Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 2: To ask the Minister for Health the action he has taken to avert a crisis situation in our public hospitals as and from 11 July 2011 in view of the hundreds of non consultant hospitals doctor posts which are vacant; his plans to reduce the excessive working hours of junior doctors and the programme he will put in place to end the over-reliance of our hospital system on junior doctors. [18076/11]

James Reilly (Dublin North, Fine Gael)
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I am working with the HSE and other stakeholders to ensure the filling of as many as possible of some 475 non-consultant hospital doctor posts which are due to be filled from 11 July. I can confirm that as of 27 June, 221 of these posts have been filled, which leaves 254 vacancies. The HSE conducted an extensive recruitment drive in India and Pakistan in recent months and succeeded in identifying 439 potential candidates for NCHD positions in Ireland. I have held meetings involving my Department, the Medical Council, medical training bodies and the HSE with a view to identifying measures to facilitate the appointment of suitably qualified doctors from abroad. The drafting of a Bill to amend the Medical Practitioners Act 2007 to enable the Medical Council to register doctors in supervised posts for a defined period is at an advanced stage.

Notwithstanding this and other initiatives, it is unlikely that all NCHD vacancies can be filled by 11 July. Hospital managements are working with clinical directors in a planned way to devise contingency arrangements which can be implemented if required to ensure that any resulting impact on services is minimised and that the safe delivery of hospital services is assured.

I recognise and support the need to reduce the hours worked by NCHDs. If further progress is to be made it is essential that, over time, reliance on NCHDs to deliver services is reduced. An expanded role for nurses and a better skill mix generally in hospitals is one crucial way of achieving this. An increase in the number of consultants and greater team-working, with a consequential reduction in the number of NCHDs, is also required. The 2008 consultant contract and the 2010 NCHD contract allow for more flexible work patterns and the further development of consultant-delivered services in hospitals. The inclusion of a better skill mix in rostering arrangements has been identified as a priority in implementing the public service agreement in the health sector this year.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Ba mhaith liom buíochas a ghabháil leis an Aire as teacht isteach chun an cheist seo a fhreagairt.

On "The Frontline" on 20 June 2011, the Minister stated we may end up with some accident and emergency departments that cannot be safely manned. He continued the difficulty would not be with any of the major ones but small, rural hospitals. While I welcome the Minister's announcement this afternoon that 221 of the 475 posts have been filled, he must fill the remaining posts by 11 July which is the week after next. Will he inform us as to where the fault lines will present in hospital services? As of 11 July, what hospitals will not have the required number of non-consultant hospital doctor, NCHDs, to guarantee safe delivery of services? Will some accident and emergency departments have a diminished presence such as closing at night and weekends?

What will happen to services at Roscommon? I note some of the Minister's party colleagues who have a keen interest in that hospital are present behind him in the Chamber. What will happen to accident and emergency services at Navan, Portlaoise, Mallow, Bantry and Loughlinstown? Will the departments in Letterkenny and the Mid-Western Regional Hospital in Limerick be closed at night? Will the Minister outline the measures he will take to ensure the required number of doctors will be recruited to avoid such a scenario? How does he propose to ensure the problem will not re-occur, as has happened historically, in six months time?

James Reilly (Dublin North, Fine Gael)
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The last part of Deputy Ó Caoláin's question is the easiest to answer. Whether we have the full complement by 11 July, we will still continue to recruit over the course of the next six months to ensure we do not face this problem again. It should be borne in mind that legislation will be introduced which will allow for temporary registration for two years. This will mean these doctors will have security of tenure for two years; likewise, we will have the security of knowing they will be here for two years.

Up to 254 places are unfilled. As the recruitment process is ongoing, it is difficult for me to tell the Deputy precisely which hospitals are going to suffer. On "The Frontline" I said it will more than likely be the smaller hospitals for several reasons, chief of which is that the regional centres serve the bulk of patients, including those from smaller hospitals with more serious injuries. Doctors who have already applied to the hospitals that will be affected will not be pulled away from them. Doctors recruited will be sent to the areas of highest need and according to their speciality. There is little point in sending a paediatrician to an emergency department.

I know today that 65 more doctors have chosen to sit the Medical Council's pre-registration examination, the PRES exam. Also, 70 visas were granted to doctors already recruited who have satisfied our requirements and are most unlikely to be unsuitable. Accordingly, with the PRES and those recruited already, we will not have unsafe or poorer quality doctors.

The number of recruited doctors is beginning to rise. I will have much clearer idea of the figures tomorrow by 5 p.m. Contingency plans are in train but are dependent on numbers we have recruited.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Minister has gone over his time. I must ask him to conclude.

James Reilly (Dublin North, Fine Gael)
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I know this is a great concern to many people who value highly their local and regional hospitals. Bad and all as the health service became over the past several years, people know that when they can access it, they get excellent service and care. I am doing everything in my power to ensure we have the required number of doctors and that we continue to recruit to ensure we do not face this problem again.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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May I ask a brief supplementary question?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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No, I am sorry. We are a minute and a half over time already.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Yet it is a huge issue.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I appreciate that. That is why I allowed the Minister a little longer to reply.

James Reilly (Dublin North, Fine Gael)
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If it is of value, I am happy to revisit the matter when we come to other oral questions.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I have to go by the rules.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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A Cheann Comhairle, there is huge frustration about this important issue.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I appreciate that but there are six minutes allocated to each priority question.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Every day it was raised with the Taoiseach, he signalled the Minister for Health would address it today. Yet, we have not even had a chance for a supplementary. It is so inadequate.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We are wasting more time now. Six minutes are allocated per question. Two minutes for the Minister and four for supplementaries. More than two minutes were taken up by Deputy Ó Caoláin and more than two minutes by the Minister. In fact, I allowed a minute and a half more on Question No. 2.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We are talking about something more than minutes in this case.

Brian Stanley (Laois-Offaly, Sinn Fein)
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We are talking about lives.