Topical Issue Debate

Consular Services Representations

Deputy Brendan Smith

I appreciate the Ceann Comhairle affording me the opportunity to raise this very important issue. I am pleased that the Minister, Deputy Charlie Flanagan, is here to reply.

The Minister will be aware that Ibrahim Halawa has been in an Egyptian prison for 666 days, or one year, nine months and 28 days. The initial judicial process has been continually delayed and we now hear that the judge dealing with the case is to retire from his post soon. An eighth court date for his trial has been set for the beginning of August, his case having been adjourned seven times from the beginning of this ordeal. The incarceration of Ibrahim has caused, quite understandably, great upset to his family and friends. As he is a citizen of this country, we must be concerned for his well-being and hope and act for his release.

We learned yesterday that Ibrahim has decided to go on hunger strike to highlight his continuing incarceration. This is a most grave development and one which should give urgency to the Government's interaction with the authorities in Egypt to seek a resolution to this deeply troubling situation.

Fianna Fáil has been raising this issue, both in the Dáil and in the other House and at the Joint Committee on Foreign Affairs and Trade, for almost two years. We are continually informed that officials from the Department of Foreign Affairs and Trade are in regular contact with Ibrahim Halawa, yet, unfortunately, we have not witnessed any significant progress in his case. I am not for one moment suggesting that our officials are not working hard on this case. From what I have heard and from what the Minister has said to me in person and in replies to parliamentary questions, the opposite is the case. Our officials are to be commended on their efforts. However, I am concerned that Government efforts appear to have hit a wall in trying to advance Ibrahim's case. We all understand that Egypt has undergone some tumultuous years. The justice system appears to be struggling to cope with the political changes which have been witnessed by the international community. This seems to be one element in the ongoing delays being put on Ibrahim's case. The fact that he is being tried as part of a mass trial is also unjust, unfair and a gross abuse of his human rights. We have been told that Ibrahim is being accused of acts of violence, yet Amnesty International researchers who were present at the time in question have stated that Ibrahim could not have been involved in such acts. They are very strong in their view on that aspect.

Looking at the basic facts of the case, one's heart could not but be moved. Ibrahim is 19 years old. He comes from a loving family who want him home. He is a citizen of Ireland who is entitled to the full rigorous support of our State in being allowed to return home, even if that means on bail. He was arrested due to his political involvement in Egypt and Amnesty International has stated that he is a prisoner of conscience, not of crime.

I believe that it is time for the Government to use all of its influence, both in the European Union and with our American partners, to put pressure on the Egyptian authorities to release Ibrahim Halawa once and for all and reunite him with his family.

Minister for Foreign Affairs and Trade (Deputy Charles Flanagan)

I thank Deputy Smith for giving me the opportunity to speak on this matter. The Taoiseach and I met Ibrahim Halawa's father and two of his sisters last week. At that meeting we were informed that Ibrahim had indicated that he was considering embarking on a hunger strike. Noting that Ibrahim's welfare was of paramount concern, I advised against this course of action, saying it would be detrimental to his health and also that it was unlikely to serve any positive purpose as regards his trial. This view was shared by Ibrahim's lawyer who had given him similar advice. I am asking Ibrahim to maintain his health by taking food and I am sure that Deputy Smith will share my view in that regard.

Embassy officials attended the most recent hearing on 3 June and visited Mr. Halawa for the forty-first time on Monday, 8 June. During this visit, Ibrahim informed the embassy officials that he had commenced a hunger strike. Embassy officials sought strongly to dissuade him and advised both him and his family that this course of action would be unlikely to serve any positive purpose at all.

Together with the Taoiseach, I met with the Halawa family on 4 June to discuss the case. The family raised the question as to why Ibrahim has not been released when other foreign citizens have been. We explained to the family that the Department of Foreign Affairs and Trade is maintaining extensive contacts with the Egyptian authorities and with other international partners who have or have had citizens in similar circumstances. It is important to note that different facts and circumstances apply to each case and it is unhelpful to make overly simplistic comparisons between them. In so far as those comparisons are possible, the information that the Department has received from several authoritative sources is very clear. Examining other similar cases, it is clear that irrespective of any political efforts made by foreign governments, including high-level requests, the trial must be completed before any political consideration of a possible release by the Egyptian authorities can take place. In Ibrahim Halawa's case, the trial is ongoing. While we continue to maintain extensive contacts with the Egyptian authorities, including at very high levels, the precedent examined to date suggests that it is unrealistic to expect that any release will take place before this initial trial concludes.

