James Reilly (Dublin North, Fine Gael)
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Question 40: To ask the Minister for Health and Children the details of the Health Service Executive plans to close or limit accident and emergency opening hours across the country as a result of cutbacks and doctor shortages; if she will identify each hospital affected by these plans; if she supports this action; if she is concerned about the impact that this will have on patient access to care; the details of the contingency plans that are being prepared for her; the action that she will take regarding the shortage of non consultant hospital doctors; and if she will make a statement on the matter. [20715/10]

Mary Harney (Dublin Mid West, Independent)
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Last year, the HSE dealt with almost 1.2 million emergency department presentations and it expects to do the same again this year. Approximately 70% of people who attended emergency departments were not admitted to hospital; they were treated and discharged. This year, the HSE is planning to increase the number who can be safely discharged home without admission to about 72%. This can be achieved by changing the way services are provided, including by providing quicker access to senior clinical decisions makers.

I am determined to move to a consultant provided, rather than a consultant led, service where consultants work on a team basis. As a result, and following agreement in 2008 on a new consultant contract, I have made it clear to the HSE that it needs to increase the number of consultants and reduce the number of non-consultant hospital doctors, NCHDs, to achieve a more appropriate balance between both groups. I am also determined to support the changes in the NCHD training status and associated medical registration status being introduced by the Medical Council under the Medical Practitioners Act 2007.

I have been advised that there are likely to be difficulties in filling some NCHD posts when doctors begin their next rotation in early July. The indications are that there will be a reduction in the number of applications for certain NCHD posts, especially in posts which are not part of a formal training rotation scheme and in the areas of emergency medicine, anaesthesia and general medicine. However, the extent of any shortfall will only become evident over the coming weeks.

It is because of the expected reductions in applications for NCHD posts, and not because of any budgetary challenges that the HSE is currently examining how best to maintain and improve the quality of services provided to patients attending emergency departments. A range of possible measures are being examined, including some relating to recruitment and training status. Other important measures include reductions in tiered on-call and improved cross-cover arrangements. Instead of cases being referred through successive tiers of doctors, we need to increase the extent to which consultants and other senior clinical decision makers respond to urgent or emergency cases.

As we are serious about patient safety we also have to ensure that acute care is dealt with appropriately.

James Reilly (Dublin North, Fine Gael)
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The Leas-Cheann Comhairle and I often have disagreements about what is a question and what is an answer.

Brendan Howlin (Wexford, Labour)
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It is not possible to disagree with the Chair.

James Reilly (Dublin North, Fine Gael)
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Indeed.

Brendan Howlin (Wexford, Labour)
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The Chair is always right.

James Reilly (Dublin North, Fine Gael)
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Indeed. You and the Pope.

Brendan Howlin (Wexford, Labour)
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No, just the Chair or whoever happens to be in it at the time.

James Reilly (Dublin North, Fine Gael)
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I put it to the Minister that the question is quite clear. It asks the Minister about her plans to limit accident and emergency services as a result of the cutbacks and shortage of doctors; if she will identify each hospital affected by these plans, which she failed to do; if she supports the action - she failed to say whether she did; if she is concerned about the impact this will have on patient care; and the details of the contingency plans. If she is not in a position to answer verbally today I would like her to submit to me a written answer outlining what hospitals are affected because we are hearing of hospitals all around the country which are being affected.

There have been changes in the visa system which mitigate against non-consultant hospital doctors, who in the past paid a fee and were issued with a visa for two years but are now only being issued with a visa for three months. Can the Minister inform us why that is the case? We are discussing further cutbacks and the European working time directive at a time when the coroner in Kildare is writing to the HSE to highlight the overcrowded nature of our accident and emergency departments after hearing that an 86 year old women died after a 36 hour wait on a hospital trolley in the accident and emergency department in Naas General Hospital. She was admitted with a suspected hip fracture and uncharacteristic confusion in February 2009. The Minister sent two HSE executives to Galway to help resolve problems with patients in the accident and emergency department there and the HSE plans to close a further 1,100 beds.

