Dáil Éireann Debate, Thursday - 28 October 2004
2 Ms McManus asked the Tánaiste and Minister for Health and Children the steps she intends to take to address the continuing severe difficulties in accident and emergency units, especially in hospitals in the greater Dublin area which cause hardship for patients and staff alike; and if she will make a statement on the matter. [26412/04]
View answer3 Mr. Gormley asked the Tánaiste and Minister for Health and Children the steps she has taken to introduce emergency measures to deal with the continuing crisis in accident and emergency units; and if she will make a statement on the matter. [26413/04]
View answerI propose to take Questions Nos. 2 and 3 together.
This Government has over recent years introduced a number of initiatives aimed at improving the delivery of acute services and alleviating the pressures on accident and emergency departments. Improved and expanded accident and emergency departments are being provided. Recently, new departments have been provided at Cork University Hospital, James Connolly Memorial Hospital, Naas General Hospital, South Tipperary General Hospital, and Clonmel and Roscommon general hospitals.
Following a submission from the Eastern Regional Health Authority in June 2004 my predecessor approved proposals for short and medium-term action to be taken to address the problems associated with emergency departments in the Dublin academic teaching hospitals. The cost of these new initiatives is €2.4 million in a full year and includes the appointment of specialist nurses, the establishment of rapid assessment teams, a clinical decisions unit and the provision of multidisciplinary teams to assess patients.
An additional 29 emergency medicine consultant posts were approved under the winter initiative 2000-2001. There are now 51 emergency medicine consultant posts in acute hospitals which is a 260% increase since 1997. The availability of senior medical staff in emergency medicine departments should facilitate rapid clinical decision making, enhanced management, diagnosis and treatment of patients.
Pressures on the hospital system, especially 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. Funding of €16.8 million has been made available to the ERHA which has resulted in some 520 patients being discharged and work is continuing to facilitate the discharge of a further 80 patients.
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 all contribute to providing alternative care packages for older people so that they can be discharged. Increasing acute bed capacity will also have an impact on the delivery of emergency services.
Notwithstanding the initiatives introduced over a period of years, there remain too many difficulties and delays in accident and emergency departments which I have already said are not acceptable. They are, however, a symptom of the underlining problem in the health care system. In dealing with the difficulties being experienced by patients, it is therefore necessary to take an holistic approach.
The effective delivery of emergency services cannot be done in isolation of all hospital services. Resolving the problems is a priority of mine. I am identifying the particular pressure points within the health system that effect the efficient delivery of emergency services. I intend to ensure the most pressing problems are addressed as a matter of urgency and in the context of the upcoming Estimates. I intend to introduce a wide-ranging package of measures that will address the problems to which I have referred.
Will the Minister accept that her reply is deeply disappointing? So far all she has had to offer is rhetoric and the repeat of measures taken in the past which have not worked. Is she genuinely not aware of the extent of the crisis in our accident and emergency departments where on a night people can occupy 100 or 200 trolleys because they cannot access a bed? Would she like to state to the House what she will do about this crisis considering that the winter has not come yet and we are in such difficulties and the elderly are suffering severely? Will the Tánaiste tell the truth about the number of acute inpatient beds that have been provided by the Government since the health strategy was published? The figure given by the Taoiseach was 900 but it turns out that was 583, which actually means just 299 inpatient beds have been provided since 2001. Does the Tánaiste think this is satisfactory and will she tell the truth so that we can at least know what we are talking about?
Will the Tánaiste use the private nursing home capacity? Will she introduce MAUs to Dublin hospitals? Will she extend medical cards to encourage access to primary care? Will she guarantee that there will be no closure or downgrading of any accident and emergency department as planned on foot of the Hanly report in order to ensure no further pressure is place on over-stretched services?
I am amused to be accused of engaging in rhetoric. Four weeks ago today I took up my position at the Department of Health and Children.
The Tánaiste has been in Government for seven years.
The Tánaiste without interruption. We need an orderly question time and the Tánaiste is entitled to be able to reply without interruption.
During those seven years I have been well aware of the substantial funding that has been given to the health services. There has been a threefold increase in funding in that period. If money alone could solve the problem, we would not have one.
Will the Tánaiste answer the question?
Will the Deputy allow the Tánaiste to reply? She is entitled to the same courtesy as was afforded the Deputy. The Deputy is not entitled to interrupt.
