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Dáil Éireann debate -
Wednesday, 28 Feb 2001

Vol. 531 No. 4

Other Questions. - Nursing Homes.

Seán Ryan

Question:

27 Mr. S. Ryan asked the Minister for Health and Children if his attention has been drawn to concerns expressed by consultants that greater use of step down facilities in nursing homes may result in elderly patients not receiving the appropriate level of medical care; the resources he will provide to ensure that all appropriate medical facilities, including rehabilitation facilities, are available in such locations; and if he will make a statement on the matter. [5970/01]

I presume the Deputy is referring to the winter initiative which was announced in October of last year. This initiative was designed to help alleviate anticipated service pressures and to maintain services to patients in the acute hospitals sector over the winter period. Under the initiative, I provided investment funding of £25 million which is being targeted at a number of areas, including the provision of aids and supports for use by older people and the recruitment of more than 40 additional hospital consultants to the hospital system. A key element of this initiative was the provision of funding to contract more than 500 places in private nursing homes. These beds are being contracted for the purpose of providing alternative complementary facilities for patients who have completed the acute phase of their treatment and care in a general hospital and who require short-term care in a more appropriate setting.

I emphasise that the continuing care needs of such patients discharged from a general hospital are determined by the appropriate consultant medical team. Consequently, there should be no question of people being discharged prematurely from acute hospital care without access to appropriate follow-up medical care provided, for example, through the general practitioner service. I recognise the need to further develop assess ment and rehabilitation services so that older people receive more effective treatment. More than £200 million has been made available to services for older people over the lifetime of the national development plan and health boards will develop such services as part of the plan. This issue is also being considered as part of the national review of bed capacity in the acute and sub-acute sectors.

In addition to the initiative I have outlined, the Government has provided considerable additional resources, both capital and revenue, for the development of services for older people. In the budget extra resources have been earmarked to continue this development. More than £10 million has been allocated for 2001 for community-based services, including improvements in the home help service and the further development of home rehabilitation services. This funding will be used to enhance the scope of the home help service to cover more people and to provide more hours for existing clients, to improve community support structures, specifically geared towards the support of older people in their homes as well as providing additional supports for carers. Additional funding has also been provided for voluntary groups who work in partnership with the health boards to provide services for older people.

Will the Minister say how many accident and emergency department consultants have been appointed? Will he state clearly that a nursing home is not a step down facility? Is he aware that some nursing homes are being asked to take patients with whom they are not fully able to cope and who have medical needs they cannot meet? Will he answer the question I have been asked by the family of a man who desperately needs to go into a nursing home where an empty bed has been commandeered by a hospital—

The Deputy's time is concluded.

I have to raise this case. This man cannot have access to proper medical care—

In fairness to other Deputies and the Minister, everyone must be confined to one minute.

The Deputy's last question is unreasonable in the sense that we took a decision to improve the capacity for public patients in terms of their discharge. I do not decide when a patient is to be discharged; this is decided by the professional medical consultant and a discharge team. A person can only be discharged when it is considered by the professionals that he should be discharged on medical grounds and no other grounds. This is an important point.

I did not invent the phrase "step down facility". I understand that it was invented by the medical community some years ago and is now out of fashion. Officials are being attacked for utilising a phrase which was perhaps invented by the medical community some time ago. It was utilised in the context of having proper facilities outside of the acute services. There should not be any argument about the need for rehabilitation services as we are committed to the provision of additional rehabilitation services.

The Minister is rambling. How many consultants have been appointed?

Please, Deputy McManus, we must have order in the House.

I do not have the figure.

The Minister does not know how many consultants have been appointed.

(Interruptions.)

I am moving on to Private Notices Questions.

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