Mary Harney (Dublin Mid West, Progressive Democrats)

The key recommendation in the Hanly report is that we need more manpower at consultant level throughout the country. Although the genesis to the Hanly report was the working time directive, its remit goes way beyond this. We need to move from having approximately 1,940 consultants to 3,600 if we are to provide regional self-sufficiency as far as is possible.

From a patient care perspective, a patient must be taken to the most appropriate hospital if he or she is a serious accident and emergency case. The sooner a patient gets there the better. For example, if one has serious brain injury, Beaumont Hospital is the national centre. A small country with 4 million people cannot have a centre in every region. While there are issues in regard to where a potential second centre should be, nobody has argued we should have a centre in every region.

The same applies in other complex areas. Services can only be provided on a national basis for a population of 4 million or on a regional basis depending on the speciality. We must make progress because of patient safety concerns. If patients are not cared for in a safe environment, lives or the chances of making a full recovery are put at risk.

That is why the establishment of the health information quality assurance authority, which will deal with accreditation and standards and provide information, is important and involves priority legislation which we hope to publish in the near future and take through the House by the summer of this year. The board has been appointed on an interim basis and will hold its first meeting in Cork at the beginning of March.

Some 85% of accident and emergency cases will still be dealt with in smaller hospitals. Many accident and emergency cases dealt with in accident and emergency departments could be dealt with in a localised hospital environment. However, more complex cases must go to the bigger hospitals where a multi-disciplinary team of specialists and greater resources are located. The Deputy knows one cannot provide in each county the range of services we would all wish to have. The best we can achieve is sufficiency at regional level.

To take the mid-west, which was part of the pilot study for the Hanly report, until recently the region had no rheumatologist, although one third of women in the country suffer from arthritis, and no plastic surgeon, which it still does not have. There are serious deficiencies in the regions and we must deal with the problem on a regional basis, which was the genesis of the Hanly report.

We would not add value by having the same group travel the country interviewing all those who work in health care. Some 95% of those the Hanly group interviewed, who were working in health care, agreed with the recommendations. We need to get on with increasing manpower, particularly at consultant level. The sooner we complete the negotiations with the Irish Medical Organisation and the Irish Hospital Consultants Association the better so we can have a more flexible, modern contract of employment, suitable to the needs of 2005.

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