Mattie McGrath (Tipperary South, Independent)
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I thank the Ceann Comhairle for selecting this topical issue for debate this evening. I note that requests tabled by other colleagues to raise similar issues have been withdrawn as they hope to have a meeting with the Minister. I hope we will make progress on this issue.

I take this opportunity to express my distaste and concern that the Ceann Comhairle refused a Special Notice Question today from the Technical Group regarding this morning's decision by the Supreme Court.

This is very unfair and unwise. We could have debated it and introduced legislation tomorrow if necessary to defer the referendum.

I am delighted the Minister for Health is in the House to take the question. If something is not broken one should not fix it. Dublin has a population of 1.2 million people and has ten hospitals. The south-east region, which I represent along with other Deputies and Senators who are present, has a population of 500,000 and only four hospitals. We bought into the idea that Waterford Regional Hospital would be one of the eight centres of excellence. We did not like the fact that South Tipperary General Hospital in Clonmel lost services but we allowed them to go on the grounds there would be specialties in Waterford such as cancer care. We all made a deal and we are happy with it. We support each other.

We cannot now have a different situation because of the Higgins report or the ideas of some geniuses in Kilkenny that they want to link up with St James's Hospital in Dublin. We want to protect our regional status. We have a population of 500,000 people, and the Minister can give all the reasons he likes but we are told this is the magical number required for a regional hospital. We also have the ambulance service required to transport people. Consultants, patients, doctors and nurses have all bought into the idea. It would also be a major blow to the economy of the south-east region which we cannot afford. The south-east region has lost much and we cannot afford to lose this. It is a matter of life and death. We must keep the hospital as it is.

Deputy Halligan also tabled a topical issue and on his behalf I wish to say we want to have a system of honour. The agreements made with Waterford Regional Hospital on the transfer of services should be kept. Consultants or others should not smash and grab services from South Tipperary General Hospital. I appeal to the Minister to leave the system alone. He has enough problems to deal with. We have a perfect working system in Waterford and we go there for specialist treatment. We need to be left alone. We must have confidence in the service. This was the model held up and proclaimed throughout the country. I ask the Minister to leave it alone. It is not broken so he should not fix it.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It has been widely reported in recent days that the report by Professor Higgins into the number and composition of the new hospital groups and their relationship to the university sector will result in an effective downgrading of Waterford Regional Hospital and the relocation of vital services to already under pressure hospitals in Cork and Dublin. This news has been met with outrage and consternation by the entire community in Waterford and the Minister needs to understand the potential medical and economic implications of this move for the people in the wider south-east region. The clinical director of Waterford Regional Hospital, Rob Landers, has said the removal of vital cancer, neurology and cardiology services from Waterford would have a devastating effect and understandably so. In the context of these reports I must ask the Minister to confirm whether the Higgins report recommends as reported the downgrading of Waterford Regional Hospital and the reconfiguration of services in the region with specialties currently available at Waterford relocated to hospitals outside the south-east region. I hope the Minister will be able to scotch these reports.

Those living and working in the area need clarification. I note a number of Deputies from the constituencies affected in the Chamber. Does the Minister agree the notion of splitting up an existing network, which I must acknowledge is one of the best performing in the State, makes little sense. Will the Minister outline how he intends to proceed with Professor Higgins's report? When is it due to be presented to the Government? Will the Minister facilitate a period of consultation to allow the stakeholders see the recommendations and respond appropriately?

James Reilly (Dublin North, Fine Gael)
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A key stepping stone towards the introduction of universal health insurance will be to develop independent not-for-profit hospital trusts in which all hospitals will function as part of integrated groups. The rationale behind the establishment of hospital groups and trusts is to support increased operational autonomy and accountability for hospital services in a way that will drive service reforms and provide the maximum possible benefit to patients. To assist the Department in advising the Government on the formation of hospital groups, in June this year I appointed Professor John Higgins to chair a strategic board on the establishment of hospital groups. The strategic board is composed of representatives with national and international expertise in health service delivery, governance and linkages with academic institutions.

A project team was established to make recommendations on the composition of hospital groups, governance arrangements, current management frameworks and linkages to academic institutions for the consideration of the strategic board. The consultation process to inform the project team has been rigorous and comprehensive. It has included meetings with every acute hospital, including consultations on two separate occasions with each hospital in the south-east region. It has involved the receipt of a significant volume of formal submissions from hospitals, clinicians, regulatory bodies and citizens, all of which have been considered.

