Seán Fleming (Laois, Fianna Fail)
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I, along with my colleagues, wish to raise the issue of the Midland Regional Hospital in Portlaoise, specifically the action plan which has recently come into the public arena. I wish to put on record my disappointment that the Minister for Health, Deputy Simon Harris, is not present for the debate. He has responsibility for this issue. Given that four Deputies are raising the issue, it would have been far better for the Minister to be here. We will have to seek a mechanism to put down a debate to ensure the Minister is here the next time.

We have serious concerns about Portlaoise. Before considering these, we have to look at the overall national context in which the report was prepared. There are 685,000 women, children and men on waiting lists for surgery and outpatient treatment. The waiting times in many of our hospitals are totally unacceptable by European standards. Every accident and emergency department in Ireland is overcrowded. People are on trolleys in the majority of them most days. The ambulance service is creaking at the seams. That is the context in which the report was drafted.

The report refers to closing the emergency department, maternity department, paediatric care unit, intensive care unit and all inpatient surgery in Portlaoise. The regional manager effectively only sees Portlaoise as a glorified health centre dealing with minor injuries and day procedures. Did those involved in the report think of the national context when drawing it up? It totally ignores the position of our health services throughout the country. The report is fundamentally flawed because it lacks an appreciation and recognition of the overall national position. For that and no other reason, this report must be rejected.

Carol Nolan (Offaly, Sinn Fein)
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I concur with Deputy Fleming. It is very disappointing that the Minister for Health, Deputy Harris, is not present to deal with such a serious issue.

If proposals are introduced by the Government to downgrade Portlaoise hospital, lives will be put at risk. There will be a knock-on effect on other hospitals, such as the Midland Regional Hospital in Tullamore. The emergency department in Tullamore Hospital has already been in crisis. For example, the emergency protocol was activated three times last year, a measure only used as a last resort.

There is no way that the hospital’s emergency department could cope with an extra intake of patients. Common sense and decency need to be exercised in respect of the emergency department in Portlaoise. It must be retained. Ill patients will be put at serious risk if the downgrading goes ahead. Surely it is high time to set about improving our hospital services, rather than downgrading them. Resources should be provided to all hospitals in the midlands region. We cannot pit hospitals against each other.

We are in the midst of chaos in our health service. It would be nothing short of reckless to pursue an action which would have dire consequences for patients. Such an action would also put our hospital staff, who are already under serious pressure, under much greater strain. People are very concerned and I want this matter passed onto the Minister, Deputy Harris. I ask that the Minister make a commitment that the emergency department at Portlaoise will not be downgraded. To do otherwise would put people at risk.

Martin Heydon (Kildare South, Fine Gael)
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I thank the Office of the Ceann Comhairle for selecting this very important matter. As the Minister of State is aware, there has been great concern in Laois and south Kildare regarding future health care services in Portlaoise hospital. Many of my constituents view the emergency department in Portlaoise as their natural place to go when there is a need to attend such a department. Many have used maternity services in Portlaoise, including people living in Kildare and along the border. From Athy to Monasterevin, Newbridge, Portarlington, Jamestown and Killenard, people see Portlaoise as their local hospital for emergency department, intensive care unit and maternity services.

First and foremost, we must ensure that we have the safe delivery of services and that the services available to the people of Laois and south Kildare are of the highest standard. Previous HIQA reports showed deficiencies and risks to patients following the death of baby Mark Molloy. I recognise the update from HIQA last December, which pointed to maternity services now being improved and delivered in a safer way, but there are still issues with understaffing and the recruitment of non-consultant doctors.

HIQA has pointed to the need for a strategic plan for the hospital and its future. A report was leaked to the media which is causing major concern in the area. The people of Laois and south Kildare need and deserve a number of things. We need clarity as to the future plans for Portlaoise hospital. We need the safe provision of health care services and a plan for the delivery of increased investment to ensure the safe provision of emergency and maternity services for the people of the area.

