Ceisteanna–Questions. - Accident and Emergency Services.

Alan Shatter


66 Mr. Shatter asked the Minister for Health and Children the action, if any, he will take to end the unacceptable delays and chaos experienced by patients attending the accident and emergency departments of hospitals in recent weeks. [2055/99]

The levels of attendance at accident and emergency departments are complex and difficult to predict. All accident and emergency departments experience periods of exceptional demand which can result in delays for patients. However, it is important to note that appropriate medical treatment is provided at all times and that waiting periods are kept to an absolute minimum.

In 1998 I made an additional £2.3 million available for the development of accident and emergency services. This additional money was provided as follows: public education – a national publication campaign launched by the Eastern Health Board aimed at persuading people with minor ailments to attend their family doctor rather than a hospital accident and emergency department, at a cost of £100,000; initiatives in accident and emergency departments – the provision of additional senior house officers, registrars, night shift nurses and triage nurses at the Mater Hospital at a cost of £200,000; the provision of increased registrar cover and additional nursing staff at Beaumont Hospital costing £200,000; the introduction of general practitioners, nurse practitioners and registrar to the accident and emergency department at St. James's Hospital at a cost of £200,000; the provision of an emergency medical ward to alleviate pressures on acute beds at St. Vincent's Hospital at a cost of £200,000; the provision of £50,000 each to Galway University Hospital and Cork University Hospital; the provision of £300,000 for 20 additional beds for three months at James Connolly Memorial Hospital; long stay initiatives – the provision of 40 elderly places at St. Monica's Home at a cost of £600,000 and the provision of 20 day care/step-down places at Crinken Lane and Crooksling at a cost of £200,000; and community initiatives – the provision of additional community ward teams costing £200,000. The total cost of these measures is £2.3 million.

This year I provided additional funding of £2 million to enable acute major hospitals to implement various initiatives aimed at addressing some of the difficulties being experienced in our accident and emergency departments, particularly during periods of peak demand. These initiatives include measures to free up beds for emergency admissions through the provision of alternative step-down facilities for patients who occupy beds in acute hospitals for lengthy periods. They will allow for the provision of enhanced staffing levels, the development of rapid diagnostic systems for common emergency presentations, continued development of treatment-observation areas in accident and emergency departments and improved access for general practitioners to urgent specialist opinion. Specifically, this funding of £2 million has been provided for a public education programme – the continuation by the Eastern Health Board of a public education campaign at a cost of £105,000; initiatives in the accident and emergency departments will include £100,000 for AMiNCH – Tallaght Hospital will provide for the introduction of measures aimed at reducing pressure from accident and emergency services on acute hospital beds; £200,000 for Beaumont, continuing the physical upgrade to the accident and emergency department and the provision of additional staff; £210,000 to the Mater Hospital towards the conversion of a day unit to provide conventional beds to be utilised to alleviate pressure on the accident and emergency department; £210,000 for St James's Hospital for continued development of rapid diagnostic systems for patients and the creation of a patient discharge waiting area-lounge for patients awaiting transport home, thereby releasing inpatient beds at the earliest opportunity; £210,000 for St Vincent's Hospital to provide for the recruitment of additional staff and the purchase of appropriate care facilities and step-down accommodation for patients who no longer require acute hospital services; £50,000 for the children's hospital, Temple Street, for the provision of additional staff; £50,000 for improved services in the accident and emergency department in Our Lady's Hospital for Sick Children, Crumlin; £75,000 for the provision of step down facilities at the Incorporated Orthopaedic Hospital, Clontarf; £350,000 for the Western Health Board to improve nursing and medical cover; and £440,000 for the provision of 20 additional acute hospital beds at James Connolly Memorial Hospital during the winter period aimed at reducing pressure from accident and emergency services on acute hospital beds. The total is £2 million.

I have also published the report of the review group on the waiting list initiative and I am committed to ensuring its recommended approach is implemented. The report is one of a number of measures which I have taken to address the question of long waiting lists and waiting times. I have provided a total of £20 million for waiting list activity in 1999, which is a 66 per cent increase on the amount provided in 1998 and is two and a half times higher than the sum of £8 million provided by the previous Government in 1997. The report recommended the implementation of a range of steps to free up acute hospital facilities for more elective work. It pointed out that a significant proportion of acute hospital beds were being inappropriately used by patients who did not need, or who no longer needed, acute hospital care. This problem arises due to a shortage of places in the areas of step-down or convalescent care, rehabilitation facilities and community based services which reduce the need to use acute hospital care. Accordingly, I have provided extra funding of £9 million in 1999 for services for older people which will be an important factor in help ing to free up acute hospital beds currently occupied by patients who could be accommodated in more appropriate convalescent or extended care facilities or discharged home if adequate community supports were available.

Among other things, the £9 million will be used to improve the home help service, increase the number of nursing and paramedical staff in the community, provide support for carers, enable a number of new health board convalescent or extended care facilities to open and increase the number of private nursing home places either subvented or contracted by health boards. There are also a number of chronic sick patients in acute hospitals who have completed the acute phase of their illness and who are awaiting placement at a level of care more appropriate to their needs. The task of identifying and securing appropriate alternative care facilities for them is under way and this will have a significant impact on freeing up acute beds in general hospitals over the coming months.

