Peadar Tóibín (Meath West, Sinn Fein)
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Some 16 months ago the Minister gave a commitment that he would do his best to defend hospital services in Navan. At the invitation of the Save Navan Hospital campaign, he addressed the 10,000 strong crowd who attended the public rally and said there would be no further cuts that would put people's health and lives in danger. Fine Gael candidates in the constituency stood on the election promise that they would ensure a new regional hospital would be built in County Meath within the lifetime of this Dáil.

The Minister is aware of the trolley count in Our Lady of Lourdes Hospital in Drogheda. It is disastrous, one of the highest in the State. Work has been carried out under his direction to ameliorate the problem to a certain extent. We appreciate this, but the figures are still stubbornly high. In the first six months of 2010, 1,664 patients were forced to wait on trolleys. In the first six months of 2011, 3,266 were forced to wait on trolleys. The INMO has stated that from January to April this year 2,422 patients were treated on trolleys in Drogheda. On each of these occasions little is offered to the patient in terms of privacy and dignity and the treatment provided is seriously sub-optimal. I am not trying to draw a direct comparison with the shocking situation in Tallaght, but this makes people cautious about allowing trolley counts to remain so high.

I bring to the attention of the House what happened in Cavan when the accident and emergency department in Monaghan was closed. The trolley count rose from 746 in the first six months of 2009 to 1,443 in 2010 and 2,745 in the six months of 2011. The increase was due to the closure of the accident and emergency department in Monaghan. In the last few weeks a document was leaked from the HSE which, in fairness to it, indicated that it reflected its current objectives. It does not hide behind the rhetoric of the previous Government in any way. The document is entitled, The Louth and Meath Hospital Group Cost Containment Draft Project Plan, and details the closure of the accident and emergency department in Navan, the reduction of three locum consultant positions, the extended closure of orthopaedic services and the reduction of surgical in-patient activity. These closures will occur despite shockingly high orthopaedic and surgical waiting times. The savings that will be achieved in the part-closure of the accident and emergency department in Navan will total €800,000, but this figure does not take into consideration the cost of treating patients in other accident and emergency departments or the cost of transport.

I appreciate that the Minister has taken a different attitude towards the health service in the Louth-Meath area and the change of direction since the term of office of the last Minister. I also recognise the work done by Fine Gael and Labour Party Deputies in County Meath in partnership with the hospital campaign in the last year. I respect that work, but crunch time is coming for the hospital. It is now or never; we must live up to the promises made and translate them into action. Will the Minister commit to maintaining services at the accident and emergency department in Navan hospital?

James Reilly (Dublin North, Fine Gael)
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I remember the meetings to which the Deputy refers. I certainly know that at no time did I promise to keep the accident and emergency department in Navan open indefinitely. I have made it clear, however, since becoming Minister for Health, that with accident and emergency departments in Cavan, Navan and Blanchardstown, all on the M3, and another in Drogheda, in the longer term the position at the accident and emergency department in Navan must be reviewed. As the Deputy rightly points out, in the current situation where there is such a capacity issue, there is no question of a reduction in the service provided in the accident and emergency department in Navan hospital.

I acknowledge the hard work and dedication of the accident and emergency services at Our Lady's Hospital, Navan. Staff ensure patients are treated in a dignified and respectful manner, even when they might have to wait for treatment or admission.

The Government is committed to securing and developing smaller hospitals to provide more services, not fewer. However, these services, including emergency care, must be right and safely delivered. HIQA has pointed to the type of patient who can be safely treated in different hospitals, depending, in particular, on the volumes of patients seen with each condition. Smaller hospitals treat only small numbers of patients with complex or acutely life-threatening conditions in scheduled and emergency care. This means clinical staff do not treat certain conditions frequently enough to ensure their skill levels. These patients may also require specialised resources, including advanced life-support machines and complex surgical facilities which it is not feasible to provide in many small hospitals. Accordingly, for certain conditions, small hospitals cannot ensure the best care and patients need to be directed to the care pathway appropriate to their needs.

