Seán Fleming (Laois, Fianna Fail)
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I want to raise the issue of the recent HIQA report into the Midland Regional Hospital Portlaoise. I am very pleased to meet the Minister of State, Deputy Finian McGrath, here. I wish him well in his Department and I know his heart is in the right place when it comes to health and disability.

I am saying clearly on the record of the House that I need to speak to the Minister, Deputy Harris, directly on this issue. Any plans by the Department of Health will go nowhere until such time as we have proper consultation with the Minister on the matter. The recent HIQA report contained nothing that was a surprise to me. Essentially, the report says that progress is being made in the maternity unit at Portlaoise hospital but that investment is required in the medical and intensive care unit in order to bring them up to standard. This has been known for quite some time but the HSE has not yet taken action. It should get a move on and do so immediately.

The main issue highlighted in the HIQA report relates to the difficulties in the accident and emergency department. The problem is that there are a large number of patients - over 36,000 - attending the emergency department in Portlaoise each year. There is not the appropriate number of consultant staff to deal with these patients and neither is there a named emergency consultant available on 24 hours a day, seven days a week. The answer is very simple. We have to take the necessary steps to ensure that we have enough consultants and medical and nursing staff available in the emergency department at Portlaoise hospital to deal with the patients who arrive there. Remarkably, the HSE's response to this problem is to consider cutting the number of hours the emergency department is open, thereby reducing the numbers attending to match the number of staff it wants to employ. This attitude by the HSE is totally wrong and if it represents the ethos of the HSE at national level, it has to be fundamentally changed.

The real issue is that the statement by the HSE regional manager on cutting the hours of the emergency department has put a cloud over the future of the hospital. The knock-on effect, as highlighted in the HIQA report, is that the HSE is finding it difficult to recruit senior medical staff to Portlaoise hospital.

Brian Stanley (Laois, Sinn Fein)
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Can the Acting Chairman confirm how long I have?

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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The Deputy has two minutes.

Brian Stanley (Laois, Sinn Fein)
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The issue arising from the HIQA report is very important and the question for the Independent-Fine Gael Government is whether it will use it as an excuse to downgrade services and close the hospital or whether it will use the report to improve services. The HIQA report said the hospital was at a critical juncture and that, to function as a model 3 hospital, it must be adequately and sustainably resourced. It said that services were being sustained through a reliance on agency staff which is costly and not good practice from the perspective of service sustainability. It stated that the ongoing reliance on agency staff had significant financial implications for the hospital. It also stated: "The ongoing lack of certainty has a negative effect on staff recruitment, retention and morale, and this further affects the sustainability of services." If firm A is the subject of constant rumours about closing, local tradespeople and other workers will not apply for a job there. They will go to firm B instead, if that firm is on a steady footing. That is what is happening with Portlaoise. None of the past four Governments has put forward a clear, long-term strategic plan for Portlaoise. HIQA said the remaining risks will only be fully addressed through the formulation and enactment of a clear strategic plan.

Last year, almost 37,000 patients attended the emergency department in Portlaoise. There is a problem with capacity across the State and every Deputy in this House knows it. If the emergency department in Portlaoise is closed, where can patients be sent? They cannot be sent to Naas and they cannot be sent to Tallaght or Tullamore because they are already out the door. The report, which is now in the Government's hands, was headed up by Dr. Susan O'Reilly . She is determined to plough on and I heard her on local radio the other morning.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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The Deputy's time has concluded.

Brian Stanley (Laois, Sinn Fein)
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I started well behind so I need another couple of minutes.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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The Deputy asked for two minutes. He has had two minutes so I have been very fair to him.

Brian Stanley (Laois, Sinn Fein)
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The ball is in the Government's court. Will it be its policy to use the HIQA report to downgrade the hospital or to fix what needs to be fixed? Will it set out a clear strategic plan to give the certainty that the community, staff and patients need?

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputies for raising this matter and giving me the opportunity to update the House on the report by the Health Information and Quality Authority, HIQA, into the services provided at the Midland Regional Hospital, Portlaoise. As the Deputies are aware, on 5 December HIQA published a review of the progress made at Portlaoise hospital in implementing the recommendations made following HIQA's investigation in 2015. The HIQA report was conducted following a request from the Department of Health, which has been overseeing the implementation of the recommendations of the original report, to examine the progress that has been made on the ground in Portlaoise.

