€300,000 set aside to run unit that could replace Portlaoise hospital A&E - Minister confirms

portlaoise a&e hospital sinn fein fine gael

Public meeting in Portlaoise to protest closure of A&E. Pic: Denis Byrne

Funding of €300,000 has been committed to a unit that could replace the Emergency Department at the Midlands Regional Hospital Portlaoise, a Government Minister has confirmed.

The future of the hospital was raised in the Dáil on Thursday, October 27 by Sinn Féin TD Brian Stanley. The TD called for certainty on the hospital's future in the wake of the leaking of a draft strategy for Portlaoise and other Dublin Midlands hospitals.

The report recommends that instead of A&E, Portlaoise would get a 12/7 local injuries unit and 24/7 GP referred Medical Assessment Unit. The building that would house the MAU was built in 2016 at a cost of €5 million.

Minister for Health Simon Harris was not in the Dáil to answer the Laois TD - in fact there appeared to have been just two TDs present at the time. 

Minister of State Damien English said the Minister was unable to be here tonight and I am not in a position to respond to the Deputy in detail. 

In his reply to Dep Stanley, Minister English would not rule out downgrade but did not say downgrade plan and been agreed to. However, he did say that money was approved for the MAU service along with other increases.

"The Health Service Executive has confirmed that hospital funding has increased by 28% relative to the 2012 budget and staffing levels have risen by 29% from the 2014 base. Funding of €300,000 has also been provided in 2017 to facilitate the opening of the new medical assessment unit," he said.

See below full text of Dáil Topical Issue Debate below 

Emergency Departments
Deputy Brian Stanley:     I am seeking certainty in respect of Midlands Regional Hospital Portlaoise. A plan was to be released in September 2015 regarding the future of the hospital but we have not yet seen that plan. However, there is a plan contained in what is described as the final draft of the Dublin Midlands Hospital Group strategy for 2018 to 2013, which was given to me at the weekend. Last night a public meeting on the matter was held and up to 400 people attended. According to the letter sent with it, this plan was a final draft which was to be signed off on yesterday (Wednesday, Oct 27) at a meeting of health managers at 2 p.m. in Dublin.

We now know what is in it but, unfortunately, what is in it is the end of emergency department services in Portlaoise. There will be no more emergency treatment in Portlaoise and trauma cases are to bypass Naas. The implications are serious. It is one of the busiest emergency departments outside of Dublin, having dealt with almost 40,000 people last year. The figure is further increasing this year, with more than 20,000 people in the first six months of the year using the unit. Where are these people to go if there is no emergency department between Tallaght and Limerick? Critically ill patients will be stuck in rush hour traffic on the N7. The other morning it took me three hours and five minutes to get from my house to the Dáil. The N7 is chock-a-block and not for one hour at rush hour. Rush hour now lasts for three hours in the morning and three hours in the evening. It starts at 3 p.m. and sometimes is not finished until 7 p.m. How does Susan O'Reilly think the 40,000 patients will be moved about? Is it by helicopter? Will there be fleets of helicopters?

The meeting last night was attended by the public, hospital staff and consultants, and general practitioners. They are the experts and they are absolutely adamant that this will not work. There is no capacity in the system. This will lead to the collapse of paediatrics and maternity services in Portlaoise, which is a huge concern. Let me be clear that Dr. Fleming, a cardiologist in the hospital, said the problem is one of capacity and resources. It is not a specialist problem. This is the key point, and I want the Minister of State to take it on board. Susan O'Reilly was put in there to do a job, but the Minister of State and I are her paymaster as are the public on the street and the citizens of County Laois and surrounding counties that depend on the hospital. The Minister of State needs to get a grip on this issue. Do not outsource this responsibility to her. If she signed off on this yesterday, get it and put it in the shredder.

On Tuesday, I raised the issue with the Government. The Minister for Foreign Affairs and Trade, Deputy Simon Coveney, who was standing in for the Taoiseach, informed me the Government had no intention of closing the emergency department in the Midlands Regional Hospital Portlaoise. Intentions can change, however. The emergency department must not be closed and services must not be downgraded or reduced. The proposals are unacceptable and unworkable. We need a firm and clear commitment that the hospital will not be downgraded and its emergency department will not be closed. We want a plan to upgrade the hospital.

I have neighbours who work in the emergency department of Portlaoise hospital and I am in touch with other staff at the hospital. I have also been in and out of the hospital with people over the years. Staff are doing their level best and should get medals for the work they do. Hospital managers all over the country, including in Portlaoise hospital, will tell the Minister that it is not possible to recruit and retain specialist staff without certainty. We need certainty but more than two years have been spent messing around with these plans, which arose from a review announced by the previous Government in 2011. Roscommon hospital was a casualty of that review and County Laois will not be another casualty. These plans will not wash. No one from a Government party will be elected in the county for a decade if they proceed.

An Leas-Cheann Comhairle:     The Deputy's time has concluded.

Deputy Brian Stanley:     The Minister has a legal responsibility and the political power to stop this proposal. He must put his foot down.