In the House earlier today, there were incorrect and overly simplistic comparisons made with the case of Peter Greste. I wish to make it clear that Peter Greste's trial had finished, he had been convicted and sentenced, and it was only when this initial judicial process had concluded that the Egyptian authorities were in a position to release him. To suggest that he was released solely because the Australian Prime Minister made a phone call is simply wrong and unhelpful to the bona fide efforts to achieve the release of Ibrahim Halawa. References made in the House earlier to Ireland demanding release are not only unhelpful and potentially detrimental to progress, but show a complete lack of understanding of the measured and responsible way that governments must work to resolve difficult consular issues.

That an early release is unlikely is obviously hugely disappointing for Ibrahim Halawa and for his family, as it is for all of us involved in working to seek progress in this case. However, irrespective of any views regarding the fairness or appropriateness of any arrest abroad, the reality is that where an Irish citizen is charged with an offence under the law of a foreign country, it is the foreign law that applies and it is the relevant foreign court which decides matters such as bail and release.

While we will continue to bring all of our influence to bear on his behalf through the appropriate channels, the decision to release Ibrahim Halawa will ultimately be a decision that is made solely by the Egyptian authorities.

Conversely, we in Ireland would not tolerate a foreign government demanding that a judicial process in the Irish courts be set aside and one of its citizens released.

The considered approach and sustained action that I and my officials have taken in this case has been to work in an appropriate way to try and achieve positive progress. Most importantly, we have worked assiduously to avoid any action that could be counterproductive or detrimental to the best interests of this citizen.

I would like therefore to thank Deputy Smith for the constructive and responsible way in which he and many members of the Joint Oireachtas Committee on Foreign Affairs and Trade have engaged on this case. Others, who adopt a polemical approach, may generate publicity and headlines but they are not serving the best interests of this Irish citizen.

Deputy Brendan Smith

I thank the Minister for his detailed reply. As I said earlier, I had the opportunity to engage with the Minister person to person, through correspondence and through parliamentary questions as well as at the Oireachtas Joint Committee on Foreign Affairs and Trade. Other members of that committee have also expressed their worry for Ibrahim. I would obviously like to see Ibrahim come off the hunger strike right away. We understand the complete stress and trauma the young man has been through for almost two years, and the natural concern and worry of his family back here at home, and of his mother, who has travelled to Egypt.

I urge the Minister that there is further concern regarding the reports that the trial judge may be retiring, which could cause further delays. We want to see Ibrahim off hunger strike, released and back at home in the bosom of his family, where he should be at his age in life. None of us can imagine what he is going through in what are very poor conditions, from what we have learned, in a foreign country away from his family. It is understandably difficult for anybody to be in prison, but to be so far away at such a tender age and in difficult circumstances - we can only imagine the agony and hurt he is going through.

I am glad the Minister met with the family again over the past week to hear at first hand their obvious concerns. I appeal to him to continue to use every appropriate means to support the case of this young man for the earliest possible release. Whatever political and diplomatic interventions can help obviously need to be pursued.

At the Joint Committee on Foreign Affairs and Trade yesterday, a suggestion was put forward that a delegation might go to Egypt to visit the man, if that was considered to be of some help. A small delegation would be glad to travel, if such a visit can be facilitated, to show the support of the Oireachtas for this family during these very trying times.

Deputy Charles Flanagan

I will continue to keep in close contact with the members of the Joint Committee on Foreign Affairs and Trade, with the spokespeople of the main Opposition parties, and with Deputy Smith in particular. There have been some concerns regarding his health and the conditions in the prison. I am very mindful of those concerns. The embassy previously lodged formal requests with the appropriate authorities for a move within the prison and for access to a doctor. The prison authorities sought to organise a trip to the prison hospital for Ibrahim Halawa last week. He declined to go. At the suggestion of the embassy, his lawyers also lodged a medical request with the prison authorities. The embassy has as yet received no response to its request for a move to another part of the prison.

