Niall Collins (Limerick, Fianna Fail)
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Question 10: To ask the Minister for Health if he will provide a list of the hospital emergency departments around the country that will not have enough non consultant hospital doctors from the 11 July 2011; and if he will make a statement on the matter. [17878/11]

Sandra McLellan (Cork East, Sinn Fein)
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Question 32: To ask the Minister for Health if he will ensure the continuation of all services at Mallow and Bantry hospitals, County Cork, in view of the non consultant hospital doctor shortage; and if he will make a statement on the matter. [17901/11]

Dara Calleary (Mayo, Fianna Fail)
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Question 33: To ask the Minister for Health if he will provide on update on the review of small hospitals; when he expects this review to be published; and the reason this review was not included in the Programme for Government. [17882/11]

Clare Daly (Dublin North, Socialist Party)
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Question 34: To ask the Minister for Health his plans for the emergency services across the country in view of recent reports that questioned the future of full accident and emergency services in many smaller hospitals. [17871/11]

Brian Stanley (Laois-Offaly, Sinn Fein)
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Question 37: To ask the Minister for Health if he will ensure the continuation of all services at Portlaoise Hospital, County Laois, in view of the non consultant hospital doctor shortage; and if he will make a statement on the matter. [17902/11]

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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Question 39: To ask the Minister for Health the current status of his review of the Health Service Executive reconfiguration process for acute hospitals; and if he will make a statement on the matter. [17866/11]

Thomas Pringle (Donegal South West, Independent)
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Question 43: To ask the Minister for Health if he plans to close 24 hour accident and emergencies across the country; the measures will put in place to ensure access to emergency services for citizens; and if he will make a statement on the matter. [17867/11]

Niall Collins (Limerick, Fianna Fail)
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Question 59: To ask the Minister for Health the small hospitals that will face the temporary cessation of certain services in 2011; and the services that will be affected. [17881/11]

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Question 62: To ask the Minister for Health his plans to shut the 24 hour accident and emergency department at St Colmcille's Hospital, Loughlinstown, Dublin; and if so, the measures he will put in place to ensure the health and lives of residents in Dublin South East and Wicklow; and if he will make a statement on the matter. [17873/11]

James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 10, 32 to 34, inclusive, 37, 39, 43, 59 and 62 together.

I am committed to ensuring that acute hospital services at national, regional and local level are provided in a clinically appropriate and efficient manner. In particular I wish to ensure that as many services as possible can be provided safely in smaller, local hospitals. I have also made it clear that patient safety must be the overriding priority. I want patients to be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible.

The configuration of services is constantly reviewed and from time to time rearranged to improve access and quality of service and minimise risk to patients. This programme of realignment of services has received recent impetus from HIQA on the need to implement the recommendations from the Ennis and Mallow reports. The reports deal in particular with the type of services that can safely be provided in smaller hospitals and the structures required for good governance and accountability. The HSE must ensure that this happens and I will be monitoring the situation closely in conjunction with HIQA.

Additional information not given on the floor of the House

The HSE has now put an implementation team in place to ensure that the recommendations of both the Ennis and Mallow reports are implemented in a speedy, systematic and consistent manner and I have asked for regular progress reports on this important initiative.

This Government is strongly committed to developing the role of smaller hospitals in Ireland so that they play a key part in the services provided to local communities. Patients should only have to travel to the larger hospitals for more complex services. The HIQA reports are entirely in keeping with this approach. I can assure the public that no hospitals will close, regardless of the difficult economic situation we find ourselves in. However, ongoing reform of the system will require some changes in how care is delivered in some locations across our health system.

I am very conscious of concerns about some hospitals in advance of the next rotation of non-consultant hospital doctors, NCHDs. The shortage of suitable NCHDs is an issue worldwide. In this context I am working with the HSE and other stakeholders to ensure the filling of as many as possible of some 475 NCHD posts which are due to be filled from 11 July 2011. 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. 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.

I can assure the Deputies that the necessary steps are being taken to ensure the ongoing safe delivery of service in hospitals and in emergency departments in particular. I am advised that while significant staffing problems remain at both SHO and registrar level in emergency medicine, it is anticipated that increasing the number of staff available to general surgery and general medicine will assist in the delivery and support of emergency department services. In this context, the HSE is focusing on addressing particular emergency department staffing issues in Our Lady of Lourdes Hospital, Drogheda, the Mid-Western Regional Hospital, Limerick, the Midlands Regional Hospitals at Mullingar, Tullamore and Portlaoise and Naas General Hospital.

Notwithstanding this and other initiatives, it is unlikely that all NCHD vacancies can be filled by 11 July. Hospital management is 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 safe delivery of hospital services is assured. Whatever happens I will not stand over unsafe care. Guarding against unsafe care must be the overriding principle driving all the actions taken in terms of clinical service provision and any changes required in that regard.

Brian Stanley (Laois-Offaly, Sinn Fein)
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In respect of the downgrading of hospitals, there is huge anxiety about small and large rural hospitals. What defines a small rural hospital? My local hospital in Portlaoise treated 41,000 emergency cases, so I ask the Minister not to count it as one. Will the Minister contact the HSE today and ask it not to pull acute surgery services in such hospitals throughout the country until the recruitment process has been completed?

Barry Cowen (Laois-Offaly, Fianna Fail)
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The Minister said earlier that of the 60 or 70 who had got visas for placements-----

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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I had indicated, a Cheann Comhairle.

Barry Cowen (Laois-Offaly, Fianna Fail)
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We are dealing with Question No. 10.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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That is what the Minister replied to. I have indicated three or four times now.

Barry Cowen (Laois-Offaly, Fianna Fail)
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May I continue?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputy Niall Collins put down this question and Deputy Cowen is here representing him.

Barry Cowen (Laois-Offaly, Fianna Fail)
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I am entitled to ask a supplementary question.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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That is not the issue, a Cheann Comhairle.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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It is the issue. Nobody is automatically entitled to ask a supplementary question other than the Deputy who put down the question.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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It is at your discretion, a Cheann Comhairle.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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That is correct. Deputy Cowen should proceed.

Barry Cowen (Laois-Offaly, Fianna Fail)
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The Minister said the first demand would be in the busier hospitals and that he is allocating them to the most pressing need. The Minister therefore has a list of those that are most pressing with regard to the 221 that have been filled and the 60 that are coming. Can the Minister tell us what is at the bottom of the list? What hospitals will not get their quota if they are not there before 11 July? The Minister also said contingency plans would be put in place. What contingency plan will there be for them? Can the Minister place on the public record or on a website or can he inform the relevant authorities what contingency systems will be in place? What can the public expect on 11 July?

James Reilly (Dublin North, Fine Gael)
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The answer to both questions is that there are a number of contingency plans contingent on the amount of NCHDs we have. I cannot say what they are until I know what that figure is. I am reliably informed that I will have a better idea at 4 p.m. tomorrow but I will have an even better one towards the end of next week. I realise people like to know what is happening in advance but I do not know and nobody can know because we do not know how many people will land here. We can only judge by the success we have had to date and see how many more people will apply for visas next week and book an aircraft to come here. I believe the vast majority of the 424 who have been identified as suitable and who arrive will remain here and will be found to be suitable. I am not as convinced about the 65 people who have applied to sit the old examination because they have not been screened and I have no idea what the pass rate will be.

I accept that this causes anxiety for people, particularly in the smaller hospitals. The rationale behind the need of bigger regional hospitals having to be addressed is that hospitals such as those in Limerick and Letterkenny must serve huge populations and other hospitals. They must be a priority. Written Answers follow Adjournment Debate.