Colm Burke (Fine Gael)
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I wish to raise an issue I have raised previously in regard to identifying a site in Cork for a new hospital. We have three main hospitals in Cork, the South Infirmary, the Mercy University Hospital and Cork University Hospital. It is accepted that both the Mercy hospital and the South Infirmary have little space to expand to provide additional services and there is a need to identify a new site. A group was set up in 2009-10 to work on this and it presented a report to the Minister.

In the context of long-term planning, as we have seen in regard to the new children's hospital, which we have been talking about for over 25 years at this stage, we are still in a situation where we are only seeking planning. I understand it will be at least 2020 by the time that hospital project is completed. A similar situation exists in regard to this issue in Cork. We need to work towards a long-term plan for the health service in Cork. The population of Cork is over 526,000 and Cork is part of the regional hospital structure that includes Waterford, Kerry and South Tipperary and further afield. However, all of the specialist services seem to focus on the Dublin region. We need to identify areas where the existing services can be amalgamated and to work towards building a centre of excellence in the Munster region, and Cork is the obvious place for that.

In terms of identifying a site, it does not matter whether it is in the docklands, the Blarney area or wherever, but we need long-term planning, and that will mean a plan covering a period of ten to 15 years for delivery. It is in that context that I raise this matter, calling on the Department of Health to accept the need for a new facility in Cork over the next ten to 15 years. The first step towards achieving that is to identify a site and we can then work from there. I am not talking about substantial moneys being spent immediately but a proposed facility should be part of the overall plan for the health service. It should be accepted that this is essential for the development of the health service in Cork. I call on the Department to come on board with the HSE to identify a site and move forward on this issue.

Dara Murphy (Cork North Central, Fine Gael)
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I thank Senator Burke for raising this issue. Again, I apologise on behalf of the Minister for Health for his absence, as he is attending the funeral of a victim of the tragedy in California.

The Minister recently met with the chair of the non-executive advisory board for reconfiguration of acute hospital services in Cork and Kerry to receive the board's final report. This report is the culmination of an extensive and pioneering process. The reconfiguration of acute services in Cork and Kerry has led the way for the development of hospital groups and the safer provision of services in smaller hospitals. Like most ground-breaking projects, it has not been an easy process but it has been the right one. It both anticipated and reflected developing concerns about smaller hospitals around the State.

In 2010 the report, Reconfiguration of Acute Hospital Services, Cork and Kerry: A roadmap to Develop an Integrated University Hospital Network, was published following wide consultation. Following the 2009 review of acute services in Cork and Kerry by Horwath and Teamwork, the roadmap provided a practical guide for developing safe and sustainable clinical services in the region.The plan involved integrating acute services into one hospital across six campuses. Complex care would be centred in larger facilities, with as much acute care as possible being provided locally. Professor John Higgins was appointed director of reconfiguration and the advisory board, chaired by Mr. Michael O'Flynn, was established.

The process has driven unprecedented change in acute care provision in the region. This has been achieved during extremely challenging economic times, with reduced budgets and staff numbers and increased activity levels. A major initiative was making the South Infirmary Victoria University Hospital the State's first dedicated elective hospital, in combination with the modernisation and reorganisation of emergency facilities across Cork city from five hospitals to two. The process is not yet complete. Since the roadmap, the south-south west hospital group has been established, in line with the hospital groups report. As the Senator said, the group includes acute services in Cork, Kerry, Waterford and south Tipperary. Therefore, there is now a need to fully integrate acute services in Waterford and south Tipperary into the wider group.

The road map recommended a single elective hospital in Cork, amalgamating the Mercy University Hospital and the South Infirmary Victoria University Hospital, to be built in a modular fashion over ten to 15 years. While the Minister acknowledges the board's recommendation, work needs to be done on assessing options and analysing the cost-benefit of any such project. Regarding site selection, a significant amount of work needs to be done before any concrete plan emerges that would support a rational and sustainable choice of location. The question of site selection would be a matter in the first instance for the south-south west hospital group, with input, as necessary, from HSE estates. The Minister and his Department would not have a direct role in that regard.

Regarding capital funding and site acquisition costs, the HSE would need to consider the proposal and prioritise the project in the context of other capital requirements around the country. The Minister and his Department would have no objection to any proposal to undertake an options appraisal for the new hospital, as well as a cost-benefit analysis, as the first steps towards assessing the viability of the proposal.

Colm Burke (Fine Gael)
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I thank the Minister of State for the reply and dealing with the matter in detail. I am concerned that the Minister and the Department would not have a direct role. The Minister is the person who develops policy. We are discussing reconfiguring the Mercy University Hospital and the South Infirmary Victoria University Hospital, which is accepted by everybody. However, we also need to examine the development of specialist services, in regard to which we are focusing on Dublin. The Minister can play a part in policy development. Not all specialist services should be located in the Dublin area. As part of the reconfiguration, we need to consider the development of specialist services for the entire Munster region. The Minister has a part to play in this and I ask that the matter be taken up with him, as I intend to do. The Department can become more proactive in the matter with the HSE. While the HSE is stating it cannot do anything because the Department has not given the go-ahead, the Department is stating it is not its problem, given that it is up to the HSE to come back to it. The Department should indicate to the HSE that it needs to progress the matter and that it will give serious consideration to what it states. The reply does not seem to indicate this, rather it seems to pass the matter back to the HSE. There is a need for clarification in the matter.

Dara Murphy (Cork North Central, Fine Gael)
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As the Senator said, the Minister is clear that, in the first instance, it is for the HSE to identify sites. I have been involved in the issue, on which I have met the HSE and local doctors. Contrary to the view the Senator has taken from the response, the crucial element is that the Minister and his Department have no objection to any proposal to undertake an options appraisal, which seems to be very reasonable to start the process, as well as a cost-benefit analysis. These are obvious and realistic first steps towards assessing the viability of the proposal. A cost-benefit analysis would almost certainly confirm the Senator's view of needs and requirements in the southern region. Not all specialised services are to be located in the Dublin area, as the Senator suggested. On the contrary, there is a strong commitment to the provision of services, particularly in the second most densely populated area of the State. The Minister, in making the point that, in the first instance, it is not a matter for the Department, leaves an obvious route for local engagement for the HSE and the group in the southern region to pursue with him his support for a cost-benefit analysis and an appraisal of the options for the location of a new hospital.