This week the Government published two reports, "The Establishment of Hospital Groups as a transition to Independent Hospital Trusts" and "Securing the Future of Smaller Hospitals". My party welcomes their publication. There was broad consultation with the professionals who carry out and deliver the services on a daily basis over the past number of years.

To be quite truthful, it is not exactly earth-shattering. When one drills down through the reports, one can see they are a continuation of what was happening in terms of reconfiguration over the past number of years. My difficult, particularly with "Securing the Future of Smaller Hospitals", is that there certainly is not a commitment to secure the future of every small hospital in this country. The Government is talking about holding a consultation process with stakeholders and the broader public, and yet there is a great deal of spin and PR coming from Government that this is guaranteed to secure the future of all small hospitals. The Government's track record on this is not great, as evidenced by what happened in the case of Roscommon Hospital, as well as the abandonment of the proposal for a 500-bed hospital in the north east, to which Fine Gael was committed prior to the last election.

There has been a downgrading of Our Lady's Hospital, Navan, from the provision of 24-hour emergency cover. The intensive care unit is being removed. If there is to be a genuine debate and honesty in this, we need to know exactly what the Government is proposing for Navan. Significant commitments were made. Promises were made about the retention of the 24-hour service because, as was said at the time, it would save lives. The Government is stating quite clearly in this report that the hospital will be downgraded, and this has happened across the country in the case of other small hospitals as well. The key question I am asking today is this: will the Tánaiste give a commitment to the people of Navan that 24-hour emergency cover will remain in the hospital and that there will be no downgrading of services, as was promised by the Minister for Health, Deputy Reilly, in 2011? I merely want to know if the Minister will live up to the commitment that was made and ensure that those services, and the broader services in the north east, are retained.

As Deputy Kelleher will be aware, on Tuesday the Minister for Health brought proposals to the Government which will result in the reorganisation of public hospitals into more efficient and accountable hospital groups that will deliver improved outcomes for patients. This represents the most fundamental reform of the Irish acute hospital system in decades.

Professor Higgins's report on hospital groups is based on a comprehensive consultation process and contains almost 60 recommendations on the formation, management and governance of hospital groups. The Minister has taken very seriously his obligation to consider the report closely to assure himself, the Cabinet and the public that it provides a robust basis for enabling timely access to a high-quality and sustainable hospital service for those who need it. The objectives of the groups are as follows: to achieve the highest standard of quality and uniformity in hospital care across the group; to deliver cost-effective hospital care in a timely and sustainable manner; to encourage and support clinical and managerial leaders and to ensure high standards of governance, both clinical and corporate; and to recruit and retain highly qualified nurses, NCHDs, consultants, allied health professionals and administrators for all hospitals.

The introduction of the groups will provide for organisational change in the first instance, giving more autonomy and better enabling the reorganisation of services in a well-planned manner. Over time this will help improve services and deliver better outcomes for patients. The Minister, Deputy Reilly, facilitated a number of briefings on Tuesday in that regard, including with Members of the Oireachtas. I note that quite a number of Members of the House welcomed the fact that they had had the opportunity of hearing at first hand from Professor Higgins on the strategic group's recommendations.

On Tuesday, the Minister for Health also published "Securing the Future of Smaller Hospitals", which offers clear information about the role of the smaller hospitals and what they will do in the future. The framework focuses, in particular, on the role of nine smaller hospitals. In developing the framework to address the development of smaller hospitals, the Government is clear that there is an important future role for smaller hospitals in which they will provide services for more, not fewer, patients; that no acute hospital will close; and that safety issues in all acute hospitals, large or small, must be fully addressed by providing the right type of service for the patient in the right setting. This framework will demonstrate clearly that the future of smaller hospitals is secure. It will set out what services can and should be delivered safely by these hospitals in the interests of better outcomes for patients.

