Mary Harney
Ceist:11 Miss Harney asked the Minister for Health his views on the present casualty crisis in the accident and emergency departments of our major hospitals; and if he will make a statement on the matter. [7068/95]
Ceisteanna — Questions. Oral Answers. - Accident and Emergency Services.
Liam Lawlor
Ceist:53 Mr. Lawlor asked the Minister for Health the number of times all non-emergency admissions have been cancelled at the Mater Hospital, Dublin 7, from January 1995, to date; the length of time for the admissions were cancelled; and if he will make a statement on the matter. [7011/95]
Ivor Callely
Ceist:63 Mr. Callely asked the Minister for Health the measures, if any, he will introduce to address the deteriorating conditions in hospital casualty departments; his views on whether Irish nurses are overstretched and lack necessary supports; and if he will make a statement on the matter. [6992/95]
Liam Fitzgerald
Ceist:64 Mr. L. Fitzgerald asked the Minister for Health if he will establish a review group comprising representatives of major Dublin voluntary hospitals, the Eastern Health Board and staff interests to undertake analysis and co-ordination of the accident and emergency services in Dublin. [7008/95]
(Limerick East): I propose to take Questions Nos. 11, 53, 63 and 64 together.
Accident and emergency services in the Dublin area are provided by six major acute hospitals; the Mater, Beaumont and James Connolly Memorial on the north side of the city and St. Vincent's, St. James's and the Meath on the south side. The accident and emergency departments of the six major hospitals in Dublin operate a 24 hour service, seven days a week. Responsibility for the service is, in the first instance, a matter for the Eastern Health Board and the accident and emergency hospitals. The operation of the service is, accordingly, co-ordinated by a steering committee chaired by the programme manager, general hospital care Eastern Health Board, and which includes the accident and emergency consultants of the six hospitals, with their hospital managers-chief executive officers. It has recently been agreed to broaden the membership of the steering committee to include representatives of the accident and emergency nursing staff from each of the six hospitals.
Generally there is sufficient capacity within the accident and emergency service to deal with the needs of patients. However, because of the nature of the work, it is not possible to predict the workload of hospital accident and emergency departments at any particular time. Accordingly, from time to time, delays do occur and some non-emergency elective admissions are cancelled, particularly during the winter when there has tended to be an upsurge in the number of patients presenting at accident and emergency for treatment. At all times, however, priority is accorded to those patients most in need of immediate medical attention and in cases where non-emergency elective admissions are cancelled I am informed that hospitals endeavour to reschedule these appointments soon afterwards. In the case of the Mater Hospital the following non-emergency elective admissions were cancelled; 266 patients in January, 143 in February and 146 in March 1995.
In addition, periodic increases in the number of patients requiring admission to hospital results in patients having to be placed in temporary accommodation, pending the availability of more appropriate facilities. Every effort is made to keep this practice to a minimum.
One of the principal causes of delay in placing patients in the most appropriate type of accommodation has been the shortage of suitable facilities for elderly patients who are no longer in need of acute hospital care. The shortage of more appropriate facilities results in elderly patients having to remain in acute hospitals longer than necessary consequently reducing the number of beds available for admissions through accident and emergency departments.
The Government has been addressing this problem over the years through the provision of funding for additional facilities for the care of the elderly in the Dublin area. I have recently provided £850,000 to the Eastern Health Board to provide additional alternative accommodation for patients in acute hospitals, who no longer require acute care. Placing such patients in accommodation more appropriate to their needs, eases the pressure on the acute hospitals and reduces the delays in admitting patients to hospital. In addition, and in view of the difficulties identified in the provision of accident and emergency services at the Mater Hospital £100,000 was allocated to the Mater Hospital in 1994 to enable that hospital to upgrade the accident and emergency facilities. As a result the hospital has provided additional treatment cubicles in the accident and emergency department together with a new 12 bed observation ward for the accident and emergency department. A further £200,000 has been approved by the Department in 1995 in respect of additional staff for these new facilities.
