Mattie McGrath (Tipperary South, Independent)
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I am delighted that the Minister for Health, Deputy James Reilly, is in the Chamber to listen to my pleas today. We waited in anticipation for a great deal of time for the Higgins report. I acknowledge that it was pulled and pushed around and that Kilkenny made a break for the border to align with Dublin. We had been working hard in the south east region for many years. We had accepted the fact that there would be change and accepted the Higgins report as an honest effort to tidy up our hospital systems. We welcome the fact that we are linked with Cork University Hospital, which is a teaching hospital. However, I want a commitment from the Minister that the seven senior registrar posts at South Tipperary General Hospital will be filled. These are senior positions for real decision-makers working under consultants. I compliment the consultants, medical staff, nurses and other full-time staff on the work they do daily to deal with the issues that arise, particularly since the closure of Nenagh General Hospital and of St. Michael's unit at South Tipperary General Hospital, with the relocation of beds to Kilkenny. These are vital posts but the hospital and regional management seem to be unable to recruit people to fill them. The deadline of 8 July is little more than a week away. I understand there is very little interest in the posts. There is nothing wrong with the facility; it is a question of an unfair balance. I call on the Minister, in the spirit of the Higgins report, our linkage with Cork and the hospital group system, to ensure that registrars are redeployed to us forthwith.

We had 32 people on trolleys in our hospital last week as we did not have senior staff to deal with the situation. We do not have anything like a full complement of staff, being short of five registrars. We will be short of the full seven by 8 July 2013. It is a serious situation. I hope it is not a question of sabotage and that we will not be closed by stealth or through something happening behind the scenes. The Minister gave a commitment to keep our hospital. These positions must be filled. I appeal and demand, as an elected representative of the people of south Tipperary, that these posts be filled, even temporarily, with registrars from Cork, Limerick and other hospitals in the group to maintain vital services and safety at South Tipperary General Hospital in Clonmel. It must happen.

The hospital management must be empowered if it lacks the power to attract people. I do not know what the reasons are. The Minister is perhaps aware of the reasons and might outline them to the House. We need support now. We are on a lifeline. If we do not recruit the registrars by 8 July we will be in big trouble. I do not want to be all doom and gloom; I want to be positive about our hospital and support it. I am critical when it is required. We have had two HIQA reports that were anything but pleasing. I am no apologist for uncleanliness in hospitals, especially where people's lives are at stake, or for lacklustre management and too many trolleys on the floor. However, I stand shoulder to shoulder with consultants and all staff from the front door up to the very top on recruiting the full complement we need. Given our reciprocal relationship with Cork and Limerick, they must provide senior registrars this week. Next week will be too late. The appointments must be made and the registrars must be on site to do rounds with junior doctors and senior house officers. We need the full complement to have a safe working hospital. The hospital has been recognised over the years for providing the treatment that the public expects and deserves.

It is over to the Minister. I hope he will have good news for me. I hope he will be able to ensure that we get these staff rather than excuses that they cannot be recruited. If necessary, staff must be redeployed.

James Reilly (Dublin North, Fine Gael)
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I thank Deputy Mattie McGrath for raising this issue. I am glad to hear that he wants to be positive about his hospital. He has every reason to be.

Particular hospitals and specialties have experienced difficulties in filling medical non-consultant hospital doctor, NCHD, posts over the past number of years. Addressing this issue has been a priority for the health service and, as the Deputy will be aware, there have been a number of recruitment programmes internationally. As a result, over the past three years, 98% of NCHD posts have been filled normally. Where staffing issues exist, there remain sufficient agency staff to meet service needs. This means that the hospital system is operated successfully with a small ongoing vacancy level in recent years. I want to reduce agency working even further and I fully intend to do so.

The total complement of NCHDs for South Tipperary General Hospital is 20 - that is, six interns, seven senior house officers, SHOs, and seven registrars. Of the seven medical registrar posts, four are specialist registrar posts and the remaining three are registrar posts. Currently in the hospital there are 17 NCHDs - five interns, seven SHOs and five registrars. A comprehensive process of recruitment has been under way in respect of the July 2013 intake since earlier this year. South Tipperary General Hospital has already recruited six interns and six SHOs, with the final post in the process of being filled. However, as the Deputy pointed out, we are experiencing a challenge in securing the necessary registrar posts, which have been allocated on a national basis by the Irish College of Physicians. There are difficulties nationally in the recruitment of specialist registrars - that is, there are more vacant posts than registrars. As a result, no specialist registrars were allocated by the Irish College of Physicians to South Tipperary General Hospital for the July 2013 intake.