Ask the Tánaiste to tell the truth.
I ask the Deputy to allow the Tánaiste to reply. She is wasting time on her own question.
I tell the truth. I will not tell lies and I will not play politics with patients. Among the measures that will be introduced are some of the matters mentioned by the Deputy and they will be addressed in the context of the Estimates, having considered the issues and spoken to those involved in delivering the services. It will not be a top-of-the-head, impatient response. Rather, it will be one that will work to change the experience of patients in accident and emergency departments in Dublin.
Annually, 1.2 million people attend accident and emergency facilities in Ireland, which is more than a quarter of the population, many of whom are on repeat visits. This is a huge volume of activity. Therefore, we must ensure that the experience of those who are required to attend accident and emergency departments is a positive one and that the service is run efficiently.
Some 78% of those who present in accident and emergency departments in Dublin do not require to be admitted to a hospital bed. We must find a speedier and alternative way to develop out of hours facilities, particularly in Dublin — in north Dublin, they are almost absent — to take some of the pressure off the accident and emergency services. We must also ensure that the late and delayed discharge of patients, in respect of which I just received information last week, is dealt with. We now know the nature of the patients' situations and what alternative facilities they require. For example, in the Mater Hospital, approximately 31 of the 68 patients are suitable for alternative facilities such as nursing homes or returning to their own homes.
The Tánaiste has known that for seven years.
This is not Deputy Seán Ryan's question.
I assure the Deputy that the data I have received was not available to me four weeks ago.
The Tánaiste's predecessors did nothing.
The remedy will cover enhancing primary care, particularly out of hours cover; medical assessment units such as those referred to by Deputy McManus and improving discharge policy so that there are alternative facilities in place that will facilitate the discharge of patients who do not need an acute bed that costs approximately €5,000 per week. These are among the initiatives we are examining. There are also issues in regard to the availability to clinicians of diagnostics on a 24 hour basis in order that they can make clinical decisions about their patients.
Does the Tánaiste accept that——
Excuse me.
Deputy Gormley has been called. He also has a question.
I have a supplementary question.
Does the Tánaiste accept that despite being in power for seven and a half years, the Government has failed miserably to address the accident and emergency crisis? Is she telling the House that where Deputies Cowen and Martin failed, she will succeed and that she will produce a world class health system? Is she living is cloud cuckoo land? How will she do this without spending money? Does the Tánaiste agree that we need to make up for the years of under-spending in the health service and that we cannot solve the accident and emergency problem unless we deal with the bed capacity problem, to which the Tánaiste only referred briefly in her answer?
The consultants and every oneelse tells us this is a bed capacity problem. Can the Tánaiste explain to people who are on trolleys or in chairs where are the 3,500 beds, which were in the system in 1990? Will she speed up the introduction of these acute beds because surely this is the nub of the problem?
I do not agree that my predecessors failed. Turning the health services around will not happen overnight, as I have already stated. We will not create the world class system — that we could and will have — in two and a half years, just as we did not turn the economy around in such a short time. However, I remain optimistic and positive that Ireland can achieve a world class health service in terms of how health care is delivered when the reforms that are under way are fully implemented. Clearly, if everything was well we would not be engaged in this programme of radical reform.
The new HSE will take office from next year and we will have a more centralised and clearly more efficient manner in which to manage the health service, which has been a difficulty in recent years. We have learnt from experience that putting more and more money into an unreformed system does not make sense. This is why more money must be accompanied by reform. Next year there will be substantially more money. To meet the health service pay bill alone will cost an extra €550 million, which is not an inconsiderable sum.
It is too simplistic to state that this is a matter of more beds. We need more beds but we also need practice reforms, reforms in working methods, new facilities that do not require beds such as medical assessment units and more out of hours cover, particularly on the north side of Dublin where it is almost absent. These are among the reforms proposed as well as step-down and alternative facilities for those who are in acute beds just because there is no alternative.
The time limit of 12 minutes has expired for this question.
It is disgraceful for the Tánaiste to take two questions together since neither questioner has had an opportunity to ask a supplementary question. It is unacceptable.
If Deputies did not interrupt, they might have an opportunity to ask a supplementary question. Deputies McManus and Seán Ryan interrupted. There were just three minutes remaining for Deputy Gormley's question and reply, whereas Deputy McManus had nine minutes for her question and reply.
