Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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Over the last month, Mullingar, Portiuncula and Galway University hospitals have been taken off call for ambulances due to the chaotic situation in accident and emergency departments. At the same time, Roscommon accident and emergency operates as a minor injury clinic for 12 hours a day, seven days a week. I do not care what name is over the door of the emergency department, what goes on inside is what is important to me and the people I represent. The reopening of Roscommon is a simple and cost effective way to take pressure off the other accident and emergency departments and the overstretched ambulance service.

Within four weeks of the closure of the accident and emergency ward in Roscommon, the Department of Finance approved the roll-out of a new nationwide telestroke service, which allows the use of IT for specialists in regional centres to conduct video consultations and communicate with patients and staff. This is the sort of system hospital campaigners in Roscommon have always sought because of our unique geographical situation. Safety, however, was never the issue in Roscommon. Local GPs were told heart attack patients would be transferred directly to Galway University Hospital for access to the CAT lab. They now feel they have been lied to as patients are being transferred to Portiuncula hospital, a hospital with the same facilities as Roscommon; the only difference now is that in some instances patients are waiting in GPs' surgeries for up to an hour for the ambulance to arrive.

Even leaving these issues aside, at this point we have some of the most skilled staff in the country twiddling their thumbs while chaos reigns in other accident and emergency departments around the country. Where is the sense in that? There is a need to review the ambulance and hospital bypass protocols relating to Roscommon. Why does someone who needs two stitches who was picked up by an ambulance go past the front door of Roscommon Hospital on the way to an overcrowded accident and emergency department? Why have 300 children with minor injuries been forced, since the closure of the accident and emergency department, to travel in pain to other hospitals because staff in Roscommon have been instructed to turn them away even though Roscommon was well capable of treating them prior to July this year?

Luke Flanagan (Roscommon-South Leitrim, Independent)
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Before the election, the Minister for Health and his party promised us they would not close our accident and emergency department. After they closed it, they told us there would not be any problems with it being closed because we would get extra ambulances and super, souped-up paramedics. That has not happened either. Last weekend put the tin hat on it when people were told by the media not to go to the hospital we were told to go to in order to save lives. As someone who has dedicated his life to saving people's lives, I wonder how the Minister for Health can stand over this. It is not unreasonable for us to have some place to go when we are sick in this area.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputies for raising this important issue. The urgent care centre now in place in Roscommon operates from 8 a.m. to 8 p.m. seven days a week and is provided by non-consultant hospital doctors with clinical governance provided by the emergency medicine consultant in Galway. In addition, a medical assessment operates at the hospital and there is an out-of-hours GP service is in operation.

The changes at Roscommon were necessitated by the serious patient safety concerns of the HSE and HIQA. The accident and emergency service situation at Roscommon followed the publication of the authority's report on Mallow General Hospital in April 2011 and this was compounded by of NCHD recruitment difficulties. The Deputy knows how many meetings were held with the various medical, surgical and emergency department experts to see if there was any way around this. None could be found so my hand was forced, unhappily but without choice.

Data from the HSE indicate that since the change of Roscommon's emergency department to an urgent care centre, the number of patients referred each day to other hospitals has been very low. The most recent data for ambulance calls in the Roscommon catchment area show that less than two patients on average per day were brought to Galway and Portiuncula hospitals.

Even fewer patients were brought by ambulance to Mullingar, Sligo or Mayo hospitals.

While I do not accept that opening the urgent care centre at Roscommon on a 24 hour basis would address the difficulties experienced from time to time at Galway University Hospital emergency department, I am committed to ensuring that problems experienced at emergency departments in Galway and elsewhere are addressed.

In recent months I have established the special delivery unit, SDU, under the leadership of Dr. Martin Connor. The SDU is working to unblock access to acute services by improving the flow of patients through the system. It is focusing initially on emergency departments and will be working to support hospitals in addressing excessive waiting times for admission to hospital.

