asked the Minister for Health whether he is satisfied with the method of screening of persons coming to out-patient clinics to ensure that resources are used in the best way possible; and whether he has any proposals for improvements in this area.
Ceisteanna — Questions. Oral Answers. - Out-Patient Clinic Screening.
8.
The investigation and examination of patients at out-patient clinics is primarily a matter for the consultants and hospital authorities concerned.
It is a basic principle of all the planning of general hospitals being carried out at present that the most effective and efficient means of providing services should be established and implemented. This applies especially to out-patient services.
Is the Minister satisfied with the situation which was revealed in answer to a parliamentary question on 12 March 1985 that of 1.5 million visits to out-patient clinics in 1983, over 1.1 million were return visits? Obviously there is concern that there is an excessive return calling to the out-patient clinics, but is the Minister also satisfied that the Department do not appear to have any record of whether these out-patient visits led to hospital admissions, their source — whether GP referral or walking in off the streets — or the accident/casualty calls to out-patient clinics?
The Deputy's implied criticism is justified and merits serious examination. There are at present about 1.54 million people attending at out-patient clinics. I wonder what they all do there because there are only three-and-a-half million people in the country including children. Attendances have grown from 1.46 million in 1980 to 1.53 million in 1983. I would say that has increased to 1.56 million now. I can assure the Deputy that the system of out-patient clinics in hospitals is being examined urgently within the Department and is in need of radical reform even to the extent of having senior consultants at the doors of the hospitals to assess people because the more people who go to out-patient clinics the more end up in beds for one reason or another whether or not that is necessary. Perhaps they are admitted on a Friday afternoon and no one sees them until the following Tuesday. That costs the taxpayer the best part of £1,000.
Would the Minister accept that a number of patients are admitted to hospital as a result of the totally inadequate facilities in out-patient clinics? Has he any plans for a major capital investment in out-patient departments? I am sure the Minister is aware that a number of them are in a deplorable condition. They are very old buildings and totally inadequate in terms of space and dressing rooms for consultants. Has the Minister any plans to ensure that there will be more consultants and fewer junior hospital staff available in out-patient departments?
I share the Deputy's concern that the physical condition of many out-patient clinics in our hospitals is, to say the least, deficient. Our big problem is to convince the people that they should not go to the out-patient facility of a hospital unless they are referred there by a general practitioner. Unfortunately it is now part of the medical culture that people just turn up at out-patient clinics and use very expensive equipment such as radiology equipment and avail of very expensive consultative and nursing staff for complaints which could be dealt with in the ordinary way by a GP. People go to out-patient clinics because they get the services for nothing by and large, except in the North-Western Health Board area. As a result, our out-patient services are enormously costly and eat up millions of pounds. People queue for hours on end for complaints which do not require hospital treatment.
Are there any plans to have more consultants?
It is understandable that junior hospital doctors would be reluctant to take decisions on the spot. I would prefer to see senior consultant staff in those clinics but the trouble about employing them is that there must be a contractual obligation that they would be there to do the work they are paid to do rather than handing it over to a junior. Naturally more senior people want to practice their profession in slightly more esoteric surroundings.
Does the Minister consider that getting information about admissions to out-patient and casualty departments is something that could be done quickly and effectively? If we had the facts before us we would be in a stronger position to deal effectively with this problem.
I usually find myself in dire trouble when I make observations of this nature but although most hospitals are funded 98 per cent by the State they regard their administrative structures and practices as being totally separate. The information the Deputy is talking about would have to be obtained on a computer basis. There is no other way it could be done unless they employed thousands of clerical staff. I hope the hospitals will cooperate in this. Frequently we do not know what is going on in out-patient clinics nor do the hospital staff because, very often, the records are not kept in a form which is conducive to analysis.