Brian Stanley (Laois-Offaly, Sinn Fein)
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Question 111: To ask the Minister for Health if he will give a definitive position regarding the practice of some hospitals informing patients that they cannot receive treatment because they do not fall within the catchment area of the hospital [29430/12]

James Reilly (Dublin North, Fine Gael)
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Under the provisions of the Health Act 1970, eligibility for public health services in Ireland is based primarily on residency and means. All persons normally resident in the State are eligible for inpatient and outpatient public hospital services, including consultant services. It is unacceptable for a patient to be informed at short notice that a hospital will not treat them because they are in the wrong catchment area, and my Department has been working with the HSE to clarify its policy in this area.

A letter issued to all hospitals on 15 May from the national directors of the HSE and the chief operating officer of the special delivery unit, SDU, setting out the position on catchment areas. With immediate effect all hospitals were instructed to refrain from any further limiting of historic catchment areas, that is, to further refusal of referrals from areas from which such referrals have been accepted since 2009. This will be retrospective to the start of this year, in most cases subject to discussion. This will apply to both new referrals and to existing patients in long-term care or treatment.

My prime objective is to ensure the safety of patients and I am pleased to say this issue was given the immediate attention it required and was dealt with in a rapid and efficient manner. I am confident the regional directors of operations, RDOs, working with the hospitals have gained their full co-operation in eradicating this issue. The SDU will continue to work with the HSE to embed improved GP referral systems which will enhance patient access to the health services.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I have seen the reply the Minister sent to my colleague, Deputy Stanley, on 6 June and I note his reply today as well. Both responses invite more questions than they answer. In the response on 6 June, the Minister speaks of "informal catchment areas", issues with the areas that are "typically cyclical" and in referring to hospitals, he referred "to what they view" as their catchment areas. In the 6 June reply, the Minister's opening line states, "any individual hospital often has a number of 'catchment areas' reflecting the different geographic areas" depending on the procedure being sought or the particular referral type.

There is a strange situation here and it is vague and unclear. Are there hospital catchment areas officially recognised by the HSE or are there not? It must come down to simple questions. If there are, can we have a map of these catchment areas that apply across the network of acute hospital sites throughout the country. In the particular instance that gave rise to the question in the first place, and while I welcome the address, as the Minister has indicated, it was where a patient was unable to secure the procedure in the hospital within his area of domicile. He sought access to St. Vincent's Hospital in Dublin, which specialises in the procedure, but was told it would not look after him because he did not live within the catchment area.

Michael Kitt (Galway East, Fianna Fail)
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I must call the Minister.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is bizarre. I want to hear what the Minister is doing to have this matter addressed properly.

James Reilly (Dublin North, Fine Gael)
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I made quite clear what we have done to address it. I will relieve Deputy Ó Caoláin's confusion for him on why different procedures have different catchment areas. It is simple and we alluded to it only a minute ago. There are hospitals that are local, there are hospitals that provide regional services and, therefore, the region becomes their catchment areas, and there are hospitals that have national tertiary services, the catchment area of which is the country.

What has arisen in this case is that some hospitals, with their budgetary constraints, saw that patients were not in their regular catchment area for ordinary secondary care and would not accept them when in the past they had been accepting them. We have stopped that. This will not be a problem under money-follows-the-patient, which is rolling out as we speak. We started in orthopaedics and it will roll out across all the specialties. Under that scenario, hospitals will be getting paid for each patient whom they treat. This is another really important part of getting rid of a self-serving system and turning it back into a patient-centred service.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In the his reply to the question on 6 June, the Minister went on to state that it had been "agreed in the interim that any planned and agreed changes in referrals-catchment areas should not impact on patients who are already on a waiting list in a particular hospital or are patients in long term care/treatment". That is fine in terms of those who are already there, but these are important decisions. Where are these decisions being made? Who is making determinations of changes in catchment areas? Who is the body of persons entrusted with this task? Is there any engagement with the public in terms of the raft of experiences? We have only cited one in terms of the question for written answer on 6 June.

What can the Minister advise in the current examination of all this? Is it within the HSE, are there specific catchment areas properly and officially recognised by the HSE in relation to these hospitals, and can the Minister provide us with copies of that information?

James Reilly (Dublin North, Fine Gael)
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I will not be providing Deputy Ó Caoláin with copies of that information. This is a consultation process that will be predicated on safe clinical practice, but also on the principle, to which I alluded in the previous answer, around the smaller hospital framework. If we are going to have a situation where we want the larger hospitals that have that received investment to deliver the tertiary services and the regional services, such as neurosurgery and cardiac surgery, then we must advise patients that they should be going to their local hospital for the ordinary procedures, such as gall bladder, varicose veins and inguinal hernia repair.

People should attend third or fourth level hospitals only where there is serious comorbidity and risk.

All Deputies are exercised about the future of small hospitals. I want to ensure smaller hospitals have a vigorous and full workload, are performing procedures and providing services that are safe, while leaving more complex procedures to larger hospitals. I will not tolerate large hospitals trying to hold on to all their services, as has been the case in the past. They may be good at accepting new services, especially in areas such as cancer care, but they are reluctant to transfer other services to smaller hospitals. Member do not agree with that approach.