James Reilly (Dublin North, Fine Gael)

I propose to take Questions Nos. 10, 32 to 34, inclusive, 37, 39, 43, 59 and 62 together.

I am committed to ensuring that acute hospital services at national, regional and local level are provided in a clinically appropriate and efficient manner. In particular I wish to ensure that as many services as possible can be provided safely in smaller, local hospitals. I have also made it clear that patient safety must be the overriding priority. I want patients to be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible.

The configuration of services is constantly reviewed and from time to time rearranged to improve access and quality of service and minimise risk to patients. This programme of realignment of services has received recent impetus from HIQA on the need to implement the recommendations from the Ennis and Mallow reports. The reports deal in particular with the type of services that can safely be provided in smaller hospitals and the structures required for good governance and accountability. The HSE must ensure that this happens and I will be monitoring the situation closely in conjunction with HIQA.

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The HSE has now put an implementation team in place to ensure that the recommendations of both the Ennis and Mallow reports are implemented in a speedy, systematic and consistent manner and I have asked for regular progress reports on this important initiative.

This Government is strongly committed to developing the role of smaller hospitals in Ireland so that they play a key part in the services provided to local communities. Patients should only have to travel to the larger hospitals for more complex services. The HIQA reports are entirely in keeping with this approach. I can assure the public that no hospitals will close, regardless of the difficult economic situation we find ourselves in. However, ongoing reform of the system will require some changes in how care is delivered in some locations across our health system.

I am very conscious of concerns about some hospitals in advance of the next rotation of non-consultant hospital doctors, NCHDs. The shortage of suitable NCHDs is an issue worldwide. In this context I am working with the HSE and other stakeholders to ensure the filling of as many as possible of some 475 NCHD posts which are due to be filled from 11 July 2011. The HSE conducted an extensive recruitment drive in India and Pakistan in recent months and succeeded in identifying 439 potential candidates for NCHD positions in Ireland. I have held meetings involving my Department, the Medical Council, medical training bodies and the HSE with a view to identifying measures to facilitate the appointment of suitably qualified doctors from abroad. Drafting of a Bill to amend the Medical Practitioners Act 2007, to enable the Medical Council to register doctors in supervised posts for a defined period, is at an advanced stage.

I can assure the Deputies that the necessary steps are being taken to ensure the ongoing safe delivery of service in hospitals and in emergency departments in particular. I am advised that while significant staffing problems remain at both SHO and registrar level in emergency medicine, it is anticipated that increasing the number of staff available to general surgery and general medicine will assist in the delivery and support of emergency department services. In this context, the HSE is focusing on addressing particular emergency department staffing issues in Our Lady of Lourdes Hospital, Drogheda, the Mid-Western Regional Hospital, Limerick, the Midlands Regional Hospitals at Mullingar, Tullamore and Portlaoise and Naas General Hospital.

Notwithstanding this and other initiatives, it is unlikely that all NCHD vacancies can be filled by 11 July. Hospital management is working with clinical directors in a planned way to devise contingency arrangements which can be implemented, if required, to ensure that any resulting impact on services is minimised and that safe delivery of hospital services is assured. Whatever happens I will not stand over unsafe care. Guarding against unsafe care must be the overriding principle driving all the actions taken in terms of clinical service provision and any changes required in that regard.

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