Seán Fleming (Laois-Offaly, Fianna Fail)
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I want to raise the very important issue of the future of the accident and emergency unit at Midland Regional Hospital Portlaoise. The Minister of State will be aware that the national director of acute hospital services published a report in which he said that the 24-hour a day, seven days a week accident and emergency unit in Portlaoise was "not clinically sustainable". His report went on to say that the department should be replaced by a medical assessment unit and local injury clinic operating during daytime hours only. He added that other services, such as day care surgery, endoscopy and a local injury unit should be developed to make up for the loss of emergency and surgery facilities, as happened after other hospitals closed their units.

The Minister for Health, responding to public pressure, said there were absolutely no plans to close the unit. I accept that but the question of downgrading the unit is in the offing. The report did not mention closing it. It referred to scaling it down and replacing it. The Department of Health’s submission to the Department of Public Expenditure and Reform, as part of the Government’s comprehensive spending review, suggested closing 24-hour services at five hospital emergency departments, including Portlaoise, if its budget were cut. The Department of Health has caused this scare. Maybe it is trying to frighten off the Department of Public Expenditure and Reform by saying if it cuts the budget it will close the accident and emergency unit.

That the Department is suggesting this possibility undermines the unit in Portlaoise hospital. There are 43,000 visits to the accident and emergency unit in Portlaoise every year. It is one of the busiest units in Ireland outside the capital city, according to the HSE report of activity to the end of July, published this month.

Brian Stanley (Laois-Offaly, Sinn Fein)
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There is great concern about the Portlaoise hospital. As the previous speaker said of its workload, it is one of the busiest accident and emergency, maternity and paediatric units outside Dublin but it has one of the lowest budgets. Its budget is €10 million lower than that of Naas General Hospital. I am not asking the Minister of State to rob the hospital in Naas. I do not want her to rob Peter to pay Paul. Despite having a bigger workload it has a much lower budget than Naas General Hospital. This year it had a budget of only €44 million which is approximately €8 million less than it had a few years ago when its budget was in excess of €51 million. The budget just about covers the payroll. Despite the best efforts of management and staff the hospital seems to be always in a precarious situation. I recognise that the State has gone through a financially difficult period but the difficult situation at Portlaoise has been compounded by the constant stream of leaked reports that we do not have sight of. We read about them on the front pages of the newspapers.

A clinical report carried out by Dr. Ian Carter earlier this year was not published. It should have been and I ask that it be published. It recommended the closure of the 24-hour accident and emergency unit and surgical services.

Then we had the confidential Department submission, which suggested that if the Government went ahead with the planned budget cuts, 20 of the 150 beds at the hospital would be lost and the emergency department's opening hours would be confined to the hours between 9 a.m. and 5 p.m. The Minister, Deputy Varadkar, has said he has no plans to close the emergency department. That may be so, but will its opening hours be reduced so that it provides a nine-to-five service only? Accidents are not confined to the hours between 9 a.m.and 5 p.m. The staff and the community are being subjected to a relentless campaign of uncertainty. Further uncertainty is being created. Can the Minister of State give me an assurance that the accident and emergency unit and the surgical services at Portlaoise are secure and safe?

Kathleen Lynch (Cork North Central, Labour)
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On behalf of the Minister for Health, I thank Deputies Fleming and Stanley for raising this issue. I think they will understand that the Minister, Deputy Varadkar, is unable to be here, unfortunately. As the Minister has previously said, there are no plans to close the emergency department at the Midland Regional Hospital, Portlaoise. Following the Chief Medical Officer's report last January on maternity services in the hospital and a visit to the hospital by the HSE national surgical clinical programme, the HSE undertook a performance diagnostic to ascertain the current performance status of the hospital in all aspects of service provision. The report identified a number of issues and made key recommendations with regard to control, leadership and clinical services at the hospital. The report suggested that some services in the hospital need to be reconfigured to ensure patients are treated in the most appropriate setting by specialist staff who can meet their needs. The over-riding concern is to address any patient safety and quality concerns that arise.

The HSE is working through an action plan with the staff in the hospital to stabilise and improve services at the Midland Regional Hospital, Portlaoise. Changes are required to enhance existing resources and structures at the hospital and to address clinical service deficiencies. A joint governance group has been established to ensure appropriate accountability and oversight of required actions and to incorporate the hospital into the existing governance structures within the Dublin and midlands hospital group, which includes St. James's Hospital and the Coombe, working in collaboration with the children's hospital group. A project team, which has been formed to support the work of the governance group, is in the hospital on a regular basis to support staff on the ground. Immediate actions to stabilise service provision include the appointment of an advanced nurse practitioner and the recruitment of a temporary consultant emergency physician to address the immediate senior decision-making issues within the emergency department. The filling of an additional physician post and replacement posts in endocrinology and care of the elderly is also being advanced.