How will the Minister achieve what she said she would achieve? I note in her answer she referred to putting in place proper community facilties. They are not there. The fair deal, which was intended to make more space available to people is now being used to close public long-term care facilities and we cannot have it for the private citizens. Does the Minister support these actions?

Mary Harney (Dublin Mid West, Independent)
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The Deputy has asked a whole host of questions. A number of issues are affecting the staffing of hospitals. The first is the working time directive, which is now Irish and European law. It is being implemented for patient safety reasons because we do not want overworked doctors attending patients. Under the new Medical Practitioners Act there is a fundamental change in the training of junior hospital doctors which is having an impact.

On the question of visas, I have had good discussions with the Department of Justice, Equality and Law Reform about reverting to a two year visa, and it is agreeable to that. We are currently awaiting a response from the Department of Enterprise, Trade and Innovation and I understand we will have it shortly.

On the wider issue, I had a meeting recently with the HSE. It is examining a number of scenarios. Obviously, it is obliged to commit itself to the 2010 service plan, and that it will do. It states we will reduce admissions from accident and emergency departments to hospital beds by 33,000, which is approximately 2% of the numbers who present at accident and emergency. There are a number of community facilities. As the Deputy probably knows, recently the Mater Hospital opened a facility to deal with minor injuries which has been highly successful. The volumes of patients attending it is in excess of anything which could have been anticipated.

A number of initiatives are under way. The HSE is due to revert to me shortly. I do not have the answer to the question on what accident and emergency departments are closing, which the Deputy would love to get. There is no plan to close any accident and emergency departments on foot of the restrictions which are taking place. There may be restrictions. The same issues are being faced in Northern Ireland and the United Kingdom. This week Northern Ireland announced the closure of two accident and emergency departments for similar reasons. We will not close facilties, rather, we will make sure the facilties which are in place provide safe and appropriate care and those that require emergency care are dealt with in the appropriate place.

James Reilly (Dublin North, Fine Gael)
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The appropriate place, with 300 people lying on trolleys every single day, is not very satisfactory. Deputy Fergus O'Dowd is from the Louth constituency, in which a new accident and emergency department which is lying idle was built in Our Lady of Lourdes Hospital Drogheda. When will it open? Why has the reduction in services not been outlined? They were not mentioned in the HSE national service plan. We knew the working time directive would be introduced and there would be a shortage of non-consultant hospital doctors. Why has this not been highlighted?

I understand there will now be integrated service areas, rather than what we have had to date, such as the HSE south. There is now talk of having 18 service areas with populations of 225,000 to 250,000. One such area might affect the constituency of the Leas-Cheann Comhairle, Wexford. Others might affect Waterford, Kilkenny, Clonmel, south Tipperary and Carlow. Could the Minister inform the House whether she is in favour of the new initiative? If so, how many will there be and when will they come into being?

Mary Harney (Dublin Mid West, Independent)
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On Drogheda, the facility is ready. There are issues in terms of recruiting staff and industrial relations. The process will happen this year and money is being provided for that. I do not have the precise opening date for the new facility. I had discussions yesterday with INMO and hope that the current staff could move into the new facility to provide the services which are currently being provided in a facility which is not fit for purpose as we ramp up to get additional staff, in particular paediatric nurses. The process of recruitment will happen this year and the facility will open.

On the integrated service areas, everything we have been trying to do is to integrate services between the hospital and the community. In some regions of the country, such as the west, we spend €2 billion on health and have 27,000 employees. It makes sense that they would work in an integrated fashion. If we are to move staff, which is part of the Croke Park agreement, from the hospital to the community in order that services can be provided there, we need to operate on that basis. If memory serves me correctly, I understand there will be 18 to 24 service areas over the next period of years. It will not happen fast; it will take a considerable amount of time, as the Deputy is aware.

The purpose of an integrated service area is to integrate all the public health services which are happening in a coherent fashion in order that we do not have a situation where the hospital is not encouraged to give somebody something to which he or she is entitled because it will come from its budget and it pushes the problem out into the community where it can be paid for out of another organisation's budget or vice versa. That is the kind of confusion which exists when we do not integrate the services we provide.