Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

Gaibhim buíochas leis an Ceann Comhairle as an deis chun an ábhar seo a phlé. We have a looming crisis in our public hospitals because of the total over-reliance of the hospital system on non-consultant hospital doctors, NCHDs. A total of 400 junior doctor posts must be filled. I regret the absence of the Minister for Health, although I commend the Minister for Agriculture, Fisheries and Food on coming to the House to take a debate designed for his address. If the NCHD posts are not filled or if sufficient numbers of those posts are not filled, we are facing, as admitted by the Minister for Health, the loss of emergency services, especially in our smaller hospitals.

We now have the utterly bizarre and totally unacceptable situation that the hospital system faces meltdown in just over a fortnight from now unless sufficient numbers of junior doctors are recruited before the 11 July turnaround date. We are used to looking with trepidation towards 12 July and now we have another reason to do so. There is an unseemly scramble on the part of the Government to put in place legislation to facilitate the recruitment from abroad of junior doctors whom we should not have to import at all. There are sufficient numbers here if only medical staffing were properly organised.

This is not a new problem. It has been known and widely recognised for years that the hospital system is totally over-reliant on junior doctors. Successive Governments have recognised this but have failed to address the problem and now it is looming again, worse than ever. No one is trying to place all the responsibility for this on the shoulders of the current Minister for Health or the Taoiseach but their response so far - and make no mistake about it - has been far from adequate.

Last week, when this was first raised in the House by Sinn Féin leader, Deputy Adams, the Taoiseach stated that the Minister for Health would make a statement last Friday; there was no statement. The Minister then went on "The Frontline" programme on Monday to say:

We may well end up with some accident and emergency departments that cannot be safely manned. It will not be any of the major ones. It will be small rural hospitals that will be the real difficulty.

For a start, there are no so-called small rural hospitals. Dundalk and Monaghan are large urban areas with densely populated rural hinterlands. Their hospitals have lost accident and emergency services. Nenagh and Ennis are also large towns with wide hinterlands and their hospitals have also lost accident and emergency departments. Navan, St. Colmcille's in Loughlinstown, Roscommon, Mallow and Bantry hospitals all serve large urban and rural populations and are losing, or are set to lose, accident and emergency services.

I have no doubt that the junior doctor issue is being used as a convenient excuse to close emergency departments in fulfilment of long-standing but ill-conceived plans on the part of the HSE and successive health Ministers. On the anniversary of the Government's 100 days in office, 16 June, there was an unprecedented number of 52 patients on trolleys awaiting an inpatient bed in Our Lady of Lourdes Hospital, Drogheda.

In April, the Irish Nurses and Midwives Organisation sought a meeting with the Minister to discuss this critical situation but this meeting has not yet taken place. The INMO industrial relations officer, Tony Fitzpatrick, has stated that overcrowding in the north east has been a critical and unresolved issue for ten years which has been exacerbated by the downgrading of services under the guise of reconfiguration, when in reality all changes have been driven by economics and not patient need. I can attest to the truth of that statement.

If the Minister's prediction is allowed to come true, the north east and all regions will face even worse situations in emergency departments from 1 July onwards. What will the winter be like? Unfortunately, recruiting sufficient additional junior doctors will be required in the short term but that will not be enough, despite suggestions from the Taoiseach to the contrary.

Root and branch reform of medical training and staffing is needed. Nurses need to be freed up to fulfil more responsibilities in our hospital accident and emergency departments, for which they are qualified and willing to undertake. Hospital consultants must be required to fulfil their contracts to serve the public hospital system, because they are being widely breached. More consultants are required in our public hospital system and the current excessive remuneration for consultants needs to be reduced to facilitate the employment of additional consultants. The coalition has promised real change and I am asking that it now delivers on that.

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