South Tipperary General Hospital, with the support of HSE South and the national HSE system, is working with the assistance of agencies to secure the necessary registrar posts for the hospital. Two registrars are considering offers currently but have not quite yet accepted the positions, while one registrar from South Africa has agreed to take up a post later on this year. The accelerated recruitment campaign is continuing with the intention of maximising what can be achieved through this process. In addition, senior management at South Tipperary General Hospital, in association with the HSE area manager for Carlow, Kilkenny and South Tipperary, are working closely with Cork University Hospital, Waterford Regional Hospital and St. Luke's General Hospital in Kilkenny with a view to securing their support for sharing the registrar posts in a way that would improve the situation in south Tipperary and ensure safe service delivery. This work is continuing. I can assure the Deputy that the matter is being addressed as a priority and progress has been kept under review on a daily basis.

Mattie McGrath (Tipperary South, Independent)
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I thank the Minister. I want to be positive. The staff are under enough pressure. We need definite dates. I am aware that there are two candidates who have not fully come on board, and one is due to take up a position later on this year, which I welcome.

In the spirit of the Higgins report, I appeal to the Minister to ensure South Tipperary General Hospital gets support from its sister hospitals, Waterford Regional Hospital and St. Luke's General Hospital in Kilkenny. As we are in that region, why abandon the recommendations of the Higgins report before they have been fully implemented? We need the support of these hospitals.

As I stated, this is a fully accredited hospital with high standards and high expectations. I know by the Minister's tone of voice that he will support it but I demand that he does because we are only days away from 8 July and the matter is serious. One can imagine the stress. I have spoken to regional management. I spoke to Ms Anna Marie Lanigan and others, who are doing their best, but this is a case in which we cannot do it on our own. We need the help of the Minister and the other hospitals need to be encouraged to allow their staff to be redeployed temporarily until we get the matter sorted out. This must be done now. We cannot allow such a situation with a deadline such as this. It is just too serious. It is a matter of patients' health and safety and, of course, all medical treatments must be available.

As I said, I do not want to see a situation in which gaps are left and we are told it is because the HSE could not recruit the staff. Whatever must be done, whatever ban must be lifted or whatever agency must be recruited or contacted, this is the eleventh hour and we need it to be acted upon. I beg the Minister and hope he delivers. Being a medical professional, he himself understands the situation better than I do.

As I stated, I am committed to the hospital. We all are in South Tipperary. We will support the Minister, but we need him to put his shoulder to the wheel. We need the meitheal spirit of the Higgins report. Hospitals must support each other and stand with each other to fill those posts. When we in Clonmel have to do the same, we will do so.

James Reilly (Dublin North, Fine Gael)
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I can assure Deputy McGrath that I take on board what he is saying. I am aware that the Minister of State at the Department of Agriculture, Food and the Marine, Deputy Tom Hayes, is most concerned about this issue too.

Mattie McGrath (Tipperary South, Independent)
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I know he is.

James Reilly (Dublin North, Fine Gael)
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As Deputy McGrath said, the hospital is a busy one. He mentioned in his earlier contribution that he hoped it was not being closed down by stealth. There is no question of closing down any hospital of this nature. That will not happen. We do not have the capacity in the system to allow for such things. It is not my intention to close any hospital.

Mattie McGrath (Tipperary South, Independent)
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Maith an fear.

James Reilly (Dublin North, Fine Gael)
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Last year there were more than 30,000 emergency department presentations, 13,490 inpatient discharges, 5,842 day cases, 1,070 births and an excellent average length of stay of 3.96 days. This is a good hospital that performs really good work. It is invaluable to the local community and also to the network.

I do not know why there is a noise. I do not think it is my phone.

Mattie McGrath (Tipperary South, Independent)
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It is the Minister of State, Deputy Tom Hayes, from Brussels.

James Reilly (Dublin North, Fine Gael)
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It must be Deputy Tom Hayes's phone. He is probably watching in.

There are a number of points I want to make, and I will take the opportunity to make them, if I may.

Michael McCarthy (Cork South West, Labour)
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The Minister has 45 seconds.

James Reilly (Dublin North, Fine Gael)
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First, the way in which we have been treating our NCHDs - giving them six-month contracts - is anathema to me. It is wrong. We should be giving them two- or three-year contracts. This would allow much greater certainty for them and for their families, and we would have greater certainty as well. Second, we are trying to create a much clearer career path for NCHDs. Third, and most important, there is nothing else that exemplifies the need for hospital groups as much as the matter we are discussing here today. This hospital in Clonmel is not a small hospital. It is a model 3 hospital but, because of its location, it occasionally has difficulties in attracting staff. By being part of the hospital group of Cork and Waterford, South Tipperary General Hospital will have access to that greater pool. Even though these groups are only starting and the Government has passed its plan, we will seek to get the help from those hospitals which are South Tipperary General Hospital's natural allies to ensure that the people of Clonmel have the staff to deliver a safe service to all. That is critically important to me as Minister for Health.

Mattie McGrath (Tipperary South, Independent)
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Beidh fíor fáilte roimh gach daoine a thiocfaidh go Cluain Meala.