I propose to take Questions Nos. 143, 154, 165 and 190 together.
Pressures on the hospital system, particularly in the eastern region, arise from demands on emergency departments and on difficulties associated with patients who no longer require acute treatment but are still dependent. There are a number of initiatives under way to deal with these pressures.
Planning for the discharge of patients by acute hospitals and the liaison with the community services has been prioritised on an ongoing basis by the Eastern Regional Health Authority. Initiatives such as Homefirst, Slán Abhaile and home subvention are all contributing to providing alternative care packages for older people so that they can be discharged.
The single most important factor for admission to hospital is bed availability. A report called Acute Hospital Bed Capacity — A National Review, carried out by my Department, identified a requirement for an additional 3,000 acute beds in acute hospitals by 2011 and this requirement is reflected in the Government's health strategy, Quality and Fairness- A Health System for You. Some 568 of the 709 beds in the first phase have been commissioned to date, of which 253 are in the eastern region. Revenue funding of approximately €40 million has already been made available to the ERHA for these beds. Funding is available to enable the balance of the 709 beds to be brought into operation this year. Also under the acute bed capacity initiative, I have provided an additional €12.6 million to the ERHA, €8.8 million, and to the Southern Health Board, €3.8 million, to facilitate the discharge of patients from the acute system to a more appropriate setting thereby freeing up acute beds. It allows for funding through the subvention system of additional beds in the private nursing home sector and ongoing support in the community. Already this funding has resulted in the discharge of a total of 223 patients from acute hospitals in the eastern region. The ERHA is actively monitoring the situation and working with hospitals and the area health boards to ensure that every effort is being made to minimise the number of delayed discharges in acute hospitals.
I have been informed by the ERHA that it is working closely with the major acute hospitals in Dublin with a view to re-opening beds which have been closed due to staffing difficulties. As part of the winter initiative, an additional 20 accident and emergency consultants have been appointed from the 29 approved. Additional appointments are being progressed by the health boards and the ERHA.
Reviews of the bed management function and nurse staffing levels in emergency departments are being progressed by the Health Services Employers Agency in consultation with health service management representatives and the nursing unions.
Emergency medicine departments may sometimes have to deal with injuries and conditions which are more appropriate to a primary care setting. General practitioner out-of-hours co-operatives have been established and are operating in at least part of all the health board areas, with one health board, the North Eastern Health Board, having a region-wide project. A total of €46.5 million has been allocated for the development of out-of-hours co-operatives between 1997 and 2003.
A media campaign has been undertaken on radio, television, and in the newspapers highlighting the pressures that exist in emergency medicine departments and encouraging people to attend only if absolutely necessary. This initiative is an attempt to focus on the need for only those in need of emergency care to attend and for others to use the primary care services.
I will continue to work with the various health agencies in looking for short-term and longer term solutions to the current difficulties.