Brian Stanley (Laois, Sinn Fein)
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It is very disappointing that the Minister, Deputy Harris, is not here to address this issue. This is not the first time he has not been present when important debates on Portlaoise hospital are taking place. Only a week ago, he failed to turn up for another debate on it.

This hospital is on my doorstep. I have campaigned with others for over 20 years because of the constant threat to downgrade the hospital. Dr. Susan O'Reilly, who headed up the preparation of the report that was hidden for a number of years, has said she is now willing to engage in public consultation. She is talking from both sides of her mouth as the decision has been made and she is ploughing on with this. According to her, the only concern is the low volume of patients going through critical care in Portlaoise. Answers have been put forward by local doctors in response.

The first plan was leaked to me almost four weeks ago now and one was leaked to the The Sunday Business Postand they spell out exactly what is supposed to happen. The minor injury and medical assessment units will operate in the day time. The paediatrics, maternity and the intensive care units will be gone. According to The Sunday Business Postleak - these leaks are deliberate - 12 hospitals, including Portlaoise, will stop taking trauma patients and major trauma centres will be created in Cork and Dublin. What absolute insanity. Does neither the Government nor the Health Service Executive understand the need for a regional network of emergency units staffed and equipped to a modern standard?

Dr. O'Reilly has not taken on board the need for the "golden hour" to be taken into consideration. This is the hour after a serious trauma, accident or injury. She has not explained how these patients will be transported to Dublin, Cork, Tullamore or anywhere else. The question is whether a patient is safer in the back of an ambulance or, in the first hour, getting to an accident and emergency department such as the facility in Portlaoise, which is well-established, well equipped and properly staffed. There is also a shortage of ambulances, with only one ambulance in County Laois on Monday and Tuesday nights. Will the Minister of State address that?

Jim Daly (Cork South West, Fine Gael)
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I thank Deputies for raising this matter. At the outset I reassure the Deputies that, as my colleague the Minister for Health, has stated, the most important issue in the consideration of services at the Midland Regional Hospital, Portlaoise, is that patient safety and outcomes must come first. The Minister, Deputy Harris, is committed to securing and further developing the role of the Midland Regional Hospital, Portlaoise as a constituent hospital within the Dublin Midlands hospital group. He has said he will bring clarity to this matter in the coming weeks.

Reports on Portlaoise hospital in recent years have pointed to the need for restructuring of some services to ensure patients are treated in the most appropriate setting by specialist staff who can safely meet their needs. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies and incorporating the hospital into the governance structures within the Dublin Midlands hospital group. Significant work has been undertaken to strengthen and stabilise current arrangements for services at the hospital to ensure services currently provided that are not sustainable are discontinued and those that are can be safety assured and adequately resourced. The HSE has confirmed that hospital funding has increased by 28% relative to the 2012 budget and staffing levels have risen by 29% from the 2014 base. Funding of €300,000 has also been provided in 2017 to facilitate the opening of the new medical assessment unit. In addition, governance and management arrangements in Portlaoise hospital have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved.

The Dublin Midlands hospital group has been working for some time on a draft plan for a new model of clinical service delivery at Portlaoise hospital. A draft plan was submitted to the Department of Health in December 2016. This draft report was reviewed in detail and was the subject of engagement between Department officials and the HSE. Significant additional work was undertaken by the HSE on foot of this engagement, resulting in a revised draft plan that was submitted to the Department in September 2017. I emphasise again that patient and public requirements are paramount and have underpinned the Department's consideration of the draft plan.

The report is currently under detailed consideration in the Department of Health. Once there is an agreed position on the draft plan, it is intended there will be further engagement with all interested parties to ensure the needs of patients, staff and the local and wider community are addressed. Any future changes to services at Portlaoise must 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.

