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Dáil Éireann debate -
Wednesday, 20 Feb 2002

Vol. 549 No. 1

Written Answers. - Employment Conditions.

Jim O'Keeffe

Question:

40 Mr. J. O'Keeffe asked the Minister for Health and Children his views on whether working conditions for staff and facilities for patients in many hospital accident and emergency units are chaotic; and his proposals to improve the situation. [5697/02]

Liz McManus

Question:

94 Ms McManus asked the Minister for Health and Children the steps being taken to deal with the crisis in accident and emergency departments of our hospitals, especially the overcrowding, threat of violence and long delays, as a result of which both the INO and SIPTU are planning to take industrial action; and if he will make a statement on the matter. [5759/02]

Question:

109 Mr. Coveney asked the Minister for Health and Children the steps he is taking to address the concerns of nurses and other care workers in relation to the state of accident and emergency facilities. [5842/02]

I propose to take Questions Nos. 40, 94 and 109 together.

I welcome this opportunity to inform the House of the many initiatives which I and this Government has taken to improve the provision of accident and emergency services in hospitals. As the Deputies will be aware, the hospital system in general is experiencing increased pressure on elective beds because of the growing number of admissions through accident and emergency departments. Available data indicates that about 70% of all hospital admissions are through accident and emergency departments. In addition, a growing proportion of bed capacity is being taken-up by the elderly who have a higher than average length of stay.

Hospitals providing accident and emergency services experience a seasonal increase in activity and surge in admissions during the winter months. Every effort is made to keep waiting times to an absolute minimum and to ensure that appropriate medical care is provided at all times. A triage system of assessment operates at accident and emergency departments whereby each patient attending at an accident and emergency department is assessed and treated according to his/her medical priority, the objective being to ensure that a person requiring treatment has access to a senior clinical decision-making service and is treated without undue delay.

One of the initiatives taken by this Government to improve services in accident and emergency departments included the provision of €40.63 million investment package in the winter of 2000-2001 aimed at alleviating service pressures and maintaining services to patients, particularly in the acute hospital sector. This investment package was targeted at a number of areas, including the recruitment of additional accident and emergency consultants.

Funding was also provided for the contracting of additional private nursing home places by the Eastern Regional Health Authority and the health boards. These places are for patients whose acute phase of treatment has been completed but who require additional care in an alter native setting. The ERHA and the health boards contracted more than 700 beds under this initiative in the winter of 2000-2001 and this helped to free up acute beds for patients awaiting admission to hospitals. Funding was also allocated to the ERHA and each health board for the contracting of private nursing home places for the final three months of 2001.
The Deputies will be aware of the health strategy Quality and Fairness – A Health System For You recently published by this Government. This strategy outlines a programme of investment and reform of the health services starting immediately and continuing up to 2011. As part of the preparation work for the strategy my Department, in conjunction with the Department of Finance and in consultation with the social partners, conducted a comprehensive review of acute hospital bed capacity needs. On foot of that review entitled Acute Hospital Bed Capacity – A National Review, which I published in early January the Government decided, in the context of the strategy, to provide an additional 3,000 beds in acute hospitals over the next ten years. I announced on 16 January a €65 million investment package in the current year for the commissioning of 709 of these 3,000 beds in acute hospitals and these will come on stream before the end of this year. I am confident that once these beds are put in place, there will be a visible improvement in accident and emergency services.
Other initiatives have been identified in the health strategy which are designed to improve the operation of accident and emergency departments. These include: the establishment of 24-hour GP co-operatives which will reduce demand from, and treat appropriately, patients who would otherwise attend at accident and emergency departments. €17.292 million is being invested in the development of this service in 2002; the appointment of additional accident and emergency consultants (12 additional consultants have been appointed over the last year and funding has been provided to recruit a further 17); the establishment of minor injury units to ensure appropriate treatment and management of non-urgent cases; the use of chest pain clinics, respiratory clinics and in-house specialist teams to fast-track patients as appropriate; the re-organisation of diagnostic services to ensure increased access to, and availability of, services at busy times in accident and emergency departments; the appointment of advanced nurse practitioners (ANPs) (emergency) in acute hospitals; the use of admission protocols to ensure that emergency patients will be the only group of patients admitted to hospital through accident and emergency departments; the appointment of additional personnel to liaise with patients while they await diagnosis and treatment at accident and emergency departments and the introduction of information systems that record comprehensive, comparable and reliable data on activity in accident and emergency departments. Such information will provide staff with a valuable tool in structuring services to meet the needs of patients.
Comhairle na nOspidéal is reviewing, at my request, the structure, operation and staffing of accident and emergency services and departments with the aim of improving the provision of patient care. This review has involved extensive consultation with the ERHA, each health board, relevant voluntary hospitals, appropriate professional bodies and other interested parties. The review also involved an extensive examination of literature regarding accident and emergency services in Britain, Europe, the US, Canada and Australia. I understand that the report of this review is almost completed and I look forward to studying its findings in the near future. Its findings will also inform and assist in the improvement of the provision of services in accident and emergency departments.
Many of the initiatives which I have outlined above will take time to come on stream and to impact positively on accident and emergency services. Therefore, on 13 February, I announced that I intended to establish an accident and emergency forum to identify steps that can be taken immediately to alleviate current problems in accident and emergency services. The forum, which will be chaired by Dr. Danny O'Hare, former president of Dublin City University, will take place shortly.
Participants will include all relevant stakeholders: hospital management, members of the medical and nursing professions, para-medical and non-nursing personnel, staff representative associations and unions, patient advocacy groups and other interested parties. Preparations for the establishment of the forum are under way and I strongly urge all stakeholders to attend. It is with dialogue and the sharing of views that we can reach workable solutions which will assist in alleviating the current difficulties, prior to the other initiatives coming on stream.
The issue of violence against any health service worker is a very serious matter. In the year 2000, I asked the ERHA and each health board to review their security arrangements in accident and emergency departments and to identify deficiencies. Arising from the review, I allocated €1.27 million in 2001 to the ERHA, health boards and directly funded voluntary hospitals to improve security arrangements in accident and emergency departments. This money was allocated to address issues such as additional security personnel, installation of CCTV and training of staff on how to manage/handle aggressive patients.
I met with the Health and Safety Authority in February 2001 and one of the issues for discussion was violence in the work place. The Health and Safety Authority informed me that they planned to step up the number of reviews of hospitals in relation to health and safety issues, of which work place violence is an important issue. I welcome this development and I have since written to the chief executive officers of the ERHA and the health boards informing them of the need to take all necessary measures to address risks to health service staff in this regard.
I am satisfied that the range of initiatives which I have outlined will contribute to a significant improvement in services to patients attending accident and emergency departments and represents tangible evidence of the Government's commitment to the development of a patient-centred health service.
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