The embassy will continue to provide strong consular support for Ibrahim Halawa himself and to monitor his health and conditions in detention. We will continue at every level to advocate on his behalf. Once the court case has been concluded, assuming a sentence in some form may well be imposed, it may be appropriate for the Irish Government to make political representations and to request the Egyptian authorities to confer a presidential pardon. At that time, we will engage. At this stage, it is not possible for such a pardon to be forthcoming because the trial has not been concluded.

I am concerned at the delay, as I have said in the House, to my counterpart in Egypt and to a number of other international actors. The position is that there is an application by the defence lawyers which led to the most recent postponement of the case. The judge has agreed to schedule the case for a hearing on 2 August. As Deputy Smith has indicated, since the hearing on 3 June, it has been confirmed that the trial judge is due to retire. It is not clear whether this will have any effect on the timing or scheduling of the current trial.

I have continued to highlight Ireland's concern at the length of time that Ibrahim Halawa has now spent in detention without conviction. The appointment of a replacement judge and the timings of the hearings in this case are entirely controlled by the Egyptian judicial system. I will keep the House, members of the foreign affairs committee and the spokespeople on the other side of the House fully informed.

Acting Chairman (Deputy Jack Wall)

The second matter in the name of Deputy Seán Ó Fearghaíl is postponed.

Deputy Seán Ó Fearghaíl

I understand the Minister for Education and Skills, Deputy Jan O'Sullivan, cannot be present and I believe the matter can be taken next Tuesday.

Hospital Staff Recruitment

Deputy Anthony Lawlor

I thank the Ceann Comhairle's office for allowing this topic to be selected and appreciate that the Minister for Health is here to address it.

Just before Christmas, there was a short strike by staff at Naas hospital regarding the number of staff in the hospital. I welcomed the Minister's announcement in February that the recruitment ban on nursing staff was to be lifted. In particular, I was glad to hear that Naas hospital was going to get 37 extra nursing staff as a result of that recruitment. As of Monday, one of those new staff members has been recruited in Naas General Hospital. There are 36 who have not yet been appointed.

The National Recruitment Service, NRS, was established in 2009, when there was a recruitment ban in place across the public sector. One wonders at the purpose of the NRS being established at that time as a centralised means of recruiting health service personnel. A certain number of health service personnel would have been recruited by it over the intervening period on an emergency basis. Since the lifting of the embargo, particularly in respect of front-line staff, I have found it difficult to explain how the Minister could make an announcement in February, yet only one staff member has been allocated so far.

The NRS told me it allowed the staff to be recruited locally. "Alleluia", I thought. I thought Naas General Hospital itself was going to be recruiting but no, that is not the case. The staff are now being recruited in Tullamore, which was the centre for recruitment in the former midland hospital board area. From what I can gather, the staff in Tullamore, who would not have had much experience of recruitment over the last six or seven years, are now being inundated, as the NRS has pushed this out to the various old boards that used to exist.

It is important that we get the staff in Naas hospital as quickly as possible, as is the case for any other staff that have to be allocated. I know there are other issues, and candidates going for interview should have all their appropriate qualifications available to show to recruiters. We are in a crisis situation and it is a different type of crisis from the one in 2009, when we could not recruit staff. Now we can recruit staff.

We are going to be actively recruiting staff in the UK who will come back to work here. We should have one organisation that will do it all and take responsibility for it rather than the haphazard approach that seems to be taken at the moment. As I said earlier, I thought Naas hospital would do the recruiting itself but the recruitment has actually been through the old health board HR offices in Tullamore.

I hope the Minister can give me some assurance that we will have a speedier approach with regard to recruiting staff. This week there was a spike in the number of people on trolleys at Naas hospital and across the whole hospital sector, and hospital staff are under fierce pressure. If I knew that could be alleviated through additional staff being allocated and put in place as quickly as possible, I would appreciate it.

Minister for Health (Deputy Leo Varadkar)

I thank Deputy Lawlor for raising this issue. The national recruitment service, NRS, is actively recruiting hospital staff, in particular for HSE hospitals. Voluntary hospitals tend to do their own recruitment. The NRS was established to deliver high quality, cost effective recruitment through a shared service model in line with Government policy. To date, the NRS provides the full recruitment service for all areas of the HSE, with the exception of non-consultant hospital doctors and home helps.