Seán Fleming (Laois, Fianna Fail)
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Everybody in Laois and in this House would accept and agree that patient safety is the most important aspect of the services in Portlaoise but this plan does not achieve that goal. In 2014, the Health Information Quality Authority, HIQA, produced a report at the request of the Minister and a second report was issued in December 2016. I will quote the statement of Dr. O'Reilly from two days ago. She states, "Specifically, in December 2016 HIQA again highlighted significant patient risk at the hospital and found that the governance arrangement in the emergency department remained largely unchanged" from 2014. Who was the regional manager from 2014 to 2016 who did nothing? In 2015, she announced the scaling down of the accident and emergency department, which did more than anything to undermine public and staff confidence. It put people off coming to take up positions in Portlaoise. Her actions before she put pen to paper to draft a report undermined the accident and emergency department. People said it was not a place to go to further one's career. That act did more to damage patient safety in Portlaoise hospital than any other action by any other person. She has done more damage than good to Portlaoise hospital.

She should have spent those two years upgrading the accident and emergency department, as it was done in the maternity section. HIQA found problems in the maternity area and there are now management arrangements with the Coombe, as well as extra resources and staff. The same is required in the accident and emergency department but she chose not to act. As a result, we are where we are. Looking at the national context of the report, one can see we need positive leadership for the region and somebody who will approach the matter positively so as to build services. Who would ever speak about closing hospital services, as proposed in the document, with 680,000 people on waiting lists? There is also talk of investment in the Coombe but the Government has already made the decision to close the Coombe hospital and move it to the St. James's Hospital site after the national paediatric hospital is built.

I ask the Minister to meet Members now rather than after a decision is made. Dr. O'Reilly wrote to me last week asking to meet and I will do that next Tuesday to discuss the matter.

Carol Nolan (Offaly, Sinn Fein)
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The decision regarding retention of the accident and emergency department at Portlaoise hospital is in the hands of the Minister for Health, Deputy Harris, who should be leading by example. The approval of the proposed action plan submitted to the Department of Health is a policy decision for the Minister, so I urge him to take immediate action. It has been stated that lessons have been learned from other downgrades but has the Minister learned any lessons? More important, have such lessons been taken on board? The Minister should be able to make a commitment as soon as possible that there will be no downgrading at Portlaoise hospital and he should seek to reassure people who are, at this time, very concerned about the possibility of a reckless and short-sighted decision being taken. Such recklessness will put the lives of many patients at serious risk. For example, we can look at attendance at the accident and emergency department at Portlaoise, which should be taken into consideration. In 2016, there were a reported 39,212 visits to the department. This demonstrates that the department is very busy and there is a need for extra resources. The emergency department should be retained and I call on the Minister to make a commitment in this regard.

Martin Heydon (Kildare South, Fine Gael)
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I thank the Minister of State for his response. I will focus on Naas General Hospital, which in some ways is inextricably linked with Portlaoise. Many of the people on the Kildare-Laois border have a decision to make as to whether attend at Portlaoise or Naas. The hospital at Naas services all of Kildare and west Wicklow, as the Minister of State is aware, and it is under very significant demographic pressure. We have seen a major increase in our population in the past 20 years and the hospital now services over 240,000 people. Last year the hospital saw a year-on-year increase in accident and emergency department attendance of 6.4%. That is purely because of demographics and it must be said that the management is doing a remarkable job in managing this increase. It is nonetheless at capacity.

We got funding to move 1,000 patients on a waiting list for endoscopy services. They were dealt with through the National Treatment Purchase Fund, NTPF. However, that still leaves 700 people on a waiting list for those services. We need the new endoscopy unit delivered for Naas General Hospital as soon as possible. Naas is under that type of pressure already. When we talk about the link with the services, what sets Naas apart from Portlaoise is that Naas does not have paediatric services. I have two young children and live in south Kildare. If there is an emergency situation, Portlaoise is the natural place to go. Tallaght is an awful long way to travel with a sick child. These are all causes of concern for residents of Laois and south Kildare. There is uncertainty in the ether. I want to see a very clear investment plan for the Midlands Regional Hospital Portlaoise to ensure that we deliver the services that are required in Laois and south Kildare and that those services are provided in a safe way in the best interests of everybody in that area.

