John Whelan (Labour)
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I welcome the Minister for Health, Deputy Leo Varadkar. I am pleased and relieved to see him here in person.

The midlands, including all of County Laois, are in turmoil owing to the speculation, scaremongering, doubt and confusion surrounding the future status of the Midland Regional Hospital in Portlaoise and, in particular, its accident and emergency department.I do not have to spell out the context of this issue to the Minister as it has been ongoing for 30 years. I have hardly got up at any stage during those years without there being some doubt, confusion and speculation about the status and future of the hospital which for years has been the poor relation and playing second fiddle for all sorts of reason and sometimes not least because of political bias and interference. Be that as it may be, the hospital has been underfunded, understaffed and under-resourced and, therefore, undermined. I thought, however, that we were coming out the other end and that we were seeing light at the end of the tunnel, thanks in no small part to the Minister's personal and direct intervention. It is, unfortunately, groundhog day for the hospital and we are back in the throes of not knowing where we stand or what the future holds. This is not fair to the staff, community and those who desperately require and need the services of the hospital daily. While it was not a problem caused by the Minister, it falls to him and the Government to address and solve it and not let it linger on.

In January the new CEO of the hospital group confirmed categorically that Portlaoise hospital was secure, that it would be retained as a model 3 hospital and that its 24/7 accident and emergency department would continue and was safe and secure. Last week, however, out of the blue, with no warning, like a bombshell, it was announced in the media that there was some doubt about the immediate term prospects of the 24/7 accident and emergency department. I cannot tell the Minister about the shock, distress, disbelief and anxiety this has caused throughout the community. The hospital has a population catchment of approximately 200,000. It is not, therefore, a local issue or a local hospital. It serves Athy, Monasterevin and Rathangan, as well as counties Carlow and Offaly.

It is a resourcing issue. If it is a question of staff, emergency consultants and nurses, let us address it in that way and once and for all stop running away from it and saying it is not a resourcing issue. No hospital in the country could bear the forensic scrutiny and microscopic investigations that have been conducted at Portlaoise hospital as a result of the tragic and unfortunate deaths in the maternity unit. I am glad to say, however, that most people now believe the Minister has vigorously and comprehensively addressed that issue.

I am not here to make an emotional appeal to save the hospital. We have a credible, coherent and constructive case to make for the Midland Regional Hospital, Portlaoise which is based on merit, medical grounds, clinical need and community requirements. It has the only accident and emergency department between Naas and Limerick. The ambulance network is not in place to start transferring patients, as suggested, to other accident and emergency departments. The Minister has seen such cases this week at St. James's Hospital, in Tallaght, Limerick and elsewhere. Is it proposed that we compound these problems by diverting between 30,000 and 40,000 cases from Portlaoise because that is the number of cases at the accident and emergency department there? It is one of the busiest accident and emergency departments in the country outside the capital and other cities. It is located near the intersection of the M7 and M8 motorways. Some 21,500 vehicles pass through Portlaoise on a daily basis and it is twice that figure at weekends. There are some 2,000 births in the maternity unit annually, which means that between five and ten babies are born there every day. As the Minister knows, babies do not always choose to come between the hours of 9 a.m. and 5 p.m. They are born at all hours of the night and at weekends.

The hospital is located across the road from two high security prisons, with 1,200 prison staff. The Prison Officers Association is incensed and cannot believe the proposition that the 24/7 accident and emergency department in Portlaoise hospital be closed, given the security, health and safety and cost implications in having to transfer staff who have been attacked or stabbed by prisoners or prisoners to other hospitals.

I want the Minister to bring some clarity to the issue. I am not saying he has to have an absolute solution today, but we need a clear plan and commitment to the future of the Midland Regional Hospital, Portlaoise. The starting point for service provision and patient safety has to be an absolute commitment to the bedrock that is the 24/7 accident and emergency department. Not everyone-----

Paddy Burke (Fine Gael)
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The Senator is over time.

John Whelan (Labour)
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I will finish on this point. Everyone cannot choose to go private and skip the queue to go to whatever new modern newfangled private clinics are being set up around the place.The people of the midlands require a 24/7 accident and emergency service at Portlaoise hospital. I am appealing to the Minister to clarify the situation.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Senator Whelan for raising this matter, which gives me an opportunity to update the House on our plans for the Midland Regional Hospital, Portlaoise. I appreciate the Senator's support for the hospital through the years and his interest in the matter. I am committed to securing and further developing the role of Portlaoise hospital as a constituent hospital within the Dublin Midlands Hospital Group, which includes St. James's Hospital, Tallaght hospital, Midland Regional Hospital, Tullamore, Naas General Hospital, and the Coombe hospital. Any change to services in Portlaoise will be undertaken in a planned and orderly manner, taking account of existing patient flow demands in other hospitals and the need to develop particular services at Portlaoise in the context of overall service reorganisation in the Dublin Midlands Hospital Group. Any decisions will be made on the basis of maximising patient safety and patient outcomes, not financial considerations or political bias or interference, to use the Senator's words. That will not happen.