The NRS carries out recruitment for vacancies that have been approved for filling. Some 1,063 posts in the acute hospital sector were filled in 2014, of which two thirds were nursing posts. From January 2015 to date, 529 posts have been filled in the acute hospital sector, of which almost half are nursing posts. There are currently 1,687 posts in the process of being filled in the hospital sector, of which 914 are nursing posts. As the Deputy can see, a lot of recruitment is under way. In local services, 115 nurses have been appointed and 403 nursing appointments are being processed locally.

A significant number of panels have been created for disciplines within the acute hospital sector, including national panels for staff nurses and allied health professionals such as therapists and audiologists, and bespoke panels for posts such as clinical nurse specialists, pharmacists and medical scientists. Jobs are being offered directly to people on these panels, thus reducing the time period for appointment to a post. A high profile national campaign to recruit nurses and midwives is in operation. This includes national and local interviewing of general nurses, registered children's nurses and midwives. The HSE has also established an international recruitment steering group to focus on attracting and recruiting Irish trained nurses back home to practice and build their careers.

In terms of consultant recruitment, 38 hospital consultant posts were filled in 2014 in HSE hospitals and 36 have been filled this year, so, in the first half of this year, we have recruited almost as many as in all of last year. Ongoing recruitment of 193 consultant posts is in progress and this is carried out in conjunction with the Public Appointments Service. Further appointments have been made in the voluntary hospitals and non-acute settings.

There are some specialties in which there are international shortages and which have been traditionally difficult to fill, regardless of the salary scale. Shortages in specialties such as emergency medicine, anaesthesia and psychiatry are a worldwide phenomenon and not specific to the Irish health service. There are also some hospitals to which it has been historically difficult to attract applicants, in particular small hospitals which are not recognised for training and continuous development purposes. The establishment of hospital groups will help to address this issue, as it will allow staff to be appointed to the group rather than one hospital.

Finally, where recruitment difficulties apply, individual strategies are developed for these in conjunction with the line managers. Where front-line staffing shortages exist, the HSE makes alternative arrangements to ensure continued service provision, including recourse to agency cover. However, it is preferable that sufficient numbers of doctors and nurses are recruited to permanent posts to support continuity of care.

In regard to Naas specifically, I am told the hospital has 37 active nursing posts it is trying to recruit for at the moment. This comprises four promotional posts, which are at campaign stage, two posts that are at job offer stage and one post at contract stage. Thirty staff nurse posts are being processed locally, which means the posts are being interviewed locally, offered locally and the clearances and the contacts are being dealt with locally. The NRS is not processing these posts. Local HR at Naas General Hospital has advised that it is actively appointing these posts in partnership with the director of nursing. In most cases, it is waiting for the return of documentation from candidates and this documentation is necessary to appoint candidates. It should also be recognised that some candidates may be offered posts elsewhere and might take those posts, which means starting the whole process again. Local HR is actively following up with candidates in this regard in order to ensure the posts are filled as soon as possible.

It is news to me that it is being done through Tullamore. As the Deputy knows, Tullamore was the centre of the old Midland Health Board. To the best of my recollection, Naas was in the Eastern Health Board and was part of the South Western Area Health Board, so I cannot imagine why it would be done through Tullamore. I will certainly have that checked out.

Deputy Anthony Lawlor

I can verify, from both Naas hospital and the NRS, that it is being done. I understand the delays can sometimes be caused by the need to get Garda clearance and there might not be enough staff in the NRS to be able to recruit the correct numbers as quickly as possible. I might make a suggestion to the Minister, given he spoke about allocating staff to groups. Why not hire the staff through the HR department within a group, as this might be more beneficial and would be much more targeted, rather than having an over-arching body which is recruiting from all parts of the country and outside the country? The group itself could identify candidates. There is a CEO and a management structure in each group, and I am sure there is a HR department. Why should the HR departments within each group not recruit locally?

Another difficulty is that the voluntary hospitals are allowed to recruit. It is one HSE and all staff are paid through the one body. Why should there be preferential treatment for voluntary hospitals as against the non-voluntary hospitals such as Naas hospital? If we are working in a group system, let us have the recruitment on a group basis and not give priority to one hospital over the other.

