James Reilly (Dublin North, Fine Gael)
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I recently asked to raise the issue of cutbacks at Cavan hospital because they caused patients serious distress and discommoded many of them. I understand that Deputy Crawford and Senator O'Reilly have received many representations from people trying to get their appointments rearranged. I am not surprised this has happened, since we warned about the inadvisability of cutbacks at Navan hospital.

We must examine what occurred in the case of Navan hospital. For several weeks, a lead clinician was rolled out to state it was an issue of patient safety. When I stood across the floor from the Minister for Health and Children two weeks ago, however, she admitted to Deputy English and me that it was a budgetary issue. Alongside Deputy McEntee, I have attended meetings in the area and it was clear that the hospital provides an excellent service, with 1,800 surgical cases treated per annum in an elective fashion. There is nowhere for these people to go. As such, their conditions will deteriorate, they will become emergencies and they will end up at the accident and emergency unit of Cavan hospital, Beaumont Hospital, the Mater, Blanchardstown hospital or Drogheda hospital. It is clear that none of those hospitals has the capacity to deal with the additional workload.

We have had nothing but cutbacks under the Government. Bed numbers have been reduced and no additional beds have been provided under co-location. Consequently, we find ourselves in this mess. No attempt has been made to reform the health service, cut backroom staff numbers or change gross inefficiencies. When I spoke with Deputy Crawford today, he told me he received representations from a lady who had been waiting three weeks for an appointment to have confirmed breast cancer removed. She has been referred from Cavan to the centre in Dublin. This is not acceptable. The other issue one must ask about is the great number of closures that took place because of an increase in referrals to the emergency department and medical assessment unit. Are we now given to believe this has all been resolved, that a week later these services are able to resume because the surge has disappeared and is unlikely to come again as we enter the winter months? That is not credible and in her answer the Minister of State must address how the sudden increase in activity occurred, what her view is vis-À-vis its recurrence and the chances thereof. That chance is very high. Ambulances will be directed to other hospitals where possible; endoscopy tests have been cancelled. Endoscopy will pick up internal illnesses of the gastrointestinal tract, the gullet and the bowel long before they are symptomatic. These can be very serious conditions such as cancer, ulcerative colitis and many other diseases such as Crohn's, which, if left untreated, can cause serious long-term illness and, in the case of cancer, catastrophic consequences, as happened to the late and very brave Suzy Long.

There is no way Beaumont Hospital can cope. People are not only waiting on trolleys, but are waiting on chairs for days on end. I heard that directly from a doctor at the hospital. We are now told there will be further cutbacks of €1 billion or, at least €600 million. How are we going to cope in the coming winter? In spite of all this, Navan hospital remains closed, elective surgery remains cancelled and 28 further beds have been closed of which 15 are medical and 13 surgical. This will be a winter of serious discontent for the people of County Meath. I fail to understand why the Government continues to cut front line services instead of addressing the waste in the HSE - the €1 billion spent on overtime last year, the €120 million on taxis and the €60 million on medico-legal payouts, of which €20 million goes straight to lawyers. There was the €92 million spent on agency staff who, people will report, are at least 36% more expensive than recruited permanent staff. The consequence is that people who could have been employed full-time are only employed part-time.

I hope the Minister of State will address these issues in her response and we do not receive a pre-written departmental missive that will be meaningless.

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

In recent weeks, Cavan General Hospital experienced an unprecedented 40% increase in referrals to its emergency department and medical assessment unit. In addition, there was a very significant rise in medical referrals and medical admissions to the hospital from September. In order to ensure patient safety, the HSE introduced temporary curtailments, which were confined to medical outpatient services and day services. This response was solely due to the increase in activity and not due to any planned budgetary reduction. It is important to emphasise that all emergency services, oncology services, antenatal clinics and phlebotomy services were not affected and continued as normal throughout the curtailment period. A significant number of clinical procedures including endoscopy and surgical procedures also continued, based on the clinical presentation of the patients. These interventions were managed on a day to day basis by the clinicians involved.

Hospital management and clinicians are actively working to ensure that patients who had their appointments deferred this week will now be rescheduled and prioritised for appointment and-or procedures as quickly as possible. It is also important to note that the Cavan-Monaghan Hospital group has one of the shortest waiting lists for endoscopy and surgical procedures in the country. All services resumed as normal at Cavan on Monday, 18 October. Emergency activity within the hospital has decreased significantly. At 2 p.m. yesterday there was only one person waiting on a chair or trolley in Cavan emergency department compared to 11 people two weeks previously.

The Royal College of Surgeons of Ireland provided the HSE with advice regarding safety issues in relation to surgery at Navan hospital. Acting on this advice, the HSE decided to cease all emergency surgery at the hospital immediately, with effect from 1 September 2010. As the Deputy will appreciate, patient safety has to be the over riding principle in our health system. The transfer of acute and emergency surgery from Our Lady's Hospital, Navan, was always a long-term objective of the north-east transformation plan. The plan is designed to build a health system that is in line with the model of care emerging internationally.

Following on from the transfer of acute and emergency surgery, there is a decreased need for surgical and medical beds in Navan. As a result, a medical ward, which opened in Navan for a period of three months only to support the reconfiguration of medical services in Louth County Hospital, is due to close on a phased basis. The HSE is closing a number of surgical beds in Navan Hospital due to the transfer of services. The closure of these beds is managed through a combination of patient discharges, the cessation of admissions to wards and the phased relocation of patients within the hospital. The process is reviewed on a daily basis by senior hospital management team.

The hospital remains the regional centre for elective orthopaedic surgery and it expects that all of its complex joint replacement surgery procedures planned for 2010 will be completed by mid-November. From then the unit will become a five-day unit and will concentrate on completing this year's planned, less complex, minor surgery cases. An orthopaedic outpatient department initiative will also be undertaken in November and December in Navan to address the outpatient orthopaedic waiting lists in the north-east region, namely, individuals who are awaiting an assessment.

I wish again to emphasise that patient safety is central to the delivery of health services. People must have confidence in the care they receive and have the best possible outcomes. All decisions regarding the operation of health services will be taken with patient safety as the priority.

James Reilly (Dublin North, Fine Gael)
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I thank the Minister of State for coming to the House.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I thank the Deputy and hope he has a pleasant weekend.