Maurice Cummins (Fine Gael)
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The south-east region has a population of more than 470,000 people, one of the highest population bases as far as regional health care is concerned. The south-east region has the critical mass to develop a whole suite of regional services, which are necessary for any regional hospital. While some regional services are already based in the hospital, such as ENT, pathology, neo-natal care and orthopaedic surgery as well as such medical specialties as rheumatology, oncology, neurology and dermatology, other services should be regionalised, including cardiology, critical care, palliative care, emergency medicine, obstetrics, radiology, specialised paediatrics and general surgery and its sub-specialities, including major surgery. While these specialties should be delivered in the regional centre, other services should remain locally based, such as general medicine, medicine for the elderly, general paediatrics, acute assessment casualty and elective surgery as part of a regional service.

Historically, funding for the south-east region was split among four locations and this has resulted in the fragmentation of health care resources and services, the inadequate development of specialist services and an under-development of regional hospitals. There is a lack of local governance because the HSE South is centred in Cork. There is a lack of direction from the HSE, which is over sensitive to political issues and this has resulted in poorly informed decision making. The Reconfiguration Steering Group was established in 2009. There has been no report as of yet and no agreement from the group. We have witnessed the continual undermining of the process and the clinical lead has resigned. I suggested he resigned because of the lack of progress and because of the direction the group was taking. These simply could not be countenanced from a medical and clinical point of view.

Will the Minister of State and the HSE inform me what reason was given for the resignation of the clinical lead? What does the Minister of State intend to do to bring this process back on track, with the best outcomes for patients as the sole prerogative of the group, rather than medical or local politics, which only lead to the muddying of the waters? The failure to develop new services that I have outlined will result in consultants leaving the regional hospital and the loss of services rather than their continued development. Although designated as one of the centres of excellence for cancer care, the resources have not been provided to Waterford Regional Hospital nor have the necessary supports to develop the centre been put in place, although that is what it deserves.

Last year the hospital outlined requirements for major capital investment in the areas of critical care, cancer care, hospice, accident and emergency and theatres. We need a clear and unambiguous direction from the HSE and the Minister in this regard. Capital investment in Cork last year amounted to €87 million but less than €500,000 was invested in Waterford Regional Hospital. This speaks volumes about the lack of investment in the hospital. The regional centre simply cannot put up with this lack of investment from the Government and the lack of direction from the HSE, which clearly still exists.

We need answers and we need investment in the regional hospital. We need the same services that are available in other regional centres and we will not accept "No" for an answer. The south east has been hit badly by unemployment and so on. Our regional hospital is being treated in a disgraceful manner. We need investment now. I call on the Minister of State to refer to the areas and services I have mentioned, which lack the support of the HSE from a capital perspective.

Áine Brady (Kildare North, Fianna Fail)
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I will take this matter on behalf of my colleague the Minister for Health and Children, Deputy Mary Harney. The Government is committed to ensuring the delivery of the best quality health services possible and to providing the highest possible standard of patient care in an effective and efficient way within the resources available. Patient safety and quality of care are at the core of how we provide health services. Patients get the best health outcomes when complex care is delivered in hospitals with high volumes of patients. Less complex care and many diagnostic services can and will be provided locally throughout the country.

Beginning in 2012, hospitals must comply with new licensing arrangements which will be underpinned by quality and safety standards. All hospitals will have to meet these standards, which will ensure people get the right care in the right place at the right time from the right person. Also, we must comply with the European working time directive, which requires the HSE to reduce the hours of non-consultant hospital doctors.

In light of these considerations the HSE commenced a review in 2009 of acute hospital services in the south east to ensure that they would be organised to meet the challenges of the future and to ensure the best health outcomes for patients. All hospitals in the south-eastern hospital group, including Wexford General Hospital, Waterford Regional Hospital, South Tipperary General Hospital and St. Luke's Hospital, Kilkenny, are encompassed by the review. Senior clinical and management personnel from each hospital are involved. The process also involves extensive consultation with professional and service user interests throughout the region.

Since his appointment in 2009, the HSE's National Director of Quality and Clinical Care has appointed several experts to examine how a range of specialist services can best be delivered. They will consult widely and work with the relevant professional bodies to develop safe and appropriate models of care nationally. Areas under examination include obstetrics, stroke services, neurology, rheumatology, diabetes, epilepsy, heart failure and cystic fibrosis. Decisions about how services are organised in the south east will be guided by this work. I emphasise that no decisions have yet been made with regard to the future organisation of hospital services in the south east. When they are developed, the HSE also intends to bring its proposals to public consultation before final decisions are made.

