Dan Neville
Question:1 Mr. Neville asked the Minister for Health and Children the plans and programmes he has in place to tackle the ongoing accident and emergency crisis in hospitals. [22643/03]
Ceisteanna – Questions. Priority Questions. - Accident and Emergency Services.
Many of the difficulties and delays experienced in emergency medicine or accident and emergency departments reflect system-wide issues, such as the demand experienced by each hospital and the resources available to it, as well as the structure, organisation and staffing profile of the hospital. Therefore, in tackling the problems in emergency medicine it is necessary to take a whole-system approach involving primary care, acute care and sub-acute and community care.
Comhairle na nOspidéal has undertaken a detailed review of the structures, operation and staffing of emergency medicine departments. The report, entitled Report of the Committee on Accident and Emergency Services, not only deals with the staffing of emergency medicine departments at consultant level but also links reform of emergency medicine 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.
Emergency medicine departments are subject to peaks and troughs but can become particularly busy in the winter months. This is mainly due to the high number of patients presenting with circulatory, respiratory and viral conditions, especially among the elderly. To deal with the current pressures on acute services both in the shorter term and longer term, I would like to outline to the House some of the key actions I have taken.
Pressures on emergency medicine departments can be due to the lack of available beds within the hospital. Increasing the bed capacity of the acute hospital system nationally is, therefore, a key priority. Following a comprehensive review of acute hospital bed needs, the Government decided to provide an additional 3,000 acute beds in the period to 2011. I introduced the first phase of this process in January 2002, which provided funding for an additional 709 beds. Over 560 new beds have been provided in hospitals throughout the country. Some hospitals that were not part of that initiative, particularly in the Dublin region, have temporarily closed some beds this year for financial reasons to remain within budget. These closures are in addition to the normal seasonal closures that take place in hospitals around the country during holiday periods. Currently the number of beds not in use represents less than 3% of overall capacity in the acute hospital system.
Additional information.It has been widely documented that there are a number of patients in acute hospital beds who have completed their acute phase of treatment and are ready for discharge to a more appropriate setting. The availability of suitable sub-acute beds is a particular problem in the eastern and southern regions. In this regard I have provided additional funding of €5.5 million in 2003 to the Eastern Regional Health Authority –€3.8 million – and to the Southern Health Board –€1.7 million – to facilitate the discharge of patients from acute hospitals to a more appropriate setting thus freeing up acute beds. This money allows for the funding through the subvention system of additional beds in the private nursing home sector and ongoing support in the community. I have been informed by the Eastern Regional Health Authority that more than 200 patients are expected to be discharged from acute hospitals as a direct result of this funding.
A total of 15 beds in St. Joseph's Hospital, Raheny, for use as acute rehabilitation beds are due to come on stream in November once refurbishment is complete. These additional sub-acute beds will further assist in the discharge of patients from Beaumont Hospital to a more appropriate setting.
As part of the winter initiative package in 2000-01, I announced additional funding of €40 million aimed at alleviating service pressures and maintaining services to patients. Part of this invest ment package was aimed at the recruitment of additional emergency medicine consultants and consultant anaesthetists. To date, 20 additional accident and emergency consultants have been recruited. Further appointments are being progressed by the health boards and the ERHA. The availability of senior medical staff in emergency medicine departments should facilitate rapid clinical decision making, enhanced management, diagnosis and treatment of patients.
In relation to staffing of emergency medicine departments, nursing management has been strengthened by upgradings and the assignment of additional staff in recent years to ensure that appropriate senior nursing staff are available at all times.
It is accepted that the bed management function is fundamental to the consistent application of admission and discharge policy within acute hospitals. In May 2002, CAPITA Consulting were commissioned by the Health Service Employers Agency, HSEA, to carry out a national review of the bed management function. This review found considerable evidence of good bed management practice around the country. However, in areas where the bed management function was underdeveloped, CAPITA made specific recommendations that will assist hospitals to structure more effective and integrated bed management departments. The implementation of the recommendations contained in the CAPITA report are now being progressed by a combined management and nursing union steering group under the chairmanship of the HSEA.
The integration of emergency services into the overall hospital framework provides the opportunity to deliver emergency care through the collective efforts of the entire hospital staff. One such hospital is St. Luke's in Kilkenny where innovative solutions and a hospital wide response have improved the delivery of emergency services to patients. The benefit of having a medical assessment unit on site has facilitated the rapid assessment and treatment of medical patients to a point where approximately one third of all medical patients referred to the unit by general practitioners can be discharged on the same day.
Improving the physical capacity and surroundings is an important element of the provision of an efficient emergency service. A number of capital developments have been completed in recent years and others are under way around the country aimed at improving emergency medicine departments. Examples of major new developments can be seen at Cork University Hospital and Tullamore General Hospital and an extensive refurbishment of the emergency medicine department is taking place at the Mater Hospital. Another recent development is the acute medical assessment unit at St. James's Hospital, which opened earlier this year. This unit has contributed to a noticeable improvement in the delivery of emergency services at the hospital.
