Vol. 483 No. 2
5 Mr. Shatter asked the Minister for Health and Children whether he will provide a cash injection of £3 million to avert a crisis in the Dublin hospitals accident and emergency services in the winter of 1997 in accordance with the request made by the Accident and Emergency Steering Group. [19943/97]
The Eastern Health Board has a co-ordinating role in relation to the provision of accident and emergency services by six major hospitals in the Dublin area. Arising from the work of the Accident and Emergency Steering Group, the board has requested funding for a series of proposals aimed at relieving pressure on the accident and emergency services during the coming winter. These proposals refer mainly to anticipated spending in 1998 and my Department will consider the board's request as part of its overall consideration of estimated budgetary requirements for the coming year.
Will the Minister accept that the steering group has advised him that, to ensure that the accident and emergency services will be in a condition to meet the expected demands to be made on them this winter, this extra financial injection is required, that it is important in the context of forward planning that the health board is advised at a very early stage as to whether this funding will be made available, and that it is not adequate that a decision should be made and funding made available only some time after the new year? It is essential that this issue is immediately addressed by the Minister, decisions communicated and the necessary action taken so that the accident and emergency services know they will be in a position to cope.
I agree that of course it would be far better had the Eastern Health Board been able to provide funds which would not have required it to wait for the 1998 allocation since it has been involved in positive measures in 1995-6 and 1996-7. However, far from having the allocation in reserve, the Deputies will be aware that the ability of health boards to keep within budget has been problematical, but it will have to be done from now, given the accountability legislation.
The Eastern Health Board has identified a number of priorities for this winter to relieve the further pressures which are expected. These proposed measures range from a major publicity campaign to discourage inappropriate attenders to the provision of additional long stay facilities, mainly for elderly patients, to free up acute hospital beds which are inappropriately occupied. The focus of attention will be the further development of community support and levels of care more appropriate to meet the medical needs of the patients, thereby ensuring the most efficient and effective use of the acute hospital bed resource.
Some of the voluntary hospitals have submitted requests for funding for initiatives aimed at improving the management of services in the accident and emergency departments. These initiatives include additional training for nurses and the extension of the triage system where nurses are trained to make immediate assessments and decide which patients require immediate care, together with the reorganisation of staff, etc.
Therefore, there are proposals in the Department and I would hope to be able to assist them in this regard as soon as the 1998 allocation has been decided finally.
Is it not the case, because of the implementation of the Health (Amendment) (No.3) Act, 1996, that if the health board is not informed within the next fortnight or so, it will not be in a position to implement any improvements during this coming winter?
I am arranging meetings with all the health boards in the next few weeks prior to allocations to impress upon them that there are major responsibilities which must be taken up as and from 1 January and they will be required to provide service plans that are within budget on the basis that supplementary estimates will not be available to them next year. That is an important departure in the delivery of health services. The statutory responsibilities lie with the health board and it is important, before giving out the allocations, that health boards are reminded of the new additional responsibilities. When the boards sit down to draw up their service plans they may set out their priorities and one of these may be among them.
I am not clear that I understand the Minister's response. My understanding is that the health boards will be informed of their allocation within two to three weeks. I understand the Minister's response to mean that if they are told at that stage they must make this sort of provision out of that allocation. Is that the case?
Yes. I expect the allocations within the timespan the Deputy mentioned. Then the boards must adopt service plans and these must be submitted. When the allocations become available, they will have to incorporate the total demand on the health boards. The allocations have never been adequate to meet the demands since the foundation of the State but they will have to shape service plans to meet the allocations.
Will there be no particular allocation for this plan?
There are some development moneys which are not yet finalised on which I am working at present. I have not decided yet whether an allocation over and above their allocation will form part of that. We are in the final throes of decision making.
I ask the Minister to make that decision, particularly for the Dublin hospitals which should be given an additional allocation this winter. I further ask him to bear in mind the exceptional demands that are placed on the Dublin hospitals' accident and emergency services. I remind the Minister that he has a duty as 1998 approaches to ensure that those services are adequately funded to ensure that the best possible medical care is available to those who require it.
The definition of adequate funding is often dependent upon the level and quality of management one is prepared to tolerate. Nothing is adequate if it depends on other criteria not being met.
There is an important problem to be resolved in the accident and emergency services in Dublin hospitals which will require a great deal of co-ordination and a mechanism for taking away from the equation those who are clearly inappropriate attenders. At present it is cheaper to attend an accident and emergency service than to go to a GP for the most basic requirements. That has been ducked for a long time and it needs to be addressed if we are serious about trying to ensure that those who require accident and emergency services can avail of them. It is quite clear, from speaking to people on the front line in those wards, that there are people attending who are depriving them of the ability to deal with those who should be there.
Is the Minister considering an increase in the outpatient charge to those using accident and emergency services?
I certainly am.