The joint governance group will also examine the future service configuration at the Midland Regional Hospital, Portlaoise, including emergency department services. It will explore opportunities to develop services like endoscopy and day surgery. Any potential future reconfiguration of services will be undertaken in a planned and orderly manner. It will take account of existing patient flows, demands in other hospitals and the need to develop particular services at Portlaoise in the context of overall service configuration in the Dublin and midlands hospital group. Recent media reports on the wider issue - the retention of funding for 24-hour emergency departments and the current number of beds across the system - were based on information in the Department's submission to the Department of Public Expenditure and Reform under the Government's comprehensive review of expenditure exercise. This review exercise is carried out every three to four years. The last such review was completed in 2011. As the Department's submission under the current exercise is under consideration, it would not be appropriate to comment further at this point, other than to say it is currently not planned to implement measures contained in that submission.

Seán Fleming (Laois-Offaly, Fianna Fail)
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The submission the Department of Health sent to the Department of Public Expenditure and Reform suggested that five accident and emergency departments, including the one in Portlaoise, should be downgraded. The Minister of State is saying it is not intended to implement that submission. The only logical thing the Department can do is publicly withdraw the submission that is the source of the problem in Portlaoise. The Department of Health caused the problem when it issued its submission. I was interested to note that the Minister of State's response did not refer to the appointment of a team of medical specialists by the former HSE national director of acute hospitals, Ian Carter, who commissioned the review we mentioned. The Minister of State did not deal with that. She mentioned all the good things that are happening but she ignored the report that questions the sustainability of the unit. She did not say the Department of Health should withdraw the submission it sent to the Department of Public Expenditure and Reform, given that it appears to have no intention of proceeding with it in any event. The problem is that the systematic cut in the budget over the past three years has undermined public confidence and the confidence of staff in the hospital in Portlaoise.

Brian Stanley (Laois-Offaly, Sinn Fein)
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The Minister of State said that as the comprehensive review of expenditure is under consideration at present, "it would not be appropriate to comment further at this point, other than to say it is currently not planned to implement measures contained in that submission". We are concerned about the possibility that 20 beds will be withdrawn from Portlaoise hospital and the emergency department at the hospital will be closed or have its opening hours reduced. That is the issue. We are trying to emphasise that the figures show that the Midland Regional Hospital, Portlaoise is a busy major regional hospital in a strategic location. The Minister of State's statement does not give any comfort to me, to the staff of the hospital or to the community in County Laois. We have not been reassured that services at the hospital are safe for the future. Although she said "there are no plans" to close the emergency department, she did not give us a funding commitment. I want the Minister, Deputy Varadkar, to give us a commitment that the clinical review will be published and that core maternity, paediatric and surgical services will be maintained. Surgical services are necessary if maternity, paediatric and emergency departments are to be maintained. I want a commitment that Portlaoise hospital will have an adequate budget in 2015 to maintain those core services.

Kathleen Lynch (Cork North Central, Labour)
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I do not think anything I might say would satisfy either Deputy. I am not certain that could be done in any circumstances, even if we had more than enough money to do everything we want to do. I do not know anyone who can say absolutely that something will not change in the future. If the Deputies know anyone who makes such statements, I suggest they should not believe him or her.

Brian Stanley (Laois-Offaly, Sinn Fein)
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I am looking for a commitment for next year, 2015.

Kathleen Lynch (Cork North Central, Labour)
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It is understood that the Midland Regional Hospital, Portlaoise is a very busy hospital. Part of the review took account of patient flow. Equally, the appointment of an advanced nurse practitioner and the recruitment of a temporary consultant physician in the accident and emergency department will help to address immediate senior decision-making issues in that department. An additional physician post and replacement posts in endocrinology and care of the elderly are also being advanced. I would not say that such actions are typical of a body that intends to close a hospital. Such measures have been taken by an organisation that is keen to ensure procedures and quality standards are maintained where that can safely be done. This is about shoring up a hospital that needs such support. Nothing I say will give the Deputies any reassurance. That is the job of the Opposition. I have set out the position as it stands. On behalf of the Minister for Health, I assure the House the intention is that patient safety will be paramount at all times when additional decisions are being made regarding the Midland Regional Hospital, Portlaoise. Considerable decisions have already been made.