Timmy Dooley (Clare, Fianna Fail)
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Question 641: To ask the Minister for Health if he will provide detailed statistics on the mortality rate increase in the mid-west region, and County Clare in particular, due to the reconfiguration of accident and emergency services in that region; and if he will make a statement on the matter. [22112/11]

Timmy Dooley (Clare, Fianna Fail)
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Question 644: To ask the Minister for Health the steps he is taking to counteract the mortality rate increase projected due to the reconfiguration of accident and emergency and surgical services in the Mid West region; and if he will make a statement on the matter. [22126/11]

Timmy Dooley (Clare, Fianna Fail)
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Question 645: To ask the Minister for Health the proposed changes to the delivery of cardiology services at Ennis General Hospital, County Clare; and if he will make a statement on the matter. [22127/11]

Timmy Dooley (Clare, Fianna Fail)
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Question 646: To ask the Minister for Health the position regarding the reconfiguration of accident and emergency and surgical services at Ennis General Hospital, County Clare; and if he will make a statement on the matter. [22130/11]

Timmy Dooley (Clare, Fianna Fail)
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Question 647: To ask the Minister for Health the proposed changes to the delivery of acute medical services at Ennis General Hospital, County Clare; and if he will make a statement on the matter. [22131/11]

Timmy Dooley (Clare, Fianna Fail)
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Question 649: To ask the Minister for Health if he plans to retain the coronary care unit at Ennis General Hospital, County Clare; and if he will make a statement on the matter. [22135/11]

James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 641 and 644 to 647, inclusive, and 649 together.

In relation to the provision of hospital services generally, I have instructed the HSE not to withdraw any services from acute hospitals unless and until I receive a full briefing on the details of what is proposed, the alternative arrangements to be put in place, and the overall implications for patients.

The National Acute Medicine Programme provides a framework for the delivery of acute medical services in hospitals. It seeks to substantially improve and standardise the care of acutely ill medical patients. The programme has been jointly developed by the HSE and the Royal College of Physicians of Ireland, to enable the hospital structure to meet present day needs in appropriate settings, thereby providing optimal care for patients.

The classification of individual hospitals will determine the type of treatment they may offer. It will be based on a range of parameters, including the type and level of complexity of treatment that can be performed safely. This in turn will be determined by factors such as volume of treatment carried out and the complementary specialties, back-up services and range of clinical skills available. The programme will set out how hospitals operate. In particular it will allow smaller hospitals to increase activity in areas such as day surgery, minor injuries, outpatients, rehabilitation and diagnostics, which are growths area for health care both nationally and internationally. I believe that smaller hospitals can and should provide as wide a possible range of services, close to the local community provided they are safe. I intend to prepare a framework for the development of smaller hospitals, which will set out how they will develop to reach their full true potential. This will specify what services are transferring to them, from the larger hospitals. Too often we have focused on what we are taking away rather than what we can add to services there.

All of this will be done with full regard to the safety issues highlighted by HIQA, in its reports on Ennis and Mallow Hospitals. When implemented, smaller hospitals will have a vibrant role, doing more work – not less – and meeting as many as possible of the needs of their local community.

Significant re-organisation of acute hospital and related services has already taken place in the mid-west region since April 2009. A single region-wide department of emergency medicine was set up with 24-hour Accident and Emergency services centralised in Limerick.

Staffing of the ambulance services in Clare and North Tipperary were enhanced and an advanced 24-hour paramedic service is in operation. Ennis and Nenagh provide an urgent care/minor injuries service for 12 hours a day). Acute and complex surgery (including all cancer surgery) is carried out in Limerick Regional. Day surgery is undertaken at Ennis, Nenagh and St. John's Hospitals. A regional department of Anaesthesia/Critical Care has been established and all critical care services are now provided in Limerick Regional.

Construction of a new critical care block in Limerick Regional Hospital is proceeding and this project is expected to be completed in the latter half of 2012.

There has been no indication of any mortality rate increase in the Mid West region since 2009 arising from the reorganisation of hospital and related services.