Billy Kelleher (Cork North Central, Fianna Fail)
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Question 38: To ask the Minister for Health the public hospitals that he considers suitable to be turned into hospital trusts; if the introduction of external management consultants represents the beginning of that process; if the move is permissible under the Croke Park agreement; and if he will make a statement on the matter. [33230/11]

James Reilly (Dublin North, Fine Gael)
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The health service requires strong management capacity to deliver on service targets in an effective and efficient way within available resources, and also to lead change in a complex environment. Over a period the HSE has identified a need to develop management capacity, especially in certain hospitals.

In June 2011, the executive invited tenders from potential service providers for a four-year framework agreement for personnel placement and supply services. Under this agreement, service providers can be asked to source and supply senior interim managers or more long-term senior management candidates. Following from this tender process, five companies were invited last month to participate in a mini-competition to source and propose candidates for an interim management support structure for HSE west. The competition has closed and the proposals are being evaluated.

Under these arrangements, it is planned to recruit a chief executive officer for the Galway university hospitals group. It is also intended to strengthen management capacity in the HSE mid-western region by putting in place other interim management supports. The successful provider will also be expected to assist in developing management capacity for the longer term. The HSE is engaged in discussions with the IMPACT trade union regarding these plans and does not regard them as conflicting with the public service agreement.

As stated in the programme for Government, in conjunction with the introduction of universal health insurance, public hospitals will become independent, not-for-profit trusts. This will require the development of the necessary corporate governance, management and clinical capacity to ensure these hospitals are equipped to function efficiently and effectively, once established as independent service providers. Under these arrangements, it is planned to recruit a chief executive officer for the Galway University Hospitals Group. It is also intended to strengthen management capacity in the HSE mid-western region by putting in place other interim management supports. The successful provider will also be expected to assist in developing management capacity in the longer term. The HSE is engaged in discussions with the IMPACT trade union on these plans and does not regard them as conflicting with the public service agreement.

As stated in the programme for Government, in conjunction with the introduction of universal health insurance, public hospitals will become independent, not-for-profit trusts. This will require the development of the necessary corporate governance, management and clinical capacity to ensure these hospitals are equipped to function efficiently and effectively, once established as independent service providers.

Billy Kelleher (Cork North Central, Fianna Fail)
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In the context of the introduction of universal health insurance and the establishment of independent trusts, by now the stated position of the Government, nine months after taking office, given what was said prior to the general election and the time the Minister has had to prepare policy documents on his own vision of what the health service should look like in the years ahead, should at least offer a blueprint for us to analyse in the near future. We are awaiting the establishment of the implementation body in respect of universal health insurance, but it is imperative that we see the criteria laid down, with the instructions and parameters for the commission when making proposals on universal health insurance. In tandem, if we are to meet the commitments given in the programme for Government, in the near future hospitals must be identified that would be suitable for removal from the HSE, or whatever structure is left after the legislation is passed, to become independent trusts managed by a local board completely separate from the national body which will manage the health service. None of this has yet happened. Does the Minister know which hospitals will be involved? Will they be large hospitals, or the smaller hospitals which are being downgraded?

James Reilly (Dublin North, Fine Gael)
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We are not of the view that hospitals are being downgraded; they are changing the emphasis on the care they provide. Our primary concern is that hospitals are safe. Decisions are still in the process of being assessed; therefore, no final decisions have been made. We are evaluating the matter. All of the hospitals are different and the universal health insurance implementation commission will examine the issue. It would be premature, therefore, to outline exactly what each hospital will do or which hospitals will be connected to which. There are different possibilities and there may be interim arrangements prior to final arrangements being made for connectivity between hospitals. There are considerations related to connectivity by road infrastructure and the complementary positions hospitals offer when in partnership with others; we do not want hospitals to duplicate services unnecessarily. This work is ongoing. It is a massive task that we are intent on completing and there has been a lot of activity to date. As soon as the implementation body produces its report, it will be brought before the Dáil.

Billy Kelleher (Cork North Central, Fianna Fail)
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Who will make decisions on the hospitals in which there will be further capital investment while we await the establishment of independent trust hospitals and the amalgamation of other hospitals? Who is going to make these decisions in the interim?

James Reilly (Dublin North, Fine Gael)
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Each Minister receives a capital budget and it is his or her responsibility and that of his or her Department to make the relevant decisions in respect of that budget. That has always been and remains the case.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 39: To ask the Minister for Health if he will put in place a programme to restore services to hospitals in the north east and, with immediate effect, maintain and sustain the minor injury unit at Monaghan General Hospital as a 9 am to 9 pm, seven days a week service, proceed with the medical assessment unit at the same hospital site and restore the rapid response vehicle to the ambulance service covering County Monaghan and north County Louth [33229/11]

James Reilly (Dublin North, Fine Gael)
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I am committed to ensuring acute hospital services at national, regional and local level will be 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 hospitals. To this end, the Government will publish a framework for the development of smaller hospitals to set out how their future will be secured. The framework will give clear information on the role of smaller hospitals and address any safety issues arising from HIQA's reports. Consultation covering all the key stakeholders, including patients and public representatives, will be an integral part of the process. In addition to the framework, the organisation of hospital services will be informed by the clinical programmes being developed and implemented by the HSE. These interrelated programmes aim to improve service quality, effectiveness and patient access and ensure patient care is provided in the service setting most appropriate to people's individual needs.

