Written Answers. - Accident and Emergency Services.
John Bruton
Question:
108
Mr. J. Bruton
asked the
Minister for Health and Children
the arrangements being made for smaller general hospitals, for example Ennis, which have not as of now, a 24 hour consultant-led accident and emergency cover; the implications for this service from long to medium term; and if he will make a statement on the matter.
[3438/03]
Pat Breen
Question:
132
Mr. P. Breen
asked the
Minister for Health and Children
the arrangements being made for smaller general hospitals, for example Ennis, that have not as of now, a 24 hour consultant-led accident and emergency cover; and the implications for this service from long to medium term.
[3435/03]
Bernard J. Durkan
Question:
149
Mr. Durkan
asked the
Minister for Health and Children
the extent to which accident and emergency facilities in hospitals are adequate to meet ongoing and increasing demands; the initiatives he proposes to address the issue; and if he will make a statement on the matter.
[3454/03]
Richard Bruton
Question:
150
Mr. R. Bruton
asked the
Minister for Health and Children
if he has received reports on the pressures on accident and emergency services on Dublin's northside; and if he will make a statement on the matter.
[3300/03]
David Stanton
Question:
164
Mr. Stanton
asked the
Minister for Health and Children
if the future of the accident and emergency department at Mallow General Hospital will be guaranteed; and if he will make a statement on the matter.
[3458/03]
Paul Nicholas Gogarty
Question:
182
Mr. Gogarty
asked the
Minister for Health and Children
his plans to fund minor injury clinics, such as that established at Victoria Infirmary and Gartnavel General Hospital in the UK, to ease the demands on hospital accident and emergency departments; and if he will make a statement on the matter.
[3466/03]
Olivia Mitchell
Question:
360
Ms O. Mitchell
asked the
Minister for Health and Children
the arrangements which are being made for smaller general hospitals that have not 24 hour consultant-led accident and emergency cover; the implications for this service from long to medium term; and if he will make a statement on the matter.
[3477/03]
Bernard J. Durkan
Question:
429
Mr. Durkan
asked the
Minister for Health and Children
if there has been a curtailment of accident and emergency facilities at various hospitals throughout the country; and if he will make a statement on the matter.
[3762/03]
Bernard J. Durkan
Question:
430
Mr. Durkan
asked the
Minister for Health and Children
the changes which have been made in respect of accident and emergency facilities at various hospitals throughout the country; if an attempt is being made to improve the degree of services; and if he will make a statement on the matter.
[3763/03]
Bernard J. Durkan
Question:
431
Mr. Durkan
asked the
Minister for Health and Children
the degree to which adequate accident and emergency facilities have been improved in the various hospitals throughout the country; and if he will make a statement on the matter.
[3764/03]
I propose to take Questions Nos. 108, 132, 149, 150, 164, 182, 360, 429, 430 and 431 together.
I am aware that the hospital system in general is experiencing increased pressure on available beds due to a number of factors, including the growth in population, the availability of in-patient beds and the increasing number of elderly people who have a higher than average length of stay. The pressure on the hospital system, and in particular on hospitals providing accident and emergency services, is more severe over the winter months.
The Government has taken a number of measures designed to enhance accident and emergency services. A €41 million investment package was provided 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 provided, inter alia, for the recruitment of an additional 29 accident and emergency consultants. Seventeen of these posts have been filled and the recruitment process is continuing in respect of the remaining posts.
Funding has also been provided in recent years to the ERHA and the health boards to support a further range of initiatives aimed at improving services in accident and emergency departments of acute hospitals. These include €6.59 million towards the development of accident and emergency facilities at St. James's Hospital; development of accident and emergency department at the Mater Hospital; development of new accident and emergency department at St. Vincent's Hospital, Elm Park; development of new accident and emergency department at the Children's Hospital, Temple Street; planning of a new accident and emergency department for Cork University Hospital; development of accident and emergency department at Galway University Hospital; development of accident and emergency department at Castlebar General Hospital; development of accident and emergency department at Tullamore General Hospital; appointment of a design team for the development of a new accident and emergency department at Roscommon County Hospital; upgrading of accident and emergency facilities at Our Lady of Lourdes Hospital, Drogheda and Our Lady's Hospital, Navan; extension to the accident and emergency department at St. Columcille's Hospital; development of pilot services for deep venous thrombosis in Beaumont Hospital; provision of a chest pain service at St. James's Hospital; the recruitment of discharge planners and patient liaison personnel at accident and emergency sites in the eastern region; and the provision of minor injuries units in Beaumont, Mater, James Connolly Memorial, St. James's and Tallaght Hospitals.