On a point of order, I asked the Minister a question about the difficulties in accident and emergency departments in recent weeks. He apparently thinks it is appropriate to deliver a second stage speech on the running of the health service. Is this not Question Time, Sir, because the Minister has ranged far and wide across a broad range of issues?

The Chair has no control over the length of the reply from a Minister. As the Deputy will be aware, the system under which the Minister had two minutes for his reply has lapsed and we have reverted back to the old system of dealing with Priority Questions. However, I ask Ministers and Members to be as brief as possible to ensure we get through as many questions as possible at Question Time.

We had this speech on the Estimates before Christmas.

The reason I am giving such detail on this matter is that it has been suggested since the Parliament last met that there was no activity on dealing with the issues arising. I am using the opportunity of the first priority question to outline to the public the detailed work which is going on in all of our hospitals and the extra money which is being provided to deal with the problem. I have already outlined the detailed provision for accident and emergency services. It is clearly the case, and it has been my contention all along, that some of the problems in the accident and emergency services cannot be dealt with in the context of the acute hospital sector alone. Therefore, I am outlining to the Deputy – perhaps to his embarrassment in view of the greatly increased allocation compared with when he was in Government – the moneys which are being made available to services for the elderly which will allow people to obtain other sub-acute care facilities in the system so that we can provide better care for people, some of whom had to deal with less than ideal situations in the accident and emergency services in recent weeks. Given that this is a priority question on a matter which has raised much public comment outside the House, it is appropriate for me to deal in detail with the issue in the House, the place to which I am accountable for my actions. I am sorry if the Deputy thought I had no response to give to the question; I have a very detailed response to give to it.

In the Eastern Health Board, where the pressure on accident and emergency services has been greatest, £3.83 million of the additional allocation of £9 million is being allocated by way of £260,000 for home help pay, an extra £504,000 for home help development, an extra £1.25 million for new units, an extra £613,000 for contract beds, an extra £120,000 for voluntary groups, an extra £532,000 for nursing home subventions, an extra £150,000 for geriatricians, an extra £125,000 for carers support, £100,000 for community supports, and an extra £176,000 for other services.

Exchequer capital spending for 1999 will be £155 million, and the corresponding allocations for next year and 2001 will be £165 million and £205 million, respectively. This three year total for the health capital programme of £525 million represents a significant increase of £216 million, or almost 70 per cent, on the sum of £309 million provided by the previous rainbow Government for the three year period 1995-97 and reflects the Government's recognition that the health capital programme has not been adequately resourced in the past. As a consequence of this increased investment, major capital projects are under way or planned for hospitals such as the Mater and Temple Street hospitals, St James's Hospital, James Connolly Memorial Hospital, Blanchardstown, Naas General Hospital, University College Hospital, Galway, Cork University Hospital, Castlebar General Hospital, Portlaoise General Hospital and Limerick Regional Hospital, all of which include the provision of enhanced accident and emergency facilities and support services.

The increase in demand which has been experienced in accident and emergency departments in recent weeks has resulted in a less than ideal situation for persons presenting for care and treatment. I regret any distress or inconvenience which this may have caused. I am confident, however, that the measures which I have outlined will contribute significantly to ensuring in future that waiting times are kept to an absolute minimum, having regard to the difficulty in predicting attendance patterns.

Has the Minister any perception of the public outrage about the chaos which prevailed in accident and emergency departments in a variety of hospitals across the country? Does he acknowledge that during his tenure in office there has been a scandalous lack of long-term planning to address the issue of peak demands on accident and emergency departments? This is the second winter during which the Minister has presided over health matters. Can he explain why he gave pledges in 1997 that difficulties experienced in accident and emergency departments in the winter months in 1997 would not recur in 1998 and why he failed to live up to those pledges?

Will the Minister acknowledge that the huge cutbacks in hospital beds during December in hospitals the length and breadth of this country contributed to the demand on accident and emergency departments in hospitals, placed the staff of those hospitals in an impossible position during December and January, more importantly, caused a great deal of pain, distress and worry to many people who had to attend at accident and emergency departments and placed lives at risk?

As regards the perception of the problem, if Deputy Shatter and those like him were politically honest, it would be very easy to dispel the perception he has been promulgating for the past three weeks, that the whole system is in a state of crisis. That is a perception which the Deputy, for his own party political advantage, would seek to have people believe. I have the political honesty to come in here to outline the actual situation and say what this Government is doing about it. I am prepared, on the basis of objective facts, to compare the work we are doing to what the Deputy was prepared to do when he supported a Government in this House.

I am prepared, based on the answer I gave to this question—

The Minister has been in office for two years, he is fixated with the previous Administration.

—and I have not interrupted the Deputy—

The Minister without interruption.

It is Deputy Shatter's tactic to raise an emotional level of concern to obscure the objective assessment of what is being done, which I have outlined in detail in my reply, compared to what was done by a Government and Minister he supported. I am prepared to allow the people compare what pro-active steps are being taken under this Administration to those taken by his.

