I propose to take Questions Nos. 156 and 835 together.
The National Task Force on Medical Staffing, chaired by Mr. David Hanly, was set up to:
devise a strategy for reducing the average working hours of non-consultant hospital doctors (NCHDs) so as to achieve the requirements of the European Working Time Directive (EWTD);
address the consequent medical staffing needs of Irish hospitals;
analyse the practical implications of moving to a consultant-provided hospital system;
and consider the requirements for medical education and training arising from any changes to the current model of delivering services.
The Report of the Task Force (generally known as the Hanly Report) made a series of important recommendations. These covered issues such as:
the changes needed in NCHD work patterns;
the need for a significant increase in the number of consultants;
the need for a revised contract for medical consultants;
reform of medical education and training;
and the reorganisation of acute hospital services.
Work is proceeding in relation to each of the main recommendations made by the Task Force. The most difficult recommendations to implement, and the ones that have proved most controversial, are those relating to the reorganisation of acute hospital services. The Task Force advised that the current organisation, structure and staffing of our hospital system is failing to deliver the care that, at its best, the Irish system is capable of giving. It further advised that patients have better outcomes when treated in hospitals with appropriate numbers of specialist staff, high volumes of activity and access to the right diagnostic and treatment facilities.
I am concerned that, at present, some patients are being exposed to increased risk because specialist services are being provided in some hospitals that lack the necessary critical mass of activity and patient throughput. Patient safety and quality must be paramount and must be the key drivers in the re-configuration of our acute hospital services and, indeed, our services generally. The policy of the Government is to provide safe, high-quality services that achieve the best possible outcomes for patients. This will mean rebalancing service delivery so that those services that can be safely delivered locally are delivered locally and that more complex services that require specialist input are concentrated at regional centres, or in the case of highly specialised services such as organ transplantation, in national centres of excellence. This approach is consistent with international best practice for the optimum delivery of patient care. The Health Service Executive has begun the process of reorganising our acute services in order to achieve these objectives. This will take time and, in the meantime, there will be no diminution in services available locally until suitable alternative arrangements have been put in place.
