Mary Harney (Dublin Mid West, Independent)

Last year, the HSE dealt with almost 1.2 million emergency department presentations and it expects to do the same again this year. Approximately 70% of people who attended emergency departments were not admitted to hospital; they were treated and discharged. This year, the HSE is planning to increase the number who can be safely discharged home without admission to about 72%. This can be achieved by changing the way services are provided, including by providing quicker access to senior clinical decisions makers.

I am determined to move to a consultant provided, rather than a consultant led, service where consultants work on a team basis. As a result, and following agreement in 2008 on a new consultant contract, I have made it clear to the HSE that it needs to increase the number of consultants and reduce the number of non-consultant hospital doctors, NCHDs, to achieve a more appropriate balance between both groups. I am also determined to support the changes in the NCHD training status and associated medical registration status being introduced by the Medical Council under the Medical Practitioners Act 2007.

I have been advised that there are likely to be difficulties in filling some NCHD posts when doctors begin their next rotation in early July. The indications are that there will be a reduction in the number of applications for certain NCHD posts, especially in posts which are not part of a formal training rotation scheme and in the areas of emergency medicine, anaesthesia and general medicine. However, the extent of any shortfall will only become evident over the coming weeks.

It is because of the expected reductions in applications for NCHD posts, and not because of any budgetary challenges that the HSE is currently examining how best to maintain and improve the quality of services provided to patients attending emergency departments. A range of possible measures are being examined, including some relating to recruitment and training status. Other important measures include reductions in tiered on-call and improved cross-cover arrangements. Instead of cases being referred through successive tiers of doctors, we need to increase the extent to which consultants and other senior clinical decision makers respond to urgent or emergency cases.

As we are serious about patient safety we also have to ensure that acute care is dealt with appropriately.

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