Paudie Coffey (Waterford, Fine Gael)
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Great concern has been expressed in the south east about the leaked content of Professor Higgins's report on the proposed hospital network reconfiguration. I wish to put on the record that I support reform and reconfiguration in the health services as long as it is in the best interests of patients and patient care.

The regional hospital network is in danger of being dismantled and fragmented despite the fact that vast human and capital resources have been invested in these hospitals over many years to deliver a more integrated health service for the region. The hospitals serve a population of approximately 500,000 people in the south east, the optimum level required for a regional health service. If we fragment this population there is a great fear that demand for critical tertiary regional health services will become unsustainable and that eventually they will be lost. I note the Minister's recent assurances that cancer care, trauma and cardiology services will be retained in Waterford Regional Hospital in any proposed reconfiguration. However, this would require reassurance with regard to parallel budgets and governance and oversight in the region and the securing of the necessary resources for the continued viability of these services.

The vast majority of the stakeholders in the hospital services of the south east support the retention of the network in the region. I note the HSE South organisation is based in Cork and Kilkenny. It has made a strong recommendation to the Minister and Professor Higgins for retention and to exploit the full potential of the regional hospital network in the south east. The Royal College of Surgeons in Ireland, an independent academic organisation with strong links to hospitals in the region and throughout the country, is fully convinced that the south east hospital network is the most integrated and efficient network in the country at the moment. It has stated that the network should be used as an example for other hospital networks in the country. The vast majority of consultants in the south-east region, including those from Wexford General Hospital, South Tipperary General Hospital and Waterford Regional Hospital, are in full support of retaining the network. Those in Kilkenny have reserved judgment. Therefore, I urge the Minster to ensure full collaboration between all hospitals and to ensure health services are protected in the best interests of patients.

This case is the opposite of the case of Roscommon General Hospital. In that case critical services were centralised to Galway to provide the best medical care for the region.

Catherine Byrne (Dublin South Central, Fine Gael)
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Thank you, Deputy.

Paudie Coffey (Waterford, Fine Gael)
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However, this proposal is for the break up and fragmentation of a regional population, which could threaten the regional health services.

Catherine Byrne (Dublin South Central, Fine Gael)
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Deputy Coffey, you are being unfair to the other Members.

Ciara Conway (Waterford, Labour)
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We cannot disagree with any of the sentiments, statistics or facts to which Deputy Coffey has referred. I am pleased to share time on this critical issue for Waterford and the south east. Some 15,000 people took to the streets in Waterford this weekend and I was proud to be there. I put it to the Minister of State with all sincerity that the people are very angry and concerned. We are their representatives in the Dáil and we need some assurances about what is happening in Waterford and the south east. The demonstration was organised in one week, indicating the outcry and concerns of the people there. I walked in the march with an old school friend whose father died when he was a young man. He put it to me that he does not want anyone else to have to get in a car to access services two or three hours away. This sentiment has been replicated by many public representatives throughout the south east who believe those days are done. Those days must be done. We must retain these services for our people in the south east. This is not only an issue for Waterford but for the south east.

If the Government decides to withdraw, dismantle and break up the health care framework provided in the south east on the whim of Professor Higgins then where is the region? What are we? That is the stark reality of what is being proposed. What will happen if these services are withdrawn? What would the south east become? We need assurances for the thousands of people and their families throughout the region who depend daily, weekly and monthly on the provision of jobs by the HSE in the south east and, more important, on access to and provision of adequate and top-class health care currently on offer. If it is not broken, why are we trying to fix it?

Catherine Byrne (Dublin South Central, Fine Gael)
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Deputy John Paul Phelan has two minutes. Please keep it tight.

John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I will try to keep to my two minutes, or as close as I can. I am pleased to have the opportunity to speak in this important discussion. I echo the sentiments of Deputies Conway and Coffey on the importance of the regional hospital. Much upset, anger and frustration exists in the region as a result of a partially leaked report by Professor Higgins in respect of the reconfiguration of hospital services throughout the country. Everyone understands that medical treatment regimes which have been in place perhaps for a long period should be examined. Nothing can be cast in stone forever. However, I echo the comments of Deputy Conway with regard to the south eastern region and the hospital network. The four hospitals, in Waterford, Clonmel and Wexford and St. Luke's General Hospital in Kilkenny, comprise arguably the most integrated unit in the country in terms of delivering health services.

