The Tánaiste and Minister for Health refused yesterday to answer "yes" or "no" to questions about whether she supported the Hanly report's view on where A&E units should be sited.
While Ms Harney told the Dáil health committee that the Hanly report was not dead and that health reform was not off the agenda, she sidestepped questions on whether she supported the report's proposal that larger hospitals only should have A&E units and that such units at smaller hospitals be transformed into nurse-led minor injury units.
She said Mr David Hanly, the businessman who chaired the expert group which drew up the report on how hospitals should be reorganised under the Government's health service reform programme, had done a good job and she would meet him next Monday.
She is expected to tell him then that his contract to draw up a blueprint for implementing the report State-wide would not be renewed. The original Hanly report mapped out a plan for just two regions.
Pressed by Labour's health spokeswoman, Ms Liz McManus, on whether she agreed with Hanly's plans for A&E, the Tánaiste said she agreed with regional autonomy and regional self-sufficiency. It was not good enough, she said, that people had to travel from the west to Dublin for acute care.
"We need to build up the medical teams in the regions. We need also to ensure things only happen where it's safe for them to happen. We can't have a hospital in every town," she said, adding that every hospital had to be put to appropriate use.
If a patient was seriously ill and spent unnecessary time "in the wrong place before getting to the right place" the chances of surviving were reduced, she added.
In some instances a certain volume of patients was required to ensure a safe service and safety had to be health reform's guiding principle. "That does not mean closing facilities. It means using facilities appropriately," she said.
While the importance of critical mass is discussed in Hanly, Ms Harney seemed to want to distance herself from Mr Hanly's report saying the reforms should not be "personalised".
The Hanly report, which was adopted as Government policy when published in 2003, has created controversy across the State, with local hospital action groups threatening to run anti-Hanly candidates in the next election.
Dr Jimmy Devins (FF) TD told the committee he welcomed the fact that Hanly was not dead. "I don't care what the name of the reforms is but I'm delighted reform is going to continue."
Senator Kathleen O'Meara (Lab), who has been a member of a national group campaigning against Hanly, said her impression was that while Mr Hanly might be leaving, his reforms were staying.
"We understand 26 hospitals will lose A&E units," she said, adding that lives would be put at risk if people had to travel for emergency care.