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

There are a few things to bear in mind. I know the Senator, and all the Senators, not just in Laois but in every constituency, would love me to be able to give a guaranteed, cast-iron commitment that services will remain on a 24 hours, seven days a week basis. That is not something I can give to anyone about any hospital in the country. Medicine changes over time and even when decisions are made, there can be difficulty finding senior staff. It is not tenable in the longer term for us to continue to provide services with locum doctors, temporary doctors and doctors who are not fully trained to do the job they are expected to do. That is a problem throughout the country.

The international standard now for an emergency department is very different from what it was in the past. Essentially, that is a department that can take undifferentiated patients who have anything wrong with them and deal with them. For example, that is someone with a major head injury who needs neurosurgery or someone with a major injury to their chest who needs cardiothoracic surgery. Portlaoise hospital has never provided those services and it has never been what we would now describe as a major trauma centre or an emergency department in an international context. In Scotland there are only two of them. In London there are only four, and the catchment area required for that type of emergency department, a major trauma centre, is a population of about 1 million. Obviously, that would mean four, five or six in Ireland, but no one is suggesting for a second that we have only four, five or six emergency departments in Ireland. However, we will have to look at emergency medicine and reconfigure it to ensure we have the right services in different places. The only guarantee I can give people is that any decisions will be made based on what is best in terms of patient safety and clinical outcomes, and not based on financial considerations, political bias or political interference. None of those things will happen.