Martin Ferris (Kerry North, Sinn Fein)
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Question 31: To ask the Minister for Health and Children if she will act on the calls of general practitioners in the mid-west Health Service Executive region not to proceed with the downgrading of Ennis and Nenagh hospitals; and if she will make a statement on the matter. [6602/09]

Róisín Shortall (Dublin North West, Labour)
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Question 40: To ask the Minister for Health and Children her views on the assertion in the Teamwork/Horwath report on the mid-west that the over-riding principle will be that no services will be withdrawn from the current general hospitals prior to the build up of the new alternative services; that is, that the regional hospital will be resourced, developed and working to recognise international best practice standards; and if she will make a statement on the matter. [6555/09]

Jan O'Sullivan (Limerick East, Labour)
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Question 76: To ask the Minister for Health and Children when she expects the level three critical care unit to be in place at the Mid-West Regional Hospital, Limerick. [6558/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 31, 40 and 76 together.

The Government is committed to ensuring the delivery of the best quality health services possible, in an effective and efficient way. Ensuring patient safety is of paramount importance, so that people can have confidence in the services and the best possible patient outcomes can be achieved.

The HSE has commissioned a number of reviews in relation to how acute hospital services should be organised, including the Teamwork/Horwath report in relation to the Mid-West region, which the Executive has recently published. The Report highlights the need for changes to be made in the provision and organization of acute hospital services across the region, particularly in relation to accident and emergency services, critical care, acute surgery and medicine. The Report finds that the services are too fragmented, carry increased risks for patients and staff and are not sustainable in their present form.

The HSE has indicated that certain changes to the present arrangements for the provision of some acute services, including accident and emergency services, must be made, in the interests of patient safety and also to make best use of the clinical resources available within the Mid West region. The HSE has been engaged in a consultation process with key stakeholders as it formulates detailed plans in relation to emergency care, critical care and surgical services in the region.

The HSE plans will involve the reconfiguration of Acute Hospital services into a network and their better integration with primary care services across the region, with a regional centre at the Regional Hospital Limerick that will deal with complex and specialist cases. The changing nature of health service delivery is such that smaller hospitals can meet much of the demand for less complex services, especially those that are increasingly done on a day case basis. The HSE plans will reorganize the arrangements in Ennis and Nenagh so that these hospitals will provide an urgent care/minor injuries service for 12 to 14 hours a day as part of a regional Accident and Emergency structure. These hospitals will also continue to admit appropriate medical cases.The plans also provide for the expansion of day surgery and diagnostic service activity at Nenagh and Ennis and the development of primary and community services.

The HSE has identified the enhancement of emergency ambulance services as an essential element of the new service delivery arrangements for the Mid West. Protocols already in place to ensure that all trauma cases will be brought directly to the major tertiary centre rather than the local hospital. Appropriate protocols in relation to paediatric and obstetric emergencies are being finalised at present. Plans are underway to introduce a 24-hour Advanced Paramedic service in Clare and North Tipperary and to enhance the level of ambulance cover in these areas.

Priority capital developments under discussion between the Department and the HSE at present include a critical care block and a new emergency theatre in the Regional Hospital and improvements to the facilities for diagnostics and day services such as CT scanning in Ennis and Nenagh.

I am satisfied that the measures being taken by the HSE are necessary and appropriate in order to ensure the provision of safe and effective health services to the people of the Mid West region.