Mark Dearey (Green Party)
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I thank the Minister of State for taking this question - it a is double question - on the new emergency department at Our Lady of Lourdes Hospital in Drogheda which, although it is standing and ready to go, has been lying idle for many months now. We are several months past the anticipated opening date, which was last March. The emergency department has been featured many times on television and the public will be familiar with how it looks from the outside, but nobody knows what it looks like on the inside. An article in The Drogheda Independent stated the facility contains separate resuscitation facilities for children and adults, separate access for patients who arrive by ambulance, a separate minor injuries clinic, X-ray facilities integrated into the unit, sub-wait areas and facilities for care of the dying. In short, it will transform people's experience of accident and emergency throughout the north-east region, yet it lies idle.

The issue is staffing. I ask the Minister of State for an update on what is being done to help break the logjam in that area, with regard to the HSE and the unions representing the workers involved. I understand many of the staff who will move from Dundalk are unhappy about the terms or are in a state of confusion about what is happening. They deserve, at the earliest moment, some clarity on that.

Notwithstanding that, it is my contention that, in broad terms, Our Lady of Lourdes Hospital is not a place in which Dundalk people care to be treated. It is not a place I see as the new regional hospital. It was never intended to be that. It is on a site which is too small; everybody recognises that. Navan was identified some years ago, after an extensive period of research by an outside consultancy, as the best location. It always struck me as a decision to serve the north-west Dublin rim and parts of the north east, but fails the people of Dundalk and the Carlingford Peninsula, as well as people from parts of Monaghan and as far as Cavan, who would be expected to make a cross-country trek on very poor country roads to Navan. It is not real.

Dr. Colm Quigley, who is overseeing the transformation programme in our region, has spoken of the possibility of the regional facility being located closer to Dundalk in future. I spoke today about the delivery of services on a shared basis with Northern Ireland and can see a case for regionalising the service on a cross-Border basis. It would require a huge amount of work. It is a grand project, but one which deserves serious attention. Authorities on both sides of the Border take the concept seriously.

On accident and emergency services in Dundalk, it is a matter of huge concern to the people of a gateway town that it will be the only gateway without its own accident and emergency department should the HSE's proposals for health services in the north east be seen through to fruition. In spatial planning terms, there is a very strong case to be made for the retention of the service if Dundalk is to achieve its status as a gateway. It is, according to the most recent analysis of the indicators, the weakest performing gateway. Removing hospital services which investors, in particular inward investors, consider very carefully along with educational facilities, with which Dundalk is blessed, will affect the area.

There are overarching economic, spatial, planning, but above all, health reasons why a town which is anticipated to grow to small city status should have access to its own accident and emergency department. I look forward to a positive response from the Minister of State in that regard, notwithstanding the recent worrying comments on cutbacks in accident and emergency services due to budgetary constraints.

Martin Mansergh (Tipperary South, Fianna Fail)
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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.

Mark Dearey (Green Party)
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It is interesting that the Department of Health and Children states it is not aware of any proposals from the HSE to deviate from its service plan, but it did not give any assurance that that would not happen. The ongoing failure of the two entities to communicate is the reason there is so much confusion in terms of the public's understanding of the health service. It is a pattern which is repeated in the language used by the Minister of State. Will external recruitment proceed following consideration of redeployment options in the case of the new emergency department at Our Lady of Lourdes Hospital, Drogheda? I think that is what has been stated, but perhaps the Minister of State will give me his own interpretation. As always, the language used is impenetrable.

Martin Mansergh (Tipperary South, Fianna Fail)
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I have some experience of the HSE in south Tipperary. I have come across various formulations of services. I am speaking for myself, not the Minister for Health and Children, but the Senator can take it that these phrases have been carefully formulated in order that hostages to fortune will not be given and that they will be capable of accommodating changes. I am afraid that that is, unfortunately, the case. Equally, I accept that what I said about recruitment might also require parsing, but I am afraid, delegating for the Minister for Health and Children, I cannot honestly parse for the Senator further what I said. No doubt he will be able to pursue his own inquiries further.