On the Minister's behalf, I echo the appreciation expressed by the HSE to Dr. Colm Quigley for the significant contribution he has made as clinical lead for the review of acute services in the south east. Dr. Quigley has devoted a great effort to working with a wide range of health professionals and users of the health services to explore workable and appropriate options for the future delivery of hospital services. Dr. Quigley will continue to represent Wexford General Hospital at the south-east hospital reconfiguration steering group, which includes clinical directors from each of the four acute general hospitals in the region. Finally, I assure the House that, while no proposals have yet been finalised or decisions made, all four acute hospitals in the south east will continue to play a significant part in the delivery of hospital services to people living in the region.

John Paul Phelan (Fine Gael)
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Does Senator Cummins wish to ask a question?

Maurice Cummins (Fine Gael)
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With all due respect to the Minister of State, it is a pity the Minister for Health and Children is not here to address the problems. The Minister of State has not alluded to the reasons why the clinical director resigned. I wish to hear the reason the clinical director resigned. That might indicate why I have raised this matter on the Adjournment. It would provide more information on what is going on with the committee. In response, the Minister of State said no decisions have been made. That is the reason I raised this matter on the Adjournment. The committee has been set up since early 2009 and no agreement has been made. It is being stifled and stalled. I tabled this matter on the Adjournment to get decisions made on the use of the regional hospital.

John Paul Phelan (Fine Gael)
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Senator Cummins should pose questions to the Minister of State.

Maurice Cummins (Fine Gael)
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I asked a question but it was not answered. Why did the clinical director resign and when will the required capital investment be made? This is the thrust of the Adjournment motion and neither aspect has been addressed.

Áine Brady (Kildare North, Fianna Fail)
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I will pass on the questions from the Senator to the Department.

Paudie Coffey (Fine Gael)
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This matter follows on from where Senator Cummins left off. There is great concern in the south east and at Waterford Regional Hospital that the status of the hospital is being undermined, not by political interference but by medical interference from professionals and consultants in other hospitals. They are undermining the HSE reconfiguration attempts since 2009. This is a cause for concern. The Minister must listen to what all public representatives are saying and must take the HSE into hand. The executive seems to be operating at arm's length with little oversight by the Department. Billions of euro of taxpayers' money has been spent on health services every year. We need more transparency on this expenditure and we need the HSE to be fully accountable. It should let us know the progress of the reconfiguration and changes in the health service.

Senator Cummins has outlined the importance of Waterford Regional Hospital in servicing the populace in the south east. This area has a population of 470,000 people. A number of regional services are in place at Waterford Regional Hospital but some of them are not receiving the resources and support they deserve. One example is neurology. We are awaiting the appointment of a consultant to treat neurology patients in the south east at Waterford Regional Hospital.

Services are fragmented throughout the region. One such example is cardiology. The ridiculous situation at Waterford Regional Hospital means whether one is treated at Waterford Regional Hospital depends on the time of the day or the day of the week one has a heart attack. We do not have 24/7 cardiology services to treat emergency patients who have heart attacks. This is the case in a regional hospital servicing the population base I referred to earlier. Why is that the case? Genuine attempts have been made by management teams in the HSE to address this problem but they are being undermined. There is interference and the Minister must take stock of what we are saying.

I acknowledge that Waterford Regional Hospital has been identified as a satellite centre for cancer care. All disciplines of cancer care are at Waterford Regional Hospital except radiotherapy. This is carried out by a private service at Whitfield Clinic. Waterford city and its environs is one of the few regions in the country without a hospice to deal with end-of-life issues. A promise had been made for a 20-bed hospice but that does not go far enough. A regional hospital should have the full range of palliative care, with all the necessary support and resources. I am a politician but we should not put up with political or medical interference in achieving that. Waterford Regional Hospital is what it says on the tin - a regional hospital servicing the entire south east. It needs critical mass for successful operation. It also needs resources. I appeal to the Minister to listen to what is being said. As public representatives, we are concerned at the lack of progress by the HSE management team. There seems to be a concerted effort to undermine that progress. We must listen to the concerns of colleagues from the south east. There is a hierarchy of needs and a hierarchy of service. Surely Waterford Regional Hospital should be at the top of the hierarchy.

A final example concerns figures quoted about the levels of capital investment. A comparison between Cork University Hospital and Waterford Regional Hospital shows that in the same timeframe, €85 million was invested in Cork University Hospital while €500,000 was invested in Waterford Regional Hospital. This matter must be addressed. I acknowledge the plans for a new accident and emergency unit at Waterford Regional Hospital but it is entitled to that and deserves it. The hospital deserves a full level of services to provide for the entire south east.

Áine Brady (Kildare North, Fianna Fail)
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I am taking this Adjournment on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. The way in which we deliver acute hospital services to our communities and their wider regions is changing. The expert advice is that when delivering complex care, patient outcomes are better where sufficient volumes of activity take place and where the appropriate necessary staff and equipment are available. The evidence also emphasises the need for the delivery of timely pre-hospital and emergency care in an appropriate setting for fewer complications and healthier lives.

