I am aware that in recent times hospitals providing accident and emergency services, including St. James's Hospital, have experienced increased activity. However, it is important to note that while patients may experience delays in accident and emergency departments, appropriate medical treatment is provided at all times.
A contributing factor to the delays for patients who are awaiting admission from accident and emergency departments to acute hospitals is the number of patients who are inappropriately occupying acute hospital beds. The report of the review group on the waiting list initiative indicated that a significant proportion of such 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.
As part of a package of measures to address these problems the Eastern Health Board, in conjunction with the Dublin acute hospitals which provide accident and emergency services, were asked to examine this particular aspect of the service and to formulate a response. The board submitted a comprehensive action plan which takes into account the complex group of patients who need a mixture of sub-acute care services. This group include young chronic sick, physical rehabilitation cases, medical rehabilitation patients and elderly patients. The implementation of the plan, which provides an additional 235 alternative care places to cater for patients across the spectrum, has already been agreed and 205 of the places are already in situ. The remaining 30 will be in place by early February 2000. These 235 places can be broken down as follows: 70 sub-acute or convalescent places, 20 of which are located on the campus of St. James's Hospital, 25 young chronic sick places and 140 long stay contract nursing home places.
In addition management at St. James's Hospital has proposed a range of measures aimed at alleviating pressure and improving the delivery of service in its accident and emergency department and these measures will be discussed in the context of the hospital's service plan for 2000.