I am in the somewhat unique position of being a Deputy for Carlow-Kilkenny while I live in and I am from the part of Kilkenny served directly by Waterford Regional Hospital. I too seek reassurances for the people I represent. I seek guarantees that the services provided in Waterford Regional Hospital will not be removed or undermined.

Nothing is more emotive than the provision of health services. Like the other Deputies I was present at the march in Waterford on Saturday. It was a well attended event held in good order and it was non-party political, but there was a clear message for all of us: the people there want to be certain that the health service and those with various expertise in the region and in Waterford Regional Hospital will continue to be in place in future. I look forward to the Minister of State's response in this regard.

John Halligan (Waterford, Independent)
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Like the previous speakers, including my colleague from Waterford, Deputy Ciara Conway, I remind the Minister of State that an estimated 15,000 people came onto the streets of Waterford last Saturday to protest at what they believe to be the latest attack on the city of Waterford. The 15,000 men, women and children had one thing in mind: to send a clear message to the Minister of State and the Government that they will not tolerate an end to the south eastern hospital network that could lead to the services being transferred to Cork. We will not tolerate an erosion of our hospital services to serve a political agenda focused on severe cuts in the health system. The Minister for Health, Deputy Reilly, has confirmed that no decision has been made yet on the issue.

However, the dogs in the street seem to believe the Government's expert group is recommending a break-up of the south-east hospital network. It is crucial that the full spectrum of health services remain in place, not only for those living in Waterford but for the 500,000 residents of the south east. Any change in the current system would have major health consequences, not to mention an adverse economic impact on a region already devastated by one of the highest unemployment rates in the country and the obvious lack of investment by the Government and its predecessor.

At an earlier meeting which all of the Deputies from the south east and members of the medical profession right across the region attended the Secretary General and the Minister gave a commitment, but we want to hear it made in the Dáil. They gave a commitment that essential and acute services such as cancer care, cardiology and severe trauma services would not be affected. What ordinary men, women and children on the streets of Waterford wanted to know on Saturday was whether that would be the case. While the Minister and the Secretary General have said this, we want to hear it from the Minister and the place to hear it is in the Dáil.

Catherine Byrne (Dublin South Central, Fine Gael)
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I thank the Deputy.

John Halligan (Waterford, Independent)
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I will finish with this point. The Secretary General, Dr. Ambrose McLoughlin, stated he would be amazed and shocked and that it would be unacceptable if it were to happen that the essential services I have mentioned were affected and that, while he was Secretary General, this would not happen. We want to have this stated in the Dáil.

Fergus O'Dowd (Louth, Fine Gael)
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I thank Deputies Paudie Coffey, Ciara Conway, John Paul Phelan and John Halligan for raising this matter. I note Senator Maurice Cummins is here also. I am taking this matter on behalf of the Minister for Health, Deputy James Reilly.

A key stepping stone towards the introduction of universal health insurance will be the development of 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 for patients.

The work on hospital groups is not about downgrading hospitals, rather 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 hospital groups are broadly comparable in size and scope in order that 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, it is about maximising the range of services available to deliver internationally comparable quality care services for patients, regardless of where they live.

Specifically with regard to Waterford, the hospital will retain its current suite of services - oncology, cardiology and emergency department. It will provide invasive cardiology and trauma services and continue to be an NCCP centre. It will retain the same population referral base for cancer patients. Joint consultant appointments such as general surgery shared with Wexford across the groups will continue to support the specialist cancer services provided. In addition, there has been significant capital investment in the provision of a new emergency department and neonatal unit which has been fully constructed and is being fitted out. As part of the project, the existing emergency department is being refurbished and will be completed in February.

To assist the Department in advising the Government on the formation of hospital groups, in June the Minister appointed Professor John Higgins to chair a strategic board on the establishment of hospital groups. The strategic board is composed of representatives with both 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 with 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.

The Minister has also made clear to the project team and the board his 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 the smaller hospitals framework which defines the role of smaller hospitals. It outlines the need for smaller and larger hospitals to operate together and, therefore, is intrinsically linked with the ongoing work on the development of hospital groups. The Minister expects to receive the report of the strategic board later this month and will be able to bring this matter to his 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 these trusts are established, the composition and functioning of the groups will be reviewed and if changes prove necessary, they will be made with Government approval when the hospital trusts are being formed.

Catherine Byrne (Dublin South Central, Fine Gael)
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I remind the Deputies that they have one minute each. I ask them to keep to questions rather than anything else.

