Peter Burke (Longford-Westmeath, Fine Gael)
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I thank the Ceann Comhairle for selecting this critical issue for debate. Local and national media reports over the weekend reported that a number of emergency departments were earmarked for closure. In fact, the first paragraph in the report explicitly stated that the emergency department in the Midland Regional Hospital in Mullingar was one of nine departments earmarked for closure, despite the fact that a €5 million new accident and emergency unit is under construction. Workers are on the site and it is due to open later this year.

Scaremongering about this subject is totally out of place. It has a huge effect on people, their families and the nurses, doctors, health care attendants and staff working in challenging circumstances in those units. The Midland Regional Hospital in Mullingar has been earmarked for a cost-benefit analysis, which is almost complete, for an investment of more than €40 million for four new operating theatres, a new endoscopy unit, a rehabilitation unit and a new intensive care unit. There has been huge investment in the hospital under this Government.

The report concerned, which was on foot of the annual general meeting, AGM, of the Royal College of Surgeons in Ireland, RCSI, examines very serious trauma, which accounts for less than 1% of all cases admitted to accident and emergency units. The hospitals in Tullamore and Mullingar are operating at capacity. These reports that a hospital unit will close are based on a report that has not been seen by the Minister or the Department. It is a report relating to one sector in the health service. The decision maker in this regard is the Minister. I telephoned the Minister for Health, Deputy Simon Harris, last Sunday night on foot of the rumours that were circulating and he was very clear that no accident and emergency unit in Mullingar is to be closed. The opposite is the fact. When the new unit is opened later this year, I hope people will eat humble pie.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I am very concerned about the media reports that appeared last weekend about the status of the emergency departments in nine hospitals, including Cavan General Hospital. The huge number of people attending the hospital in Cavan every week clearly indicates the need for its emergency department to retain all services. Only last May, in parliamentary questions, I raised the need to provide new accommodation and additional facilities at the Cavan emergency department, given the large number of patients attending. Subsequently, the HSE replied to me and stated that Cavan and Monaghan hospital group is currently preparing a proposal regarding the expansion of adult and paediatric resuscitation space for the emergency department in Cavan General Hospital.

Indeed, I had a Topical Issue debate on this subject with the then Minister, Senator James Reilly, in the middle of 2014. At that time, the Minister indicated to me that the figures available to him indicated there had been a 33% increase in the number of patients presenting in Cavan General Hospital. I know from my own contact with clinicians and other staff in the hospital that the number of people presenting has dramatically increased since then, as Deputy Ó Caoláin and other Oireachtas colleagues will know.

I want the Minister of State to give us a firm assurance that there will be no change to the status of the emergency department at Cavan General Hospital. The hospital has a catchment area of 136,000 people. Thankfully, the population of counties Cavan and Monaghan is growing, as recorded in this morning's census figures. As the hospital also covers part of north Longford, south Leitrim and south Meath, this means there is a total population of close to 150,000 in its area. Thankfully, in the period 2001 to 2011 there was major investment, with the provision of new and additional facilities at Cavan General Hospital, including a special care baby unit, additional bed capacity of more than 21 beds, an MRI unit, a CT scanner, other diagnostic facilities, major expansion of the renal dialysis unit and an upgrade to a very high standard of the intensive care unit. With all the additional activity at the hospital, it needs to retain its emergency department and it also needs additional services and accommodation.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I propose to take Deputy Burke’s and Deputy Smith’s issues together given they both refer to the same recent media reports concerning trauma services. I thank both Deputies for raising the issue, which I know exercised many people over the weekend, not only in the counties the Deputies are from but also in others which are referred to in the report. I welcome the chance to update the House on the actual position in light of these recent reports. At the outset, I would like to reassure the Deputies that the work underway in developing a policy on a national trauma system is about getting the best outcomes for a particular, small category of patients who sustain traumatic injuries. It is not about closing emergency departments or diminishing services.

To put this in context, emergency departments provide 24-7 access for emergency and urgent presentations across the spectrum of medical and surgical conditions, and major trauma patients represent a very small percentage of total emergency department activity, as noted by the Deputies. A trauma patient needs access to the best service that has the right resources to match their often multiple and critical needs in the shortest time possible. The aim of developing national policy on trauma networks is to ensure that trauma patients are brought to the right place at the right time, for the right care, so they can make the best recovery possible. It is about building on the strengths of pre-hospital care so all of our acute hospitals and post-acute services can provide an optimal configuration of trauma services. The implementation of hospital groups provides an opportunity for hospitals to work together to enhance trauma services for patients and allows resources for trauma to be co-ordinated in a more focused manner.