I hope any staff who are going forward for interview would present as much of the documentation as possible so there is not this delay later on. I know we are in a situation where staff do not know if they will get permanent posts in the new recruitment process. I hope that, as this works its way through, it will be speeded up. We are at a sort of crisis point at the moment, as I see on a daily basis with people on trolleys at Naas Hospital and at other hospitals around the country. At the same time, there is potential for us to recruit the staff. I welcome that the Minister has given sanction for these staff and I appreciate his comments. However, I ask that the groups be able to hire separately from the NRS.

Deputy Leo Varadkar

I will make three points. The first is that we are in a very different situation this year than we were for the last three or four years. The last three or four years were all about not recruiting and not filling vacancies and now, all of a sudden, the NRS has been told to recruit lots of people very quickly. It is a struggle to turn around from being an organisation that was about staff retrenchment to being one that is now about recruitment. However, we have 1,000 more people working in our health service today than we had this time last year, so it is happening, albeit not quickly enough.

Second, it is my intention to allow the groups to recruit in the medium term. That is difficult at present, for one very obvious reason, namely, the groups do not exist as legal entities; they are administrative bodies and do not exist in law and, therefore, cannot be employers. That is in stark contrast to the voluntary hospitals, which do exist in law and can be employers. If one works in a voluntary hospital like St. Vincent's or the Mater, one is not an employee of the HSE but an employee of St. Vincent's or the Mater, whereas an employee at Naas is an employee of the HSE. That is a complication that, as the Deputy will have noticed, is making the newspapers in various different ways in the last while.

Third, one downside of going back to allowing the groups to recruit is that we then go back to one of the problems that caused the NRS to be set up in the first place. Before the NRS was set up, people would go around doing interviews in four or five different health boards, and 6,000 to 7,000 days were lost every year with people doing one interview in the Southern Health Board, then one in the Midland Health Board and then one in the Western Health Board. When recruitment was centralised, the number of days lost to people doing interviews was reduced by 70%. One of the downsides of bringing that back and allowing local and group recruitment is that many more people will be looking for time off either to do interviews or to be on interview panels. We would have to bear that in mind given the impact it would have on patient care.

Hospital Services

Deputy Sean Fleming

I want to raise the issue of the cutbacks to accident and emergency services at Portlaoise which were announced recently, although some might say that no final decisions have been made.

There was a report in The Irish Times last September which stated that Department of Health submissions to the Government's comprehensive spending review suggested closing 24-hour services at five hospital accident and emergency departments, including Portlaoise hospital. For several months, the HSE, the Department of Health and the Department of Public Expenditure and Reform have planned for what was announced last week. It has now been said that no final decision has been made and that charade will continue for some time to come.

Since that announcement was made there have been further difficulties in Portlaoise hospital as a result of a lack of funding and resources provided by the Minister and the HSE. This time last year there were 41 people waiting over one year for an outpatient appointment. Today, the number has increased by 427 to 468 people, a tenfold increase, or a 1,000%, increase in the number of people.

We know there have been problems in the maternity unit. I will give the Minister credit for addressing them properly. The changes have resulted in an additional 15 or 16 staff being employed and the memorandum of understanding with the Coombe hospital, which is now managing the facility. We are happy to have national management and standards in the maternity unit in Portlaoise hospital. What is now needed is the same dedicated approach to the accident and emergency unit to ensure that additional staff can do their work.

I would be happy for St. James's Hospital, which is in the group, to take over the management and control of the accident and emergency department in Portlaoise hospital to ensure national standards apply and services are delivered there.

Deputy Brian Stanley

I welcome the opportunity to address this important issue and the fact three relevant Ministers are present. The HSE statement to local media on 3 June set the issue off, but there was some information about it beforehand. The relevant part of the statement referred to a complex planning process that, in the medium to longer term, will result in a reduction in emergency department opening hours overnight.

I do not need to make the case for the hospital in terms of the number of patients, motorways, the two large prisons in the area and that we need to have accident and emergency services available so that people can be brought in within the golden hour. It is not a case of parochialism and the Minister, Deputy Flanagan, knows that. This is a case of cold logic in terms of life and death.

The HIQA report highlighted shortcomings in the hospital in regard to a number of services, in particular maternity services. I compliment the Minister for the work that has been done regarding maternity services. It was long overdue. The Minister took the bull by the horns, did what needed to be done and recruited 16 extra front-line staff, which I welcome.

