Joe Higgins (Dublin West, Socialist Party)
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In recent times serious concern has been expressed by the local community and staff members about aspects of the service provided by Connolly Hospital Blanchardstown. There have been consistent cutbacks in funding to the hospital in recent years as there have been to other hospitals. There have been suggestions that one emergency department of the three in the north Dublin area would be closed and that the hospital at Blanchardstown could be the casualty or at least that its emergency service could be reduced to a 12-hour 8 a.m. to 8 p.m. service. This would have drastic consequences for residents of catchment areas. Some 35,000 attendances are recorded at the emergency department annually. Trauma services are in great need in this hospital, which serves a very large catchment area and there is already great pressure on the other major hospitals in north Dublin, Beaumont and the Mater. If the emergency department were scaled down, it would have a major impact on the community in the catchment area. It would seriously inconvenience many people who would not have their own transport to travel long distances in the event that they were travelling there themselves. It would also have a serious impact on the availability of junior doctors coming there to work who would then not get the experience and training they need. We need an absolute assurance that the emergency departments in all three north Dublin hospitals are maintained on a 24-hour basis.

There is a second issue of great concern. Connolly Hospital Blanchardstown recruited its own junior doctors and was very successful in doing so. Many young doctors were eager to go to Blanchardstown to get training and experience. Now the HSE has intervened to stop this and proposes to recruit centrally and then dispatch people to different hospitals.

I am told that between 50 and 60 junior doctors are needed for a number of hospitals and that the HSE is going to far-flung corners of the world to recruit. This will be extremely cumbersome for Connolly Hospital Blanchardstown. There are fears it will make it far more difficult for the hospital to recruit the necessary staff, bearing in mind the linking of recruitment systems generally in many areas. We need the Minister to ensure hospitals will have the right to recruit locally. Connolly Hospital Blanchardstown was doing so successfully. Why fix something that is not broken? The funding cuts are causing big problems for the community that needs the health service and also for health service staff who are under great pressure. The flexibility afforded to hospitals such as that in Blanchardstown to recruit directly their own complement of junior doctors is absolutely necessary.

Kathleen Lynch (Cork North Central, Labour)
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I am taking this Adjournment matter on behalf of the Minister for Health and Children, Deputy James Reilly. The HSE has no plans to cease 24-hour emergency department cover at Connolly Hospital Blanchardstown. It is incumbent on the HSE to make the best use of available resources to meet the needs of the population served. In doing so it must consider a range of factors, including changes in medical practice and possible changes in the way hospitals are organised and run. However, there are no plans to change the current service at the emergency department in Connolly Hospital Blanchardstown. The Minister is committed to ensuring acute hospital services at national, regional and local levels are provided in a clinically appropriate and efficient manner. In particular, he wants to ensure as many services as possible can be provided safely in smaller, local hospitals.

The Deputy referred to concerns about the recruitment of junior doctors for Connolly Hospital Blanchardstown. In this regard, the HSE has implemented a detailed non-consultant hospital doctor, NCHD, recruitment project plan to facilitate and maximise recruitment, to ensure the shortage of junior doctors and any resulting impact on services are minimised and that patient safety is maintained. In certain locations this can require a flexible reorganisation of services in order that patients' needs will be met in the best possible way. Typically, where services are affected, it is because there is a shortage of doctors to fill rosters. In such circumstances the focus is on the safe provision of services. If there are insufficient numbers of doctors available, the HSE must make alternative arrangements.

The HSE is working with a number of consultants, the Forum of Postgraduate Medical Training Bodies and others to recruit NCHDs in India and Pakistan for employment in Ireland commencing in July. It has recently progressed the centralisation of recruitment which will support the filling of priority posts.

An important part of providing high quality services in the right location will be the national clinical programmes being developed by the HSE. These inter-related programmes aim to improve service quality, effectiveness and patient access and ensure patient care is provided in the service setting most appropriate to individuals' needs.

The Minister is very supportive of the work done by Dr. Barry White and his colleagues in developing the clinical programmes and has had several discussions with him on how best to ensure they are implemented. He has also made it clear that patient safety must be the overriding priority.

One of the HSE's new clinical programmes, the national acute medicine programme, provides a framework for the delivery of acute medical services in hospitals that seeks to improve substantially and standardise care of acutely ill medical patients. There is also a clinical programme being developed for the provision of emergency department services. These programmes are aimed at helping each hospital to meet the needs of patients in the best possible way. The acute medicine and emergency department programmes are clinically led and a whole-system approach is being taken, driven by a quality agenda. The focus will be on implementation, not just on the recommendations

The Government is committed to ensuring appropriate services, including emergency department services, can be provided safely in hospitals such as that in Blanchardstown. The Minister will continue to work with the HSE to secure the best service for patients in the right location. I thank the Deputy for raising this subject.