Martin Mansergh (Tipperary South, Fianna Fail)

I am taking this Adjournment Matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney, and thank the Senator for raising it.

The transformation programme for the north-east region involves widespread and fundamental change. It is designed to build a health system that is in line with the model of care emerging internationally. This can be achieved by centralising acute and complex care in order that clinical skill levels are safeguarded by ensuring access to a sufficient throughput of cases.

The need to reconfigure health services in the north east was highlighted, with identified patient safety and quality of care issues, in the 2006 teamwork report to the HSE, Improving Safety and Achieving Better Standards - An Action Plan for Health Services in the North East. The report demonstrated that the service configuration then in place in the region was unsustainable.

The first step in transforming services in the north east is to develop a fully integrated regional health service to ensure the people of the north east have local access to both routine planned care and immediate life saving emergency care. The HSE began this process with the transfer of acute inpatient services from Monaghan Hospital to Cavan General Hospital on 22 July 2009, which was supported by the opening of the medical assessment unit, MAU, in Cavan General Hospital in March 2009, the development and implementation of an enhanced ambulance and pre-hospital thrombolysis service, together with enhanced primary care services.

The immediate focus is on service reconfiguration in the Louth-Meath area, which involves transferring acute services to Drogheda, strengthening existing medical services, enhancing emergency department capacity, developing appropriate ambulance protocols, completing surgical reconfiguration and providing additional community packages of care.

The new emergency department at Our Lady of Lourdes Hospital, Drogheda will provide an improved service for both patients and staff within the Dublin north-east region. This new department which encompasses best design principles is approximately 1,300 sq. m in size and represents a 300% increase in size from the existing department in use today. The increased size of the department and the specific entrance points will allow patients to access it in a more timely manner by separating patients at first point of contact, with one entrance for patients with trauma requiring ambulance care or a stretcher and another for those patients who can walk in. Once the department opens, all paediatric patients presenting to it will be assessed and treated in a designated paediatric area. Adult patients will be allocated to one of three distinct assessment and treatment areas - the minor injuries department, the major treatment department and the resuscitation area. Patients will have more immediate access to diagnostics, with an on-site emergency department dedicated X-ray facility and staff. Patients will benefit from more immediate treatment, enhanced outcomes and a more patient focused environment. Staff will benefit as the new infrastructure and design of the department will facilitate easier access to patients and, ultimately, earlier admission or discharge.

The increase in size of the emergency department means that staffing levels have to be examined. Under the 2010 employment control framework, the filling of posts is, in the first instance, to be by redeployment from within current services. Once redeployment options have been explored, external recruitment may then proceed in line with this framework. The HSE is committed to opening the new emergency department at the earliest possible date.

Negotiations are in progress between the HSE and unions in order to agree a mechanism to redeploy staff at all grades and, in some instances, consider outsourcing or contracting. Unfortunately, it has not been possible to reach agreement on these matters to date, but the HSE will continue to try to achieve an agreement as quickly as possible.

As the Minister stated earlier this year, when she approved the HSE national service plan 2010, the focus for acute hospital services was on managing inpatient care activity levels, providing for a shift to care on a day case basis and on performance improvements such as same day of surgery admission and minimising length of stay.

In regard to consideration by the HSE of proposals to close emergency departments for budgetary reasons, the Department of Health and Children is not aware of any proposals to move from service commitments given by the HSE in its service plan. One of the key result areas for it in its service plan is to continue the reconfiguration of emergency services to ensure they serve an appropriate population catchment and are properly resourced to provide comprehensive 24 hours a day, seven day a week emergency services, while also caring for other urgent needs and minor injuries. Plans to meet this objective continue to be developed by the HSE.