Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Question 48: To ask the Minister for Health if he will provide a progress report on the reconfiguration of health services in south county Dublin; if a decision to downgrade the Loughlinstown Hospital accident and emergency to an 8am to 8pm minor injury unit has been agreed and if there is a planned date for same; and if he will make a statement on the matter. [33032/11]

James Reilly (Dublin North, Fine Gael)
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I am preparing a framework for the future development of smaller hospitals, which includes St. Columcille's, Loughlinstown. The HSE and my Department are working with the Health Information and Quality Authority, HIQA, on the safety aspects concerned. As I stated earlier, consultation covering all the key stakeholders, including patients and public representatives, will be an integral part of the process. The three hospitals in the region, namely, St. Michael's, St. Columcille's and St. Vincent's, are working together with the HSE to ensure the appropriate level of service is provided in the best location to ensure clinical safety, quality and patient safety and to manage risk. As for the reconfiguration of emergency department services in the integrated service area, a project steering group is reviewing the current service provision and is in the process of generating proposals as to how the new service configuration will operate.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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While I have been asking this question for six months, I still am no closer to getting an answer from the Government as to whether it plans to downgrade the accident and emergency service in Loughlinstown hospital. The people of Loughlinstown and south County Wicklow seek an answer and a timeframe as to when the Minister will publish or announce his plans or recommendations. I appeal to the Minister not to downgrade the accident and emergency unit at Loughlinstown hospital. I note the Minister has stated this is all about safety. A total of 21,000 people go through the accident and emergency unit at Loughlinstown hospital each year and were it to be downgraded to a minor injuries service operating from 8 a.m. to 8 p.m. and if, at a conservative estimate, half or even 10,000 of them were to be pushed down to St. Vincent's Hospital, this would mean the attendance of an additional 28 people per day at that hospital's accident and emergency unit. As 31 people already were on trolleys in that hospital yesterday, this does not add up because as matters stand, St. Vincent's Hospital cannot cope.

Tom Hayes (Tipperary South, Fine Gael)
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Does the Deputy have a question?

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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If one pushes thousands of accident and emergency cases on to St. Vincent's Hospital, which already is in chaos, there will be more chaos, suffering and lives lost. I appeal to the Minister to do in his review what the people of south County Wicklow and Loughlinstown want, which is to retain the 24-hour accident and emergency service in Loughlinstown hospital and if safety issues exist there, to put the requisite resources into it.

Finian McGrath (Dublin North Central, Independent)
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Hear, hear.

James Reilly (Dublin North, Fine Gael)
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Deputy Boyd Barrett would be correct in his assumption of the additional thousands turning up at St. Vincent's Hospital if it was the case that they could not be seen at Loughlinstown.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I suggested half of the 21,000 people.

James Reilly (Dublin North, Fine Gael)
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It will not be half. First, the numbers of people who attend after 8 p.m. are quite small. Second, most of the patients can still be catered for in a minor injuries or urgent care centre. Only cases involving serious multiple trauma, undifferentiated chest pains and acute abdomen pains end up going to St. Vincent's. Consequently, the numbers will be nothing like those which the Deputy suggests. I will publish the framework document and as a public representative, the Deputy will have an input into the draft. He will not have a veto on it - no one will - but people have a right to be informed, to have a consultation process and to be allowed to make an input into the document. This will happen and already has been outlined. The process has been a little slower than had been anticipated but it is better to be a little slower and to have agreement and to get it right than to rush in and to have regrets.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Minister still has not informed Members when they will get a chance to be consulted on this issue or when his recommendations for the so-called reconfiguration of services will be out in the public domain. Moreover, the Minister is not answering the question about how St. Vincent's Hospital already is unable to cope on a daily basis. He appears to suggest the downgrading of the accident and emergency service at Loughlinstown hospital, both what it does and the hours it will be open, will have no impact on St. Vincent's, which already is overrun. This does not add up.

James Reilly (Dublin North, Fine Gael)
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I must beg to differ with the Deputy opposite, as it does add up. What is required is for appropriate services to be available in the appropriate setting and that they are safe. I have made the point previously that there has been much talk about what has gone out of small hospitals. However, one should wait for the rows that will take place when we begin to take stuff out of the bigger hospitals to put it back into the smaller hospitals. People attending major hospitals such as St. Vincent's or Beaumont for inguinal hernias or varicose veins is akin to sending one's ten year old Volkswagen up to the Ferrari testing centre. While it will do a great job, the local garage would do it just as well and a great deal more efficiently and conveniently. My point is the more complex cases will be left for the secondary and tertiary hospitals, while the smaller hospitals such as Loughlinstown and others will deal with a far wider range of problems in respect of procedures, including cataract surgery and various other day case surgery that can take place. Moreover, each small hospital is different and sits in a different place with regard to the overall hospital network in which it is located. For instance, Roscommon hospital would have a different range of procedures carried out than might the likes of Loughlinstown hospital. I again revert to Louth County Hospital, in which the footfall has greatly improved.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Does this mean the Minister has already decided without consultation?

Tom Hayes (Tipperary South, Fine Gael)
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Please allow the Minister to respond.

James Reilly (Dublin North, Fine Gael)
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No, not at all. I told the Deputy there would be a consultation process. There is a menu of approximately 24 different types of procedures that can be carried out safely at present. However, this is a dynamic situation and this list may be added to next year as things change, as medical procedures and surgical techniques improve and as more stuff will leave the bigger hospitals for the smaller hospitals. Moreover, more activities will leave the smaller hospitals to go back into primary care. It is all about treating the patient at the lowest level of complexity that is safe, timely, efficient and as close to home as possible.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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All those who can afford to will be running off to the Beacon Clinic.