As the House may be aware, I launched the influenza vaccination campaign 2003-04 on 24 September 2003. Many respiratory diseases occur every winter but influenza is one of the most severe. In those with underlying diseases, especially the elderly, complications are common and hospitalisation rates are high. Considerable resources are devoted each year to treating patients in emergency medicine departments and as in-patients in hospital who contract influenza and subsequently develop complications.
The immunisation advisory committee of the Royal College of Physicians of Ireland advises that influenza vaccine should be considered for all health care workers who have direct patient contact in both the community and health care institutions, such as hospitals and nursing homes. I have asked that the health boards encourage health care workers, particularly those on the front line to be immunised annually against influenza. My Department has written to the health boards' chief executive officers requesting that they encourage their staff to be immunised as soon as possible.
Emergency medicine departments sometimes have to deal with injuries and conditions which are more appropriate to a primary care setting. There are out of hours co-operatives in all health board areas at present, the majority of which provide full out of hours cover while others in the eastern region provide limited hours of operation. The level of patient satisfaction with the service being offered by the co-operatives is very high from both the patient and provider perspectives. Government support for the development of general practitioner out of hours co-operatives nationally for the period 1997 to 2003 amounted to €46.5 million. In time, these co-operatives can be developed to provide a much wider range of services to ensure that communities, irrespective of size and distance from major urban centres, enjoy appropriate access to primary care services.
The nature of emergency medicine presents a particular challenge in relation to the appropriate measures needed to deal with the issue. As I have already said, the various problems can only be addressed on a system-wide basis. I want to assure the House of my continuing commitment to ensuring the appropriate management response to the provision of emergency services.
The chaos over the summer period in accident and emergency units, especially in the Dublin area, is totally unacceptable. Patients were left on trolleys for days, while others were treated in ambulances in hospital car parks. Given that such serious overcrowding took place over the summer and continues to occur now, which is traditionally a period of low demand, how does the Minister expect these services to cope during the winter months? Will he open any of the beds that have been closed around the country in recent months to ensure that the accident and emergency services are ready for the dif ficulties he has mentioned are likely to arise from now to next March or April?
The additional part of my reply dealt with that issue. In July, I allocated about €5.5 million to the system, particularly to the Eastern Regional Health Authority, which received €3.8 million to facilitate the discharge of patients from acute hospitals to a more appropriate setting, thus freeing up beds for other patients. I met the ERHA, and the management of the two hospitals that were particularly concerned at that stage, and received a breakdown of the application of that money to free up beds in the acute hospitals. The ERHA has informed me that more than 200 patients are expected to be discharged from acute hospitals as a direct result of this funding, which will alleviate pressures on accident and emergency services.
Every hospital in the region will benefit from this initiative. In addition, I have provided funding for the opening of 15 acute rehabilitation beds in St. Joseph's Hospital, Raheny, which will be used by Beaumont Hospital. Some years ago, I purchased St. Joseph's for Beaumont Hospital from private concerns to be made available for public patients but, to date, it has not been used for that purpose. I spoke with the Northern Area Health Board in July and I insisted that something had to happen in this regard. I provided additional funding to open those 15 acute rehabilitation beds, which will again alleviate pressures on Beaumont Hospital.
Since the winter initiative 2000-01 – there was much scepticism at the time about the number of accident and emergency consultants who would come on stream as a result – about 20 consultants have been recruited, of the 25 agreed. Some 18 anaesthetists have also been appointed as a result of that initiative.
In the programme for Government, the Minister stated that he would implement a full range of measures to improve accident and emergency services by significantly reducing waiting times and by having senior doctors available at all times. Progress has not been made in this area, however. Will the Minister respond to the concerns that have been expressed about the fact that waiting times have not been reduced, despite the promise in the programme for Government? The Minister commented on Beaumont but will he also comment on the situation in Birr and Mullingar?
As I have outlined, additional measures have been taken. More than 20 extra senior clinical decision-makers have been recruited as a result of initiatives I have taken. That is a quantum leap forward, historically, in terms of the numbers of emergency medicine consultants we had.
Why are people still being treated in this way?
We have moved from 16 consultants in 2000 to a current total of 36, which is a substantial increase in consultant manpower for any particular speciality relative to the historic performance in that regard.
The service is not improving.
In addition, chest pain clinics have been established in many hospitals, which have had a dramatic impact on waiting times for those with chest pains, including cardiac conditions. Other hospitals have examined different ways of managing admissions and emergencies. There was a good article recently in The Irish Times dealing with the example of St. Luke's in Kilkenny where an innovative solution involving a hospital-wide approach to the delivery of emergency services was developed. That has had a significant impact. About one third of all medical patients referred to that unit by general practitioners can be discharged on the same day. That is the type of progress that can be made by reorganising and looking innovatively at solutions to this issue.
The other example concerns the acute medical assessment in St. James's Hospital, which is another major development that we have funded. That has also made a significant impact on the admissions issue there.
We have run out of time for this question.