Terry Leyden (Fianna Fail)
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I acknowledge the presence of the Minister of State, Deputy Mary Wallace. No disrespect, but I requested the presence of the Minister for Health and Children because the questions I raise are for her. I want confirmation from the Minister on the commitments given on the future of Roscommon County Hospital. The Minister of State is in a difficult position as she did not give those commitments as Minister, but she is here to reply on the Minister's behalf. I assure the Minister of State that I make these comments with respect, as she knows from previous contact over the years. The situation with regard to the future of Roscommon County Hospital is a serious issue that has caused deep concern for the people of the county. I have been fighting for the cause for many years.

My adjournment issue raises the need for the Minister for Health and Children to confirm that commitments made by current and previous Ministers for Health and Children will be honoured and that Roscommon County Hospital will continue to provide full consultant-led accident and emergency services on a 24 hours a day, seven days a week basis, and on-site acute medical, psychiatric and surgical services including coronary care.

It is essential to retain the current services of Roscommon County Hospital. A review was carried out of services at Roscommon County Hospital and Portiuncula by the HSE. The review referred to a number of options, but gave prominence to only one preferred option. The preferred option for the people of Roscommon is to retain the existing acute surgical medical and psychiatric services of the Roscommon County Hospital on a 24-hour, seven day a week basis. However, Professor Drumm has now made recommendations that go further than the review board document ever went and proposes to reduce accident and emergency services by 33%. I do not see how this can be justified. The numbers attending the accident and emergency unit are in the region of 13,000 per year.

I was chairman of the Western Health Board in 2002 when it signed the contract for a new €10 million accident and emergency department for Roscommon County Hospital, which is an outstanding facility. The latest proposal goes beyond the Hanly report, which made a geographical consideration with regard to the provision of acute services. Galway has Merlin Park Regional Hospital, UCHG, two private hospitals and Portiuncula is within 25 miles of the city. It is obvious, therefore, that if any hospital should retain its acute surgical services and be developed further, it should be Roscommon County Hospital, which has served the needs of the people of Roscommon since the mid-1940s.

The Minister who comes from Meath should realise that the situation in Roscommon is similar to that in Meath. In the past 12 months the lives of a number of young men have been saved because of the presence of Roscommon County Hospital's accident and emergency department. How would anyone explain the situation to parents of such young men if that service were discontinued and lives were lost? This is a matter of life and death.

When I was a Minister of State in the Department of Health, from 1987 to 1989, and the Western Health Board proposed the closure of Roscommon County Hospital, I got a clear commitment from the Government and thereby prevented the closure of the hospital. I want to make this clear. No independent Deputy was elected in Roscommon before 1989. The Government gave a commitment in 1987 that we would retain acute surgical, medical and accident and emergency services, as well as additional psychiatric services, and a statement was issued to that effect. On 12 September 2006, the Minister for Health and Children met my colleague, the Minister of State at the Department of the Environment, Heritage and Local Government, Deputy Finneran. The latter indicated in a recent statement that senior officials from the Department and the HSE attended this meeting, at which it was agreed that inpatient surgery would continue to be provided at Roscommon County Hospital and that a joint department of surgery and anaesthesia would be established between Roscommon and Portiuncula hospitals, with two surgeons based at each hospital. A fifth surgeon was to be appointed to specialise in gastrointestinal surgery, with hours to be agreed by the hospitals.

This issue needs clarification and the Minister needs to confirm the commitments she made in September 2006 to the Minister of State. I call on her to honour the commitments she gave to the people of County Roscommon and those who rely on Roscommon County Hospital for acute treatment. I hope the response to my appeal will be positive but, if it is not, I intend to pursue other parliamentary means of raising this matter.

Mary Wallace (Meath East, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. The Government is committed not only to ensuring the delivery of the best quality health services possible but to doing so in an effective and efficient way. Ensuring patient safety is of paramount importance so that people can have confidence in the services and the best possible patient outcomes can be achieved.

The Health Information and Quality Authority was established on a statutory basis in 2007 and is responsible for driving quality and safety in health and social care services. In the same year, the enactment of the Medical Practitioners Act 2007 represented the first major overhaul in 30 years of the law regulating the medical profession. The new Medical Council appointed under this Act came into office on 3 July. Also in 2007, the Minister established the commission on patient safety and quality assurance to develop proposals for a health service wide system of governance based on corporate accountability for the safety and quality of all health services. The commission is due to submit its report by the end of this month. In this context, it is essential that every health care provider and facility is fully cognisant of patient safety and quality and takes account of these in the organisation, management and delivery of services.

In the past, Roscommon County Hospital and Portiuncula Hospital, Ballinasloe, have operated independently, with two consultant general surgeons in each hospital. The difficulties faced by Roscommon and Portiuncula in maintaining surgical services independently and the need for closer co-operation between them were highlighted by the former Comhairle na nOspidéal in March 2006. Advances in clinical care and ever increasing levels of specialisation mean that the present model of care is no longer sustainable. Small stand-alone hospital services will not be able to offer doctors the opportunity to treat a sufficient volume and variety of patients in order to maintain their skills nor will they be able to provide the range of experience required for doctors during training. As a result, it will prove increasingly difficult, and perhaps impossible, to fill consultant posts on a permanent basis.

In light of these factors, the best way of retaining and developing services at Roscommon and Portiuncula hospitals is for the hospitals to work together. I am confident that the development of joint departments of surgery and anaesthesia at the hospitals will provide a better service for patients of both hospitals. The Health Service Executive is undertaking a detailed planning and consultation process with stakeholders on how best to implement the proposed changes to the organisation of services at the two hospitals. This will include consideration of the most appropriate arrangements in regard to the provision of accident and emergency services for the populations served by the hospitals concerned. The resource implications of the new service configuration in revenue and capital terms will be considered in the context of the planning exercise which I have described.

Terry Leyden (Fianna Fail)
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I thank the Minister of State. She stated that discussions are ongoing, whereas the impression given locally by Professor Drumm is that they have been concluded. The only glimmer of hope is that further discussions will take place. I hope the Minister will be made aware of my concerns before a final decision is made on the configuration of the two hospitals.