Vol. 411 No. 6
11 Mr. Carey asked the Minister for Health whether he has received a report from the steering committee on Dublin hospitals accident and emergency service in the wake of the new rota system; and if he will make a statement on the matter.
36 Mr. McCartan asked the Minister for Health whether his Department have received a report on the way Dublin hospitals are coping with the new accident and emergency rota service introduced at the beginning of September 1991; if he will publish the report; the number of hospitals and occasions they have to divert ambulances taking patients from their own catchment areas; the impact the changes have had for patients awaiting treatment at casualty units; and if he will make a statement on the matter.
I propose to take Questions Nos. 11 and 36 together.
I have only recently received the interim report on the operation of the Dublin accident and emergency service since the introduction of the revised rota on 2 September 1991. This is being examined by my Department at present. Arrangements will be made to discuss its contents with the accident and emergency steering group at an early date.
I appreciate that the Minister only very recently received the report of the accident and emergency steering group and is examining the matter. Would he bear in mind my strongly held view as a Dublin Deputy — and I am sure other Members will want to advise him of the position — that what has now been put in place by the hospital services in Dublin is a disaster? Would he accept that clearly, the indications are that the reorganised service does not work? It does not work internally, in so far as it imposes massive pressure on the everyday services within the hospitals concerned, secondly it is proving totally disastrous for the population of Dublin. Would the Minister undertake to move as quickly as possible to restore full accident and emergency services on a 24-hour basis? Does the Minister accept as satisfactory, for example, that somebody living on the northside of the city in my constituency should have to have recourse to a hospital in Blanchardstown as an emergency outlet at night time, when there is no bus service available and when many of the people who badly need that service would not have the necessary resources to avail of a taxi to get to that hospital or return home? Would the Minister accept that major problems obtain wanting urgent attention by him at this stage?
I agree with Deputy McCartan that there are problems in the Dublin area needing to be addressed. The first one that needs to be addressed is that of the first point of referral to medical care within our health services. There is also the question of the number of people who bypass their general practitioners, resorting to the hospitals services leading in some instances to a delay in the treatment of more serious casualties in hospitals. That is an issue that must be addressed. Indeed, the Kennedy group examined and commented on that. I have initiated something in an endeavour to deal with that issue.
On the question of the hospitals involved in the Dublin accident and emergency service, as the Deputy is aware, before, I think, 1989, just one hospital on the northside and one on the southside of the city was open at night. Because of the problem that caused, the number of such hospitals was increased to six. The figures made available to us — I should say this is monitored all the time — showed there had been a major reduction in the level of activity, with some very high staffing levels, particularly throughout the night. I remember that in one such instance the average was that 13 patients were tended during the night by seven staff. Therefore, it was considered appropriate to reduce the number of hospitals to two on each side of the city. As the Deputy rightly said, we have not as yet completed our study of the report; it is an interim one only, but I must add that we are monitoring the position very carefully.
Is the Minister not aware of the leaked information from this report, which was reported in the Medical News, indicating that this measure has thrown waiting lists into complete chaos, has led to a lengthening of waiting lists, and that there is major concern about the continuity of care when, as Deputy McCartan said, somebody is taken from Beaumont and admitted to Blanchardstown Hospital? Is he not aware also that the consultants running these departments indicate that there will not be the cost savings the Minister thought he would effect? Does the Minister not agree that the reality is that these hospitals cannot cope with the 50 per cent increase in their load the Minister says they should have? Even last year we knew that patients were left on trolleys overnight during the winter peak activity. Especially when all of the accident and emergency consultants have so advised him, would he not agree that this is not a sensible way to save money?
I do not accept what the Deputy is saying. I should say that the hospitals now do have a full week during which they are not on accident and emergency duty, which should have given consultants and hospital managements an opportunity to plan their admissions for elective work.
Would the Minister read the report.
One of the issues that arises in the Dublin hospitals, one that must be of concern to everybody in this House, is that Dublin hospitals are being funded as tertiary referral hospitals. A fair question to ask is: why is it costing so much if the accident and emergency services they are providing are similar to that being provided by general hospitals throughout the country? That is one of the questions I have posed.
Would the Minister not agree that even without this report it is public knowledge that as soon as this new interim arrangement was put in place it failed utterly. We are as concerned as those in the city of Dublin about this accident and emergency service which is not available when required?
I do not accept that contention at all. The position is that in the initial weeks when the revised accident and emergency service was implemented there was no problem about it, but it had been predicted by accident and emergency consultants that it would fail. That had been predicted before it came into operation at all. They kept predicting it would fail.
And they were right.
No, they were not right, because in the first three to four weeks there were no problems encountered. As I understand it, there were one or two problems experienced but those were problems that had obtained even when the six accident and emergency hospitals were open, when all the beds were full and when patients had to be transferred to another hospital. That happens all the time irrespective of the number of hospitals open. Even when the six were open there was the same problem experienced of patients being transferred to other hospitals where beds were available rather than opening up new beds. That makes sense.
Has the Minister's attention been drawn by his Minister of State who was present at a recent public meeting in my constituency where testimony was advanced about a traffic accident when the casualty was left lying on the road for some time while the emergency staffs argued about which hospital was on duty that night? Does the Minister not agree that this is further evidence of the serious deficiency in the accident and emergency service in Dublin? Furthermore, does he not agree that it ought give him additional motivation to reverse his disastrous decision to longfinger the construction of the Tallaght Hospital?
I can assure Deputy Rabbitte that the Minister of State at my Department keeps a very close eye on what is happening generally. The Minister of State has had the particular incident to which the Deputy referred investigated. He keep me well informed of what he sees and hears, particularly in his area.
He has a lot to hear.
He might as well while he is around.
Would the Minister not agree that it is totally unacceptable for him to come in here and talk about people going to accident and emergency units wrongly and that they should go elsewhere? He wonders why this service is so expensive. Is it not the reality that the Minister is trying to make penny pinching savings at the cost of vulnerable people who have to go to accident and emergency units? That is not acceptable.
I appreciate that the Minister has the report, review and many fundamental questions to consider but would he not accept that there are grave problems for both hospitals and people in the community who require their services? Given that it appears that the impetus for this change — this was confirmed by the Minister today — came from his Department in the hope of saving money, may I ask the Minister to ensure, whatever decisions are taken, that there will be easy access to this service from a geographic point of view? If the service is to be limited, I ask him to ensure that it will at least be provided at the six major hospitals in the city as heretofore. As a man from a rural area, the Minister may not appreciate the major logistical problems being experienced by people who live in the city in terms of travelling at night time and outside normal bus hours to and from hospitals.
The Deputy said that as I come from the country I would not appreciate the major logistical problems being experienced by people. Nobody appreciates this more than people from the country who have to travel 40 or 50 miles to a hospital. For example, people from Belmullet have to travel 50 miles to the general hospital in Castlebar and if they have to go to a tertiary referral hospital they have to travel another 80 or 90 miles to Galway.
And the Government have taken their transport facilities away from them.
As someone who comes from the country I appreciate the travelling difficulties involved for people who do not live in close proximity to a hospital.
Question No. 12.
The difficulty is that——
Let us be fair, Deputy.
——some people who travel to Blanchardstown Hospital pass Beaumont Hospital on their way there.
The next question has been called and will be responded to.
