I have asked the groups dealing with the implementation of the Hanly recommendations in the mid-west and east coast regions to ensure that medical cover will continue to be provided overnight in each acute hospital. The issue will also form a part of the work of the acute hospitals review group which is to develop a national hospitals plan in line with the principles of the Hanly report.
Medical cover means that a doctor is available to provide a medical assessment or treatment overnight. The grade of doctor called on to provide medical cover will be in line with anticipated patient need. There may be a number of options for ensuring appropriate overnight medical cover. These could include, for example, consultants, doctors in training, general practitioners, medical officers or a combination of these, depending on the circumstances.
The issue of medical cover relates to services for patients who need medical attention overnight. I look forward to constructive proposals emerging from the two local implementation groups and the acute hospital review group in this regard.
We will work to ensure that arrangements for overnight medical cover are in keeping with the requirements of the European working time directive, under which no doctor may work for longer than an average of 58 hours per week by 1 August this year. This will reduce to no more than an average of 48 hours per week in August 2009.
I have already taken a number of steps to develop further the services being provided in smaller hospitals. In Ennis General Hospital I have given approval for the appointment of a design team to plan for infrastructural improvements. This underlines that I am committed to developing smaller hospitals appropriately rather than closing or downgrading them, as some have claimed.
Regarding accident and emergency services, I have put in place a number of initiatives to deal with pressures in emergency medicine departments. An additional 20 consultants in emergency medicine have been appointed and a further nine appointments are in train. This more than doubles the number of emergency medicine posts in place since 2000 when there were just 21 such posts. The total is now 51 approved emergency medicine posts.
The Mid-Western Health Board has recently advertised for a number of emergency care physicians. These are fully registered doctors who will complement service delivery in emergency departments in the region. I have also announced my intention to provide, as soon as possible, extra resources for the roll-out of training for emergency medical technicians.
I have provided €21.4 million to facilitate the discharge of patients from the acute system to more appropriate settings, thereby freeing up acute beds. I have also taken steps to reduce the extent to which emergency medicine departments must deal with injuries and conditions which are more appropriate to the primary care setting. A total of €46.5 million has been allocated for the development of out-of-hours co-operatives since 1997.