As part of the recent reconfiguration of Dublin hospitals, the emergency department at St. Columcille's Hospital, Loughlinstown was downgraded to a minor injuries unit and 24-hour care was stopped. I, and many others, supported these changes because the clinicians leading the reconfiguration unanimously believed that it would save lives. The HSE gave us repeated assurances that St. Vincent's University Hospital would be given sufficient resources to absorb the extra workload from Loughlinstown hospital. Despite these assurances, the following letter appeared in The Irish Times from a registrar in St. Vincent's:

The real scandal at St Vincent’s University Hospital is the overwhelming increase in acutely unwell patient volume since the effective closure of St. Columcille’s Loughlinstown to out-of-hours admissions. [This] has led to a doubling of medical and surgical admissions to an already stretched but otherwise efficient and well-run public hospital. Clinicians of all grades and disciplines are working flat out to cope with the increased demand.

I followed up with clinicians in St. Vincent's and they said ambulance arrivals and GP referrals to the emergency department there are up approximately 50%. Overall admissions are up approximately 50% and have doubled in out-of-hours. They say that in spite of this the emergency department has received no additional nurses and only a token complement of doctors. Just last week staff that were promised from Loughlinstown to St. Vincent's have been pulled, so the emergency department in St. Vincent's is dealing with a 50% increase in volume with only a handful of extra medics, contrary to the assurances we were all given.

That is not the only problem. St. Vincent's has not been given the additional ward beds to deal with the additional volume either. Patients at Loughlinstown who become very sick are referred directly to the intensive care unit in St. Vincent's, which is also bringing that to over-capacity, according to the medical staff there. Not only is the emergency department working flat out, there is nowhere in the hospital for them to send the patients once they have stabilised them. The letter ends: "The end result is an unsustainable, overcrowded and unsafe mess with significant compromise in delivery of care." Patients are suffering and some will die.

This is outrageous. It is unacceptable to me and I have no doubt that it is unacceptable to the Tánaiste that this has happened. Why have the additional resources, which we were promised would be put in place, not been put in place? Why has a situation been allowed to develop in St. Vincent's hospital which clinicians are now telling us will lead to patients in the Tánaiste's constituency, my constituency and many other places dying?

As the Deputy is aware, prior to the changes taking place between Loughlinstown hospital and St. Vincent's University Hospital, I convened a number of meetings with the HSE and the managements of the two hospitals. I invited the Deputy and other Deputies who had expressed an interest in this issue-----

Not me.

-----because the Deputy had not expressed any interest in the issue to me. He is only interested in standing outside the hospital with a picket; he has no interest whatsoever in solving the problem.

We were leading the protest and I warned the Tánaiste what would happen.

As Deputy Stephen Donnelly knows, we convened meetings with the managements of the HSE and the hospitals to discuss their plans. Arising from what the Deputy has just read, I will arrange another meeting-----

Will the Tánaiste arrange meetings around the country?

-----and ask the managements of St. Vincent's University Hospital, Loughlinstown hospital and the HSE to address the issues he has raised. I would share his concern if the service was not being adequately delivered. I am a little surprised at the increase of 50% in the number of ambulances-----

There are 21,000 cases a year.

-----because prior to the changes at Loughlinstown hospital for a period of two years or more trauma cases had been going directly to St. Vincent's University Hospital. However, I take these issues seriously and will ask the HSE and the hospital managements to meet me again to discuss the issues involved.

I appreciate the Tánaiste's offer to set up a meeting. However, I suggest a meeting is probably not enough at this stage. We have been given many assurances. I was given an assurance by the HSE that the combined budgets of the three hospitals involved, St. Vincent's University Hospital, Loughlinstown hospital and St. Michael's Hospital, would increase as part of the reconfiguration. One year later I was told that not only would the budget not be increased, it would be decreased. We were given assurances regarding the timing of when this would happen, but they did not come to pass. Now we have an extremely serious situation where a medical registrar and medical staff are saying people will die. They are telling us the assurances we were given by the HSE have not been met.

Can we, please, have the Deputy's supplementary question?

I suggest to the Tánaiste that while having a meeting is fine, because the allegations are so serious, we need an independent and urgent review. I do not know whether the 50% figure is correct, whether ICU is operating at overcapacity, whether GPs are referring patients or whether there has been a doubling of admissions out of hours, but we need an urgent and independent review. I have two requests to make of the Tánaiste. I thank him for saying he will arrange a meeting, but as well as this, will he ask that an independent review be commissioned immediately and a report provided? Will he also commit that if the review finds that the allegations have substance and that the necessary resources have not been provided for St. Vincent's University Hospital, the Government will provide them immediately?

The first thing we must do is probe the facts to establish the position. It might be a good idea to ask the registrar concerned to come and tell us directly and probe the issue and statements he is making with the managements of the hospitals. We must establish the factual position. We can then set about resolving the issue. The outcome we want is to have is the highest level of service being available to the public. The Deputy mentioned beds. I understood beds in Loughlinstown hospital were to be used for elective cases which would, in turn, free up beds in St. Vincent's University Hospital and enable a throughput of patients through the accident and emergency service. The Deputy is aware that by the time the changes were made in Loughlinstown hospital, the numbers attending the accident and emergency ward at night were very small, because for some time if an accident occurred on the N11, for example, the patient was brought directly to St. Vincent's University Hospital. I would like to probe the facts to establish the position. We can do this and, if necessary, then ask the registrar who has written about these matters to come and give us the information he has available.