I propose to take Questions Nos. 380 to 386, inclusive, together.
The Health Service Executive (HSE) is in the process of reconfiguring the way services are provided in the region, including services at Louth County Hospital, in the context of the HSE North East Transformation Programme. The Transformation Programme for the North East region involves widespread and fundamental change and is designed to build a health system that is in line with the model of care emerging internationally. The international evidence indicates that this can be achieved by centralising acute and complex care so that clinical skill levels can be safeguarded through ensuring sufficient throughput of cases. This was highlighted in the Teamwork Report — "Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North East".
In progressing the Transformation Programme the HSE has repeatedly emphasised its commitment that existing services in the region will remain in place until they are replaced with higher quality, safer or more appropriate services. The overriding aim of the Programme, which I fully support, is the need to improve safety and achieve better standards of care for patients in the region.
The immediate focus of the Transformation Programme, which has now moved into the detailed design and implementation phase, is to have acute and complex care moved from five to two hospital sites and to ensure that services in the region are organised to optimise patient safety.
The HSE has advised that the initial set of service changes for Louth-Meath in the context of the Transformation Programme centres on the reconfiguration of surgery with the establishment of a single Department of Surgery for Louth-Meath and the centralisation of complex major surgical care to one hospital.
In relation to out of hours emergency surgery activity levels in Louth County Hospital, the HSE has advised that there were 14 out of hours surgical procedures in 2007, effectively a rate of little more than one a month. In the context of its ongoing assessment of services and reflecting this level of activity, changes in the provision of surgical cover in Louth County Hospital were announced by the HSE from 1 July. These changes will ensure that any on call requirements at the Hospital will be provided in the first instance by the Surgical Registrar, the most senior doctor apart from a Consultant. It is my understanding that certain issues have arisen following these changes and that these have now been referred by the HSE to the Labour Relations Commission.
Operational responsibility for the implementation of specific service changes is a matter for the HSE. Therefore, my Department has requested the Parliamentary Affairs Division of the HSE to arrange to have a reply issued directly to the Deputy in relation to the specific issues raised.