Brian Stanley (Laois-Offaly, Sinn Fein)
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I thank the Leas-Cheann Comhairle for taking the issue. I wish to raise the plans for the future of Portlaoise hospital, particularly with regard to the intensive care unit and the accident and emergency unit, the plans to proceed with the model 2 proposal, if any, and the implications for the maternity unit at the hospital. I am glad the Minister for Health is here and is taking time to deal with the matter. I note the HSE statement of 22 September states:

The HSE continues to work towards the full implementation of the HIQA report into Ennis Hospital and further recommendations arising from HIQA's Mallow report. Both reports will ultimately give rise to changes in the role of smaller hospitals, which include Portlaoise Regional Hospital and...Loughlinstown hospital.

In his statement the following day, 23 September, the Minister said:

In July of this year I attended the Oireachtas Joint Committee on Health and Children and made clear that Portlaoise is a Model Three hospital, and will remain a Model Three hospital. I stated to the committee that this is Government policy and will not change. I confirm that this remains the position.

We have two different positions, and that is why I am raising the issue. There is huge concern in the community, across County Laois and in south Kildare - the Acting Chairman will be aware of that - because many people from that area use the hospital. There is also huge concern in parts of Offaly. Staff, patients and users of the hospital are concerned.

When I and other Deputies for the constituency met the Minister in the summer, he outlined the same position. I have to report to him that, in the second part of the meeting with the officials, they were strong in pushing the model 2 position regarding Portlaoise. It was talked about at length. For my part, I believe Portlaoise must retain the vital services - the accident and emergency unit, the paediatric units, both of which are new, modern and well functioning, the intensive care unit and the maternity unit, which is busy and has a huge catchment area. Portlaoise is the second busiest hospital outside the Dublin region, with a huge throughput of patients, and it is also a very efficient hospital. The report shows that the cost per attendance is €149 whereas the next lowest figure is €195 and the figures for other hospitals are much higher.

I ask the Minister specifically to address maternity services. The hospital needs a new maternity unit. I recall a meeting with local councillors and Mr. John Bulfin in 2008, at which he stated that €8 million was being ring-fenced to provide a new maternity unit. There has been talk that Portlaoise will be reconfigured with the Coombe, Loughlinstown and Naas. Is there a plan in some people's heads in the HSE to transfer maternity services to the Coombe? I hope not. Perhaps the Minister will confirm that for me. I ask him to address the points I have raised.

James Reilly (Dublin North, Fine Gael)
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I thank Deputy Stanley for the opportunity to clarify the situation. I do not believe there is any difference between the two statements, to be frank. There is an association because many of the hospitals mentioned in conjunction with Portlaoise are model 2, but I did not say that Portlaoise was going to be model 2. I have certainly never said that. Let us clear that up at the outset.

I want to place on record that the Midland Regional Hospital at Portlaoise will continue to deliver a quality-driven, people-centred service to the population of the region and the people of Laois in particular. There is no plan to reduce services at the hospital. Lest I forget to address the Deputy's question about what is in the heads of the myriad people working in the HSE, I think he will agree I could not possibly know what is in all their heads, but I know what is in my head and I put it on the record again today.

I remain committed to ensuring that acute hospital services at national, regional and local level are provided in a clinically appropriate and efficient manner. In particular, I want to ensure that as many services as possible can be provided safely in smaller, local hospitals. I have also made it clear that patient safety must be the overriding priority and I want patients to be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible. Patients should only have to travel to larger hospitals for more complex services. I do not mind stating that the battles we have had on moving what it is not safe to provide in smaller hospitals will be superceded by the battles to get what should not be provided in the bigger hospitals out of them and back to the smaller hospitals. We will engage in these battles and win.

In the recent past there has been much speculation regarding the future of Portlaoise hospital. Certain reports have cited correspondence, as Deputy Stanley has done, and referred to the possibility of Portlaoise becoming a model 2 hospital, which would have implications, particularly for the emergency department. In July of this year, as Deputy Stanley pointed out, I attended the Oireachtas Joint Committee on Health and Children and made it clear that Portlaoise is a model 3 hospital and will remain a model 3 hospital. I said to the committee that this is Government policy and will not change. I confirm that this remains the case. I might mention that I intend to develop a framework for the development of smaller hospitals that secures their future and specifies the additional services it is safe for them to provide. The framework will underline the Government's commitment to the real development of smaller hospitals and not their closure, as some people would have us believe. It is important to point out that there are safety issues at Portlaoise and they are being addressed but addressing them does not mean it will become a model 2 hospital.

On the intensive care unit and critical care of patients at Portlaoise, there is currently a four bed ICU with the capacity to ventilate two patients should the requirement arise. As Portlaoise provides both obstetric and gynaecology and paediatric services 24 hours a day, seven days a week, anaesthetic and surgical cover is required 24 hours a day, seven days a week on site. In this regard, I am happy to confirm that it is envisaged the Midlands Regional Hospital at Portlaoise will maintain its current ICU service.

Furthermore, a proposition to appoint a clinical director for the midlands region is currently being considered by the HSE. A single clinical director would lead the provision of these services within the region and within the guidance of the national clinical care programmes. In advance of that process, I wish to re-iterate that the retention of Portlaoise Hospital as a model 3 facility remains Government policy. Accordingly, the recent speculation around the downgrading of Portlaoise Hospital is not accurate and I am pleased to set the record straight. Portlaoise remains a model 3 hospital.

Brian Stanley (Laois-Offaly, Sinn Fein)
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The Minister can understand where the confusion is coming from but I welcome the reply. In his statement he went into some detail. Can the Minister confirm there will be a new maternity unit in the hospital? What is the position with capital funding? I have tried to track the €8 million for the last three years, all the way from the council chamber in Portlaoise to the floor of this Chamber and I have not been able to get any answer.

I take the Minister's remarks in good faith. The budget for the hospital is €42 million for the year. The Minister as a medic knows that €42 million will not fund the operational costs of a busy regional hospital. While we might have the status, will we have the funding? I know these are difficult times financially but if we intend to retain those services, the capital costs are required for a new maternity unit and there is annual funding for the running of the hospital, which amounted to €51.5 million just a few years ago. There are decisions to be made on this so I would like to hear the Minister's opinion.

James Reilly (Dublin North, Fine Gael)
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There is no provision in capital funding in the current year or next year for a maternity unit for Portlaoise that I am aware of. I will check that with my officials and would be happy to be proven wrong. We live in straitened times and we all know why, because of the previous Government's approach to our economic affairs. Equally, as a doctor, I do not know that €42 million is not enough to run this hospital.

Brian Stanley (Laois-Offaly, Sinn Fein)
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It has 400 staff.

James Reilly (Dublin North, Fine Gael)
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I do know, however, that many of our hospitals must change the way they deliver care. We must have far more day case surgery, we must have far more cases admitted on the day of surgery, rather than the night before and I know we need greater flexibility in our staffing and how we approach this problem. There is huge room for improvement within our hospitals. That is not to castigate those who work there; people must work within the system as it exists. The Government's commitment is to change that system so we can have greater results for patients and greater numbers of patients treated safely in an appropriate setting. We do not want to have patients being treated in Dublin who should be treated in Portlaoise and we do not want to have patients being treated in Portlaoise who should be treated by their GP.

The Deputy is right; there is no question of maternity services leaving Portlaoise. There is no capacity within the greater Dublin maternity hospitals to cater for people beyond the Dublin region, even though small numbers have come from outside the catchment areas. It is difficult, however, to assess how many but I encourage people who have uncomplicated pregnancies to go local, which is more convenient and the service is excellent.