I have also made clear to the project team and to the board my determination to ensure that as many services as possible can be provided safely and appropriately in smaller, local hospitals. On this basis, the organisation of hospital services nationally, regionally and locally will be informed by the ongoing development of the HSE clinical programmes and by the smaller hospitals framework. This framework defines the role of the smaller hospitals. It outlines the need for smaller hospitals and larger hospitals to operate together and therefore is intrinsically linked to the ongoing work regarding the development of hospital groups.

The work on hospital groups is not about downgrading hospitals. It is about bringing together groups of hospitals into single cohesive entities to allow maximum flexibility in management, budgets and service delivery. It is about ensuring that hospital groups are broadly comparable in size and scope so they can attract high quality staff and trainees across all health care specialties and professions. It is about creating efficiencies by using common business processes and economies of scale and avoiding unnecessary duplication. Most importantly of all, it is about maximising the range of services available to deliver internationally comparable quality care for patients, regardless of where they live.

I hope to receive the report of the strategic board on the establishment of hospital groups later this month and that I will be able to bring this matter to my Cabinet colleagues for decision shortly thereafter. It should be remembered that the hospital groups are an interim collaborative measure pending the legislation required to establish hospital trusts. Before the trusts are established, the composition and functioning of the groups will be reviewed and if changes prove necessary then they will be made with Government approval when the hospital trusts are being formed.

Mattie McGrath (Tipperary South, Independent)
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I am not at all reassured by the Minister's statement. We have gone down this road. We have reconfigured, and Waterford Regional Hospital is the regional cancer care hospital. I get worried when I see professors drawing up reports and discussing further reconfiguration and change. The public must have faith and trust in the system. The people of South Tipperary bought into it as did the people of Kilkenny, Carlow and Wexford. We have an excellent service so why break it? We do not need any more reconfiguration. We reluctantly accepted this but we have reconfigured. We have excellent services in Waterford Regional Hospital and in the smaller hospitals such as the one in Clonmel which I represent. The system is working fine and people are reassured they have a 90 minute window of opportunity to get from a smaller hospital to the regional hospital. The Minister did not answer my question as to how 1.2 million people in Dublin have ten hospitals while we are expected to have only four. Now we are facing a situation whereby Waterford Regional Hospital might be downgraded to a district hospital. It is not at all clear. I hope when my colleagues meet the Minister that he will listen to them and engage with the elected representatives rather than with professors doing reports and reconfiguration by faceless officials.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I am disappointed that in the Minister's reply he did nothing to allay the real and current fears and this is regrettable. I do not know what has given rise to the reports, but the concern is none the less sincere across the board. I note from the information available to me that four of the five hospitals in the region are in support of maintaining the current configuration. From all that I am aware of with regard to the situation in Waterford Regional Hospital and the current grouping it is, as I already put on record, if not the best performing then certainly one of the best performing in the State. I appeal to the Minister because I do not want to feed ill-founded concerns and all that will spill from them.

The reason for my raising this matter is, as I indicated in my opening question, to scotch the fears on the basis of what the Minister knows. This is important. I appeal to the Minister to take on board what I have said and the validly held concerns. The attendance in the Chamber of Deputies and Senators from across the region indicates shared concern and anxiety over the future. I urge the Minister to avail of the opportunity that presents itself.

James Reilly (Dublin North, Fine Gael)
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I too acknowledge the presence of Deputy Paudie Coffey and Senator Cummins, who is in the Gallery. They are clearly very concerned.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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And Senator Cullinane, who is also observing from behind the Minister.

James Reilly (Dublin North, Fine Gael)
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The Deputy had his moment to speak and in which to acknowledge his colleagues, if he so desired. I recognise that Deputies Conway, Ann Phelan and John Paul Phelan are present. There is concern in the south east owing to difficulties associated with the configuration there. There are associations elsewhere in the country that do not seem to create difficulties. In other words, as one person put it, there seem to be marriages made in heaven that people seem to be very happy to allow to proceed.

In my original answer, I stated this is a grouping exercise. It is not a question of the trusts. If they do not work out, we will have the opportunity to carry out a review before we finalise any trust legislation. It is not fair to say that these provisions will be set in stone. However, it would be very wrong of me to pre-empt the outcome of the report. I have not seen it, I acknowledge there are concerns and that some hospitals within the south east have different views. We must bring people together or let them part, depending on evolving circumstances.

While I cannot pre-empt the content of the report, I take on board the concerns of the people in Waterford. They, including Deputy Deasy, who is not present, have made representations to me. Equally, the Deputies from Wexford are concerned. All these agendas are different. The Members reflect the worries and concerns of the people who elected them and this must be taken into consideration. We will continue to listen and I hope there will be a resolution that will serve everybody's purpose and, most important, the needs of patients.