Dr. Susan O'Reilly, CEO of the Dublin Midlands Hospital Group, said on 26 February, "I intend to have 24 hours ED services continue in Portlaoise. You have surgical services that can provide general surgery. They need to be strengthened. I am confident we can continue to provide safe services." That is very clear. On 14 May the Minister said that the risk to patients in Portlaoise emergency department is very low as there are consultant staff and everyone is under the governance of a named consultant.

I want the Minister to address Government policy regarding regional hospitals like Portlaoise hospital where there is a long distance between accident and emergency units and they are strategically located on a road network, as well as taking the prison situation into account.

Deputy Martin Heydon

I thank the Minister, Deputy Varadkar, for being present to take this very important issue. Recent media reports and commentary regarding Portlaoise hospital have been a cause of great concern for my constituents in Kildare South. Many have used the maternity services in Portlaoise hospital and many residents in Athy, Monasterevin and Newbridge have used the hospital as much as Naas. Portlaoise hospital also has a paediatric emergency department which Naas does not, as the Minister will be aware, and the next nearest paediatric emergency department is Tallaght hospital, which is a long way to drive from south Kildare if one has a sick child.

I am mindful of the HIQA report and the absolute necessity to ensure the safe delivery of services. I acknowledge the moves already made in Portlaoise hospital, including the Coombe hospital's management of maternity services, which is to be welcomed. Recent commentary about examining future complex surgery and the emergency department has caused major concern. Since the media report and commentary, Naas Hospital has seen a significant increase in the pressure on its emergency department. That, coupled with the fact that there were very few people on trolleys in Portlaoise hospital in the past week, means one can see the inextricable links between the two hospitals, even when there was media commentary about the future of Portlaoise hospital.

I do not want to see the loss of the 24/7 emergency department in Portlaoise hospital in the future, but in any review that looks to maximise safety and the provision of services following the HIQA report, I want the safety of patients in Naas General Hospital and the residents of south Kildare's safety to be considered equally with that of Portlaoise hospital. There needs to be an acceptance that any decisions in Portlaoise hospital have a direct impact on the services in Naas General Hospital and Kildare.

I want a commitment from the Minister in the House that there will be no change to the services in Portlaoise hospital without due consideration of the impact on Naas General Hospital and south Kildare. We need to increase the capacity of Naas General Hospital as it is. The endoscopy unit and day ward plan for Naas General Hospital need to be constructed in 2015, not started in 2016 as originally planned. The building needs to commence, even if Portlaoise hospital maintains its currents services due to the size and scale of our county.

Deputy Leo Varadkar

I thank the Deputies for giving me the opportunity to again update the House or plans for Portlaoise hospital. The Government is committed to securing and further developing the role of Portlaoise hospital as a constituent hospital within the Dublin Midlands Hospital Group, which also includes St James's, Tallaght, Tullamore, Naas and the Coombe hospitals.

Any change to services at Portlaoise hospital will be undertaken in a planned and orderly manner and will take account of existing patient flows, demands in other hospitals and the need to develop particular services at Portlaoise hospital in the context of overall service reorganisation in the Dublin Midlands Hospital Group. Decisions will be made on the basis of maximising patient safety and patient outcomes, not financial considerations, and that is the only guarantee I can give.

In recent months, substantial investment and enhancement measures have been put in place to ensure a safer level of service at the hospital. Maternity services will be upgraded following a memo of understanding between the HSE and the Coombe hospital to provide a managed clinical maternity network within the Dublin Midlands Hospital Group. Furthermore, improvements in Portlaoise hospital generally include a number of additional consultants posts in anaesthetics, surgery, emergency medicine, paediatrics, obstetrics and medicine, and an additional 16 midwifery posts. It is also intended to provide a new acute medical admissions unit and to expand day surgery, and a new paediatric emergency triage unit is being developed.

The group CEO has set out clearly what is being proposed for Portlaoise hospital and has made it clear that maternity, acute medical and paediatric services will continue, as will 24/7 anaesthetics, and that elective day surgery is likely to be expanded. Patient safety and best clinical outcomes for patients must come first and, as Deputies are aware, last week the HSE advised that complex surgery, such as bowel surgery, in Portlaoise hospital will be transferred to St. James's Hospital or Tullamore hospital as the volumes are too low to maintain the requisite expertise of clinical staff.

