Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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The Health Service Executive, HSE, told the Health Information and Quality Authority, HIQA, in February in a progress report what it was doing to curtail risks at several smaller hospitals. The HSE's plans were outlined in a HIQA report in April on the quality and safety of services at Mallow General Hospital. The HSE also identified ten other hospitals where significant risks had arisen with matters raised in the HIQA report. One of the hospitals cited in the report is St. Columcille's Hospital, Loughlinstown, County Dublin.

In a response to a recent parliamentary question on this particular HIQA report on the 30 June 2011, the Minister for Health, Deputy James Reilly stated:

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. ... 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.

The HIQA report stated plans are in place to cease acceptance of emergency services at St. Columcille's, Loughlinstown and that there are plans to convert the 24-hour emergency services to a daytime minor injury unit operating as a satellite. While a date has yet to be decided for when this is to happen, it is certain to happen this year.

Following the removal of emergency services from Roscommon on Monday, there are increasing concerns that the recommendations in HIQA's report on Loughlinstown will be implemented sooner rather than later. The people of Roscommon were given only a week's notice that their emergency services were to be removed. There is no guarantee that the same will not happen at Loughlinstown.

Last week, the Taoiseach, Deputy Enda Kenny, denied he had made any personal commitment to the people of Roscommon during the general election. However, evidence has emerged that he made clear commitments to retain services.

Unfortunately, it was not only Fine Gael who made an array of false promises about small hospitals. An Tánaiste and Minister for Foreign Affairs and Trade, Deputy Gilmore, also promised to retain services at Roscommon hospital along with other small hospitals. Before the election campaign, Labour made a series of promises to protect small hospitals. The Tánaiste and Minister for Foreign Affairs and Trade said the Labour Party believes in the importance of the local hospital and keeping hospital services close to where people are. While Deputy Jan O'Sullivan, former spokesperson on Health and now Minister of State at the Department of Foreign Affairs and Trade, said before the election "at present, services are being taken away from smaller hospitals and patients are being forced into centralised services that have not been given the resources to look after them. This cannot and will not continue".

The Tánaiste and Minister for Foreign Affairs and Trade recently said he would campaign to keep a 24-hour emergency department open at St Columcille's which is in his constituency of Dún Laoghaire. In the Irish Independent on 16 June, he was quoted as saying, "he would continue to campaign to keep them going" and " it is important that accident and emergency services are continued in St. Columcille's Hospital and that is something I will be talking to the HSE about".

How can the Tánaiste and Minister for Foreign Affairs and Trade be trusted on Loughlinstown hospital after what happened at Roscommon hospital this week? The Minister for Health must clarify the extent of his discussions on this matter with the Tánaiste and Minister for Foreign Affairs and Trade, if he agrees with him and if any agreement has been reached to retain 24-hour emergency services at Loughlinstown.

It is clear the Government made promises on Roscommon hospital which it could not keep. This is now damaging trust in the Government and also raising fresh concerns that Loughlinstown hospital is next in line.

In light of the Minister's stated intention to implement the recommendations of the HIQA report and the removal of services at Roscommon, the Minister for Health must immediately clarify if there will be a reduction in services at St. Columcille's Hospital, when exactly this will happen and what additional resources will be put in place at St. Vincent's University Hospital, Dublin. He must also explain if he agrees with the Tánaiste and Minister for Foreign Affairs, Deputy Eamon Gilmore, on retaining services at the hospital.

John Perry (Sligo-North Leitrim, Fine Gael)
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I am taking this matter on behalf of my colleague the Minister for Health, Deputy James Reilly.

There has been considerable debate around the issue of the role of smaller hospitals, much of which has been ill-informed. There have been many claims around lack of resources both financial and human. The real issue at stake is the need to ensure acute hospital services at national, regional and local level are provided in a safe and efficient manner. It is widely recognised that safer outcomes can only be achieved through the delivery of health services in the appropriate setting.

For certain medical specialties, particularly where complex care is required, many smaller hospitals do not have the throughput of patients which would enable doctors to maintain their skill levels. This applies no matter what resources are put in place.

The HSE, with the advice of HIQA, is taking steps to address the issues of safety. The steps being taken aim to ensure the appropriate treatment will be provided in the appropriate setting. This does not mean the closure of smaller hospitals. The Government is committed to ensuring as many services as possible can be provided safely in smaller, local hospitals. In fact this is likely to increase the volume of services delivered while ensuring their appropriateness and effectiveness. Patients should only have to travel to the larger hospitals for more complex services.

St. Columcille's Hospital, Loughlinstown, is part of a joint acute hospital service operated alongside St. Vincent's University Hospital and St. Michael's Hospital. These hospitals provide a range of services associated with acute hospital provision across three sites in a collaborative arrangement. As part of this provision, the configuration of services is constantly reviewed. From time to time, it is reorganised to improve access and quality of service and minimise risk to patients. While the range of services provided by the three sites will continue, the location of service provision will be configured in line with how best to deliver the service and maintain patient safety.

In recent years, St. Columcille's has implemented a trauma bypass protocol which allows patients suffering major trauma to be brought directly to the most appropriate site deemed necessary to treat their condition. These measures, combined with strong regional links to larger hospitals, are designed to ensure safety and are crucial to delivering the most effective outcomes for patients everywhere. The HSE is working to progress these initiatives in a collaborative framework in consultation with all stakeholders.

The Minister has made it clear that patient safety must be the overriding priority. He wants patients to be treated at the lowest level of complexity which 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 assured the public that even in the difficult economic situation in which we find ourselves and which is the legacy left to us by the previous Government, no hospitals will close. St. Columcille's, Loughlinstown, has a very important role to play in the provision of acute services and this will continue into the future.