As regards the more general question of staffing levels, it is a matter for each agency to manage the allocation of their staff and other resources to meet service demands with as much flexibility as possible. It is open to agencies to make staffing proposals which take account of any problems such as stress which can be attributed to staffing levels. My Department's review of any such proposals is then undertaken having regard to the related service and personnel criteria which impact upon the situation, including the availability of financial resources for the health service as a whole.
The position with regard to the accident and emergency departments is monitored by my Department on an ongoing basis and I assure the Deputy of my continuing concern that that accident and emergency hospitals in Dublin are enabled to respond effectively to the demands placed upon them. I will continue to monitor the situation with a view to taking further action if required.
On the crisis in the casualty departments in the Dublin hospitals, — there have been strikes at the Mater and Beaumont Hospitals — is the Minister aware that a meeting was to take place yesterday between the Eastern Health Board and the management of the major hospitals? That was the outcome of those negotiations? Apart from the problem associated with the provision of acute beds for elderly persons, does the Minister agree that there must be inefficiencies in the system given that long waiting times are now the norm at casualty departments? Those who have to attend such departments expect that they will have to wait a long time before being treated. Does the Minister consider this acceptable? Does he have any information on the percentage of those who present at a casualty department in hospitals throughout the country who could be dealt with adequately by their general practitioner?
(Limerick East): We are aware of the excellent service being provided by nurses in general hospitals and of the difficulties under which they had to operate during the periods of bad weather in January, February and March. This led to increased pressure being put on the accident and emergency services in the major hospitals in Dublin.
I thank the Deputy for her approach to this question because the simplistic political demand would be to provide more beds in the acute hospitals. However, that would not solve the problem.
The House is already aware that my concerns about the Eastern Health Board are greater than those about other health board areas. Those of us who operated in health boards outside Dublin know that, to put it in general terms, the Mid-Western Health Board or the Western Health Board have control of almost all the health services in their particular region. In Dublin, the Eastern Health Board has control of only a small portion of the health services — approximately 25 to 30 per cent. Some voluntary hospitals in Dublin have a direct relationship with my Department and the Eastern Health Board needs a more integrated service. I accept the point by Deputy O'Donnell that, since Christmas, there are patients in hospitals in Dublin who should be under the care of their general practitioners because they do not need hospitalisation. Other people are in acute hospital beds because sub-acute beds are not available, nor are there beds for the elderly in the Eastern Health Board area. There is a general problem underlying the industrial action, which is only the tip of the iceberg.
I would like the advice of Deputies on this matter. I intend changing the structures in the Eastern Health Board area and I would like Deputy Callely, who has a lot of experience in the Eastern Health board area, to give me his views. I hope to set up informal discussions with Deputies on all sides of the House to see how we can progress matters.
The conventional wisdom is that the best medical service is in Dublin. That is true if one is talking about a particular set of specialities because some are not available elsewhere in the country. However, in terms of integrated medical service across a community, I would much prefer to be in Letterkenny.
Our time is exhausted. I will call Deputy Callely, who has tabled one of these questions, for a final supplementary.
I welcome the Minister's response and his comments in relation to my knowledge of the Eastern Health Board area.
The Deputy is a former chairman — he should know everything there is to know about the board.
I would be happy to respond to the Minister in a helpful and practical way. I wrote to his predecessor in February 1993 pointing out exactly what has happend today, and I mentioned a pilot project that I know would be successful. I would be happy to give full details of that to the Minister. The Minister identified the areas of the step down facilities and the long stay care accommodation for the elderly which are urgently required. They are the two areas——
We must proceed by way of a question, Deputy.
——that must be addressed. In light of what the Minister said today, I will not question him further on this matter but I ask him to indicate the time schedule he envisages in regard to the measures he hopes to enact to adequately address the difficulties of accident and emergency departments.
(Limerick East): I am setting it in the context of the reform of the Eastern Health Board and I have already had in-depth discussions with my officials. As other issues move along, for example, the one we discussed in Question No. 1 today, this particular issue is moving up the priority list. I hope to have discussions with Deputies before the summer either informally or in some structured fashion. I have not yet worked out the manner of the discussions but they will take place.