I am also committed to the future of Roscommon and to other smaller hospitals. There was a safety issue. I absolutely concur with the sentiment expressed in the Deputy's question. Why does someone needing two sutures need to go to Galway? I ask why someone needing two sutures needs to go to hospital in the first instance. Why is the GP not suturing? That is what I was trained to do as a GP.

With regard to media reports, it is my understanding that people were asked to stay away from Galway University Hospital unless they were acutely or seriously ill. This was because there was such overcrowding at the hospital. There were 32 people on trolleys on the Saturday morning. By mid-afternoon the number had reduced to the mid-teens, by 6 p.m. it was down to ten and by 8 p.m. it was down to five.

There are problems in Galway and Limerick and in other hospitals around the country. There are difficulties with work practices. Difficulties have arisen because people have not done what was asked of them. Day surgeries that should have moved from larger to smaller hospitals, such as Roscommon and Portiuncula, did not do so. That problem is being addressed.

I understand that a plastic surgery outpatient clinic began last week in Roscommon and that the first plastic surgery will take place next week, with a new plastic surgeon. I welcome her return to Roscommon. She is Ms Deirdre Jones and I believe she is from Roscommon originally.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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I ask the Minister to address my questions regarding children and minor injuries which can be treated in Roscommon.

I bring the case of Mary to the attention of the Minister. Three weeks ago she had a mini-stroke at 10 p.m. The ambulance arrived within 15 minutes to bring her to the Midland Regional Hospital in Mullingar. When the ambulance was outside Edgeworthstown, the crew received a call to say that Mullingar was no longer accepting patients. The ambulance was turned around and the woman had to be transferred to Sligo General Hospital. She spent two hours in the ambulance and reached hospital three hours after the time of the stroke. This is contrary to all the publicity we see regarding fast action in relation to strokes. That ambulance was tied up for three hours and taken out of the area for which it should have been providing cover.

Before July, approximately 280 patients per week attended the accident and emergency department in Roscommon County Hospital. Currently, between 40 and 60 patients per week attend the department. Where are the other patients? I believe they are afraid to go to their GPs for fear they will be referred to other hospitals. Many of these people are elderly and vulnerable.

The Minister gave a commitment to the Joint Committee on Health and Children that he would have an independent evaluation of the medical evidence regarding the effect on a critically ill patient of an ambulance transfer in excess of two hours. Has that evaluation been completed and when will it be published?

James Reilly (Dublin North, Fine Gael)
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The issue of children is of concern. Yesterday, at the request of Deputy Frank Feighan, I met a group from Roscommon hospital, including some of the surgical staff and management. This issue was raised and it will be addressed in the next week. There will be availability for staff to deal with minor injuries and lacerations. I received that undertaking from a senior clinician at the hospital.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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That is a positive development.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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That is only for children.

James Reilly (Dublin North, Fine Gael)
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The Deputy also mentioned other matters.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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I also mentioned minor injuries and ambulance transfers.

James Reilly (Dublin North, Fine Gael)
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People should be able to go to the hospital. At yesterday's meeting, the senior staff member from Roscommon hospital said he is available to GPs at the end of a telephone. He will be letting them know that so that they can send people to the hospital. He is on call and will see people if needs be.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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The Minister is missing the point.

James Reilly (Dublin North, Fine Gael)
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I did not interrupt the Deputy. I ask him not to interrupt me. There will be an improved service in this regard and GPs will be informed of it.

The total number of paramedics in County Roscommon is 26 and the total number of advanced paramedics is seven. The paramedical service is working very well and has already had a positive effect on a number of individuals, at least one of whom believes their life was saved as a consequence of being able to access the paramedical service as rapidly as they were.

Our commitment to Roscommon remains. The hospital has a bright future. Several other developments are in hand and will be coming down the track. I will not make a habit of saying what will come but I will report regularly to the House as to what has come. The first new development is the new plastic surgery service. There will be other developments over the next number of months and I will be happy to bring them to the Deputy's notice.