Waterford Regional Hospital is a pivotal component in the provision of acute services in the south east. Within a budget of €145 million and with a staff of almost 1,800, the 2010 service plan for Waterford Regional Hospital sets out targets for the treatment of 21,000 inpatient cases, almost 20,000 day cases and in excess of 131,000 outpatient attendances. Significant investment continues at the hospital. The Minister for Health and Children recently opened the new cardiac catheterisation laboratory. Waterford Regional Hospital is now the designated regional cardiology intervention centre and it serves a catchment population of more than 460,000 people. The capacity of this service will be further developed as resources allow. This will assure Waterford's role as a major centre for the diagnosis and treatment of cardiac disease.

The hospital's design brief and development control plan provides for phased and integrated development on the campus and additional accommodation for future requirements. The plan includes provision for critical care facilities and high dependency and cancer services units. The HSE has approved the expansion of Waterford Regional Hospital emergency department at a cost of approximately €10 million, and construction is expected to begin soon.

Waterford Regional Hospital is one of the two designated specialist centres in the HSE south region under the national cancer control programme. Waterford will provide initial diagnosis and surgery for the region by multidisciplinary teams. Chemotherapy and routine follow-up will be provided locally, as appropriate, as will palliative care.

The Health Information and Quality Authority, HIQA, reported in September that Waterford's breast cancer service meets the key requirements in the national quality assurance standards on symptomatic breast disease. Rectal cancer surgery is also centralised at Waterford. A rapid access diagnostic clinic for lung cancer opened this year and a similar clinic for prostate cancer is planned. A palliative care consultant was appointed in September 2009. A hospice site has been identified on the hospital campus under the development control plan. This will be progressed with the Irish Hospice Foundation. For palliative care for children, the HSE intends to appoint a clinical nurse specialist. I am confident that Waterford Regional Hospital will continue to be a vital component in the delivery of health services across the south east.

Paudie Coffey (Fine Gael)
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I have an important question. The last line of the response of the Minister of State, where she comments that Waterford Regional Hospital will continue to be a vital component in the delivery of health services across the south east, does not go far enough. It should be the lead component. It is the regional hospital serving an entire region. It is not just a vital component, which is true of any hospital. The Minister of State referred to the resources and investment in cardiology. We lost a leading consultant in cardiology last year because resources were not allocated. When will the cardiology unit in Waterford Regional Hospital be properly resourced in order that it can provide a 24/7 emergency service, as any regional hospital should provide? It is not doing so at present. I appeal to the Minister of State to take the HSE into hand. If we cannot get it, at least the Minister and departmental officials should secure full accountability from the Health Service Executive lead teams which are managing reconfiguration of the service.

Áine Brady (Kildare North, Fianna Fail)
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The cardiology service will be expanded as resources allow. I have taken on board the point made by the Senator on the availability of the service 24 hours a day, seven days a week.

Liam Twomey (Fine Gael)
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I am concerned about the way health services are delivered in County Wexford. This ties in with the issues raised on the Adjournment by the two previous speakers.

The general manager of St. Vincent's University Hospital wrote to general practitioners in County Wexford to state the hospital was no longer in a position to see public patients from the county. That means patients who require tertiary services, namely, highly specialised services such as plastic surgery, will no longer be seen in St. Vincent's University Hospital. Instead of having to travel for between 50 minutes and one hour to St. Vincent's University Hospital, they will now have to travel three and a half hours to Cork University Hospital. There is no direct train or bus service to that hospital. This shows the ridiculousness of the thinking of the Health Service Executive, that patients living within one hour of a hospital must now travel three and a half hours to fulfil the administrative needs of the executive.

A number of patients from north County Wexford also attend St. Vincent's University Hospital for specialised regional services such as ear, nose and throat services. They have now been told they must travel to Waterford. When I initially heard the news, I asked GPs about their concerns. They said the waiting time was approximately six to nine months for a public ear, nose and throat outpatient's appointment in St. Vincent's University Hospital, but one had to wait for up to two years for an appointment in Waterford Regional Hospital.

The Minister of State has indicated the Minister for Health and Children is in favour of the effective and efficient delivery of health care services. One thing she is not interested in, however, is equality in the delivery of such services. When I made further inquiries, I found out that one had to wait for approximately nine months for an orthopaedic outpatient's appointment in St. Vincent's University Hospital, while one had to wait four years for an appointment in Waterford Regional Hospital. One sometimes has to wait weeks but normally less than three months for a scope procedure, used to diagnose stomach or bowel cancer, in St. Vincent's University Hospital if a doctor contacts the consultant specialist there. In Waterford Regional Hospital and Wexford General Hospital one has to wait far longer because the services are completely under-resourced in both hospitals.

