James Reilly (Dublin North, Fine Gael)

It will be very difficult to respond in five minutes to everything that has been said. I hope, therefore, that those Members whose comments I will not address will forgive me.

I thank everyone who took part in the debate and for its tone, which, in the main, was very constructive. I thank the colleges and the council for their co-operation. I also thank the HSE officials who put a great amount of work into this legislation, especially Mr. Seán McGrath, as well as my departmental officials for the work they have done.

I apologise for the late appearance of the Bill, but the reality is that the Office of the Attorney General has been very accommodating in achieving what we have achieved. I hope Members will take this on board.

Deputy Catherine Murphy referred to the need to assess fully the doctors involved, while several Members spoke about the future training requirements of doctors. We will put in place a forum with the various stakeholders involved which will report not later than the end of the autumn in order that we can provide for proper manpower planning.

Deputy Clare Daly was concerned about the specific nature of the Bill and asked why people would be tied to a particular job. The reason is they will be examined in their area of expertise beyond which we do not want them to wander into other areas in which they might not be as competent, in respect of which we will not examine them. The forum was also an issue for Deputy Calleary.

There is a need for a protocol on how people behave, senior colleagues deal with their peers, juniors and patients. The special delivery unit will introduce and implement such a protocol. There is a poisonous relationship in one hospital to which NCHDs just will not go. That is not good enough in 21st century Ireland.

Deputy Calleary also spoke about the level of complexity involved. We want to treat patients at the lowest level that is safe and in a timely and efficient manner as near to their home as possible. That is why smaller hospitals are so important to us and have a bright future. One can use the term "downgrading" in terms of making something safe, but I do not accept this. We should bring to smaller hospitals the patients they are capable of treating. I have listened intently to what Members have had to say and it is a problem that the so-called centres of excellence do not divest themselves of all the other non-specialist stuff, which is what they should be doing. I have already used the analogy of taking a ten year old Volkswagen car to the Ferrari testing centre. I am sure it would do a great job, but there is no need to bring such a car there. Why are patients with a hernia, varicose veins, or a gall bladder problem going to hospitals such as Beaumont Hospital, the Mater Hospital or University College Hospital, Galway instead of going to hospitals such as Roscommon County Hospital, Our Lady's Hospital, Navan or Mallow General Hospital in which they would be cared for every bit as good and in a far calmer and nicer surroundings?

Concern was expressed about the monitoring of private clinics by HIQA, which body will soon have the right to inspect these clinics and have licensing authority over them. I want to see the HIQA standard extended to primary care centres and GP surgeries. There ought to be a role for HIQA wherever health care is delivered in order to ensure standards are maintained.

Deputies Mitchell O'Connor and Wallace, among others, spoke about doctors undertaking a two year internship programme. We should examine this issue in the context of the forum. I am a great believer in using the carrot rather than the stick and would prefer to ask why they are leaving, rather than telling them they cannot leave. Let us get a fix on the reason they are leaving, which is the lack of career opportunities, a clear career pathway, proper training programmes in some instances and the fact that they are used as gofers. The economics in training someone at a cost of €150,000 and having him or her run around a hospital looking for X-rays and blood test results are just crazy. Deputy Healy also spoke about this issue. Regisration for two years should mean we will not have to face this problem again. As I said, we will aggressively pursue the matter.

Deputy McHugh called for the redesignation of Letterkenny General Hospital. I am very familiar with this issue and I am going to address it because the hospital should be redesignated, as it is losing out on the fees that should be paid by insurers for treatments carried out on private patients.

Deputy Ó Cuív raised a number of points, in particular, what he sees as the hold of consultants of the system. We have had a few years of consultant bashing here, during which they were portrayed as the rogues in the system. It was stated we needed a new consultants contract and that once that bugbear was out of the way, all would be well in the health service. We have a new consultants contract, yet we know all is not well with the service. The bulk of consultants are hard-working, good and committed professionals. There are only a few rogues and I have undertaken publicly to follow and deal with them. They will be dealt with, but to tar all of them with the one brush is not fair. There is no doubt, however, that they work differently and as such, the need for a specialist grade must be examined closely.

That would significantly address the number of manpower issues we face.

I did not want this to get political but Deputy Ó Cuív decided to go there. I never made a promise which I knew was undeliverable. I made a promise in good faith. I was not aware of the HIQA Mallow report as it had not been published. I did not have access to all the information I have now as Minister for Health. The reason I alluded to the smaller rural hospitals as being likely to suffer as a result of an NCHD shortage was that one must prioritise the larger hospital because it looks after the larger population. It will be temporary.

I thank everyone who contributed and I will take on board everything said and examine many of the aspects. In regard to the mid-west, had that teamwork report been followed properly, it would have been a great success but instead it stripped out what was in Nenagh and Ennis and did not put in what was supposed to go into Limerick in terms of extra consultants, a new accident and emergency department, a 40-bed high dependency unit and extra beds in the hospital.

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