Seán Fleming (Laois-Offaly, Fianna Fail)

I welcome the opportunity to speak to the Bill. It is excellent that we are in such broad agreement on this essential emergency legislation, which everyone of sound mind should support. Obviously, there will be a few who may find some reason it should not be supported, but the people will see their objections for what they are.

I wish to highlight certain observations from this side of the House. The Medical Practitioners Act 2007 allows for four divisions, namely, the general division, the trainee specialist division, the specialist division and the visiting EEA practitioners division. The Bill provides for the establishment of a new fifth division to allow for the difficulties we are having in obtaining non-consultant hospital doctors in sufficient time for them to be processed, pass the relevant tests and be approved by the Medical Council. This new supervised division will allow the council to assess applicants under a range of headings and link doctors' registration with an identifiable supervised post in a specific speciality for a contract period which will be less than two years.

The HSE has been very busy recently in the filling of these points. I am informed that as of three days ago, 4 July, data collected from individual HSE hospitals indicate approximately 172 posts were still vacant. Up to then, there were 4,660 non-consultant hospital doctors in the country, with a vacancy level of some 5%. In filling these posts, much activity has been undertaken by the HSE. Some 208 appointments were made following round one, 294 additional applications were made in round two and there were 229 additional applications in round three. Round four closed on Wednesday, 22 June, with 101 applications received, and round five opened on 23 June and closed on 30 June, with 215 applications received. It is anticipated that the number of appointments from these rounds will be low but will further reduce the existing vacancy levels.

Interviews were held in regard to Indian and Pakistani doctors between 2 and 14 May. Some 34 consultants and six HSE staff participated in the process. In Pakistan, 314 candidates were interviewed and 276 individual follow-up meetings were held. In India, 233 candidates were interviewed and 179 follow-up meetings were held, followed by meetings entailing detailed assessment, confirmation of relevant documentation and preliminary offer of employment. During the recruitment process candidates were informed they would be offered a post and that the HSE would provide the following: an allowance of €700 towards the cost of the flight to Ireland to take up the contract of employment with the HSE; an allowance of €100 per week towards the cost of accommodation for the first eight weeks of the contract of employment with the HSE; refund of the Irish Medical Council registration costs; and refund of their Irish visa costs, all of which is welcome.

I acknowledge that the issue of proficiency in the English language is very important. The HSE informs us that the interviews were conducted through English, using the standard approach, and that the applicants were assessed on this issue.

An issue that arises regularly for Deputies in our daily lives is that of Garda vetting, although I raise it simply in the form of a request for information. Are doctors exempt from Garda vetting? If a person is on a FÁS scheme delivering meals on wheels to elderly people, he or she cannot do it without being vetted by the Garda. This can take up to six months to complete and we all know of people who have been unable to take up posts working with vulnerable cases, including elderly people and children. It goes without saying that anyone who attends an accident and emergency unit, by definition, is in a vulnerable position, and they deal with doctors in sensitive situations. While I am not suggesting there is a scintilla of an issue in this regard, I would like by way of information to know are doctors required to be vetted by the Garda or are they exempt from the general legislation. If it is required, will this be built into the process?

Many issues have come to light and HIQA has prepared reports identifying a number of significant issues relating to hospitals with a similar skills profile to Ennis hospital. Some have referred to the "HIQA ten", which are the hospitals it lists as a particular risk and where issues are being addressed. The hospitals include Our Lady's Hospital, Navan; the midland regional hospital group, including Midland Regional Hospital, Portlaoise; St. Columcille's Hospital, Loughlinstown; Mallow General Hospital; Bantry General Hospital; the Mid Western Regional Hospital, Ennis; Nenagh hospital; St. John's Hospital; and Roscommon County Hospital, which, as we all know, has been in the news.

A high level status report detailing the progress on each of these hospitals has been prepared by the HSE and was presented to HSE management. I have just come from a meeting of the Committee of Public Accounts. The chief executive of the HSE, Mr. Magee, was present to answer detailed questions about accident and emergency services which, although not specifically related to this week's events, arose from a report produced on the subject. Among the information he presented to the committee was an internal report on the ten hospitals mentioned. In respect of Portlaoise hospital, it states the volume and complexity of surgical cases are under review with the clinical leads and that risk is otherwise being managed in accordance with HIQA requirements. I am happy to hear that the accident and emergency, pediatrics, obstetrics and psychiatric departments at Portlaoise hospital are being managed in line with HIQA requirements.

The approach adopted by the Department of Health is to designate hospitals as models 4, 3 and 2. It appears Portlaoise hospital will be designated as model 2, which means it will carry out more day cases and fewer overnight or complicated procedures such as heart stents. As I am not a medical professional, as will be obvious to the Minister, I will not speak further on that subject. We all understand as lay people that complicated surgery needs to be carried out in hospitals which offer a range of services.

It is important that senior medics and management in hospitals such as Portlaoise be proactive, rather than refusing to let anything go, with the result that they will be left swinging in the wind when it is all over. Portlaoise hospital is in a unique position. I am speaking for the benefit of the people of County Laois, rather making a criticism. Historically, the hospital was tied with Tullamore and Mullingar hospitals, although it no longer has a relationship with Mullingar hospital. I see our natural hinterland as including Naas, Tallaght, the Coombe and St. James's hospitals. From Portlaoise it is a 30 to 40 minute drive to the southside of Dublin city. I advise the senior medics and administrators in Portlaoise hospital to get on their bicycles and start negotiating with the hospitals mentioned because we do not want to lose out in terms of the direction of the Tullamore-Mullingar axis. There are clear opportunities for development provided the initiative is taken locally.

Everything is contingent on having a good ambulance service. It would be remiss of me to say the ambulance service in County Laois is adequate. There are regularly two ambulances in the county, but sometimes there is only one which may be used to transfer patients to Tullamore. It is often the case that an ambulance has to be despatched from the far side of counties Offaly and Kildare. The ambulance service in the county is not sufficient, but centralisation will only work if an adequate service is guaranteed.

Overall, I support this excellent Bill. The changes it introduces are necessary and, while it will not solve all of our problems, it will allow an appropriate arrangement to be put in place from next week.

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