Wednesday, 1 July 2009

Questions (30)

Thomas P. Broughan

Question:

46 Deputy Thomas P. Broughan asked the Minister for Health and Children the progress made in implementing the recommendations of the emergency department task force, published in June 2007; if the targets set for waiting times have been met; if the targets for step-down beds to free up acute beds have been met; the number of acute beds occupied by delayed discharge patients; and if she will make a statement on the matter. [26309/09]

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Written answers (Question to Minister for Health and Children)

The Emergency Department Task Force Report, which was published by the HSE in June 2007, recommended that the issues in Emergency Departments be examined on a whole hospital and whole system basis. It identified the requirement for hospital specific initiatives as well as the development of national responses in relation to key structural issues.

A key requirement was the development of strong internal management control processes at hospital and community levels to ensure that capacity is fully optimised and that measures designed to unlock capacity were supported by strong controls which enable an appropriate balancing between emergency and elective workloads.

The Winter Initiative was established by the HSE in July 2006 to address many of the problems that manifest themselves in the emergency departments and occur nationally, particularly in the winter months. The findings in the Emergency Department Task Force Report, and indeed other Reports since then, have informed the approach adopted. These findings continue to be prioritised by the HSE. The emphasis in year 1 of the initiative was on three areas which covered measures for:

Promotion and prevention

Hospital avoidance, and

Capacity building and generation.

A fourth dimension was added in year 2 which focused on improving the processes to reduce length of stay in hospitals in line with best practice e.g. integrated discharge planning, increased usage of day surgery and access to diagnostics.

In this context, a key component of the Winter Initiative Plan was to work to maximise long stay care capacity. This was planned by means of a combination of contracting beds in private nursing homes and fast tracked initiatives to increase public long stay capacity. I understand that at the end of March 2009 there were a total of 29,000 beds in nursing homes. Of these approximately 25,985 are long stay beds. There are currently in the region of 23,000 people in long stay residential care in Ireland (7,500 public,15,500 private). A monthly average of 9,161 beds were reported as subvented at the end of April 2009.

In addition, in early 2009, the HSE provided 235 additional contract beds to alleviate pressure on the acute hospital system by the numbers of patients whose discharges are delayed as follows:

Number

Dublin North East

90

Dublin Midlands

75

South

60

West

10

As of the 26th June, 225 of these contract beds are occupied.

At the end of 2008, 273 additional long stay beds were made available under the Fast Track Initiative. In 2009, a further additional 725 beds and 371 replacements will be provided for older people. This includes beds being provided under the Capital Plan and beds being provided under the Fast Track Initiative.

Hospitals and the Primary Community and Continuing Care Division of the HSE have delivered in excess of their Service Plan targets for 2008 despite financial constraints and increasing demands for service, which the HSE has said equated to about 54,000 extra patients attending and 13,500 extra emergency patients being admitted to hospitals.

Following on from the launch of the Code of Practice for Integrated Discharge Planning, the HSE is initiating an "early transfer" pilot programme across 4 sites (Tallaght, Beaumont, Drogheda and Cork University Hospitals), starting today (1st July). Under the programme, patients can be transferred from the ED to a ward earlier than would normally be the case. The decision to transfer patients will be based on a prior analysis of the number of planned discharges each day.