Brian Lenihan Jnr (Dublin West, Fianna Fail)

I thank Senator Coonan for affording me the opportunity to clarify the position. I am replying on behalf of the Tánaiste and Minister for Health and Children, Deputy Harney. I want to emphasise the Government's commitment to the continued development of services at St. Joseph's Hospital, Nenagh, and the continued provision of high quality, safe acute hospital services to the people of north Tipperary. In recent years, funding of €2 million has been provided to facilitate the extension of the existing building and significant refurbishment of existing facilities. Some €750,000 was spent on refurbishment and the upgrading of mechanical and electrical services at the hospital. Additional ultrasound equipment was purchased at a cost of €200,000.

Planning permission has been obtained for an acute psychiatric unit with 24 beds. Space has been protected on the Nenagh campus for the proposed future provision of a geriatric assessment and rehabilitation unit. The Department of Health and Children has given approval to the development of a health centre and community care headquarters. In 2004, €1.6 million in funding was approved for a capital project involving an extension to the laboratory and development of X-ray and accident and emergency services. These are signs of a Government that is clearly committed to the development of a proper hospital service at Nenagh.

The actions under way to improve the delivery of accident and emergency services take a wide-ranging approach and are aimed at improving access to accident and emergency services, improving patient flows through accident and emergency departments, freeing up of acute beds and providing appropriate longer-term care for patients outside the acute hospital setting.

The Health Service Executive is working with hospitals, including Nenagh, to deliver these measures and to ensure the investment produces sustainable solutions. Additional actions are needed which relate more to the management, work practices and processes in hospitals. These will also be addressed by the Health Service Executive.

In Nenagh, an additional consultant anaesthetist post was filled in 2002 and the appointee was designated as overall manager of the accident and emergency department in compliance with the guidelines of the Irish Medical Council. Progress has been made on securing dedicated non-consultant hospital doctor staffing within the accident and emergency unit to complement additional nursing posts approved in 2002.

Senator Coonan referred to the report of the national task force on medical staffing, commonly referred to in public debate as the Hanly report. It made a series of important recommendations regarding the development of hospital services. It recommended that we put in place a consultant-provided service, harness the contribution of all our hospitals and provide a wider range of appropriate services and procedures in hospitals such as that in Nenagh. The report stated a full range of acute hospital services should be available within the mid-western region so patients would not have to travel outside the region other than for specialised supra-regional or national level services. This would involve the appointment of an additional 195 consultants to the region. These consultants will be required to work both in hospitals such as that in Nenagh as well as the Mid-Western Regional Hospital, Limerick. This would ensure hospitals such as that in Nenagh would continue to cater for the vast majority of patients attending accident and emergency units.

In the debate about the future organisation of acute hospital services, it is important to remember that we are obliged to implement the European working time directive, which involves a considerable and welcome reduction in the working hours of non-consultant hospital doctors. We are already involved in a process aimed at reducing average working time to 58 hours per week. Local European working time directive implementation groups are established in nine hospitals and have been working on a detailed analysis of hospital activity and how medical staff respond to that activity. This is part of a longer-term process to achieve the 48 hour working week for junior hospital doctors by August 2009, less than five years away.

It is simply not acceptable for doctors, including some in Nenagh, to have to work 70 or 80 hours per week, or even more in some instances. Excessive working hours are not good for doctors or for patients. We need to find alternative ways of providing services in our acute hospitals so doctors can work reasonable hours and patients can be sure of a top-quality service at all times. This means looking carefully at how we configure our acute services. It does not mean closing hospitals or downgrading them. There is substantial scope for increasing the services provided in many hospitals, including Nenagh, and those others claimed by some as being in danger of losing services. As far as the Government is concerned, we need to harness the potential of every acute hospital to provide the best possible service to the local community.

We must decentralise as much as possible the elective treatments currently provided in the larger acute hospitals to smaller local units. At present, the larger hospitals tend to provide a very high proportion of all day surgery and medical procedures. If properly structured and developed, the smaller local hospitals such as Nenagh could take on significantly more of these treatments. This would greatly reduce the need for people to travel outside their own region for most procedures. Far from reducing the importance of smaller hospitals, the Government is committed to expanding considerably the services that can safely be provided within local communities. This will be to the benefit of all patients and will ensure that they receive as many services as possible closer to home. A second reality to be faced in the future organisation of hospital services is the need to provide much greater access to senior clinical decision makers so that patients can receive speedy and effective attention. We remain overly dependent on doctors still in training, and we have an insufficient number of consultants. This means that patients who could be diagnosed and treated quickly by experienced clinicians have to wait for unacceptably long periods, in some instances, until their condition can be identified and dealt with. The Government, in accordance with the Hanly report's recommendations, is committed to developing a consultant provided service, rather than one which is predominantly consultant-led. We need consultants to work closely together in teams, so that senior clinical decision makers have a substantial and direct involvement in diagnosis, delivering care and overall management of patients. Achieving this will require change. It will involve more consultants, fewer non-consultant hospital doctors and will require reform of existing work practices.

We are ready, willing and able to engage in the necessary negotiations. We can and will make progress in developing our acute hospital services in a way that is in the best interests of patients. Whatever position we take on the future of acute hospitals, it is clear that the present situation is not satisfactory. We cannot continue with more of the same. Change is necessary, and we can achieve it in a positive way that benefits all. However structured, acute hospitals need to work closely together in recognised groupings, or networks, so that we can maximise the services that can be provided by each hospital. Every hospital, whether big or small, has a vital role to play. We need to stop talking about hospitals supposedly in danger or under threat and concentrate on how we can harness the contribution of every hospital to delivering quality services for patients.

I am satisfied that the initiatives outlined to the House represent tangible evidence of the commitment of the Government to the continued provision of high quality, cost effective, timely and responsive hospital services in Nenagh for all. The Government is committed to supporting and developing critical services, including key areas such as maternity and accident and emergency services. Let us move away from scare tactics and unfounded claims about downgrading and loss of services. Instead, let us have a debate about how best to work together to develop a quality health service for the future and as part of that, ensure a high quality, sustainable hospital service in Nenagh.