Other initiatives which are designed to improve the operation of accident and emergency departments are outlined in the national health strategy, Quality and Fairness – A Health System for You. These include the establishment of further 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; 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. In addition, at my request, Comhairle na nOspidéal has undertaken a detailed review of the structures, operation and staffing of accident and emergency departments. The report entitled, Report of the Committee on Accident & Emergency Services, not only deals with the staffing of accident and emergency departments at consultant level but also links reform of accident and emergency departments with the need to look critically at hospital processes and patient flows through the hospitals. The report provides valuable advice on the structure of our emergency services and the necessary linkages which will be required to eliminate delays in emergency departments.
Last year I established an accident and emergency forum to identify urgent measures which could be taken in order to enhance accident and emergency services in acute hospitals, consistent with the commitment in the health strategy. The work of the forum helped to build on the existing and proposed policy framework for accident and emergency services as set out in the strategy. A number of short, medium and long-term actions aimed at alleviating service pressures were identified and these are now being advanced by the national partnership forum through the involvement of partnership groups at local level.
The provision of accident and emergency services must also be seen in the context of a range of additional initiatives which are being taken by this Government to significantly enhance the treatment capacity of the hospital and community sectors. Following a comprehensive review of acute hospital bed capacity needs, the Government decided, in the context of the health strategy, to provide an additional 3,000 beds in acute hospitals over the next ten years. My Department provided funding to the Eastern Regional Health Authority and the health boards for the commissioning of 520 of these additional beds in 2002. This exceeds the target of 450 public beds as announced in the health strategy, Quality and Fairness – A Health System for You.
Additional sub-acute capacity has also been provided. For example, in the eastern region community nursing units, each with a 50 bed capacity, have opened in Lusk, Maynooth and Dalkey. Revenue funding has been provided to the ERHA to ensure that all of these additional beds will be commissioned in the current year. A major refocus 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, has taken place. 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. My Department provided funding of €17.29 million for development of this service in 2002. The standards applying to the training of postgraduates are being reviewed on an ongoing basis. As changes to these standards have implications for service delivery I established the inter agency health care forum, IAHCF, to allow those who set standards and those who deliver service to discuss emerging issues. The IAHCF meets quarterly to discuss various issues of concern, including the implications of the implementation of new training standards. The forum is chaired by the chief medical officer at my Department. Comhairle na nOspidéal, the health boards, the Medical Council, the postgraduate medical and dental board and the training bodies are also represented at the forum.
In June 2002, the Irish surgical postgraduate training committee, ISPTC, of the Royal College of Surgeons of Ireland published guidelines for the recognition of training posts in accident and emergency departments of acute hospitals providing such services. These guidelines state that:
The [Accident and Emergency] Department must be under the clinical and administrative control of one or more Emergency Medicine Consultants devoting the whole or major part (eight or greater sessions) of their clinical time to the day to day supervision and training of the junior medical staff.
The RCSI has indicated that these guidelines represent an "ideal situation" and is willing to meet with service providers to agree interim arrangements which will allow hospitals to continue to provide accident and emergency services while arrangements are being put in place to meet the standards required. Discussions on the guidelines are also taking place between Comhairle na nOspidéal, the Medical Council and the RCSI.
The provision of accident and emergency services at Mallow and Ennis General Hospitals is a matter in the first instance for the Southern and Mid-Western Health Boards respectively. I understand that the interim arrangements which I have referred to are being fully adhered to by the Mid-Western Health Board and that the Southern Health Board is awaiting the outcome of the discussions on the guidelines which are taking place between the comhairle, the Medical Council and the RCSI before finalising its proposals in relation to accident and emergency services at Mallow.
I am aware of the accident and emergency pressures which are being experienced on Dublin's north side. A number of initiatives are being taken to alleviate this situation including the provision of 35 additional beds at Beaumont Hospital and capital funding in excess of €1 million for the extension and refurbishment of facilities at the Mater Hospital's accident and emergency department. In early 2002 action was taken by nursing staff employed in accident and emergency departments in hospitals providing such services. The Labour Relations Commission put forward proposals aimed at resolving the dispute. These included the undertaking of a full security assessment of accident and emergency departments of hospitals providing such services.
The establishment of a national accident and emergency nursing staffing structures review group to carry out an immediate examination of existing structures and staffing levels in accident and emergency departments and a review of the bed management function in acute hospitals providing such services. I am pleased to advise that the staffing review is nearing completion, a review of security practices was conducted and its recommendations are being implemented while the report of the bed management function has recently been completed. This report, while critical of certain aspects of bed management, found, in general, evidence of good bed management practices throughout the country. The report is designed to ensure the development of enhanced and uniform bed management practices across the hospital system. Its recommendations are being considered by the management and staff sides in the context of the continuing implementation of the LRC proposals.
Finally I assure the Deputies that I remain committed to ensuring that accident and emergency departments are in a position to respond effectively to demand. I am confident that hospital management and staff in hospitals providing accident and emergency services will continue to work together to respond to any difficulties presenting and to ensure that a high quality service is provided to patients in the best conditions possible.
