national income, which is very high by comparison with other countries. I do not have additional money and neither does the Exchequer to allocate to any hospital that falls short in its budget in terms of it elective or other procedures.