Paddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Alex White, to the House.

John Kelly (Labour)
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I also welcome the Minister of State, Deputy White, to the House.

As he will be aware, prior to the last election the issue of Roscommon hospital and Roscommon accident and emergency department was hot on the agenda in the county of Roscommon. Prior to the election, there were promises given by the Minister for Health, Deputy Reilly, that the accident and emergency department would be retained under his watch, and everybody in the county bought into that. Anyone who might have considered supporting me at the time decided that the next likely Minister for Health would not let them down and they supported Fine Gael.

Subsequently, as the Minister of State will be well aware, the consultants in Roscommon were worried that they were short of staff to ensure that the accident and emergency department operated fully within health and safety guidelines and they wrote to the Department of Health to inform it that they needed extra resources.

At this point HIQA got wind of it, and without ever calling to Roscommon County Hospital, shut down the accident and emergency department, more or less implying the consultants stated it was an unsafe place to work. What we have seen in recent weeks, with regard to the hospital in Kilkenny and extra funding for the accident and emergency department in Wexford General Hospital, has re-opened the debate on the accident and emergency department in Roscommon County Hospital. The people of Roscommon quite rightly feel aggrieved because instead of HIQA shutting down the accident and emergency department, investment could have been made in it to ensure it was up to the required standard. We must bear in mind an investment of ¤17 million was made in recent years in the accident and emergency department in Roscommon County Hospital. It is state-of-the-art and all that was lacking was the support staff sought by the consultants.

I had received a commitment from the former CEO of the HSE, Professor Drumm, that the accident and emergency department at Roscommon County Hospital would not be closed and that albeit it was under threat by the previous Administration, there was no question of it being closed. Although this was a HSE agenda with which Fianna Fáil was going to play ball, I had received a commitment from Professor Drumm that the doors of the accident and emergency department would not close until the advanced paramedics were up and running and had proven to the people of Roscommon over a period of six months that their service was every bit as good as, if not better than, an accident and emergency department. This promise was also reneged upon.

I have always stated HIQA was established by the HSE to be its chopping block and everything it has done to date has proven me right. In recent times HIQA was asked whether a health and safety issue would arise if many HSE front-line staff took early retirement and pressure was put on the services. It answered that it has no role in staffing, but it had a bloody role in staffing when it came to Roscommon County Hospital accident and emergency department. It stated it was time to close down the department because the staffing was not there.

I ask the Minister of State to relay back to the Minister, Deputy Reilly, that at this late stage he should consider putting in place a stabilisation unit in the accident and emergency department at Roscommon County Hospital so people in the area who have heart attacks, strokes or accidents can be dealt with, stabilised and moved to an appropriate hospital. At least they would know there was something behind the doors and would feel safe at night if something unforeseen happened. People feel let down.

Alex White (Dublin South, Labour)
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I thank the Senator for raising this issue. In the notice for this Adjournment debate, the Senator used the phrase the "most appropriate hospital" for treatment of those serious conditions which he described and I also note his appreciation that transfer to such facilities is essential. One of the key functions of pre-hospital emergency care is stabilisation. On arrival at an incident, paramedics and advanced paramedics assess, treat and stabilise the patient, prior to transporting him or her to the most appropriate, which is not necessarily the closest, facility. This treatment continues during transit.

Given this and the fact these types of patient, in particular those suffering cardiac arrest and stroke, are time-critical - which the Senator emphasised and was correct to do so - there is no clinical value in diverting to a stabilisation unit before continuing to a level 3 or 4 hospital, when stabilisation has already been done by the ambulance crew. It is worth noting also that a bypass protocol, diverting ambulances to level 3 and 4 hospitals for life-threatening cardiac, respiratory and other serious conditions was put in place for Roscommon County Hospital before the emergency department was closed in 2011, in line with national clinical care protocols for best practice and safe management of a patient with a heart attack or stroke. These protocols require such patients to be treated in a level 3 or 4 hospital as a level 2 hospital does not have a critical care unit.

Accident victims should only be managed in a hospital with a full emergency department with the necessary available acute care backup, including ICU. The essence is that patients should go to the hospital best able to treat them. This is particularly important for heart attack and stroke victims whose survival rate and long-term prognosis is dependent on how quickly they reach an appropriate hospital.

None of the national clinical care programmes envisages the development of "stabilisation units" in model 2 hospitals. It is debatable whether these would improve outcomes for patients or whether they would actually delay them from reaching the necessary level of care in an appropriate facility with the necessary clinical expertise and equipment to fully meet their needs. Having said that, I and the Minister for Health acknowledge that Roscommon County Hospital is leading the way by demonstrating the range of services that can be developed in a smaller hospital. In July 2011, Roscommon County Hospital commenced a process of reconfiguring services in line with HIQA recommendations. I respectfully disagree with the Senator's description of HIQA as a chopping block for the HSE. HIQA does important expert work through its role in our health services and is a very important institution. It is also a requirement for excellent health services that we have a body such as HIQA doing the type of work it does.

Roscommon County Hospital now has a medical assessment unit that is open from 9 a.m. to 5 p.m. from Monday to Friday for the assessment of medical patients who are referred by GPs, after initial phone triage with one of the medical consultants to ensure the medical assessment unit is the appropriate care pathway for the patient. In addition, it has an urgent care centre open 8 a.m. to 8 p.m., 7 days a week, which deals with minor injuries and trauma, as the Senator is well aware. Developments in 2012 include plastic and reconstructive surgery, sleep studies, urology services, a radiology upgrade, a newly-developed endoscopy suite, dental service, nurse prescribing and re-accreditation for student nurse training.

Roscommon County Hospital played a key role in the Galway Roscommon hospital group, with more than 520 endoscopy procedures transferred from Galway to Roscommon. Future plans for Roscommon County Hospital will see increases in elective inpatient care, in particular in endoscopy, plans for which are well advanced with design agreed, site identified, tender documents complete, funding secured and awaiting planning permission. Roscommon County Hospital is an excellent example of delivering appropriate care in the appropriate setting to maximise patient safety and resources.

John Kelly (Labour)
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I expected nothing from the Department other than the response given by the Minister of State, because it appears it has a total reluctance to revisit the issue which is so important to the people of Roscommon, bearing in mind Roscommon County Hospital was always considered by virtue of the county's rural nature to be a special case. I also note that in his response the Minister of State said a stabilisation unit was debatable. This means it is unclear and that the Department does not know whether it is the right or wrong thing to do, no more than 45 years ago when the Government thought if we took up our train tracks we would never need them again but now we are putting them back down. The Minister of State said Roscommon County Hospital is leading the way. No matter what is put into Roscommon County Hospital which leads the way, the people of Roscommon want an accident and emergency department. This is all they want. I will not let this issue go and I hope Minister of State will relate this to the Minister, Deputy Reilly.

Alex White (Dublin South, Labour)
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I cannot state the matter any further than I have. I understand the Senator's concern and he has been to the fore on this question and makes his case well, as he has done in the past. Stabilisation is required to be done at an early pre-hospital emergency care stage, and to the extent to which stabilisation is properly done one then looks for the most appropriate facility for the patient. In these circumstances it does not follow that the nearest hospital is the most appropriate. It depends on a clinical assessment. If stabilisation has already been completed it would not be appropriate for a stabilisation unit to be placed in a hospital, as the job can be done at the pre-hospital emergency stage after which the patient goes to hospital. I take the points raised by the Senator.