Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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Question 32: To ask the Minister for Health and Children when the Prospectus Review of Critical Care Services will be published; and if she will make a statement on the matter. [26307/09]

Jan O'Sullivan (Limerick East, Labour)
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Question 39: To ask the Minister for Health and Children if she is satisfied that the measures to be put in place at the Mid-West Regional Hospital, Limerick in advance of the reconfiguration of accident and emergency and surgical services are all in place; if not, the action which remains to be taken in terms of physical infrastructure and staffing; and if she will make a statement on the matter. [26319/09]

Arthur Morgan (Louth, Sinn Fein)
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Question 40: To ask the Minister for Health and Children the steering groups and other bodies that are in existence in each of the regions of the Health Service Executive which prepare proposals for the future organisation of acute hospital services or to implement proposals already adopted by the HSE; and if she will make a statement on the matter. [26284/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 32, 39 and 40 together.

The Government is committed to ensuring quality health services, delivered efficiently and effectively. Ensuring patient safety is paramount, so that people can have confidence in the services and that the best possible patient outcomes are achieved. There is significant international and national evidence that acute complex healthcare, particularly for emergency medicine, complex surgical services and critical care should be provided in hospitals which are suitably staffed and equipped and which undertake sufficient volumes of such activity in order to maximise clinical outcomes and ensure safe services. At the same time, there is a significant range of less complex care which can continue to be provided safely in smaller hospitals, especially in day surgery, medicine and diagnostics.

In 2008 the HSE commissioned a comprehensive review of adult critical care services in order to inform the planning and future provision of this key element of the acute hospital system. Prospectus Strategy Consultants undertook this work. The company's brief was to consider the current provision of adult critical care services in the public health system and to provide advice on the appropriate model and configuration of critical care provision. It was also asked to advise on such matters as appropriate governance arrangements and on HR, work practice, clinical audit and training issues, as well as supporting provisions such as transport and infrastructure.

The Prospectus Team included four international advisors, together with two critical care experts nominated by the Intensive Care Society. Their work included site visits to each of 37 hospitals with Critical Care facilities, a 30-day survey and audit of critical care activity in each hospital, stakeholder consultation and a review of best international practice. I understand that the report is expected to be completed shortly.

In relation to acute hospital services, recent reviews have highlighted the need for changes to be made in the provision and organisation of acute hospital services in the regions concerned, particularly in relation to accident and emergency services, critical care and surgical services.

The first phase of the reconfiguration of acute hospital services in the HSE Mid-West involved the reorganisation of the arrangements in Ennis and Nenagh so that these hospitals provide an urgent care/minor injuries service and a medical assessment service for 12 hours a day as part of a regional Accident and Emergency structure. This took effect on 6 April 2009.

In the context of the reconfiguration process, the level of staffing of the ambulance services in Clare and North Tipperary has been enhanced and a 24-hour advanced paramedic service is in operation. Advanced paramedics are trained to a high standard which equips them to provide more complex pre-hospital care than other personnel. This includes the administration of a wider range of drugs and the urgent assessment and treatment of patients with life-threatening conditions. Protocols are in place to ensure that all trauma, paediatric and obstetric emergency cases are brought directly to the major tertiary centre at the Regional Hospital in Limerick rather than to Ennis or Nenagh.

The next phase of the process, which includes the reconfiguration of surgical services, is at an advanced stage. This will involve the transfer, on a phased basis during the period July to October 2009, of acute surgery services from Ennis and Nenagh to the Regional Hospital in Limerick. Since the beginning of January 2009 an additional emergency operating theatre has been in operation at the Regional Hospital in Limerick in anticipation of this change. The operation of this theatre will be extended to provide additional capacity seven days a week from July 2009. The extra activity involved will be facilitated through 30 additional surgical beds being commissioned on a gradual basis from July at the Regional Hospital in Limerick and at St. John's Hospital.

The recruitment of staff to accommodate the re-configuration of services is in hand. Agreement with the unions has been reached on the transfer of acute surgical services.

Reorganisation of services must of course occur in consultation with the key stakeholders and on an incremental basis. I believe that it is important to work with health professionals and other interested parties to secure an increasing set of improvements over time. This approach will, I am confident, produce the best outcome for patients. The HSE has therefore established appropriate structures at regional level to give effect to this approach. In the Mid-West there is a Project Board chaired by a Clinical Project Leader, Mr Paul Burke. This is supported by a Project Implementation Group with three sub-groups on Emergency Medicine, Surgical Services and Primary Community and Continuing Care and a Project Team with an Executive Project Leader.

In the North-East there is a Steering Committee chaired by the Director of the National Hospitals Office and the National Director of Primary, Community and Continuing Care. This is supported by the HSE North-East Leadership Group and local implementation groups.

In HSE South the Director of Reconfiguration of Acute Services in the Cork and Kerry Region, Professor John Higgins, is assisted by a Reconfiguration Team and a Reconfiguration Forum comprising representatives from general practice, community health services and all of the acute hospitals in Cork and Kerry. A number of subgroups are in place to review specific issues.

In HSE South East a Steering Group has been established to develop a strategy by the end of 2009 for the future delivery of acute hospital services in the region. Three Regional Advisory Groups on General Medicine, General Surgery and Women's and Children's Health have been established to advise on specific services in the context of this work.

I believe that the approach being taken by the HSE in relation to the configuration of acute hospital services is the best way forward and will result in a system which will facilitate the maximisation of patient outcomes and the further improvement of the health status of the population.