Indeed, the HIQA report specifically criticises the HSE for recruiting additional consultant surgeons at Portlaoise hospital when patient numbers were not sufficient to allow them to maintain their skills. Anyone who is perpetrating the nonsense that this is about resources needs to read and understand that report. The HSE was criticised for hiring more consultants and overstaffing a service, thereby making it unsafe because the patient load was not adequate.

Currently, all categories of surgical patients can arrive at the emergency department at Portlaoise hospital. The hospital group, in collaboration with Portlaoise hospital and other hospitals in the group, need to plan for how some of these patients can be transferred and cared for in the most appropriate high volume surgical services within the group.

Deputy Stanley referred to the golden hour. It is important to understand to what that applies and means. It is particularly relevant for something like an ST elevation MI, STEMI, where ideally one needs to be in a cath lab within 90 minutes of diagnosis. Going to Portlaoise hospital now is not a good idea if one has a STEMI because it does not have a 24/7 cath lab. People with STEMIs are not taken to Portlaoise hospital because they will not be treated within the golden hour. The same applies to major trauma orthopaedics. Such patients are not and should not be taken to Portlaoise hospital, because they need to be taken to a major trauma centre. That is why they are taken to Tullamore hospital.

The important point to understand here is that work is being done to strengthen services in Portlaoise hospital from a patient safety and quality perspective and to ensure that services currently provided by the hospital that are not viable are discontinued and those that are, are safety assured and adequately resourced.

This is also in keeping with the recommendations of the report by HIQA into services at the hospital and indeed other hospitals.

The emergency department at Portlaoise hospital has between 30,000 and 40,000 attendances per year. Its patient experience times are the best in the country. There is no question, therefore, of it being closed. The only question that has emerged, as raised by the chief executive officer, is whether 24-hour services are sustainable. No decision in this regard has been made or can yet be made. In the case of Navan, for example, surgical services are no longer provided but the hospital continues a 24-hour emergency department for medical patients and those with minor injuries.

I strongly agree that any proposal to end 24-hour services at Portlaoise could not be advanced without a clear and credible plan to provide additional capacity at Tullamore, Naas and Tallaght hospitals, which are already overstretched. At the same time, I hope Deputies understand that a hospital that does not and cannot do complex surgery is not the best place to take a patient who needs complex surgery in an emergency, for the obvious reason that it cannot be done there.

Deputy Sean Fleming

I thank the Minister for his reply. He has given a commitment to meet with public representatives from County Laois some day next week, along with his colleague the Minister for Foreign Affairs and Trade, Deputy Charles Flanagan.

He stated that changes would happen but that they would be done on a planned basis. He also stated that the CAT scan does not operate on a 24-hour basis.

Deputy Leo Varadkar

No. I said there was no cath lab in Portlaoise.

Deputy Sean Fleming

Okay. Will he clarify for how many hours the CT scanner is open in the hospital?

The real concern is about the downgrade. We already understand the ambulance protocols that are in place. If there is a serious accident on a motorway, even within a mile of Portlaoise hospital, those with broken limbs will be sent to Tullamore, as it deals with orthopaedic issues. If one has a stroke in County Laois, one goes to Naas. Those protocols are already in place and people are satisfied with them. To say that the facility will be for medical patients with minor injuries, as is happening at Navan, is essentially a downgrade.

If the service is scaled back from 24-hour to 12-hour, people will stop going to the hospital in the evening because they might not be seen by eight o’clock. The regional manager has suggested that people who are not in the immediate vicinity of Portlaoise should be going somewhere else to start with. There is a plan in place, whether it is on the Minister’s desk or not - and he should know about it - to reduce the numbers attending Portlaoise hospital so that the HSE can ultimately say the service is not sustainable in the interests of patient safety. Once one starts reducing the hours from 24, one is on the slippery slope.

Deputy Brian Stanley

I thank the Minister for his reply and welcome his acceptance that Naas, Tullamore and Tallaght are already overstretched. The concern is that the acute medical unit may be used as a replacement for the emergency department. Being a medical person, the Minister will understand that these are two very different facilities.

