There is a joint HSE/Departmental group which is developing a framework for the future development of smaller hospitals with oversight from a steering group comprising of HSE and Departmental officials. No external consultants are being used for this process. Consultation covering all the key stakeholders including patients and public representatives, will be an integral part of the process and plans for the consultations required are currently under development and are expected to be completed shortly. The three hospitals in the region (St. Michael's, St. Columcille's and St. Vincent's) are working together with the HSE to ensure that the appropriate level of service is provided in the best location to ensure clinical safety, quality and patient safety and to manage risk. No downgrading of the emergency department at St. Columcille's hospital has been announced. Work has been ongoing for a number of months and transfer of services from one site to another will not occur until all patient safety issues and clinical issues are fully considered. Any future changes will take place within the context of the Clinical Programmes and the developing Framework for smaller hospitals.