In the context of the specific questions raised by the Deputy, the minor injuries unit at Monaghan General Hospital provides an eight hour service, from 9.a.m. to 5 p.m. This service came into effect on 1 November. The change in opening times is the direct result of the current budgetary and financial position facing the health system. The HSE has reviewed other possible options to save money or increase revenue but concluded that they would not generate sufficient savings in the short term. Following a detailed analysis of this issue, it has estimated that total annual savings of almost €400,000 will be generated with this alteration of opening hours.

I am favourably disposed towards the development of medical assessment units because they provide excellent service for patients. However, it is essential that such units be justified from both a service delivery and value for money point of view. The HSE has, as the Deputy is aware, established an independent feasibility study which will examine if there is a clinical need for a medical assessment unit in Monaghan General Hospital for the population of County Monaghan. It will also establish the pay and non-pay costs and internal-external support services associated with the establishment and running of an medical assessment unit in Monaghan General Hospital. The group commenced its work on 17 October and the timeframe for completion is six to eight weeks.

Additional information not given on the floor of the House

The HSE national ambulance service initially put in place a rapid response vehicle to assist with the smooth and seamless transformation within the area. This is a non-transporting vehicle, carrying advanced paramedics and an extended range of equipment to provide advanced treatment. This model is not sustainable locally because of the unavailability of appropriately qualified staff, but the matter will be kept under review, with a view to reintroduction when the National Ambulance Service is in a position to deliver it at the appropriate service level. Staff resources have been redirected to front-line ambulances to ensure there will be no change in the clinical levels available throughout the area. The region has a fully functioning emergency ambulance service.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Unfortunately, I cannot say "Go raibh maith agat" to the Minister because, not for the first time when addressing the people of County Monaghan, he has referred to yet another framework document. That phrase will have a serious echo for those familiar with the history of Monaghan General Hospital. The Minister referred to the minor injuries unit offering services between 9 a.m. and 5 p.m., but he did not indicate that such services are only available Monday to Friday, nor did he state the unit remains closed on Saturdays and Sundays. This represents a significant contraction from the 9 a.m. to 9 p.m. service that was previously available seven days a week. Savings and cuts are the only matters about which the Minister speaks.

Only a couple of weeks ago the Minister tabled to a Private Members' an amendment which followed on from amendments I had tabled seeking to secure the future of the minor injuries unit at Monaghan General Hospital, ensure the establishment of a medical assessment unit there and have the rapid response vehicle recently removed from the facility restored to it. Government Deputies supported that amendment which stated the House "supports the Government's policy of developing the role of smaller hospitals to their full potential rather than closing or downgrading them". At the same time, however, the services on offer in the minor injuries unit at Monaghan General Hospital on Saturdays and Sundays were being discontinued. In addition, they were being significantly reduced on every other day of the week.

What makes the Minister's approach different from that of his predecessor, Mary Harney, and the former Fianna Fáil-led Government which introduced a series of cuts? That is what we are facing. There is no difference between this and the previous Administration; all there has been is a change in personnel.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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There is just over one minute left.

James Reilly (Dublin North, Fine Gael)
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I am not sure what was the supplementary question.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is the same question I put to the Minister: will he restore-----

James Reilly (Dublin North, Fine Gael)
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I made the position clear. I made clear why we face the position in which we find ourselves. It is due to the current economic fiasco left by the preceding Government. The health sector, just like any other of the spending Departments, must make savings and we have had to make very unpleasant decisions to stay within budget. These are not decisions that I particularly like but they must be made.

It is not all one way action by any means. As I have told Deputy Ó Caoláin, a framework document on small hospitals is being worked on. There will be opportunity for all Deputies to have an input. There will be consultation. There will be more services of a safe nature brought to smaller hospitals.

I mentioned previously the many new services that have evolved in Louth County Hospital which is close to Deputy Ó Caoláin's constituency of Cavan-Monaghan. The footfall of people through that hospital has increased dramatically as a consequence. The future for smaller hospitals is around services that can be delivered safely in those hospitals, not the very complex emergency department facilities which are restricted to the major hospitals.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Briefly-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We are over time.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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-----there was nothing of an overly specialist nature in the services at the minor injuries unit. It was an essential component part of what remained.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I thank Deputy Ó Caoláin.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It was never envisaged that there would be further cuts.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I thank Deputy Ó Caoláin.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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All the Minister is doing is complicating an impossible situation in Cavan and Drogheda by further displacement of patients.