Terry Leyden (Fianna Fail)
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I welcome the Minister of State, Deputy Brian Lenihan. This motion relates to the Hanly report and the effect the European Union directive in respect of non-consultant hospital doctors will have on the provision of services at hospitals such as Roscommon, Nenagh and Ennis and other smaller institutions.

During our Presidency of the EU, the Minister for Health and Children will effectively be its Minister for Health and I encourage him to seek a derogation to allow non-consultant hospital doctors to opt either for a more realistic approach or for a phasing in of the new hours, which are highlighted in the Hanly report. I understand that it is proposed to bring forward legislation in the United Kingdom to allow an opt-out clause.

It is ironic that the Minister of State, Deputy Brian Lenihan, is taking this matter. I was assistant director of elections to his father and my good friend, the late Brian Lenihan senior, in 1969 when the development of Roscommon County Hospital was a major issue.

In May 2002, I had the pleasure of signing a contract for €5.1 million for a new accident and emergency department at Roscommon County Hospital. This building has been completed, responsibility for it will be transferred to the hospital authorities in the next seven days and it will become fully operational from the middle of February. It is important that this be taken as an indication that the hospital will operate accident and emergency services in the area in the long term. The new building is state-of-the-art. Grant aid of over €800,000 in respect of equipping it was received from the Department. I invite RTE and others to visit the hospital when the new building is operational so that they can show the investment being made in our hospitals at present.

Roscommon County Hospital is performing very well. In addition to the contract for €5.1 million that I signed, I also signed a contract for €1 million for the refurbishment of operating theatres when I was chairman of the Western Health Board from 2001 to the end of June 2002. We have refurbished St. Coman's ward, we have new screening rooms and there has been a doubling up of all consultant surgeons, physicians, anaesthetists, radiologists and radiographers. We have a top class hospital which provides an excellent service.

The hospital provides accident and emergency services on a 24-hour basis and I wish this to be maintained. Discussions must be entered into with the Department of Health and Children, those responsible for the Hanly report, Comhairle na nOspidéal and others to ensure that Roscommon County Hospital is retained for the training of non-consultant hospital doctors and that the services of a full-time accident and emergency consultant be provided there. This is the way the hospital should be maintained and developed.

When the new accident and emergency unit becomes operational in the middle of February, it will be a great beacon of hope. However, that is only in the short term. I am seeking a long-term commitment that the accident and emergency unit will be open on a 24-hour basis. That is a major issue in Roscommon. I seek assurances that, by introducing a method to rotate staff, a quality, 24-hour service will be provided at the accident and emergency unit at Roscommon County Hospital. The accident and emergency unit currently receives approximately 13,000 referrals and these need to be handled. There are large numbers of active elderly citizens in County Roscommon who are more prone to illness and who require more access to emergency services than their counterparts elsewhere.

I will not outline all the reasons for developing and maintaining Roscommon County Hospital. It is vital to have consultants available to the people of the county and surrounding areas. The Minister will be aware of the situation on the ground.

I ask the Minister of State, the Minister, Deputy Martin, and the staff in the Department to review this situation. There is an opt out clause in the Hanly report, on the basis of geography and demographic trends, whereby certain circumstances can ensure the maintenance of a quality accident and emergency department in a hospital such as Roscommon Hospital. The journey from Roscommon to Galway takes an hour and a half and involves travelling on bad roads. If I was in an accident or was unwell, I would prefer to be brought to a small hospital such as Roscommon Hospital than to have to travel many miles. It is better for a first referral and to maintain life. If the person has to be referred to another larger hospital, so be it. That is how it operates at present. The hospital does not provide heart surgery, for which patients are referred to the Mater and other large hospitals. Roscommon Hospital liaises closely with Portiuncula Hospital in Ballinasloe and the two hospitals should be viewed together as offering a combination of services for the people of the area.

I hope the Minister will use his good offices to support the work of the members of the Western Health Board and the public representatives in Roscommon, who are committed to the development of services at Roscommon Hospital. We owe a great debt of gratitude to the Minister, Deputy Martin, the Minister of State and the former Minister, Deputy Cowen, for providing the financial resources to develop the hospital. As a result, we were able to provide the new accident and emergency department. I spoke to the programme manager for general hospitals, Dr. Mary Hynes, today and I suggested that an open day be held at the accident and emergency department before it is officially opened. It will give the public an opportunity to see the facilities we have provided in the hospital.

I will not comment on individuals in broadcasting organisations but RTE should send cameras to film what has been provided in Roscommon and project a positive approach to the provision of health services rather than always focusing on negative issues in the sector. I invite RTE and TV3 to show what is being developed in Roscommon. The new accident and emergency department has been designed to accommodate the inmates of Castlerea jail. They require specialist security facilities when using the new department.

With the decentralisation of the Land Registry and other offices and Departments to Roscommon, Longford and surrounding areas, including Athlone, it is vital to have a good quality health service in the area. The development of Roscommon Hospital and the maintenance of its accident and emergency department on a 24-hour basis is crucial in that regard.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I thank Senator Leyden for raising this matter. I commend his industry both as chairman of the Western Health Board and as a Senator in championing the cause of Roscommon Hospital. He never misses an opportunity to do it. I assure him that just as the Minister for Justice, Equality and Law Reform has no plans to close the prison at Castlerea, the Minister for Health and Children has no plans to close the accident and emergency unit, which he funded, at Roscommon Hospital.

This issue arises from the European working time directive which requires that from 1 August, doctors must work no more than an average of 58 hours per week. By August 2009, their average working hours will have to be reduced to no more than 48 hours per week. The report of the national task force on medical staffing, known as the Hanly report, details the measures we must take to comply with the directive while maintaining high quality patient care and moving to a consultant provided service.

At present, the majority of non-consultant hospital doctors work excessively long hours. The current average is approximately 75 hours per week and some doctors work considerably longer than this. That is not sustainable. It is not good for doctors and, above all, it is not good for patients. The Hanly report strongly recommended against any suggestion that we simply increase the number of NCHDs so as to reduce their working hours. It estimated a further 2,500 junior doctors would be required for this purpose. Even if we could recruit this number, it would not be satisfactory from a quality perspective and it would not offer the additional doctors adequate training opportunities.

The Hanly report recommends that we develop a consultant provided service in which there would be considerably more consultants and fewer NCHDs. The Government has accepted this recommendation and is working towards its implementation. The report sets out an implementation plan for reducing the average working hours of junior doctors in line with the European working time directive while maintaining high quality training. It identifies a need for consultants to be more involved in patient care, taking a hands-on role in the provision of services, and concludes that we require a new way of organising hospital services so patients can be treated in hospitals that are fully equipped and staffed to cope with their condition. The Hanly report's proposals mean that no hospitals will close, nor will any accident and emergency departments close.

Staffing levels in Roscommon Hospital are determined by the chief executive officer of the Western Health Board, in line with service plans and the regional employment ceiling for the Western Health Board. Total staffing levels in the hospital have increased by 39% since 1997. This includes increases of over 25% in both medical and nursing staff and an increase of almost 50% in the number of health and social care professionals working in Roscommon Hospital.

The future role and provision of acute services in Roscommon will be examined as part of the work of the acute hospitals review group, which will prepare a national hospitals plan for the interim health services executive in line with the principles identified in the Hanly report. That work has not yet commenced. I welcome the fact that the new accident and emergency unit, which was funded by a capital allocation determined by the Minister and the former Minister, has now been completed and that this marvellous new facility will open in the spring.

The acute hospitals review group will focus on the provision of the best possible service for patients as we implement the European working time directive, introduce a consultant provided service and reorganise medical education and training.