Billy Kelleher (Cork North Central, Fianna Fail)
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Question 1: To ask the Minister for Health if he has read the recommendations of the Health Information Quality Authority update on the implementation of the recommendations of the Ennis Report received from the Health Service Executive in February 2011; and his views on the implementation of the recommendations relating to small hospitals. [18079/11]

James Reilly (Dublin North, Fine Gael)
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I am fully aware of the recommendations of HIQA with regard to Ennis hospital and its subsequent report on Mallow General Hospital. Both reports deal with the types of service that can safely be provided in smaller hospitals and with the structures required for good governance and accountability within our hospitals. The report on Mallow reiterates the implications of the Ennis report for all hospitals of a similar size. I have said on many occasions that local hospitals can and should be a vibrant element of local health services, providing treatment and care at an appropriate level of complexity to patients in their areas. I have also said I will not stand over unsafe care that puts patients at risk.

The recommendations in these HIQA reports need to be implemented in order to ensure the standards of care delivered in smaller hospitals are as high as possible and that the type of care provided is appropriate to the clinical setting and to the needs of patients. I have had a number of meetings with clinicians and officials in my Department and the HSE about the progress being made in implementing the HIQA recommendations both generally and in specific hospitals. I intend to keep myself fully briefed about ongoing developments.

The Government is strongly committed to developing the role of smaller hospitals in Ireland so they play a key part in the services provided to local communities. Patients should need to travel to the larger hospitals only for more complex services. HIQA's reports on Ennis and Mallow are entirely in keeping with this approach.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister has stated that he accepts and agrees with the HIQA reports on Ennis and Mallow hospitals and the recommendations with regard to the other hospitals named in the Ennis report. Obviously, nobody can stand over unsafe provision of care in any hospital, particularly in smaller hospitals. However, there are two ways of addressing this issue. We must either accept the report in full, agree with its findings and close the smaller hospitals, or address the deficiencies in the smaller hospitals and make sure acute services and accident and emergency services, for example, are provided safely. For many of the hospitals named in the report, the Minister intends to use these reports to downgrade smaller hospitals. This is clear and evident from the actions of the Minister today and over recent days with regard to Roscommon County Hospital, for example, which was to have a 24-hour accident and emergency service and is now to have none at all. This report should not be used as a mechanism by the Minister to retract promises made prior to the election and subsequently. Rather than withdrawing services entirely, he should address the deficiencies in the services.

James Reilly (Dublin North, Fine Gael)
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I could not agree more with the Deputy. I do not believe HIQA reports should be used to close smaller hospitals. If they highlight problems, these should be addressed as far as possible.

The Deputy mentioned Roscommon County Hospital, which will be discussed later in another question. Roscommon hospital is faced with a number of difficulties at the moment. One is a shortage of non-consultant hospital doctors, and another is HIQA patient safety concerns, which arise because of the low volume of patients going through the emergency department - 30 people a day. There is also a difficulty in providing supervised training for doctors, which means these posts are unpopular. We are seeking to address this; I will cover it in a later question. However, the biggest problem facing the hospital is safety.

Let us be absolutely honest about what is currently available in Roscommon hospital. We have an unsafe service. The obvious question is why it is unsafe. I say it is unsafe because it deals with undifferentiated multiple trauma cases, undifferentiated medical cases, including heart attacks and strokes, and undifferentiated surgical problems. If people are brought there by ambulance, they have a right to expect that the skills are available to deal with their problems. However, if a person is suffering from multiple trauma, broken bones and blood vessel damage, there is no orthopaedic surgeon and no vascular surgeon. If a person has had a heart attack, there are excellent physicians, but there is no facility to insert a stent, if that is what is required.

I am happy to come back to the issue of Roscommon hospital in another question. However, I say this to the Deputy. The HIQA reports, particularly the Mallow report, are clear. The Deputy's question is a bit confused, if I might point that out. He refers to a report received in February 2011, but no such report was received. The Mallow report, which I have in front of me, is from April 2011.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The time has expired.

James Reilly (Dublin North, Fine Gael)
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The answer to the Deputy's question is that the reports will not be used - I will not stand over them being used - to close hospitals or reduce services where they can be provided safely. I will return to this in the later question on Roscommon hospital, with the Ceann Comhairle's permission.