Skip to main content
Normal View

Dáil Éireann debate -
Wednesday, 20 Mar 2002

Vol. 550 No. 4

Written Answers. - Accident and Emergency Services.

Bernard J. Durkan

Question:

451 Mr. Durkan asked the Minister for Health and Children the way in which he proposes to address the evolving situation at accident and emergency departments in the various hospitals throughout the country in view of the seriousness of the overcrowding, under-staffing and dangerous working conditions; and if he will make a statement on the matter. [9518/02]

As the Deputy 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 or 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 2000-01 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 alternative setting. The ERHA and the health boards contracted more than 700 beds under this initiative in the winter of 2000-01 and this helped to free up acute beds for patients awaiting admission to hospitals. This level of funding was repeated over the winter period October 2001 to March 2002 and has been of significant benefit to health agencies in responding to the high level of demand for hospital beds over the winter periods.
The Deputy 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.
In recent years there has been an increasing concern that adequate out-of-hours general practitioner provision could not be found. In itself this perception has led to increasing attendance at accident and emergency departments. A new quality based approach founded on co-operation and partnership between health professionals seemed to be the answer.
A major re-focus on primary care services marked by the introduction of new models of care involving core multi-disciplinary primary care teams, which will work with a wider network of health and social care professionals and which will offer 24 hour cover to patients. This will also help to reduce demand from and treat appropriately patients who would otherwise have to attend at an accident and emergency department. This sector will therefore take on a pivotal role in helping to reduce pressures in accident and emergency departments. A sum of €17.29 million is being invested in the development of this service in 2002.
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 general practitioner co-operatives which will reduce demand from, and treat appropriately, patients who would otherwise attend at accident and emergency departments; the appointment of additional accident and emergency consultants, 12 additional consultants have been appointed over the past 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 – 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; 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.
When I approved the additional accident and emergency consultant posts, I requested Comhairle na nOspidéal to undertake a review of the structures, operation and staffing of accident and emergency departments. Comhairle na nOspidéal has undertaken a lengthy consultative process involving health boards and health professionals and their report, the publication of which I understand is imminent. This report not only deals with the staffing of accident and emergency departments at consultant level but links reform of accident and emergency departments with the need to look critically at hospital processes and patient flows through the hospitals. The report of Comh airle na nOspidéal will provide valuable advice on the structure of our emergency services and the necessary linkages which will be required to eliminate the delays in emergency departments.
Many of the initiatives I have outlined 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 is chaired by Dr. Danny O'Hare, former President of Dublin City University, is taking place today, Wednesday, 20 March.
Participants 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. The work of the forum will help to build on the existing and proposed policy framework for accident and emergency services as set out in the national health strategy.
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 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 or handle aggressive patients.
I met the Health and Safety Authority in February 2001 and one of the issues for discussion was violence in the workplace. The authority informed me that it 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.
In relation to the action being taken by nursing staff in accident and emergency departments following discussions held on 15 and 16 March and on 19 and 20 March, the Labour Relations Commission has put forward a series of proposals aimed at resolving the current dispute. Both sides are recommending acceptance of the proposals and these will be presented by the Nursing Alliance to its members tomorrow, 21 March. I hope the proposals will be accepted and the dispute, as a consequence, will be resolved speedily.
Top
Share