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.