Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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In the past week or so a local newspaper in County Wicklow reported on what can only be described as a secret meeting involving the Tánaiste and senior administrators and medical personnel from St. Vincent's and Loughlinstown hospitals. It was also attended by Deputies from County Wicklow and the Labour Party Senator Aideen Hayden.

The purpose of the meeting was to discuss the Government's intention to downgrade the 24-hour accident and emergency service at Loughlinstown hospital to that of a minor injury unit and to transfer the accident and emergency service to St. Vincent's Hospital.

I find it strange that the Minister of State, Deputy Perry, rather than the Minister or either Minister of State at the Department of Health is taking this matter. I find strange also that no Deputy from Dún Laoghaire was invited to a meeting to discuss an issue which has been very controversial for quite a few years. Despite that I have raised this matter during the Topical Issue Debate on several occasions and have tabled numerous questions about it the Department, or whoever organised the meeting, did not have the courtesy to invite representatives from the Dún Laoghaire area, where the hospital is located. It is extraordinary that this should have happened. This smacks of political manipulation of the worst kind and shows disrespect not only to the elected representatives from the Dún Laoghaire area but, more important, to the people of Dún Laoghaire, Loughlinstown, Shankill, Ballybrack and other areas surrounding the hospital.

I understand that at the meeting people were informed of the Minister's intention to bring a proposal to Cabinet to reconfigure accident and emergency services in south Dublin by downgrading the 24-hour accident and emergency service at Loughlinstown hospital. I would like to know why Deputies from Dún Laoghaire were not invited to the meeting. Had this anything to do with the fact that I and others have campaigned against the downgrading of these services? Also, where are the details of this reconfiguration? I understand that people were also told at the meeting that this reconfiguration would result in a better, safer and more efficient service. Given the large numbers of people regularly left lying for hours and often days on trolleys at the accident and emergency unit at St. Vincent's hospital it is hard to understand how it will cope with the overflow of the approximately 21,000 people per year who attend the accident and emergency unit at Loughlinstown hospital.

Can the Minister of State confirm that the hospitals' budget for the reconfigured services will remain the same? I understand they are to decrease by 3%. As such, not only will the accident and emergency service be downgraded but the budget to deal with the same volume of cases will be smaller. How does all of this tally with the long stated commitment of the Tánaiste, who is from Dún Laoghaire and, mysteriously, was invited to the meeting when other representatives of the area were not, to upgrade Loughlinstown hospital to a regional hospital and with the Government's commitment to care in the community and so on? This reconfiguration will result in a displacement of services so that they will be at an ever greater distance from people in the Wicklow and Dún Laoghaire areas.

John Perry (Sligo-North Leitrim, Fine Gael)
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I thank the Deputy for raising this issue, which I am responding to on behalf of the Minister for Health.

Small hospitals, such as St. Columcille's hospital, Loughlinstown need to be supported within a hospital group. This is necessary for the safe management of patients who present with varying levels of complexity, for education and training, continuous professional development and the sustainable recruitment of high quality clinical staff. The framework for smaller hospitals, to be published in the near future, and the hospital groups report, define the role of small hospitals. The framework outlines the need for small and large hospitals to operate together and the wide range of services that can be provided within smaller hospitals. It also sets out to address the services that should transfer from large to small hospitals and vice versa within a group. This allows services to be delivered in the most appropriate hospital and as close to the patient's home as possible.

In developing the framework for the development of small hospitals, the Government is clear on the important role that can be played by small hospitals in terms of the provision of more rather than fewer services for more patients. With this in mind, the framework will set out what services can and should be delivered safely by these hospitals in the interest of better outcomes for patients. Local hospitals may deliver services such as ambulatory care, including chronic disease management and day surgery, diagnostics and rehabilitation services and have minor injuries and medical assessment units. Local injuries units treat patients with minor injuries such as suspected broken bones, sprains and strains, facial injuries, minor scalds and burns. Patients can self-refer or can be referred by their general practitioner. Medical assessment units receive general practitioner referrals and provide access to diagnostic services. Patients will be admitted, if necessary. Those requiring interventions not available in the local hospital will be transferred to the larger hospital under appropriate protocols.

The organisation of hospital services nationally, regionally and locally will be informed by the HSE clinical programmes, including the HSE report of the national acute medicine programme, which recognises the essential role of large and small hospitals in the delivery of acute care services. Loughlinstown hospital provides joint acute hospital services with St. Vincent's and St. Michael's, Dún Laoghaire. Together, they provide a range of services for the catchment of Dublin south-east and Wicklow across three sites in a collaborative arrangement. In this context HSE Dublin-mid-Leinster is reorganising services provided at St. Columcille's in South County Dublin. This reorganisation is in the interests of patient safety and better service provision. It is planned to proceed with reorganisation on publication of the small hospitals framework, with a lead-in time of six to eight weeks. There has been ongoing communication with staff and local public representatives and a detailed communication plan has been developed for use at implementation stage.

On the Deputy's question of why he was not invited to the meeting, I imagine it would be up to the management team and clinical staff of the hospital to invite representatives to a meeting. All of the invitations which I have received to attend meetings at Sligo General Hospital were from management at the hospital.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Minister of State's response is not satisfactory. Virtually every month for the past year and a half I have asked what is happening in regard to the reconfiguration of services in this area and about the possible downgrading of accident and emergency services at Loughlinstown hospital. I have been told time and again by the Minister, Deputy Reilly, that the report is imminent but it has not yet materialised. Lo and behold a secret meeting takes place at which everybody but those who have expressed opposition to the plan are told what is proposed. Even now, I do not know what is planned. The response provided by the Minister does not give details in regard to what will happen.

I understand that people at the meeting were told that the 24-hour accident and emergency service at Loughlinstown hospital will be downgraded to a minor injuries surgery which will operate from 8 a.m. to 6 p.m., which is a substantial downgrading. How can the Minister claim, as suggested in the response, that this reconfiguration will, as a result of their being more experience people in particular areas, improve services when budgets are falling and St. Vincent's hospital accident and emergency service is already, judging by the number of people regularly on trolleys for hours and days there, unable to cope? How is St. Vincent's to cope with the overflow from Loughlinstown hospital once downgraded, which overflow is also likely to result in a deterioration of the service available to people living in the areas surrounding St. Vincent's hospital? Reference was made to proximity to the home in terms of the provision of services.

The hospital was situated in Loughlinstown precisely to provide services for people in areas as far as south Wicklow, as well as in Cherrywood, Shankill and so on. The people living in these areas will now have to travel much further to access these services. This decision flies in the face of the commitment to provide services for people closer to home.

John Perry (Sligo-North Leitrim, Fine Gael)
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The message in this respect could not be more clear. The hospital provides acute hospital services jointly with St. Vincent's University Hospital and St. Michael's Hospital in Dún Laoghaire. This reorganisation does not represent a downgrading of the hospital in Loughlinstown but a reconfiguration of services. The Deputy does not appear to have heard clearly the message contained in the reply. This reorganisation of services is in the interests of patient safety and providing a better service. It is planned to proceed with the reorganisation of services on publication of the report.

The Deputy may be a little peeved that he was not at the meeting, but the fact is that the Minister for Health, Deputy James Reilly, is doing an outstanding job in the reconfiguration of hospitals. I am familiar with this issue from the perspective of the status of the regional hospital in Sligo which covers a vast region. There are three hospitals and under the plan, there will be a reconfiguration of services and a defining of the services to be delivered in each hospital. This is a very intelligent plan, about which I would not be as pessimistic as the Deputy. When he has read the publication, he will note the opportunity the reconfiguration of services presents.