Dáil Éireann debate -
Thursday, 18 Nov 1999

Vol. 511 No. 2

Written Answers. - Health Service Expenditure.

Noel Ahern

Question:

116 Mr. N. Ahern asked the Minister for Health and Children the resources spent in each health board area for the most recent year available by health services expenditure, hospital expenditure and accident and emergency department expenditure; and the accident and emergency improvements in the Dublin area in progress or planned. [23983/99]

Minister for Health and Children (Mr. Cowen)

Unfortunately, some of the information requested by the Deputy is not available in the format sought. The original non-capital expenditure provision for 1999 for the health services was some £3,508 million. Spending on the general hospital programme constituted £1,724 million or 49% of the total. In 1999, a total of £70.9 million was made available for service developments in the acute hospital services. Further funding was provided for pay increases, non-pay inflation and other cost increases. The Abridged Book of Estimates published last week sets out the funding available before the provision of any additional funding in the budget. These Estimates provide £69 million for service developments in the acute hospital sector. The scale of increased resources being provided by this Government will undoubtedly deliver major improvements in hospital services. The capital provision for hospital services alone under the national development plan will be of the order of £1 billion. This is an unprecedented level of investment and will transform the fabric of hospital infrastructure throughout the country.

With regard to accident and emergency improvements, in 1997 £2 million was provided for the delivery of an accident and emergency plan in Dublin. In 1998, a further £2.5 million was made available to accident and emergency services nationally but concentrated particularly in the Dublin region. In the current year, a further £2 million was made available of which £1.65 million went to agencies in the Dublin region. The initiatives taken as a result of this funding include measures to free up beds for emergency admissions through the provision of alternative step down facilities for patients occupying beds in acute hospitals for lengthy periods. This has also allowed 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.

The single biggest contributing factor to delays for patients in accident and emergency departments is the inability to secure acute hospital beds for patients who require admission from accident and emergency departments. There are in excess of 200 acute hospital beds inappropriately occupied at any given time in the Dublin area. This problem has occurred as acute hospitals have not been able to discharge patients in sufficient num bers and quickly enough, to cater for new patients seeking the services of the hospital. The importance of this issue was confirmed in the report of the review group on the waiting list initiative. As I have stated on a number of occasions, I am committed to ensuring that the recommended approach in this report is speedily implemented.

In particular, the report identified 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. In an effort to address these problems, I provided extra funding in 1999 of £9 million for services for older people. This funding will help to free up acute hospital beds which are 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. It will improve the home help service, increase the number of nursing and paramedical staff in the community, enable 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 patients, including the chronic sick and disabled, 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. Earlier this year, I asked the Eastern Health Board, in conjunction with the Dublin acute hospitals which provide accident and emergency services, to examine this particular aspect of the accident and emergency services and to formulate a response to the situation. I am pleased to say that the board has submitted a comprehensive action plan which takes into account this group of patients who need a mixture of sub-actute care services.

I have already agreed to the implementation of the action plan which provides for an additional 235 alternative care places to cater for patients across the spectrum at a capital cost of £1 million and revenue cost of £438,000 in 1999. These 235 places can be broken down as follows; 70 sub-acute/convalescent places, 25 young chronic sick places, and 140 long stay contract nursing home places. These places are now coming on-stream and I am assured by the health board and Dublin hospitals involved in the plan that these additional places will significantly reduce the pressure on our accident and emergency services in the immediate future.

I am confident that the major initiatives already under way will impact in a significantly positive manner in addressing the difficulties facing our accident and emergency departments.

Finally, I am happy to announce that as a result of the revenue funding provided in last week's Estimates a further £5 million will be available next year to build on these initiatives and enhance significantly sub-acute services to continue to free up resources within hospitals for the treatment of those requiring acute hospital treatment.