Seán Barrett (Dún Laoghaire, Fine Gael)
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Question 50: To ask the Minister for Health and Children if she will provide details on the hospital accident and emergency units that will close or limit opening hours as a result of health service cutbacks; and if she will make a statement on the matter. [20236/10]

Mary Harney (Dublin Mid West, Independent)
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Last year, the HSE dealt with nearly 1.2 million Emergency Department presentations and it expects to do the same again this year. About 70% of people who attended Emergency Departments last year were not admitted to hospital: they were treated and discharged. This year, the HSE is planning to increase the number who can be safely discharged home without admission to about 72%. This can be achieved by changing the way services are provided, including by providing quicker access to senior clinical decisions makers.

I am determined to move to a consultant provided, rather than a consultant led, service where consultants work on a team basis. As a result, and following agreement in 2008 on a new consultant contract, I have made it clear to the HSE that it needs to increase the number of consultants and reduce the number of NCHDs to achieve a more appropriate balance between both groups.

I am also determined to support the changes in NCHD training status and associated medical registration status being introduced by the Medical Council under the Medical Practitioners Act.

I have been advised that there are likely to be difficulties in filling some NCHD posts when doctors begin their next rotation in early July. The indications are that there will be a reduction in the number of applications for certain NCHD posts, especially in posts which are not part of a formal training rotation scheme and in the areas of emergency medicine, anaesthesia and general medicine. However, the extent of any shortfall will only become evident over the coming weeks.

It is because of the expected reductions in applications for some NCHD posts, and not because of any budgetary challenge, that the HSE is currently examining how best to maintain and improve the quality of services provided to patients attending Emergency Departments.

A range of possible measures are being examined including some relating to recruitment and training status. Other important measures include reductions in tiered on-call and improved cross-cover arrangements. Instead of cases being referred through successive tiers of doctors, we need to increase the extent to which consultants and other senior clinical decision makers respond to urgent or emergency cases.

Because we are serious about patient safety, we also have to ensure that complex acute care – particularly for emergency medicine, critical care and complex surgery - is provided in hospitals with a sufficiently high volume of activity to ensure the clinicians providing those services can maintain their skills. However, quality care also means accessible care and I am equally determined to ensure that the vast majority of people attending Emergency Departments, who require relatively straightforward levels of urgent care, can continue to receive this care locally.

The changes I have outlined are driven by concerns about patient safety, quality of care and financial sustainability, not by immediate budgetary issues. They are the right changes for patients – people want to access care as close to home as possible but also want to be sure they are getting safe high-quality care.