In recent months, substantial investment and enhancement measures have been put in place to ensure a safer level of services at Portlaoise hospital. Maternity services are being upgraded following the agreement of a memorandum of understanding between the Health Service Executive and the Coombe to provide a managed clinical maternity network within the Dublin Midlands Hospital Group. This will provide for the delivery of a single maternity service over two sites, Portlaoise and the Coombe, with clinical governance led by the latter. Agreement has been reached on the recruitment of two additional obstetricians, one of whom will be the new clinical lead for the Portlaoise hospital maternity service, two neonatologists, to be shared across both sites, some additional clinical and allied health support, and a broad agreement on shared services and information technology. An implementation plan in this regard will be put in place in the coming months. Further improvements in Portlaoise include the provision of a number of additional consultant posts in anaesthetics, surgery, emergency medicine, paediatrics, obstetrics and general medicine, and 16 midwifery posts. In addition, it is intended to provide a new acute medical admissions unit and expand day surgery at the hospital.

The hospital group CEO has set out clearly what is being proposed at Portlaoise, with maternity, acute medical and paediatric services to continue and elective day surgery likely to be expanded. Patient safety and patient outcomes must be the first consideration. Last week, the HSE advised that complex surgery at Portlaoise - bowel surgery, in particular - will be transferred to St. James's or Tullamore, as the volumes at Portlaoise are too low to maintain the requisite expertise of the clinical staff. Indeed, the Health Information and Quality Authority report specifically criticises the HSE for recruiting additional colorectal surgeons at Portlaoise when patient numbers were not sufficient to allow those staff to maintain their skills. Patient volumes are very often a consideration, not just staff and resources. One must have both and be able to sustain both. As a result of this change, we will see the discontinuation of undifferentiated surgical cases that present at Portlaoise emergency department.

The important point to understand is that the work is being done to strengthen services in Portlaoise from a patient safety and quality perspective and to ensure services currently provided by the hospital which are not viable are discontinued and those which are viable are safety assured and adequately resourced. This is in keeping with the recommendations of the HIQA report into services at Portlaoise and reports on other hospitals in the past. I am confident these changes will improve services for patients at Portlaoise.

In respect of Portlaoise emergency department specifically, it receives, as the Senator noted, between 30,000 and 40,000 attendances per year. There is no question, therefore, of its being closed. The only question that has emerged, as raised by the CEO, is whether 24-hour services are sustainable. No decision in this regard has been made or can yet be made. In the case of Navan, for example, surgical services are no longer provided, but the hospital continues to offer a 24-hour emergency department for medical patients and those with minor injuries. I strongly agree with the Senator that any proposal to end 24-hour services at Portlaoise could not be advanced without a clear and credible plan to provide additional capacity at Tullamore, Naas and Tallaght, which are already very overstretched.

John Whelan (Labour)
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I thank the Minister for his comprehensive reply and for departing from his script to deal specifically with the accident and emergency service issue. There is an incontrovertible case to be put regarding the retention, in absolute terms and in perpetuity, of a 24/7 accident and emergency service at Portlaoise, based on patient safety concerns, patient demand and the requirement to serve a huge population catchment.Regardless of the alternative ambulance services put in place, I do not believe it would be possible for that volume of care provided in a 24 hours, seven days a week accident and emergency department to be diverted to any of the other hospitals as is being suggested.

I beg to differ with the Minister on one point. I believe the group chief executive officer added to the confusion and created a great deal of anxiety when he went on the airwaves, without consultation with anyone, and certainly not the public representatives or the community, and speculated as to the future prospects for 24 hours, seven days a week accident and emergency services. As far as I am concerned it would be an untenable position to consider phasing out those services or returning them on an 8 a.m. to 8 p.m. basis. It is no longer an accident and emergency department unless it is operated on a 24 hours, seven days a week basis.

Leo Varadkar (Dublin West, Fine Gael)
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There are a few things to bear in mind. I know the Senator, and all the Senators, not just in Laois but in every constituency, would love me to be able to give a guaranteed, cast-iron commitment that services will remain on a 24 hours, seven days a week basis. That is not something I can give to anyone about any hospital in the country. Medicine changes over time and even when decisions are made, there can be difficulty finding senior staff. It is not tenable in the longer term for us to continue to provide services with locum doctors, temporary doctors and doctors who are not fully trained to do the job they are expected to do. That is a problem throughout the country.

The international standard now for an emergency department is very different from what it was in the past. Essentially, that is a department that can take undifferentiated patients who have anything wrong with them and deal with them. For example, that is someone with a major head injury who needs neurosurgery or someone with a major injury to their chest who needs cardiothoracic surgery. Portlaoise hospital has never provided those services and it has never been what we would now describe as a major trauma centre or an emergency department in an international context. In Scotland there are only two of them. In London there are only four, and the catchment area required for that type of emergency department, a major trauma centre, is a population of about 1 million. Obviously, that would mean four, five or six in Ireland, but no one is suggesting for a second that we have only four, five or six emergency departments in Ireland. However, we will have to look at emergency medicine and reconfigure it to ensure we have the right services in different places. The only guarantee I can give people is that any decisions will be made based on what is best in terms of patient safety and clinical outcomes, and not based on financial considerations, political bias or political interference. None of those things will happen.