Brian Stanley (Laois, Sinn Fein)
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The real issue here is a lack of resources and staff. There have been some improvements. The budget has gone from €44 million to €56 million this year. There have been improvements in the maternity services, which have almost a full complement of staff now, whereas before they were working with less than half the staff required. Portlaoise has always been on the back foot. Ms Susan O'Reilly wants to spend €100 million on a fantasy plan. If €10 million of that were given to Portlaoise, I guarantee that we would have a good, state-of-the-art, properly equipped hospital.

In reply to a parliamentary question I raised over a week ago, the Minister gave an answer similar the one the Minister of State has just given. It seems as if the Minister is kicking the can down the road, because he said, "Once there is an agreed position on the draft plan, it is intended there will be a further engagement with all interested parties". The draft plan has been on the Minister's desk for the past year. Who is to agree that position?

We need certainty. The answer to the parliamentary question and the reply here today do not give us any certainty. We need confirmation of what is happening. People in Laois and the surrounding counties are entitled to answers to that. Reports on Laois are getting worse by the week. It is obvious what is coming. The Laois faculty of the Irish College of General Practitioners and Midoc have expressed a total lack of confidence in Susan O'Reilly. She is due to retire in early January. She will go, but the local community will still be there. The people will be there. This is her plan, but it is on the Minister's head as to whether it is signed off on.

The plan put forward by both the GPs and the Midoc staff mentions that, "it is recognised internationally that attempting to centralise high volume essential services produces risks for patients and does not achieve cost savings". They go on to say that it should be the bedrock of a system that is already low in terms of capacity. The Minister is here day after day. There is no capacity in the system. There has to be a regional network. I want the Minister of State to take that message back to the Minister for Health, Deputy Harris. There has to be a regional network of fully equipped emergency departments. Portlaoise is in the strategic location for that. I want the Minister to come back quickly on this matter, secure the future of the hospital and put Ms O'Reilly's plan through the shredder. She is retiring in the first week of January and she needs to take her plan with her. The copy that the Minister of State has should be put in the shredder.

Pat Gallagher (Donegal, Fianna Fail)
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My problem is that I am too lenient.

Jim Daly (Cork South West, Fine Gael)
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I assure all of the Deputies that I have taken note of all of their contributions and will relay them back to the Minister of Health, Deputy Harris, who is the line Minister with responsibility for this. Due to the competing demands on his time, he is not always able to come into the House. It is practice that Ministers of State from the Department would take some of these debates, but that does not mean that the Minister is any less-----

Brian Stanley (Laois, Sinn Fein)
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There is €100 million at stake here, not to mention lives.

Pat Gallagher (Donegal, Fianna Fail)
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The Minister of State should continue.

Jim Daly (Cork South West, Fine Gael)
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It does not mean that the Minister is any less interested or committed to the project. Deputy Stanley is correct to say that it is not about resources. The resources to the hospital have improved under this Government by €12.5 million over the past three or four years, which is a significant increase in investment in any hospital the size of Portlaoise over that time. Nobody has a monopoly on the right thing to do. I welcome the debate in the House and the opportunity for public representatives to have their say. Our duty, as public representatives, is to feed into this process, and we have to have the voices of local people heard in our hospitals because they are the owners. Other voices have to be listened to, which voices have as much if not more expertise in different areas which affect the future of hospitals. I am referring to clinicians and people who practice, and also, of course, to the management of the HSE and departmental officials. Public representatives are a vital cog in that as well. I welcome the opportunity to air the debate here.

The draft report that we referred to was revised and resubmitted back in September after further consultation. There was a commitment that there would be an update on that report in the coming weeks. The Minister of Health, Deputy Harris, will give us an update on that revised report.