The implementation of the hospital groups report will begin immediately. The Minister intends to seek and appoint a chairman for each group within the next two months. Advertisements to seek other board members will be placed in parallel with the process of appointing the group chairmen and the subsequent appointment of group CEOs and management teams. All appointments will be made based on the competencies that the individual brings to the board in line with the HIQA report on Tallaght hospital and, obviously, there will be reference to representation from geographical areas as well. Once formed, the groups will prepare within the first year of their formation a strategic plan for the delivery of services. These strategic plans will determine the way services are provided within each group. The operation of each group will then be rigorously reviewed in the second year, including all necessary due diligence checks, to determine whether it is in a position to advance to hospital trust status during 2015. These reviews may lead to changes in the composition of the trusts versus the traditional groups, as decided by the Government. This is as it should be.

The announcement represents a major milestone in the health reform programme and the Government is confident that the new groups will deliver a more effective and efficient hospital service for patients in all parts of the country.

Deputy Kelleher should put that in his pipe and smoke it.

If the Tánaiste believes what he just read out, it means he was making things up two years ago.

Burn the bondholders.

What he stated is clearly at variance with what was stated prior to the last election with regard to small hospitals. Let us be honest about this. If we are talking about genuine reform, establishing hospital trusts and having engagement with the public so that they can have confidence in the services, we should at least be honest with them.

The people of Navan are a case in point. We have already highlighted the issue in Roscommon but we need fundamental trust between the Government and the people in the delivery of services. Unfortunately, there is more rhetoric than reform and nothing is happening other than a reduction in services to the people in Our Lady's Hospital in Navan. If there is to be reform and engagement between all political parties, broader society and stakeholders, the Government must be honest in its dealings, but in Navan and the north east there has been a withdrawal of fundamental services, where the 24-hour emergency care has been reduced to 12 hours. The intensive care unit is also being withdrawn, and other services will be withdrawn in a process that will clearly undermine the confidence in the discussion on the issue.

The Government parties campaigned with promises but, being honest, they seem to govern with broken promises week after week.

Hear, hear.

May I get an assurance that there will be no downgrading of services in Our Lady's Hospital? When the Minister for Health arrives, may I get a commitment on a new hospital for the north east?

There is much concern for Our Lady's Hospital.

Where has the commitment gone for the 500-bed hospital to serve the north east? It was meant to be built in advance of any reduction in services in Navan. That was a solemn promise by the Minister for Health. Is the Tánaiste supporting the downgrading of the services of Navan or will he stand with the people, as he pledged?

Our hospital services were a mess before the last election.

So this is how it starts.

It was a mess Fianna Fáil left behind.

We know why.

Fianna Fáil had the opportunity in the 14 years it was in government-----

Leave the "14 years" comments behind you.

Burn the bondholders.

The Government is there two years and things have gotten worse.

-----when there was plenty of money available to deal with the reform of our hospitals and it did not do so. This Government is-----

Downgrading.

-----reforming our hospital services.

Reform.

We are appointing hospital groups-----

This is back of a lorry stuff.

-----centred on the teaching hospitals and the universities and medical schools they are linked to. The smaller hospitals within the catchment will be tied to larger hospital groups. This is about making best use of the hospital services. It is about where is the best place to have the major equipment and concentration of specialists, and how to use the smaller hospitals to do the elective-----

So the Government was wrong two years ago but is right now.

The reform is being done.

Which the Tánaiste opposed.

The Deputy should not try to scratch around reports to find something in desperation.

Hear, hear.

This is about-----

The Hanly report

Did the Tánaiste support the Hanly report? I am not scaremongering like the Labour Party.

The Deputy is the health spokesperson for his party and when this report was published on Tuesday, his correct attitude was to be broadly supportive of it.

We are entitled to read it.

He has spent two days trying to scratch through it to see if he can find something in it to criticise.

Listen to the people of Navan.

There is plenty to be found.

It is not pretty or convincing. Our hospitals are being reformed in a modern way and the Deputy's party failed for 14 years to reform our hospital services.

The Tánaiste dismissed-----

This Government will reform our hospitals and provide a better quality of hospital care for the people of this country.

Hear, hear.

The Tánaiste is dismissing the people of Navan just as the people of Meath dismissed the Labour Party.

They are embracing Mary Harney's legacy.