Acute services: The current medical staffing arrangements in many accident and emergency units are unsustainable, according to the chief executive of the Health Service Executive (HSE), Brendan Drumm.
Speaking following his appearance before the Dáil Public Accounts Committee, Prof Drumm suggested that alternatives to the current arrangements included the introduction of a new "hospitalist" grade of doctor in the health service or greater liaison between accident and emergency units and local GPs.
He said that in many cases accident and emergency services outside of normal working hours were currently being provided by doctors in training.
However, he said that in some acute units the reality was that these services were actually being provided by doctors who were not part of any formal, structured training programme.
Prof Drumm said that having accident and emergency services in some acute units provided by doctors in training who were not under a formal training programme was not sustainable in the future.
Prof Drumm had earlier told the committee that the provision of full-scale accident and emergency services would be very expensive given the terms of the European Working Time directive.
This directive limits the amount of hours which non-consultant doctors can work in hospitals each week.
Prof Drumm suggested that options for consideration as alternatives to the current medical staffing arrangements were the introduction of a new hospitalist grade of doctor or greater liaisons between hospital accident and emergency units and local GPs at night-time.
He said that a hospitalist grade was a post that existed in the United States. He said that a doctor in such a post would provide medical cover throughout a hospital outside of normal working hours.
He said the other option was for greater links between hospitals and local GPs.
The controversial Hanly report of 2003 suggested that full-scale 24-hour accident and emergency services might not be sustainable in some centres.
It suggested that these full-scale accident and emergency facilities could be replaced by minor injury units.
However, these proposals generated strong opposition in many local communities around the State.