The need for a national trauma system has been recognised for many years. Experience from other countries demonstrates that the establishment of trauma networks improves patient outcomes in terms of mortality and morbidity. In June 2015 the national clinical programme for trauma and orthopaedic surgery published the model of care for trauma and orthopaedic surgery and strongly recommended that a national approach to trauma services should be taken. The Royal College of Surgeons in Ireland, the professional body representing all surgeons and emergency medicine specialists, also called for its establishment at its annual scientific meeting last year. As these are the experts in this field, we must listen to them carefully.

Last year, the then Minister for Health appointed a national steering group to develop policy on a major trauma system for Ireland. This is a joint initiative from the Department of Health and the HSE, developed in recognition that we do not at present have a co-ordinated trauma network structure in Ireland. The steering group has been working with the Department of Health, the HSE and all relevant HSE national clinical leads, including pre-hospital emergency care, orthopaedics and trauma, surgery and critical care, on the development of the policy. I want to emphasise that the group has not yet reported and neither the Minister, Deputy Harris, nor I have seen any output from its work. The group's recommendations are not expected until later this year and the Minister and I look forward to receiving the report at that stage. Let me reiterate that this is not about reducing services and it is certainly not about closing emergency departments.

Peter Burke (Longford-Westmeath, Fine Gael)
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I thank the Minister of State. I welcome the clarification that this is not about closing accident and emergency departments or reducing services, which is critical. The health service is famous for reports. However, every report that comes out of the health service should not be taken as read or exaggerated in the manner in which this one was, because it causes significant and unacceptable heartache to people.

This sector is focused on getting the best outcomes for patients. In the catchment area of Mullingar Regional Hospital, if a person breaks a leg and is stable, the person is brought to Tullamore Hospital because it is the orthopaedic centre. Patients are not brought to a hospital where they cannot be treated. That is called a bypass protocol, and such protocols have been in place for a long time. If someone has a serious brain injury, it is important the person is brought to the proper centre as quickly as possible to ensure they have the best chance of survival and the best outcome.

I thank the Minister for clarifying this issue. It is very important that all politicians are responsible in terms of their approach to these reports.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the Minister of State for her reply. I take the opportunity to compliment the staff in Cavan General Hospital, many of whom I know personally. All the staff, regardless of the discipline they work in, work extremely hard under a lot of pressure and stress and they are diligent and committed to their patients.

As I said earlier, fortunately, there was major development and investment at Cavan General Hospital in the period up to 2011 but this extra capacity creates extra demands on the emergency department. An area I did not mention is the increased provision of oncology services, with linkages to the Mater Hospital. There have also been developments in the area of nephrology, with the development of a substantial dialysis unit.

It is extremely important that a message is given to the people through the Members of this House that there will be no diminution in the status of the emergency department at Cavan General Hospital. What we need, and what I and fellow public representatives have been arguing for, is an investment in new facilities at Cavan General Hospital because of the increasing presentation of patients. The hospital is under extreme capacity pressure. I hope the Minister of State will bring that message back to the Department and the HSE.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I understand where both Deputies are coming from. Any person who heard this news at the weekend, whether one is a politician or not, was naturally concerned, not only for potential patients but also for staff and the people connected to the hospitals to which the Deputies referred. It is unfortunate there would be the type of confusion, concern and uncertainty raised as a result of a news report like this.

I very much welcome the comments of both Deputies about the fantastic care our front-line staff provide when any of us is unfortunate enough to have the need of the excellent staff in our hospitals across the country. They probably do not get enough recognition so I particularly welcome that both Deputies recognised the marvellous care we get when we need to avail of these services.

Given the fact trauma makes up such a small percentage of the overall care the emergency departments provide, it is critical we at all times have skilled people to manage the horrendous injuries people suffer as a result of, for example, a car accident or a fire. With regard to the information we need, we currently have difficulty in getting good, robust population based data.

I very much welcome the fact a report is imminent and we will have it in the autumn. I know the Minister is anxious that the all-party committee on health will discuss the contents of the report. I look forward to the findings of the report. I reiterate this is absolutely not about closing or reducing services in emergency departments in any hospital in the country.