I would like to get a straight answer to my questions from the Minister of State. If Waterford Regional Hospital is not functioning, as is the case - it does not even compare to St. Vincent's University Hospital - is it because the resources provided for it are insufficient or is it because there is incompetent management? I want these questions answered because they are issues the people in the south east want to have addressed. I refer to the concerns expressed by my two colleagues, that in Waterford one should only have a heart attack three days a week between 9 a.m. and 5 p.m., whereas one can have one at any time of the day in Dublin. People in Wexford want to know if they have a substandard regional hospital in comparison to people living in Dublin in which there are five major hospitals and four general hospitals serving a population of approximately 1.4 million. Given that hospitals in Dublin are writing to general practitioners in County Wexford to state they will no longer see patients with an address in County Wexford, I wish to know what the Minister is going to do to improve services rapidly in Waterford Regional Hospital and Wexford General Hospital because we are capable of doing much of the work required ourselves if given the resources.

The Minister of State referred to the catheterisation laboratory and the rapid access diagnostic clinic for prostate cancer in Waterford Regional Hospital. However, there are no fully functioning urologists in Waterford Regional Hospital. There was no urologist in the hospital up to a few months ago and in its wisdom the Health Service Executive then took on three. However, it has not allocated any resources to provide the urology services available in St. Vincent's University Hospital.

There is marked apartheid in the delivery of care services in the capital and 100 miles down the road in County Wexford. Much of this is being driven by the nonsensical administrative ideas outlined by members of the Health Service Executive who literally draw lines on the map and say if one is on one side of the line, one will receive a first-class service, but that if one is on the other side of the line, one will receive whatever service it happens to make available at the time within existing resources. That is the type of rubbish that has become the hallmark of the Government and we want to see it stopped. In the context of the setting up of a unifying service, namely, the Health Service Executive, we want the service to be available to everyone in exactly the same way no matter in which part of the country one lives.

Áine Brady (Kildare North, Fianna Fail)
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I am taking this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

The HSE has confirmed to the Minister that St. Vincent's University Hospital has recently written to general practitioners in the Wexford area to advise them that, owing to an increase in general practitioner referrals both from within and outside the hospital's catchment area, it is only able to provide ear, nose and throat and plastic surgery services for GP referrals from within the catchment area. The hospital has written to general practitioners situated outside its catchment area to advise them of the situation. It has proposed to them that they should consider referring patients to the appropriate clinical services in their local hospital in the first instance. It is the hospital's intention that this will facilitate the patient being seen in a more timely manner.

Cork University Hospital provides plastic surgery services for the south-east hospital group in its plastic-maxillofacial unit. The Health Service Executive plans to develop a plastic surgery service in the south east as a matter of priority. Regional ear, nose and throat services are provided in Waterford Regional Hospital, but there may be sub-specialties that are appropriately referred to national or other regional centres such as Cork University Hospital. It would not be appropriate for me to comment on a particular case. However, the Health Service Executive has assured the Minister that patients referred for treatment will be prioritised on the basis of clinical need. The priority list is regularly updated. It is important that there is a co-ordinated approach to the management and treatment of patients in order that patients who require treatment can receive it as quickly as possible in the appropriate health care setting. The Minister has asked the Health Service Executive to address the issue as a matter of priority.

Liam Twomey (Fine Gael)
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I guarantee the Minister of State that I will continue to pursue the matter until I receive a straightforward answer. I am not finished yet. Given what I said, how could the Health Service Executive write such rubbish? Is the reference to "in a more timely manner" made in the context of a patient travelling between Gorey and Cork, or is it made in the sense that instead of having to wait for six months, one will have to wait for four years, or that instead of having to wait weeks, one will have to wait months to have bowel cancer diagnosed? That is the sort of nonsense written in some of the replies we receive in this House. If that is the policy to be enforced by St. Vincent's University Hospital, is the Health Service Executive stating the funding Dublin hospitals receive for the 15% of patients who historically have come from outside of their catchment areas will be reduced and that the money will be transferred to Waterford Regional Hospital to make up the shortfall in treating patients who will not be seen in a Dublin hospital? The Minister of State must answer that question. It is very easy for hospitals to state they will not see patients from outside their catchment areas, but they have received funding for that purpose for a number of years.

Áine Brady (Kildare North, Fianna Fail)
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The Senator wishes me to ask whether Waterford Regional Hospital is under-resourced or if the problem there is due to incompetent management. He also wishes me to ask whether the funding received by Dublin hospitals for treating patients from outside their catchment areas will be transferred.

Liam Twomey (Fine Gael)
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I appreciate that.