Minister of State at the Department of Health (Deputy Róisín Shortall:

This Government's prime concern is the safety of patients. We will not stand over unsafe services. No one here would agree that an unsafe service should continue. We need the best possible service for patients in our emergency departments, inpatient services, day cases and outpatient departments. We want to achieve what is best for patients, and as quickly as possible.

While there is much analysis remaining, the picture so far shows that for stroke, cancer and heart attacks, in-hospital mortality rates vary widely. Some smaller hospitals have noticeably poorer mortality rates than larger hospitals. This supports the international evidence that smaller hospitals, with lower volumes and fewer support services, have poorer patient outcomes than larger hospitals with appropriate resources and patient volume.

The Minister has repeatedly stated that smaller hospitals should provide as wide a range of services to their local communities as possible. Smaller hospitals should be the cornerstone of local health care provision, with clear links to other services. They should provide a range of diagnostics and expanded elective day surgery and medical procedures. These should transfer from the larger hospitals, freeing these facilities up for more complex work. In addition, smaller hospitals should provide locally accessible outpatient care as well as access for GPs to services and diagnostics. That is the direction in which we are going.

We are implementing the best care model for complex and emergency cases. Highly trained ambulance personnel treat patients immediately at the scene and get them to the most appropriate - not necessarily the nearest - hospital as quickly as possible, giving a greater chance of survival. That is the key. Smaller hospitals should continue immediate and urgent treatment for less complex, non life-threatening cases, through urgent care centres which can manage most typical emergency presentations. This approach is endorsed by the Irish Association of Emergency Medicine, the medical director of the National Ambulance Service and the national programme director of the HSE's clinical programme on emergency medicine.

Our immediate problem is the world-wide NCHD shortage. The Minister intends to reintroduce temporary registration for overseas doctors, giving secure tenure for up to two years. Likewise, we will be sure they are here for two years. There are currently around 180 HSE vacancies. While some will be filled before 11 July, the HSE and hospitals are working on contingency arrangements, if required, to minimise any impact and to ensure safe delivery of hospital services. I welcome Sinn Féin's support of the legislation that will be taken tomorrow and Friday to address that urgent matter.

It is unacceptable that some patients wait so long to be assessed and treated. This cannot be resolved in emergency departments or hospitals alone but must be done on a system-wide basis. The special delivery unit will unblock obstacles that stop patients being seen and treated quickly. It has started work already on emergency department issues and will also concentrate on inpatient and outpatient waiting times and access to diagnostics.

We intend to provide equal access to health services through a single-tier system supported by universal health insurance. Among the steps needed, the special delivery unit has already been mentioned. We must also reform primary care, with phased removal of cost barriers. We must move to integrated care in the primary and community sector. This work is under way. It has been accepted for many years that we should have the vast bulk of health care provided at primary level. This has not happened until now, and we are determined to make it happen.

If we want the best health system with the best outcomes for our patients, we must work together. We must deliver services at the right time, in the right place, to the right people. We cannot safely provide all services from all hospitals at all times. We can provide safe services across our whole system through larger and smaller hospitals, community and primary care. We are committed to driving the changes needed. Those changes are long overdue and, regrettably, they were not implemented by the previous Government. It will not be easy and not everyone will be happy, but it has to be done and this Government will see it through, because patient safety is our absolute priority.

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