Seán Fleming (Laois, Fianna Fail)
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On behalf of the people of Laois, I have to express severe disappointment that the Minister, Deputy Harris, is not here today. The Minister should be here because the problems at the Midlands Regional Hospital in Portlaoise are firmly within his resolution. He is the only person who can solve them. In light of his failure to attend this debate, I formally invite him to visit the hospital in Portlaoise in the coming weeks between now and the Christmas period. He made a visit there during the Christmas period over two years ago, but he has not been seen or heard from at the hospital since then. The inaction of the Minister for Health with regard to a report that is on his desk is the key source of the problem at the hospital in Portlaoise. The proposal that has been on the Minister's desk since September 2017 involves the full closure of the emergency, maternity and paediatric care departments at the hospital, as well as the cessation of all inpatient surgery there. A small amount of such surgery is taking place there at the moment. The report in question, which was prepared on foot of detailed consultation by the HSE and senior management in the Department of Health, has been left sitting on the Minister's desk for more than two years. Therefore, the position set out in the report remains the current position of the HSE and the senior management personnel. The Minister's inaction is causing serious problems. It is undermining current services in the hospital. Why would people seek to take up employment in the hospital as consultants, surgeons, doctors, non-consultant doctors, nurses or care staff when they know this cloud is hanging over it as a consequence of the Minister's failure to take action?

The previous Topical Issue debate showed us what happens when an accident and emergency department is closed in a region without the promised additional facilities being provided in the locations where patients are expected to go. That is the state we are at. According to this report, the closure of the services at Midlands Regional Hospital in Portlaoise that I have mentioned would necessitate the provision of a minimum of €140 million to upgrade services at Tullamore and Naas hospitals and to facilitate the transfer of all births in Portlaoise hospital to the Coombe Hospital. That money is simply not available. It cannot and should not happen. We are formally asking the Minister to visit Portlaoise and to make a positive statement on the future of the hospital there. The current level of services should be supported and all necessary funds should be provided for consultant posts to facilitate the development of services into the future. Parts of County Laois are only an hour from Dublin. People in County Laois are used to travelling to St. James's Hospital for critical hospital surgeries. We are all familiar with that. Midlands Regional Hospital in Portlaoise, St. James's Hospital and the Coombe Hospital are part of the Dublin Midlands hospital group. It is good that complicated births are transferred from Portlaoise to the Coombe. More than 400 children were delivered in Portlaoise hospital last year. I would say the hospital got close attention in the form of HIQA reports, etc., as a result of the controversy of some years ago. As I have said previously, the circumstances of the death of a child in the hospital were covered up by senior HSE management.

It took a great deal of legal work to establish that. People knew that a child had died at the hospital and HSE senior management covered it up. While there were with no repercussions for the HSE, the reputation of the hospital was damaged. Following on from the HIQA inspections, most people will accept that maternity services at Portlaoise hospital over the past two or three year have been among the safest in the country. I am not aware of any maternal or infant death on delivery in recent times. As a result of a light having been shone on the facility it has improved.

It would be a shame if the Minister were to proceed with the closure of the maternity services and emergency department. If the emergency department is closed, the maternity ward would have to be closed because it would not be safe. We need confirmation that the emergency department will continue to operate 24-7, 365 days of the year, as it currently does. If the Minister would confirm that, we could get on with the future development of the hospital.

Jim Daly (Cork South West, Fine Gael)
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I do not have a formal reply to read. I acknowledge the Deputy's concerns. I am happy to pass on his invitation to the Minister to visit the facility and to update all of the Members representing the area on the plans regarding the hospital.

Seán Fleming (Laois, Fianna Fail)
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I addressed my opening statement to the Minister, Deputy Harris. People will be shocked that the Minister is not here to respond to this Topical Issue matter, which was selected yesterday for discussion today. I expected the Minister to be here. Not only is he not here, he has not afforded the Minister of State, Deputy Daly, the courtesy of giving him a script to read on his behalf. Shame on the Minister, Deputy Harris, for treating the Oireachtas Members of County Laois in such a manner. I do not have an ego, but I represent 85,000 people who live in County Laois and the surrounding counties. I have never encountered this treatment before.

Approximately 40,000 people visit the accident and emergency department each year. On 17 April 2018, in a written reply to a parliamentary question, the Minister said that he would engage in a consultation process with local GPs. In September 2018, well over a year ago, he told me that the process for that consultation had been agreed and an external facilitator was to be appointed. That has not happened. Nothing the Minister has said to date has happened. I note the Minister of State is being provided with a script. If it is related to this matter, it is welcome, belatedly.

My opening statement on this Topical Issue matter is verbatim my opening statement on a Topical Issue Matter on this issue on 19 April 2018, which means I have been raising this issue for 20 months and the Minister has done nothing but add to the uncertainty by not resolving the issue. This uncertainty is damaging the hospital and public confidence in it. It is also preventing staff taking up positions in the hospital. I reiterate my invitation to the Minister to visit Portlaoise hospital and to confirm that the accident and emergency department there will continue in operation. If the Minister was even to contemplate scaling down services, he would be adding to the already overcrowded accident and emergency departments in neighbouring counties in terms of trolley numbers and queues. The other hospitals could not possibly cater for additional people. The Minister needs to confirm that the services currently provided in Portlaoise hospital will continue to be provided, following which we can focus on the development of services into the future.

Jim Daly (Cork South West, Fine Gael)
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I would like to clarify that there was no intention to insult the Deputy or degrade the issue. It was human error that I was given a response to a different Topical Issue matter. I now have the correct script, which, with the indulgence of the Leas-Cheann Comhairle, I will read.

I thank Deputy Fleming for raising this matter. I would like to reassure him that, as stated previously by the Minister, Deputy Harris, the most important issue in regard to the consideration of services at the Midlands Regional Hospital Portlaoise is that patient safety and outcomes come first. The Minister has committed to securing and further developing the role of the Midlands Regional Hospital Portlaoise as a constituent hospital within the Dublin Midlands hospital group. 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 that services that are not sustainable are discontinued and that sustainable services are safely assured and adequately resourced. Funding has increased by 42% relative to the 2012 budget and staffing levels have risen by 31% from the 2014 base. 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 that takes account of the need to develop services at Portlaoise in the context of developing a model of service provision for the entire hospital group. The draft plan has been submitted to the Department of Health. I would like to emphasise again that patient and public requirements are paramount and have underpinned the Department's consideration of the draft plan.

The HSE group involved in the development of the draft action plan for Portlaoise hospital included eight national clinical programmes, the National Ambulance Service and the HSE national acute hospitals division. This group focused on the risk issues and the interdependencies of the various clinical services across the emergency department, general surgery, general medicine, general paediatrics, obstetrics, gynaecology and neonatology. The HSE consultations took place with the clinical staff and management in Portlaoise general practitioners, the Irish Prison Service, Tallaght Hospital, paediatric surgery and emergency department services, and the master of the Coombe Women and Infants University Hospital. As the Minister outlined previously, no decision has been made on the draft action plan for Portlaoise hospital. He has committed to ensuring that local clinicians and the community will be consulted before a decision is made, and he has decided that a comprehensive consultation exercise should be undertaken by the HSE with an external facilitator and involving the key stakeholder groups in Portlaoise hospital. The consultation will involve key stakeholders and local community representatives and provide an opportunity to listen to and address the issues and concerns that stakeholders have highlighted. The consultation will also provide an opportunity to set out the immediate priorities for service development and improvement in the hospital.