Liam Twomey (Fine Gael)
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I know Senator John Paul Phelan will support me fully on this issue. I want the Minister of State, Deputy Kelleher, in his reply on behalf of the Minister for Health and Children, Deputy Harney, to make clear there has been no attempt to downgrade the accident and emergency services at Wexford General Hospital. Some concerns have been expressed recently that an attempt would be made to change the current 24-7 availability of accident and emergency services at that hospital. This concern is genuine. When I was Fine Gael spokesperson on health an attempt was made under the Hanly proposals to downgrade our accident and emergency department. Subsequently, there were supposed to be plans to expand this department when we had put Hanly to one side but that has not happened. There is concern at Wexford General Hospital, not only for the accident and emergency department but also because there have been bed closures there in recent weeks. We fought for years to get an additional 21 beds at the hospital and now 25 beds have been closed, so we are again in a negative situation.

There is concern that front-line services are taking a major hit, regardless of what the Government is saying at present. There is extreme difficulty in getting home helps, as I know from being both a political representative and a doctor. It is difficult to get additional home help hours for patients and hours for new patients at present. This does not relate just to the elderly but is happening in the disability sector as well. Respite beds are also restricted at a rate that has not been seen for many years.

I would like the Minister of State to deal with these issues in his reply in terms of the effects these cuts are having, not just on primary care. That includes services in the community provided by home helps, public health nurses and occupational therapists. I want him to confirm that the accident and emergency services at Wexford General Hospital will not be downgraded and that no attempts will be made to change this, either now or in the future. I would like a comprehensive reply from the Minister of State in that regard.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Senator. The Minister for Health and Children sends her apologies for not being able to attend the House to discuss the issues he has raised.

Wexford General Hospital provides comprehensive acute services to the 130,000 people living in County Wexford and to the thousands of tourists who visit the area each year. It benefits from a committed workforce who in 2009 will treat 15,400 patients, 6,500 day patients, 39,600 ED attendances and 2,400 mothers giving birth in the maternity unit. In addition, the hospital deals with almost 56,730 outpatient attendances.

The hospital has strong partnerships with colleagues working in primary, community and continuing care sectors and aims to provide patients with fully integrated services. I am pleased to say that a capital allocation to progress the design of a new front entrance and accident and emergency extension in 2009 has recently been approved. This amounts to some €7.75 million, with €400,000 to be expended in 2009.

The HSE anticipates approval to proceed to the next stage in 2010. In line with the national service plan 2009 and in accordance with the HSE's transformation programme, the executive will be reviewing the current configuration of acute hospital services in the south east. A steering group has recently been put in place to this end and is tasked with developing a plan for hospital reconfiguration that will deliver optimal and cost effective services easily, of high quality and delivered through centres of excellence. No decisions regarding the roles of services of any hospitals will be taken until this plan is completed through a process of broadly based consultation within the services. It is likely to be the end of 2009 or early 2010 before this review is completed and a plan is put in place. The Government is committed to ensuring the delivery of the best quality health services possible in an effective and efficient manner. 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.

In summary, a review is being carried out and this will report towards the end of 2009 or early 2010. It will be a broadly based consultation with all the stakeholders providing services in that area.

Liam Twomey (Fine Gael)
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I would like to clarify something the Minister of State said. There are excellent staff at Wexford General Hospital and it is a centre of excellence. I would ask the Government to stop using this term, "centres of excellence", as if hospitals were not centres of excellence apart from those specified as such. The services provided by Wexford General Hospital are of the highest standard. We accept that some procedures such as breast cancer and some gastrointestinal surgery are carried out at Waterford General Hospital because that is for the safety and benefit of patients. However, the services provided by Wexford General Hospital are excellent, as are the accident and emergency services. They are an integral part of the health service in Wexford at present.

The Minister of State is not talking about spending €7.5 million but rather €400,000 in 2009. I do not know who sits on the acute hospital transformation programme but if it reflects what has happened in the north east or at Ennis and Nenagh hospitals, although I know these are not comparable to Wexford General Hospital or St. Luke's in the south east, I would worry because such initiatives always mean a reduction in services and not necessarily the efficient use of resources. We can accept the transfer of certain services to a regional hospital, and I would prefer if the Government would use the term "regional hospital" rather than a centre of excellence, but we cannot accept the reduction in front-line services that affects patients in Wexford.

Billy Kelleher (Cork North Central, Fianna Fail)
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In the context of the capital allocation, funding for the accident and emergency entrance has been recently approved. Some €400,000 will be spent in 2009 and the rest of that budget will continue into the calendar year and the financial year of 2010. The commitment is made in the context of the provision of the new front entrance.

A steering group has been established and is assessing the provision of health services across a full range. The Senator is right in saying that centres of excellence can exist in different faculties and for different treatments. For example, there could be centres of excellence in the context of cardiology that may not be the same as those being provided in the treatment of cancer services. We can agree that a centre of excellence does not necessarily cover all areas of medical procedure. We will await the outcome of the steering group which will assess the best treatments for patients, indicating where services may best be used efficiently and wisely to ensure there is an integrated approach so that wherever services are located, patients can have confidence in them.