Paudie Coffey (Waterford, Fine Gael)
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The existing network of five hospitals serves a population of 500,000 in the south east. There is almost a network of ten hospitals, with much duplication of resources, serving a population of 1.2 million to which we now want to add by sending some of the population of the south east to Dublin and Cork, into hospitals that already have capacity problems. This is a critical health care issue that needs to be deeply analysed before a Government decision is made and requires the full attention of the Minister and the Government. The Minister must listen to the public representatives who are voicing the concerns of the people of Waterford and the south-east region. They must be able to stand over any Government decision which must be justified in terms of equality of access to health care in the regions. I ask the Minister to take into account this view which I am not expressing lightly. We are working on a cross-party basis - I acknowledge the presence of Deputy John Halligan and all of the Oireachtas Members in the south east - to try to find a solution and resolve this critical issue.

Ciara Conway (Waterford, Labour)
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I thank the Minister of State for his response. However, I question the reference to the consultation process as having been "rigorous". As I understand it, Professor Higgins met a delegation on two occasions, but I am not sure that his board has done so. The consultants from the south east have drawn together a concise and well researched evidence-based report on what a configuration in the south east would look like to best serve the needs of all its residents. I would like to know whether Professor Higgins has read this report and, if not, why. I ask the Minister of State to follow-up on this on my behalf. We must be listened to. This is democracy in action. We are representing the 15,000 people who took to the streets at the weekend and the Minister must engage on the process involved. We understand there is a need for reform. The health system is one we inherited and that has been neglected and mismanaged for many years and we want to see the reforms deliver. With this in mind, Waterford Regional Hospital has been one of the most efficient and leanest hospitals in the country, as verified by outside bodies. This also needs to be included in the mix when examining this issue.

Catherine Byrne (Dublin South Central, Fine Gael)
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I am sorry, I have to pull the plug on the Deputy.

John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I thank the Minister of State for his reply. Deputy John Halligan asked him to state what had been said at a meeting at which we were all present earlier and, in fairness, he has done so. My question relates to the document prepared by the consultants in the south east. I have yet to see a justification given in any quarter for the breaking up of the regional structure. Ultimately, if the four hospitals are to be dismembered and included in four separate trusts, that is what will happen.

I would like an answer but the Minister of State who is here today is not in the Department of Health and may not be able to give me one. I would certainly like him to bring a message to the Minister that we wish to see some sort of analysis of why this change would even be considered. I acknowledge that in his response he has stated the crucial tertiary services that are currently available in the region will remain intact. That is certainly very important. The south east hospital network has been integrated to an enormous extent over the last 20 to 30 years and works well. In that context, I would need to see more justification for a change. I am not one who is against change because I believe the health service must be constantly examined, in terms of its structure. However, I need to be convinced.

John Halligan (Waterford, Independent)
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I am not here to criticise the Minister for Health, but when he came to power he spoke about taking a "hands-on approach" that would be different to that of the last disastrous Government, in order to improve the terrible health system he inherited. However, my understanding of a hands-on approach was that he would be in contact with and would speak to people who work on the front line, like professors, consultants, surgeons, nurses, doctors and others working on the ground. All of those people have come together and said that it is essential that Waterford Regional Hospital remains the strategic hospital in the region and keeps its status. One cannot find anybody who is more frontline than the people who met the Minister today, who perform the operations, lecture in the theatres and treat people in the accident and emergency department. They know what Waterford Regional Hospital is all about. The Minister must take on board the fact that, for the first time ever, politicians of all persuasions, as Deputy Coffey said, have come together in this House, not to score points, but united in their belief about what is the right decision for Waterford Regional Hospital. I wish to remind the Minister that 15,000 men, women and children, many of whom support the Government parties, marched on the streets of Waterford in unison to say they will not accept the downgrading of their hospital.

Fergus O'Dowd (Louth, Fine Gael)
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I thank the Deputies for their comments and acknowledge the presence of Senator Maurice Cummins in the House. All I can say is that I will make sure the Minister is made aware of the concerns raised by the Deputies and of the local feelings that were so clearly expressed. I wish to reiterate the point that, with specific regard to Waterford, the intention is that the hospital will retain its current suite of services, including invasive cardiology, as well as trauma and cancer services. That is an absolute commitment, which is underlined in the text before me. I will ensure that the Minister is made fully aware of the views of all of the Deputies.