I accept his point about the golden hour and stabilised patients. However, it is necessary to have an accident and emergency unit in the hospital because of the case I outlined earlier. To have the accident and emergency unit staffed properly with proper consultancy cover is important.

I am concerned about the grouping of emergency services among some of the Dublin hospitals. It has been done already with maternity services in Portlaoise, which people accepted. This is not blind parochialism. The case was made for this and the results so far have been good. That, along with the extra staff recruited to the maternity service, is a positive step.

The hospital needs new accommodation for its maternity unit. I accept that no final decision has been made. However, I do not want the Government dragging this process beyond the general election. We want this sorted. The situation with Abbeyleix hospital has been allowed to drag on for three years since the public consultation process ended. This cannot be allowed to happen with this hospital, as it is an important issue. I hope it is resolved quickly.

Deputy Martin Heydon

I thank the Minister for his detailed response. I welcome his statement on maximising resources and improving outcomes and the fact that it is not about financial considerations. We are all on the same page when it comes to patient safety and quality. It is about finding the best way to achieve that for the residents of Counties Laois and Kildare. I also welcome his acknowledgement of the pressure that management, staff and patients in Naas hospital are experiencing. In acknowledging that, we then have to figure out how best we can alleviate it both in the short and long term.

Kildare has a population of 210,000 people but it has a disproportionate number of nursing homes, particularly in the north of the county, because there are fewer of them in Dublin. That means some of the patients who present at Naas are older and sicker compared to those presenting at other hospitals, which brings its own pressures. The emergency department in Naas has eight cubicles and two resource rooms. This is not enough for the size of the population in Kildare. We are lucky to have an amazing staff in Naas hospital who work under intense pressure. We need to relieve the pressure and ensure it is not intensified by any future actions. Construction of the endoscopic unit needs to be commenced this year. As part of that build, there is the potential to build several extra wards. Will this be considered by the HSE and the Department as a means of addressing the pressure that Naas hospital is under? I also welcome the Minister's statement that no decision would be made without due consideration for Naas.

Deputy Leo Varadkar

I very much agree that the maternity ward in Portlaoise hospital needs a capital investment. This will be discussed with the master of the Coombe and others in the next while. The unit in Portlaoise is probably about 30 to 50 years old. However, Deputies should bear in mind that there are other hospitals, both paediatric and maternity, that are 200 years to 300 years old. Unfortunately, we need to prioritise which need investment first.

The potential impact of any changes on Naas, Tullamore and Tallaght is fully understood. We have seen reconfiguration without adequate provision in other regions in the past. In the north east enormous pressure was put on Drogheda, while in the mid-west it was Limerick that bore the brunt. That was done by the last Government and I do not intend to repeat it. It was right to do the reconfiguring, but the central hospitals should have been properly resourced too.

What I cannot do is give absolute commitments. No honest politician can and nobody should trust a politician who goes around making absolute commitments about the future because we cannot predict it. What if it turns out that we cannot hire senior staff to work an emergency department at night? It will not be possible in ten or 15 years to be staffing emergency departments at night with locum doctors with poor English and no emergency training. That might have been fine ten years ago, and we might even get away with it now. However, that is not the kind of health service we want in ten years’ time. We have to know we can staff it with senior staff.

We also have to ensure we can indemnify it. What if the State Claims Agency were to remove indemnification? Will we then ask patients to sign a waiver before they go in at night to say they will not sue if anything goes wrong? Anyone making these kind of cast-iron promises for the future is just not an honest person. I was disappointed to hear Deputy Sean Fleming make those kind of undertakings. Will he tell the people of Laois if he has discussed this with his party leader, Deputy Martin, and whether Fianna Fáil will stand over that commitment as a party? It should be borne in mind that Deputy Martin, one of the most senior politicians in Cork and a Minister in the last Government, was in power when the number of 24-7 emergency departments in County Cork was reduced from five to two. That was done in his county and he stood over it. He was right to do so. Can Deputy Fleming be sincere about his commitments when his party leader did the exact opposite in his own county?

The Dáil adjourned at 6.30 p.m. until 10 a.m. on Friday, 12 June 2015.

Dáil Éireann díospóireacht - Thursday, 11 Jun 2015