Tuesday, 27 January 2004

Questions (26, 27, 28, 29, 30)

Thomas P. Broughan


143 Mr. Broughan asked the Minister for Health and Children the steps being taken to address the continuing crisis in the acute hospital service, especially in the greater Dublin area; the steps he intends to take to deal with the problems of bed blockers; and if he will make a statement on the matter. [1885/04]

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Pádraic McCormack


154 Mr. McCormack asked the Minister for Health and Children the steps he intends to take to deal with the ongoing accident and emergency crises whereby patients are continually spending unacceptable lengths of time awaiting admission. [1544/04]

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Trevor Sargent


165 Mr. Sargent asked the Minister for Health and Children if he will deal with the serious overcrowding in hospital accident and emergency departments which has deteriorated in recent weeks; and if he will make a statement on the matter. [2035/04]

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Eamon Ryan


190 Mr. Eamon Ryan asked the Minister for Health and Children his plans to deal with the worsening crisis in accident and emergency departments; and if he will make a statement on the matter. [2033/04]

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Written answers (Question to Minister for Health and Children)

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.

Willie Penrose


144 Mr. Penrose asked the Minister for Health and Children the steps he intends to take to provide services for people with neurological disabilities as proposed by the Neurological Alliance of Ireland; and if he will make a statement on the matter. [1915/04]

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Comhairle na nOspidéal recently published the report of a committee to review neurology and neurophysiology services and I am happy to endorse its recommendations for a significant enhancement of services, including increases in consultant manpower. The report also recognises that there are aspects of a number of other specialties and services, such as rehabilitation medicine, geriatric medicine and old age psychiatry, which are related to and overlap with neurology services. Comhairle has recommended that a national multidisciplinary review of rehabilitation services be undertaken to further inform the policy framework in relation to the development of neurology services.

Consistent with this recommendation, and in line with commitments in the national health strategy, a national action plan for rehabilitation services is being prepared by my Department. The action plan will set out a programme to meet existing shortfalls in services and to integrate specialised facilities with locally based follow-up services. The rehabilitation action plan, together with the Comhairle report and the work undertaken by the Neurological Alliance of Ireland through its own publications will, in my view, offer a comprehensive policy framework for the future development of neurology and neurophysiology services in this country.

My Department will continue to work closely with the alliance and with the Irish Consultant Neurologists' Association in relation to the future development of services. The implementation of the Comhairle recommendations will be progressed having regard to the evolving policy framework in this area, competing funding priorities and the report of the national task force on medical staffing.

Specialty costing data in respect of hospitals which provide neurology services indicate that in-patient costs for this specialty for 2002 were more than €19 million. This figure excludes costs in respect of neurology services provided in out-patient and accident and emergency departments and specialist day case activity which are not routinely collected by my Department.