The controversial Hanly report should be read as a template for the reorganisation of hospital services rather than as a bible for the reforms, the Minister for Health, Mr Martin, said yesterday as he shrugged off suggestions that he was adopting an a la carte attitude to the implementation of the report's proposals.
Speaking at a press briefing in Killarney where he was attending the annual conference of the Irish Medical Organisation, Mr Martin said the Hanly report did not have an entire prescription for the reorganisation of services in all regions.
This was why regional implementation groups were set up, and he felt it was reasonable to give them some leeway in devising a strategy for their own region, as long as it fitted in with the overall goal of reducing junior doctors' hours.
"They were very happy with their terms of reference which allow them some space to respond to local anxieties and concerns. That is reasonable, like we live in a democracy," Mr Martin said.
However, the Hanly report, which has been adopted as Government policy, recommended that A&E units at local hospitals such as those in Ennis and Nenagh be replaced by minor injury nurse-led units with limited opening hours.
This differs from comments by Mr Martin earlier that they would continue to have 24-hour A&E units with doctors in situ. Emergency care physicians are now being recruited on two-year contracts by the Mid Western Health Board for both units.
When it was put to the Minister that his pledge to keep both units open was a deviation from the nurse-led units proposed by the Hanly report, he said: "No, you see Hanly did not envisage the entirety of his proposals being implemented by this July". Doctors had to be recruited to maintain services in the meantime, and he approved of the health board move.
"I would argue that we are sticking with Hanly," he said. "No one anywhere suggested that we should discontinue A&E services in July 2004 or July 2005 for that matter".
Mr Martin also said that, with an average of only two overnight attendances at the Nenagh A&E unit, he would suggest that the hospital did not need 21 senior consultants to provide for that. Hanly said hospitals providing emergency care must have an irreducible minimum of 21 doctors and that only major hospitals should provide this care.
Furthermore, Mr Martin rejected the suggestion that the recruitment of emergency care physicians, about which the IMO has concerns as it says there is no such grade in the Irish health service, was an attempt to bring in a sub-consultant grade by the back door.
He said these physicians would have completed their training but were not in consultant posts and would be paid about 65 per cent of a consultant's salary.
In addition, the Minister defended his decision to visit Nenagh and Ennis, where there has been huge disquiet about the threat to A&E units as they are currently constituted, in advance of the June local elections.