Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Gaibhim buíochas leis an Ceann Comhairle as an deis chun an ábhar seo a phlé. We have a looming crisis in our public hospitals because of the total over-reliance of the hospital system on non-consultant hospital doctors, NCHDs. A total of 400 junior doctor posts must be filled. I regret the absence of the Minister for Health, although I commend the Minister for Agriculture, Fisheries and Food on coming to the House to take a debate designed for his address. If the NCHD posts are not filled or if sufficient numbers of those posts are not filled, we are facing, as admitted by the Minister for Health, the loss of emergency services, especially in our smaller hospitals.

We now have the utterly bizarre and totally unacceptable situation that the hospital system faces meltdown in just over a fortnight from now unless sufficient numbers of junior doctors are recruited before the 11 July turnaround date. We are used to looking with trepidation towards 12 July and now we have another reason to do so. There is an unseemly scramble on the part of the Government to put in place legislation to facilitate the recruitment from abroad of junior doctors whom we should not have to import at all. There are sufficient numbers here if only medical staffing were properly organised.

This is not a new problem. It has been known and widely recognised for years that the hospital system is totally over-reliant on junior doctors. Successive Governments have recognised this but have failed to address the problem and now it is looming again, worse than ever. No one is trying to place all the responsibility for this on the shoulders of the current Minister for Health or the Taoiseach but their response so far - and make no mistake about it - has been far from adequate.

Last week, when this was first raised in the House by Sinn Féin leader, Deputy Adams, the Taoiseach stated that the Minister for Health would make a statement last Friday; there was no statement. The Minister then went on "The Frontline" programme on Monday to say:

We may well end up with some accident and emergency departments that cannot be safely manned. It will not be any of the major ones. It will be small rural hospitals that will be the real difficulty.

For a start, there are no so-called small rural hospitals. Dundalk and Monaghan are large urban areas with densely populated rural hinterlands. Their hospitals have lost accident and emergency services. Nenagh and Ennis are also large towns with wide hinterlands and their hospitals have also lost accident and emergency departments. Navan, St. Colmcille's in Loughlinstown, Roscommon, Mallow and Bantry hospitals all serve large urban and rural populations and are losing, or are set to lose, accident and emergency services.

I have no doubt that the junior doctor issue is being used as a convenient excuse to close emergency departments in fulfilment of long-standing but ill-conceived plans on the part of the HSE and successive health Ministers. On the anniversary of the Government's 100 days in office, 16 June, there was an unprecedented number of 52 patients on trolleys awaiting an inpatient bed in Our Lady of Lourdes Hospital, Drogheda.

In April, the Irish Nurses and Midwives Organisation sought a meeting with the Minister to discuss this critical situation but this meeting has not yet taken place. The INMO industrial relations officer, Tony Fitzpatrick, has stated that overcrowding in the north east has been a critical and unresolved issue for ten years which has been exacerbated by the downgrading of services under the guise of reconfiguration, when in reality all changes have been driven by economics and not patient need. I can attest to the truth of that statement.

If the Minister's prediction is allowed to come true, the north east and all regions will face even worse situations in emergency departments from 1 July onwards. What will the winter be like? Unfortunately, recruiting sufficient additional junior doctors will be required in the short term but that will not be enough, despite suggestions from the Taoiseach to the contrary.

Root and branch reform of medical training and staffing is needed. Nurses need to be freed up to fulfil more responsibilities in our hospital accident and emergency departments, for which they are qualified and willing to undertake. Hospital consultants must be required to fulfil their contracts to serve the public hospital system, because they are being widely breached. More consultants are required in our public hospital system and the current excessive remuneration for consultants needs to be reduced to facilitate the employment of additional consultants. The coalition has promised real change and I am asking that it now delivers on that.

Ciarán Cannon (Galway East, Fine Gael)
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I am taking this matter on behalf of my colleague, the Minister for Health. He is conscious of concerns about some hospitals in advance of the next rotation of NCHDs. Departmental officials are in constant contact with the HSE and relevant authorities to make certain the necessary steps are being taken to ensure ongoing safe delivery of service in hospitals and in accident and emergency departments, in particular.

The shortage of suitable NCHDs is an issue worldwide. The HSE has taken a range of actions to address NCHD vacancies to ensure the resulting impact on services is minimised and patient safety maintained. A recruitment drive abroad is included in this process. Officials from the Department of Health are at an advanced stage of drafting a Bill to amend the Medical Practitioners Act 2007 to support the recruitment process. This will empower the Medical Council to register doctors in supervised posts for a defined period. The aim is to ensure a speedy availability of suitably trained NCHDs. The Minister has stated publicly that it will be a challenge to maintain current services in all accident and emergency departments because of the difficulty in recruiting NCHDs. The measures he is taking are designed to address this challenge as effectively as possible.

The wider difficulties in accident and emergency departments, where patients wait unacceptably long periods, cannot be resolved solely within the departments themselves and must be addressed on the basis of a health system-wide approach. In particular, overcrowding in these departments is caused by many factors and any solution to problems that may arise from this issue must reflect this reality. We must ensure patients are treated in the most appropriate way in the most appropriate location. This means that, where and whenever possible, patients who can be treated in the primary care setting receive that treatment in a timely manner. This means that patients can be confident of receiving the necessary treatment on time and that there is less need for patients to attend at accident and emergency units.

The Minister recently established the special delivery unit, SDU, and assigned to it, as a priority, the task of addressing the issues arising in accident and emergency departments. The SDU is a key part of the Government's plans to reform the health system in Ireland radically, with the ultimate goal of introducing a system of universal health insurance. Its establishment was one of the Minister's key priorities for the first 100 days of the Government's term of office. Dr. Martin Connor has been appointed as adviser to the SDU. He has extensive experience in the NHS and led a similar initiative in Northern Ireland with considerable success. His principal task will be to build the SDU and to prepare proposals for the Minister on how best it can be placed on a permanent footing within the next six months. The SDU will work to unblock access to acute services by significantly improving the flow of patients through the system and by streamlining waiting lists, including referrals from GPs. The SDU is already working closely with the HSE, building on initiatives already under way, which include the clinical programmes developed by the HSE's national directorate for clinical strategy and programmes.

The SDU's priorities, set by the Minister, will encompass: emergency departments where waiting times for admission have been unacceptably high in several hospitals, often breaching the current six-hour maximum waiting time target; in-patient waiting times, where the trend recently has been upwards, despite the work of the NTPF; out-patient waiting times because the time from GP referral to an appointment with a consultant is unacceptably long in many specialties; and access to diagnostics which forms an essential part of the patient journey for all the areas of access mentioned.

I am confident that with improved processes for the recruitment of NCHDs, leadership from the special delivery unit, the implementation of the HSE's emergency medicine programme and related clinical programmes, we will be in a position to reassure patients that the challenges for the delivery of services related to emergency departments will be quickly and decisively addressed.