Skip to main content
Normal View

Dáil Éireann debate -
Tuesday, 11 Feb 2003

Vol. 561 No. 1

Written Answers. - Accident and Emergency Services.

Thomas P. Broughan

Question:

122 Mr. Broughan asked the Minister for Health and Children his views on the findings of the CAPITA report, commissioned by the Health Service Employers Agency into accident and emergency departments; the steps he intends to take to address the shortcomings identified in the report; and if he will make a statement on the matter. [3399/03]

In early 2002 action was taken by nursing staff in accident and emergency departments of hospitals providing such services. Proposals put forward by the Labour Relations Commission – LRC – aimed at resolving the dispute included an independent review of the bed management function in acute hospitals providing accident and emergency services. The review was commissioned by the Health Service Employers Agency – HSEA – and the unions representing nursing staff in accident and emergency departments. Its purpose was to help to establish some of the causes of weakness in the system and to provide guidance on how these difficulties might be addressed. The CAPITA report referred to by the Deputy is the product of this independent review and was completed on 27 January 2003.

While the report is critical of certain aspects of bed management it found, in general, evidence of good bed management practices around the country. The report is designed to ensure the development of enhanced and uniform bed management practices across the hospital system. Its recommendations are at present being considered by the management and staff sides in the context of the continuing implementation of the LRC proposals.

Improved bed management is one of a range of measures being taken to improve accident and emergency services arising from the LRC proposals. Management structures and procedures have been strengthened; a staffing review is nearing completion while a review of security practices was conducted and its recommendations are being implemented.

In addition to the LRC initiatives the Government has taken a number of measures designed to further enhance 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 now 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 in accident and emergency departments. These include: €6.59 million towards the development of accident and emergency facilities at St. James's 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; 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; development of accident and emergency department at the Mater Hospital; extension to the accident and emergency department at St. Columcille's 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; the provision of minor injuries units in Beaumont, Mater, James Connolly Memorial, St. James's and Tallaght Hospitals; and the development of pilot services for deep venous thrombosis in Beaumont Hospital.
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, ERHA, 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 re-focus on primary care services, marked by the introduction of new models of care involving core multidisciplinary 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. Over €17 million was invested in the development of this service in 2002.
Finally, I can assure the Deputy 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.
Top
Share