Mary Harney (Dublin Mid West, Progressive Democrats)

Deputy Jan O'Sullivan is familiar with the proposals tabled by the HSE to the various employee representatives. She was well briefed prior to the previous attendance of Professor Drumm at the Dáil committee. Essentially, the HSE has tabled a number of proposals requiring greater flexibility. We want to treat more patients next year on a day-case basis, in line with best practice not only in Ireland but internationally. Clearly, to do that we require changes in how people work. We need to reduce in particular the level of dependence on overtime by many staff in the health service and having people in hospital at weekends when they should be discharged.

The new consultant contract will be a key to the reform of how hospitals operate because for the first time consultants will work as part of teams with a clinical director, working days will be longer, structured cover will be in place at weekends and seven-day discharges will be introduced. All of those elements are important in order to ensure we optimise the use of the acute hospital system. However, I have made clear that there will be challenges next year.

Specifically in relation to A&E, we have three children's accident and emergency units open in this city 24/7. It is expensive to staff accident and emergency departments 24/7, but during the night I think it is something in the region of 20 visits is the average attendance, between the three units, between the hours of 8 p.m. and 8 a.m. It would be in all our interests if we can reorganise our services better during those night-time hours.

Many of the attendances at accident and emergency units are not strictly accident and emergency cases and could and should be dealt with at primary care level. As Professor Drumm indicated at the committee, the hope is that more activity will be switched to the level of primary, community care rather than the focus being constantly on hospital attendance.

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