Mr. Ian Carter:

I will start with Waterford hospital. There are a total of 20 posts currently being advanced of which seven are new consultant posts and of those five are starting. It has proved difficult to recruit consultants to three posts. I note from discussion on this that the construct of the post is causing one of the issues. An exercise is being carried out to see how that posting in Waterford hospital can be linked possibly with CUH to see if it can be made a more attractive post. We are examining that.

In terms of south Tipperary hospital, plans are currently being developed to see what can be done to reduce the congestion in the emergency department. They are threefold. Some beds are currently closed in the hospital and it ensuring that it can properly staff those funded beds. There is an issue relating to the staffing levels and configuration in the emergency department and one of the other key initiatives as we move forward is moving from our solid hospital centring approach to try to improve the community services that prevent admission and facilitate far quicker and more timely management of patients back out to the communities. Those plans as they relate to the hospital should lock on board in the next two to three months.

On the reconfiguration issue, as has been said, the groups are only just starting to come alive with the CEOs to them, hopefully, being recruited later this month. The reconfiguration plans will take some time to generate but the key issue is that they are not going to be somehow a secret. They will be subject to validation but the logical grouping to come up with those reconfiguration plans is the local hospitals working as a cohesive network.

In terms of the European working time directive, EWTD, I suppose that needs to be seen as a journey rather than a specific funding initiative. At the moment the hospitals have been working for the majority of this year on how services can be reconfigured with a higher reliance on consultants and slightly more sensible rosters to ensure there is an overall reduction of the working hours with no service diminution. Within that framework we are just completing the first phase of the exercise. It is a joint exercise with the Irish Medical Organisation, IMO, which is looking at the first milestone to moving to EWTD, that is, the removal of the requirement for non-consultant hospital doctors, NCHDs, to work for longer than 24 hours. We are just completing that exercise to see where we are. We have identified some level of funding, as would have been seen from the service plan. That is for a mixture of investment, as it will translate to a region-by-region basis or a hospital-by-hospital basis in terms of additional NCHDs, consultants and nursing staff.