I welcome this HIQA report, which found that significant progress had been made at the hospital in relation to governance, patient safety and quality, and shows how much services have improved for the women using maternity services at the hospital. Portlaoise maternity services are reporting monthly maternity patient safety statements and are participating in national data collections, including the Irish maternity indicator system. This has led to a confirmation by HIQA that the hospital's maternity services are performing in line with nationally reported rates. I would like to acknowledge that we have travelled this far thanks to the bravery of the families who spoke out in the midst of their grief at a very sad time for many of them. The extent of progress in patient safety measures also demonstrates the commitment of the staff and the leadership team at Portlaoise hospital, as well as the team at hospital group level.

There has been considerable investment in Portlaoise in recent years. Hospital funding has increased by 15% since 2012 and staffing levels have risen by 18%. Additional funding is to be provided to facilitate the opening of the new medical assessment unit at Portlaoise in 2017. The HIQA report also identified immediate issues to be addressed in general hospital services. The HSE has been asked to address these immediate issues as a priority, and to ensure that the hospital is appropriately supported in its role by the other hospitals in the hospital group to serve the patients of the midlands. The Dublin Midlands Hospital Group has produced a draft action plan for Portlaoise hospital which takes account of the need to develop services in the context of developing the model of service provision for the entire hospital group. The HSE has now submitted the draft plan to the Department of Health, where it will be reviewed in detail. I reassure the Deputy that the Minister for Health is committed to securing and further developing the role of Portlaoise hospital as a constituent hospital within the Dublin Midlands Hospital Group.

The most important issue in relation to any changes at Portlaoise hospital is that patient safety and outcomes must come first. Any changes to services at Portlaoise, once approved, will be undertaken in a planned and orderly manner to further improve services for patients at the hospital and will take account of existing patient flows and demands in other hospitals, as well as the need to develop particular services at Portlaoise in the context of the overall service configuration in the Dublin Midlands Hospital Group.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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The Deputies have one minute each and I will be very strict about this as other Members are waiting.

Seán Fleming (Laois, Fianna Fail)
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I acknowledge the positives in the approach taken by the HSE on the maternity hospital in Portlaoise and, as has been mentioned, this has resulted in significant improvements. The same positive attitude now needs to be demonstrated towards the emergency department to bring it up to service. A sustainable hospital can only exist if it has sustainable resources and adequate staff to provide the required care. The biggest difficulty in Portlaoise in the past 12 months was the statement by the HSE regional managers who have sought to downgrade the hospital. This has damaged the confidence of the public towards the hospital because the suggestion that accident and emergency services might be reduced has resulted in people not wanting to take up employment there. It is damaging to the morale of existing staff and, above all, it is damaging to the quality of service people feel they will get if they go into hospital. The HSE needs to fundamentally change its attitude. If it does not, I will demand that the Minister does it for it.

Brian Stanley (Laois, Sinn Fein)
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Any extra cash is welcome but HIQA has said the extra money is being eaten up in expensive temporary staff, such as locums and agency staff. HIQA also said this had significant implications for the budget of the hospital going forward. The minor medical assessment unit, operating between 9 a.m and 5 p.m, is no replacement for 24-hour emergency department services. As the 69 local health professionals who put their name to the report to the Minister said, paediatric, maternity and ICU services depend on emergency departments. The moment of truth has arrived. Are we going to have a strategically located regional hospital in Portlaoise, with maternity services, an ICU unit, paediatric services and an emergency department, or are we not? We need a clear plan with a clear strategy to give certainty for the future which none of the past four, five or six Governments has provided.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputies again, in particular for acknowledging the work of staff and the excellent resources we have in that regard. Deputy Sean Fleming has a valid point about sustainable resources as these are vital for running a proper hospital. The Deputy also raised the issue of morale among staff. Deputy Brian Stanley talked about the capacity issue and about the fact that the extra cash was being eaten up.

I strongly take his point and I will bring all these points to the attention of the Minister, Deputy Harris. He is attending a very important Cabinet sub-committee meeting on health at the moment, which is why I am taking these Topical Issues. It is important that we also acknowledge the fact that since 2012, there has been an 18% increase in staffing levels across maternity services, paediatric medicine and the emergency services, and a 15% increase in funding in 2016. However, there remain real issues of concern. I am aware of them in my local hospital, Beaumont Hospital. We have difficulty recruiting staff and we then find ourselves spending extra money on emergency agency staff. I take that point because I have experienced this in the disability sector.

Deputy Brian Stanley mentioned the 69 medical professionals who have been lobbying local Deputies. This is very important. Their voices must be heard. I will absolutely bring Deputy Stanley's concerns to the Minister's attention.

To follow up on Deputy Sean Fleming's point, the Minister should meet him to discuss the issue raised.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank both Deputies for their co-operation.