It is suggested that I deal with perceptions. I have no intention of dealing with perceptions. I intend to deal with the realities.

The activity levels in all our hospitals since I entered office have increased. There is more surgery, more in-patient procedures, more day care procedures, more people being treated in our hospitals than in the history of the State and more resources are going towards ensuring these procedures continue. As regards the symptomatic problems in the accident and emergency services to which the Deputy referred, I have outlined the detailed plan being implemented while the Deputy continues to contend at every opportunity when he sees a microphone, that the health system is in crisis.

That does a great disservice, not to me as it is a typical and predictable political onslaught from an Opposition which has nothing else to say but to the professionalism and commitment of people in hospitals who are providing an adequate level of service, albeit in some instances in less than ideal circumstances.

Is the Minister seriously suggesting we have not experienced weeks of crisis in the health service? Does he regard it as acceptable that an 89 year old woman with pulmonary pneumonia should be on a hospital trolley in a major hospital for 32 hours before she can be provided with a hospital bed? Does he regard it as acceptable that an 11 month old baby with a leg broken in two places should wait in an accident and emergency department for two hours to see a junior doctor, with the parents then being told that no-one could let them know at what time the child might be x-rayed, as a result of which, the parents had to go to another hospital? Is the Minister seriously suggesting that when events of that nature take place in our hospitals, we have a temporary difficulty and that services are adequate? Will the Minister acknowledge the crisis which has been seen by the vast number of people who have attended our hospitals? It is not the fault of hospital staff but of the Minister and his Department for failing to plan for the winter months and for not providing in good time the resources these hospitals need.

The Deputy can list individual cases, of which there are many more than the two listed by him, where people have faced difficulties because of the surging demand on services in the past three weeks. That is not a novel phenomenon and is one which, unfortunately, is present in every advanced health care system which I know of in the western world. If Deputy Shatter says it is possible to devise a health system where that will not occur on any day of the week, at any time of the year, he is being politically dishonest and is saying to the people that he can deliver that level of service when he knows, in his heart and soul, he cannot. If the Deputy wishes to persist with that perception to make himself popular by riding on that kind of politics, I will not play that game.

Where was the Deputy when he supported a Government which gave less money, provided fewer resources and which did not provide any capital expenditure to improve facilities which he now says are inadequate? People can see the Deputy's motivation, which has nothing to do with improving services. The Deputy may give subjective cases and what he outlined is not ideal, but it happened this year, it unfortunately may happen in the future and it certainly happened in the past. More resources are being provided by this Administration to ensure that fewer of the hard cases to which the Deputy referred occur. I can give no absolute guarantee, as the Deputy certainly cannot, that it might not happen again. The public should be credited with more intelligence than the Deputy is prepared to give it.

Is the Minister aware that the logic of what he is telling the House is that he does not regard it as his job to ensure the type of crisis experienced this winter does not recur? Is he aware that the public regard it as his job to ensure this crisis does not recur? Is he aware that when, in a recent broadcast, he spoke about his commitment to the taxpayer in the context of saving money, the majority of people listening were of the view that it is the Minister's job to protect the health of patients and to deliver the medical care which people require to lead a normal life? Will the Minister acknowledge that his fixation with taxation issues at a time when this country is overflowing with money does not do service to those on escalating waiting lists who look to him to do his duty?

The Deputy is not doing a service to the public by coming out with that nonsense. I presume he believes taxpayers are also patients – has he a problem with that? His argument is based on a totally nonsensical premise. If we are seriously honest with the people, this year we will pay back interest totalling more than £2.5 billion on our national debt. If we had less debt we would not pay as much interest. It would be great if we could contribute £700 million or £800 million pounds of that £2.5 billion to the health service every year—

What is more important – to save lives or pay back more of the debt than we need to?

—that would be the prudent and proper thing to do.

The Minister's priorities are wrong.

The Minister without interruption.

To revert to the Deputy's central criticism, I am prepared to do in Government what he was not prepared to do, which is to stand over an agreed basis on which we believed we could plan an orderly development of the health services, based on the costs coming down the system to us – that is to provide for proper and full accountability of taxpayers' money.

The Minister is accountable for the chaos we have seen in the past month.

I will insist that the money we get should be used properly and to the best possible benefit of everybody using the health service. I have succeeded in getting more money for the health services than anyone on the Deputy's side of the House.

No one outside this House believes the Minister is doing his job properly.

This year I obtained an increase of 10 per cent on the budget so that we can deal with some of these problems. People are fed up with the vacuous arguments of people on the opposite side of the House who are not prepared to face up to the realities. The realities are that we have a greater demand on our health services, we need to invest in our facilities and we must be prepared to have a larger capital programme which we did not have under the Deputy's Administration. With the provision of the money referred to in my detailed reply, we have an opportunity to deal with the problems which occur perennially in our health services by putting in place an investment programme in our hospitals and health services generally to improve the situation. We have, in construction and in planning, a far greater number of projects in that respect than was within the capability of the Deputy's predecessor, however well meaning he might have been, who did not get the money from a Labour Minister for Finance.

We want a guarantee that the same crisis will not recur next year.