Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Of course Joyce was a socialist who left the country because he felt those who were going to inherit the Irish revolution would replace one form of subservience with another. The IMF-EU deal seems to vindicate many of Joyce's thoughts on the matter.

Brian Hayes (Dublin South West, Fine Gael)
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Does the Deputy want to follow his lead?

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Many people are already being forced into exile because of the deal and let us hope that more are not forced out if we continue along this disastrous path. One more victim of the austerity being forced on the country by the IMF and EU is our hospitals. In a shocking announcement yesterday, Loughlinstown hospital's 24-hour accident and emergency service is to be abolished and replaced with a daytime minor injuries service and surgical procedures are to be limited at the hospital. This is an appalling move, which will have a very damaging effect. The hospital serves a catchment area of approximately 160,000 people. It is the only 24-hour accident and emergency service between St Vincent's Hospital and Wexford General Hospital. It treated 21,000 accident and emergency patients last year so it is clearly a service that is being used.

A number of years ago the 24-hour accident and emergency service in St. Michael's Hospital in Dún Laoghaire was reduced an 8 a.m. to 8 p.m. service. This is a retrograde, disgraceful move which is inexplicable given the commitments the Minister, Deputy Reilly, gave to me in response to a question on the future of Loughlinstown hospital a few weeks ago when he stated: "The HSE recognises that it is of paramount importance that there is no impact on services to patients as a result of the recent redeployment of staff from St. Columcille's Hospital, Loughlinstown and community services". That was in the context of me asking why staff were being moved from there against their will to work on the other side of the city.

We now discover that his assurances were empty and that those redeployments were part of a deliberate run-down of services, which pre-empt the review the Minister promised after which the Government would consider the services that might be impacted. However, we now discover that the 24-hour accident and emergency service in Loughlinstown is to be shut down, causing extreme hardship and anxiety for many people.

All of these people will now be forced to go to St. Vincent's Hospital or to Wexford General Hospital. That means 21,000 additional people into an already over-stretched service in St. Vincent's. This is a disastrous move, the background to which is the €1 billion reduction in health service funding, which the Government has refused to reverse as a result of the IMF-EU deal. I appeal to the Government to reverse this move and retain the 24-hour accident and emergency service which is desperately needed in the area. If that does not happen I would anticipate rage in the County Wicklow as well as in the Loughlinstown, Ballybrack and Dún Laoghaire areas. We are already planning meetings and protests about the issue. I appeal to the Minister of State to save me the trouble of having to having to organise demonstrations and the anxiety of the people in the area by ensuring this accident and emergency service remains open.

Anne Ferris (Wicklow, Labour)
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I thank the Minister of State for taking the debate tonight, he obviously drew the short straw this evening.

Brian Hayes (Dublin South West, Fine Gael)
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The graveyard shift.

Anne Ferris (Wicklow, Labour)
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I am very happy to share the time with Deputy Boyd Barrett. I raised the matter this morning under Standing Order 32. I am sorry there are not more Deputies from the Wicklow and Dún Laoghaire constituencies to lend their support.

I too was shocked to learn of the HSE's decision to downgrade the accident and emergency services in St. Columcille's Hospital. This news was delivered in the form of an e-mail sent to public representatives and the media without any consultation with any public representatives. The decision makes no sense. As it stands the hospital's accident and emergency service serves approximately 21,000 cases every year. This proposal would mean that all those people would need to transfer from St. Columcille's all the way into St. Vincent's Hospital, which will cost people their lives and is a further example of the mismanagement of the health service by the Fianna Fáil-led Government. While we have inherited this legacy, I call on the Minister for Health to intervene with the HSE to reverse this decision.

Thousands of people from County Wicklow rely on the accident and emergency facilities in St. Columcille's Hospital every year. If they were forced to travel from somewhere like Carnew, Rathdrum or Aughrim - never mid Bray where I live - into St. Vincent's Hospital their lives will be put at risk. God forbid, if I ever have an accident in time to come, I hope it takes place here in Leinster House because I would be nearer to St. Vincent's Hospital than I would be at home in Bray.

The Labour Party has campaigned for years for the service at St. Columcille's Hospital to be saved because it was under threat in recent years. We ran a "save our services" campaign, which was very successful in retaining the accident and emergency unit in Loughlinstown. I raised the issue at a meeting with the Tánaiste this morning and he informed me that he only learned about it yesterday and has already met the Minister for Health to express his outrage with the HSE. I know he has written to the CEO of the HSE today demanding a meeting.

This issue is too important to be turned into a political football and I call on all public representatives living in County Wicklow, Dún Laoghaire and those parts of County Wexford that will be affected by the closure to stand together in a joint effort to reverse this unnecessary and illogical decision. The Minister of State told Deputy Costello the matter of designating an additional national holiday for Bloomsday was not among the Government's priorities. Let us hope Loughlinstown hospital is.

Brian Hayes (Dublin South West, Fine Gael)
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I thank Deputies Boyd Barrett and Ferris for raising this issue, which is very important to the people of Dún Laoghaire, Wicklow and Wexford. Its importance is recognised throughout the House.

.St. Columcille's Hospital, Loughlinstown, is an important, integral part of the joint acute hospital service operated between St. Vincent's University Hospital, St. Michael's Hospital and St. Columcille's Hospital. The three sites provide a very wide range of acute services to the local population in a collaborative arrangement. There is no need to cease any of the current services at St. Columcille's Hospital. However, the configuration of services is constantly reviewed and, from time to time, rearranged to improve access and quality of service and minimise risk to patients. For instance, in regard to accident and emergency services, a trauma bypass arrangement was introduced in recent years that allows for patients to be brought directly to St. Vincent's University Hospital to ensure the most appropriate treatment. This programme of realignment of services has received recent impetus from HIQA in regard to the need to implement the recommendations from the Ennis and Mallow reports. The conclusions of these reports were a very important contribution to driving further improvement in the quality and safety of acute hospital services. The reports deal, in particular, with the types of services that can safely be provided in smaller hospitals, and with the structures required for good governance and accountability. The HSE must ensure that this happens and the Minister will be monitoring the situation closely in conjunction with HIQA.

The Minister is strongly committed to developing the role of smaller hospitals so they can play a key part in the services provided to local communities. Local hospitals can and should be a vibrant element of local health services, providing treatment and care at the appropriate level of complexity to the patients in their area. The restructuring of services will also be closely aligned with the programme of care set out in the HSE's Report of the National Acute Medicine Programme, which recognises the essential role of large and small hospitals in the delivery of acute services. The HSE is working to make progress on these initiatives in a collaborative framework in consultation with all stakeholders.

The Minister has made it clear that he expects to be briefed by the HSE where there are any proposals to withdraw services from individual hospitals. He has also made it clear that patient safety must be the overriding priority and wants patients to be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible. These are the factors which will inform our future decisions on the provision of acute hospital services.

The Minister has clearly assured the public that, even in the difficult economic situation we find ourselves in, no hospitals will close. However, ongoing reform of the system may result in some changes in how care is delivered across our health system.