Deputy Damien English:     I thank Deputy Stanley for raising this matter and apologise on behalf of the Minister for Health, Deputy Simon Harris, who could not be here tonight. I assure the Deputy that, as the Minister stated previously, the most important issue with regard to consideration of services at the Midlands Regional Hospital Portlaoise is that patient safety and outcomes must come first. The Minister is committed to securing and further developing the role of the Midlands Regional Hospital Portlaoise as a constituent hospital within the Dublin Midlands Hospital Group.

As the Deputy is aware, there have been a number of reports on the Midlands Regional Hospital Portlaoise in recent years. These reports have pointed to the need for reconfiguration of some services to ensure patients are treated in the most appropriate setting by specialist staff who can safely meet their needs. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies and incorporating the hospital into the governance structures of the Dublin Midlands Hospital Group.

Significant work has been undertaken to strengthen and stabilise current arrangements for services at the hospital to ensure that services currently provided that are not sustainable are discontinued and those that are sustainable are safety assured and adequately resourced. The Health Service Executive has confirmed that hospital funding has increased by 28% relative to the 2012 budget and staffing levels have risen by 29% from the 2014 base. Funding of €300,000 has also been provided in 2017 to facilitate the opening of the new medical assessment unit. In addition, governance and management arrangements in Portlaoise hospital have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved.

The Dublin Midlands Hospital Group has been working for some time on a draft plan for a new model of clinical service delivery at Portlaoise hospital which takes account of the need to develop services at the hospital in the context of developing the model of service provision for the entire hospital group. The draft plan has been submitted to the Department of Health and is being reviewed in detail. I emphasise again that patient and public requirements are paramount and have underpinned the Department’s consideration of the draft plan.

Any changes to services at Portlaoise hospital would have to take account of existing patient flows and demands in other hospitals as well as the need to develop particular services at the hospital in the context of the overall service configuration in the Dublin Midlands Hospital Group. As the Deputy is aware, there is increased pressure on the emergency department, patient flows and other services.

I assure the House again that once there is an agreed position on the draft plan, it is intended that there will be further engagement with all interested parties to ensure the needs of patients, staff and the local and wider community are addressed.

Deputy Brian Stanley:    The problem with the Minister of State's reply is that HSE management has jumped the Minister on this issue. It met at 2 p.m. yesterday to sign off on the final draft. The cover letter, of which I have a copy, uses the term "final draft" to describe this plan. The Minister of State read out a response from civil servants and the HSE but I am not interested in it. The medical staff in the hospital and general practitioners providing a service in County Laois, south County Kildare and County Offaly are the experts on this issue and they have stated this plan will not work. The Minister must intervene at this point and stop the HSE from proceeding with it. The plan is the same as the document on the Minister's desk and it must be stopped.

The Minister of State stated that "services currently provided that are not sustainable" will be "discontinued". They cannot be discontinued because there is nowhere to send 40,000 people. What about the golden hour? It took me three hours and five minutes to travel from home to Dublin. Lives will be lost as a result of this plan.

Some years ago, a problem occurred in the maternity unit at Portlaoise hospital. Staff at the hospital worked with management locally to resolve the problem. They also networked with the Coombe Hospital and the Portlaoise hospital now provides fantastic maternity services. Doctors have proposed a plan similar to the process adopted in the case of the maternity unit. The approach taken some years ago must be replicated for emergency services at the hospital. This will require staff and resources to be provided. Once they are provided, the service will improve. The current service is good but it does not have sufficient capacity.

The Government and HSE will not get away with this plan, not because I say so but because people in the catchment area of Portlaoise hospital will not allow them to do so. We will not be another Roscommon. The Minister must take responsibility, shred the plan and work with local management to ensure the hospital has the staff it needs. The most important issue, however, is to have a plan for Portlaoise hospital because staff, ranging from the people sweeping floors to top managers at the hospital, are crying out for one. We need a plan and certainty.

Deputy Damien English:     I reiterate that the Minister was unable to be here tonight and I am not in a position to respond to the Deputy in detail.

Deputy Brian Stanley:     The Minister of State should communicate with the Minister.

Deputy Damien English:     I will do so and I will also ask him to contact the Deputy to bring him up to speed on the matter. I make clear, however, that it is a draft plan on the Minister's desk.

Deputy Brian Stanley:     Was it signed off yesterday?

Deputy Damien English:     It will be considered on the basis that it is a draft plan and a decision will be made after such consideration has been given.

I emphasise the clear statement made by the Minister that patient and public requirements are paramount and have underpinned the Department's consideration of the draft plan. The Department and Minister will do what is right for patients. The Minister has been very clear on this matter. I will ask him to communicate with the Deputy in the near future.

When the plan is being considered it will be from the perspective of ensuring the Dublin Midlands Regional Hospital Group, of which the Midlands Regional Hospital Portlaoise is part, provides the best services possible. The group is trying to develop the best services for Portlaoise hospital and the patients who use it. The Minister will update the House when the draft plan has been further considered by the Department.

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