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Hospital Services

Dáil Éireann Debate, Tuesday - 18 May 2010

Tuesday, 18 May 2010

Questions (6)

Jan O'Sullivan


41 Deputy Jan O’Sullivan asked the Minister for Health and Children the advice she will give to hospitals such as Beaumont whose financial allocation is not adequate to address the needs of patients in their catchment area; the way in which patients are to be protected when wards and theatres are closed and accident and emergency departments are overcrowded and understaffed and when there are growing waiting times for outpatient clinics and for elective procedures; if she will intervene to ensure that patient welfare is not compromised; and if she will make a statement on the matter. [20560/10]

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Oral answers (5 contributions) (Question to Minister for Health and Children)

I have been assured that Beaumont Hospital will meet its service plan targets for 2010. These involve treating the same number of patients this year as last but with less reliance on inpatient stays. In turn this will involve reducing inappropriate hospital admissions, more same day of surgery admissions, more day care cases, earlier discharges and reductions in waiting times for elective surgery. The planned changes announced by Beaumont are designed to allow it deliver its service plan targets while remaining within its budget. For example, the increase in day case activity and the reduction in beds occupied by long-stay patients means the hospital can treat the same number of patients as previously with fewer in-patient beds. Beaumont has also assured my Department that neurosurgery, transplantation and cancer services will not be affected by the changes.

Treating people in more efficient and effective ways like this, with no reduction in access to appropriate services, is obviously the right thing to do given the very difficult financial position facing the Exchequer. However, it is also the right thing for patients. People want to access quality care as quickly as possible and be allowed to go home as soon as possible. There are constant calls inside and outside this House for a more efficient public service, changes in work practices and greater productivity. Despite this, we still hear opposition to such changes, with the focus being put instead on issues like the number of in-patient beds rather than the number of patients being treated and the achievement of best outcomes for patients.

Reforming the way services are provided, reducing costs and maintaining a clear focus on patient safety will allow us to treat people in more effective ways and protect access to appropriate services. I want to make it clear to this House that the implementation by Beaumont Hospital, and other hospitals, of this type of patient-centred reform will have my full support.

I put it to the Minister that on 29 March 2006 she issued a statement declaring accident and emergency departments to be a national emergency. In 2007 she stated that the HSE said no patient should be waiting more than 24 hours in any accident and emergency unit for admission to a ward and by next year the target is to be a maximum of six hours. The HSE also stated its aim is that no accident and emergency unit should have more than ten patients waiting for admission to a ward. She has again given us a beautiful flow of rhetoric. The reality is totally different. How, with 52 fewer beds, will Beaumont achieve the target she has outlined to us? How will other hospitals throughout the country achieve their targets?

The Minister referred to the fair deal and the fact that people will be able to leave hospital more easily. I spoke to a social worker who was working in another large Dublin hospital last week who told me that most of her day is now spent trying to deal with the financial assessments of the fair deal to get elderly patients who are ready to be discharged out of hospital . What is the Minister going to do to ensure that the financial assessment element of the fair deal does not keep people in hospital unnecessarily? I am told that nursing homes will not take them until it is certain they will qualify.

As my colleague the Minister of State, Deputy Áine Brady, will address the fair deal scheme, I will only make a brief comment on it. We were dealing with a large volume of applications which came in at the same time because the scheme was only introduced last October. In many cases, court and other legal procedures are involved because we have to deal with people who have diminished mental capacities.

We are receiving a fantastic response on the fair deal scheme. It has freed up 50 beds in Beaumont hospital alone and we are currently awaiting HIQA registration before allowing that hospital to open St. Joseph's, which will provide a further 100 beds. Beaumont has dealt with 1,000 more patients on a day case basis over the first four months of this year than it did during the same period last year. By moving to same day surgery and day case activity, more patients can be treated within available budgets.

Of course accident and emergency provision is not perfect but I can outline data that show year-on-year improvements in the waiting time target of six hours from time of arrival to either being sent home or admitted. Many hospitals meet that target but, unfortunately, approximately six hospitals are not in a position to do so for various reasons and these institutions are now receiving special attention from the HSE at my request.

More than 300 people were accommodated on trolleys on one day last week. That is the average figure for the month of May, when normally the number of people on trolleys is very small. Despite the Minister's claims about what hospitals will be able to achieve, year after year we see the same statistics. We are not seeing improvements in trolley figures. The same difficulties arise in terms of moving people from accident and emergency units to wards, even where they are ready to be transferred. Given the level of cutbacks with which hospitals must contend, does she really believe they will be able to achieve the targets she is setting for them?

I believe hospitals can meet the 2010 service plan to which the HSE is committed. I referred specifically to Beaumont, which is a national tertiary referral centre. The financial pressures are enormous and although we have provided some new money for the fair deal scheme, comparing like with like, we have taken an additional €1 billion from the HSE over last year. Approximately €630 million of that comes from staff reductions and the remainder has to come from value-for-money, reductions in drug costs, etc. Notwithstanding these pressures, the activity level at Beaumont was higher over the first four months of this year than in the same period last year.