Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I thank Senator Whelan for raising this matter, which gives me an opportunity to update the House on our plans for the Midland Regional Hospital, Portlaoise. I appreciate the Senator's support for the hospital through the years and his interest in the matter. I am committed to securing and further developing the role of Portlaoise hospital as a constituent hospital within the Dublin Midlands Hospital Group, which includes St. James's Hospital, Tallaght hospital, Midland Regional Hospital, Tullamore, Naas General Hospital, and the Coombe hospital. Any change to services in Portlaoise will be undertaken in a planned and orderly manner, taking account of existing patient flow demands in other hospitals and the need to develop particular services at Portlaoise in the context of overall service reorganisation in the Dublin Midlands Hospital Group. Any decisions will be made on the basis of maximising patient safety and patient outcomes, not financial considerations or political bias or interference, to use the Senator's words. That will not happen.

In recent months, substantial investment and enhancement measures have been put in place to ensure a safer level of services at Portlaoise hospital. Maternity services are being upgraded following the agreement of a memorandum of understanding between the Health Service Executive and the Coombe to provide a managed clinical maternity network within the Dublin Midlands Hospital Group. This will provide for the delivery of a single maternity service over two sites, Portlaoise and the Coombe, with clinical governance led by the latter. Agreement has been reached on the recruitment of two additional obstetricians, one of whom will be the new clinical lead for the Portlaoise hospital maternity service, two neonatologists, to be shared across both sites, some additional clinical and allied health support, and a broad agreement on shared services and information technology. An implementation plan in this regard will be put in place in the coming months. Further improvements in Portlaoise include the provision of a number of additional consultant posts in anaesthetics, surgery, emergency medicine, paediatrics, obstetrics and general medicine, and 16 midwifery posts. In addition, it is intended to provide a new acute medical admissions unit and expand day surgery at the hospital.

The hospital group CEO has set out clearly what is being proposed at Portlaoise, with maternity, acute medical and paediatric services to continue and elective day surgery likely to be expanded. Patient safety and patient outcomes must be the first consideration. Last week, the HSE advised that complex surgery at Portlaoise - bowel surgery, in particular - will be transferred to St. James's or Tullamore, as the volumes at Portlaoise are too low to maintain the requisite expertise of the clinical staff. Indeed, the Health Information and Quality Authority report specifically criticises the HSE for recruiting additional colorectal surgeons at Portlaoise when patient numbers were not sufficient to allow those staff to maintain their skills. Patient volumes are very often a consideration, not just staff and resources. One must have both and be able to sustain both. As a result of this change, we will see the discontinuation of undifferentiated surgical cases that present at Portlaoise emergency department.

The important point to understand is that the work is being done to strengthen services in Portlaoise from a patient safety and quality perspective and to ensure services currently provided by the hospital which are not viable are discontinued and those which are viable are safety assured and adequately resourced. This is in keeping with the recommendations of the HIQA report into services at Portlaoise and reports on other hospitals in the past. I am confident these changes will improve services for patients at Portlaoise.

In respect of Portlaoise emergency department specifically, it receives, as the Senator noted, between 30,000 and 40,000 attendances per year. There is no question, therefore, of its being closed. The only question that has emerged, as raised by the CEO, is whether 24-hour services are sustainable. No decision in this regard has been made or can yet be made. In the case of Navan, for example, surgical services are no longer provided, but the hospital continues to offer a 24-hour emergency department for medical patients and those with minor injuries. I strongly agree with the Senator that any proposal to end 24-hour services at Portlaoise could not be advanced without a clear and credible plan to provide additional capacity at Tullamore, Naas and Tallaght, which are already very overstretched.