James Reilly (Dublin North, Fine Gael)

I did not interrupt the Deputy. I do not accept that the changes to the emergency department at Roscommon hospital represent the downgrading of the entire hospital. I want to be clear about what I want to see. I want to see it made safe. I do so, as the Deputy rightly pointed out, with the background of a non-consultant hospital doctor shortage. We have known for the past 20 years about our dependence on non-national, non-consultant or junior hospital doctors in this country. However, in 2007 we changed the law and got rid of temporary registration, which made it more difficult and less attractive to come here. We changed the way we treated our non-consultant hospital doctor posts, so we have created training and non-training posts. Many of these non-training posts are simply not attractive either to our own doctors or to doctors coming from abroad. We have sought to correct that legal deficit, which is giving an advantage to our UK neighbours and others across Europe who are seeking doctors. In that way, we can now create new supervised posts with temporary registration which allows doctors to come here. They will be subject to an intense assessment, including a one-day exam followed by two weeks of assessment on site. These doctors will be extremely well assessed, therefore. Even if by some quirk, however, we find that an individual is not suitable for the post, he or she will not be able to leave that post - having come here to do surgery - and go off to do psychiatry in Cork and present a danger to patients. They will automatically lose their registration and will have to return to their country of origin.

I want to talk about the safety of emergency departments and the increased survival rates at bigger hospitals. In recent days, a draft report has become available which has not yet been finalised. Some of the statistics in the report, while rough, are so startling that they cannot be ignored. They were gathered over the past three years. One set of statistics shows that a patient attending Galway University Hospital has a 5.8% mortality rate compared with a 21.3% mortality rate in Roscommon, which is four times greater. That is not the fault of doctors in Roscommon hospital; it is a reflection of the fact that the skillsets and backup are not there. There is no intervention cardiologist or multiple trauma team to deal with patients. Talking about cardiology alone, it comes down to the fact that there is no ability to put a stent in, which is now the required standard of care. Thrombolitis only goes so far. One must be able to get angiography and a stent in to where the blockage is. That is what improves survival and that is what one gets when one goes to a bigger hospital, but it is not available at Roscommon and other smaller hospitals. That realisation must be taken on board by all of us.

Does that mean that people in Roscommon will be left without a 24-hour service? Not if I can help it. I have asked that we should have an urgent care centre there and I am guaranteed it will be staffed from 8 a.m. to 8 p.m. by a non-consultant hospital doctor supervised by a consultant with the backup of a medical assessment unit. I can give an undertaking that between 8 p.m. and 8 a.m. there will be a new GP out-of-hours co-op service in Roscommon town, based in the hospital outpatients department. I hope that will only be a temporary situation and that we can ultimately move, within a month or so, to that being carried out in the urgent care centre with access to diagnostics. In the interim, and the HSE is trying to find the right person to do this because it involves a particular skillset, I am seeking one, but I think we will need two, non-consultant hospital doctors to staff the urgent care unit between 8 p.m. and 8 a.m. under the supervision of local consultants. This is only a temporary measure. It will be run on a bona fide, pro bono basis by local consultants and would not be sustainable in the long term. The Health Information and Quality Authority, HIQA, will not accept it for longer than a month, nor will the HSE's clinical leads. However, it would buy time to allow the GPs to consider moving to the urgent care centre.

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