Dáil Éireann díospóireacht -
Wednesday, 28 Jun 2000

Vol. 522 No. 3

Priority Questions. - Hospital Services.

Alan Shatter

Ceist:

6 Mr. Shatter asked the Minister for Health and Children his views on whether it is unacceptable that an 85 year old woman spent 14 hours awaiting treatment for a broken pelvic bone, a laceration to her elbow and other injuries in the accident and emergency department of St. James's Hospital on 16 December 1999, following a fall on a bus, and who subsequently died of her injuries; and the action he will take to ensure that treatment is never again withheld for such a lengthy period from a seriously injured person attending the accident and emergency department of an acute hospital. [18806/00]

Mr. Martin:

I wish to avail of this opportunity to offer my sincere condolences to the family of the person concerned. I consider it totally unacceptable that any patient, particularly an elderly patient, should be obliged to endure such long waiting times in accident and emergency departments for necessary medical treatment or admission to an acute hospital ward, especially when the first priority of such departments is to provide appropriate care and treatment for patients presenting with serious injury or illness.

As the Deputy may be aware, the provision of health and social services, which includes accident and emergency services, in the eastern region is a matter for the Eastern Regional Health Authority. I have, therefore, asked the regional chief executive of the ERHA to examine this case and forward a full report on it to me. I assure the Deputy my Department is committed to ensuring that accident and emergency departments are in a position to respond to the need for their services, particularly during periods of peak demand. Specific additional funding has been targeted at accident and emergency departments in acute hospitals providing such services, mainly in the eastern region, aimed at the enhancement of accident and emergency services. This additional funding, which amounted to £2 million in 1998, £2.3 million in 1999 and a further £2 million in the current year was used to fund measures to free up beds for emergency admissions, enhanced staffing levels, the continued development of treatment-observation areas in accident and emergency departments and improved access for general practitioners to urgent specialist opinion, among other measures.

The hospitals seek to manage surges in activity by a faster throughput of patients through the system, improved admission and discharge management, redesignation of day care and five day beds as emergency in-patient facilities, rostering of additional staff where feasible and the provision of additional long-term care and chronic sick beds outside the hospital setting.

As I have already mentioned, the pressures with accident and emergency are felt most acutely in the eastern region. This is where the major problems are arising. The Eastern Regional Health Authority has already decided that improvements in accident and emergency services are a priority matter for the authority this year and it has established a dedicated team to review accident and emergency services in the eastern region as a whole. As a result of this review, the authority intends to put forward a comprehensive policy for accident and emergency services which it expects will overcome many of the problems currently experienced in accident and emergency departments.

The authority has stated that it will seek to redress any imbalance in emergency care in terms of access, timeliness, appropriateness and quality.

Additional Information.The review will examine issues such as the physical and human resource requirements to reduce waiting times for treatment and admission in accident and emergency departments. The review will also seek to improve emergency access to treatment through a detailed examination of policies, procedures and protocols for emergency services. It will also consider the provision of alternative care options for persons presenting with minor injuries. These options will include general practitioner “out of hours” services in community or hospital settings.

I am confident this approach will lead to a continued enhancement of our accident and emergency services and will, in future, prevent a recurrence of the very regrettable incident referred to by the Deputy.

Mr. Shatter:

Does the Minister accept that, in the context of this tragic case involving an 85 year old woman who was left unattended in the accident and emergency unit of St. James's Hospital for 14 hours and subsequently died and in the context of the previous case I brought to his attention involving a 66 year old woman who spent ten hours trying to find a hospital bed and being ferried by ambulance to three different hospitals and who also subsequently died, the health service totally failed these people? Will the Minister acknowledge and accept that part of the reason for that failure is that hospital accident and emergency units are overworked, under resourced and lack the appropriate number of accident and emergency consultants for hospitals which regard to accident and emergency services as a speciality? Does the Minister accept that for far too long, junior doctors with limited experience have been left in charge of accident and emergency units for lengthy periods of time? Will the Minister acknowledge that the fact that he has had to express sorrow to two different families for gross failures in our health service in a single Dáil Question Time represents a gross indictment of this Government's capacity to properly manage our health service and provide proper patient care?

Mr. Martin:

The situation outlined in regard to the case raised in this question was unacceptable. The accident and emergency consultant involved in the case has issued an apology to the family. I read the background to this case which was the subject of a coroner's review and I acknowledge the enormous and increasing pressures under which accident and emergency personnel work.

The events which occurred in this case are difficult to comprehend. Certain recommendations flowed from the coroner's report to the accident and emergency service in this case. One must be careful not to tarnish the entire service or to suggest that these cases, tragic and regrettable though they are, are symptomatic of what occurs in our hospital or health services generally.

Since I took up office, I am on record as stating that accident and emergency services and waiting lists are two of my main priorities. While I acknowledge that we must appoint more consultants to hospitals which do not have accident and emergency consultants, we must also change what happens in accident and emergency departments over a 24 hour period in terms of senior decision makers. The current deployment of manpower is not acceptable. Agreement has not yet been achieved in the context of the Medical Manpower Forum on how we could resolve the problems which exist. That has been one of the key issues for the past 20 years.

The pressure on accident and emergency departments has increased due to a dramatic increase in the number of people attending accident and emergency departments, particularly in the Eastern Regional Health Authority area. I have held consultations with the Chief Executive of the ERHA about accident and emergency services in the Dublin area—

An Ceann Comhairle:

The time for this question has expired. We must proceed to Question No. 7.

Mr. Martin:

—and he is giving this issue top priority.

Mr. Shatter:

Will the Minister publish the coroner's report?

An Ceann Comhairle:

The Chair has called Question No. 7.