The HSE clinical programmes delineate acute hospital services, based on the safe provision of patient care for given facilities, staff resources and local factors. Under this framework, the future growth in health care for local populations is firmly in local hospitals for ambulatory care, diagnostics and rehabilitation and with close links with primary health care. Suitable services for expansion in smaller hospitals include minor injury units and urgent care centres; day surgery, including cataracts, hernia and other surgery safe for day provision; ambulatory care, including chronic disease management and assessment for older persons; medical services, including cardiac failure clinics, cardiac rehabilitation and chronic obstructive pulmonary disease outreach clinics; rheumatology, dermatology, diabetic day centres and rehabilitation; and diagnostics, including blood tests, X-rays, endoscopy and bronchoscopy.

The HSE is reviewing all services against its cost containment plans and a number of proposals are being considered for Navan. The HSE is focusing on improving accident and emergency department and related services at Drogheda. The HSE has been engaging with Navan Hospital Alliance and will continue to do so. Under the public service agreement, there will also be engagement with staff and staff representatives. However, the HSE has informed my Department that there will be no significant service changes in Navan or Dundalk pending the outcome of the discussions. We must ensure hospitals deliver on the SDU's access requirements, within Government budgets and HIQA's safety and quality requirements. The best way forward for smaller hospitals is to operate initially within hospital groups and ultimately within the proposed independent hospital trusts. Consultations on these groups will commence this week with hospitals and other key stakeholders.

Peadar Tóibín (Meath West, Sinn Fein)
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Central to the reconfiguration process that was signed up to by health professionals in the north east was the building of a new regional hospital, but this has not materialised. I hear much good medical advice to say there must be a certain through-put for procedures to be clinically safe, but I cannot find any medical professional who will say reducing services in existing hospitals whereby patients will not receive a service because of waiting lists or be seen promptly and will have to spend a long time on a trolley is sufficient. We are told we will create a new medical order whereby there will be an increase in medical procedure numbers leading to better outcomes, but the elephant in the room is that individuals are not given the option to avail of improved clinical procedures, rather they face longer waiting lists and longer waiting times on trolleys. The Minister mentioned there would be no significant reduction in services.

Does that mean there will be overnight or part closure of the emergency department until the necessary capacity exists? Those of us involved in the hospital campaign are strongly of the view that we will fight for the emergency department until such time as there is a new regional hospital. We look forward to working in partnership with the Minister in the future. We might not agree on everything but there is no doubt we hope to work in partnership with the Minister in the next year or so to achieve some of our shared objectives.

At a meeting of the hospital campaign last Wednesday many individuals there related their personal experience of arriving in the accident and emergency unit in Navan and their lives being saved or at the very least their health being repaired by the existence of the unit. The hundreds and thousands of personal stories must be remembered on these occasions. As a result of the personal experiences that were related, it was stated at the meeting that people would do their utmost, including mobilisation if necessary, but we hope that time will not come and that we can work in partnership with the Minister.

James Reilly (Dublin North, Fine Gael)
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I hope the Acting Chairman will allow me some latitude. I wish to put on record and to say to those watching the debate on the Internet or who will see it later that the trolley count for the first five and half months of this year is 20% lower than for the same period in the previous year. That is despite taking €1.75 billion out of the health budget, 6,000 staff leaving the service since last year and 4,500 staff being redeployed. It is also despite a 6% increase in admissions through emergency departments and a 7% increase in admissions overall.

There was no commitment by me, when I was spokesperson, to a new hospital in the north east. Approximately 48,500 people were on trolleys for the first five and a half months of last year. The figure has fallen to 38,000 this year. I accept that there are still too many people on trolleys. We continue to work hard to move to a nine hour period from admission to a unit to either discharge or admission to a ward. We are also working towards a maximum waiting time for treatment of nine months. I am sure Deputy Tóibín agrees that the person who is waiting the longest should be treated first once urgent cases and those with cancer have been looked after. When we came into power, more than 3,800 patients has been waiting more than a year for treatment. When I last checked there were approximately 102. I might be slightly incorrect in the figures but it is no more than approximately 125. We did not get all the way there but we got a long way along the road. We will continue to do that.

We listened to what people had to say on Drogheda hospital. We increased the number of medical beds, community intervention teams, home care packages, long-term care and intermediate care and we promised to carry out a capacity study. The study revealed there was a capacity issue. We put in additional medical beds to get on top of the situation. There have been improvements but I accept they are not enough. I make it clear there will be changes to the emergency department in Navan hospital, but they will not happen immediately because the capacity is not there to maintain a safe service. I always said I would put patient safety first, be honest with people and say whether a service was being closed because of money or due to safety.