Vol. 527 No. 5
3 Mr. G. Mitchell asked the Minister for Health and Children the number of beds out of use in hospitals at 30 November 2000; and if he will circulate a tabular statement giving the numbers of vacant beds for each hospital. [28806/00]
I am circulating a tabular statement with this question which details the numbers of beds out of use in each health board. The total number of beds out of use on 30 November 2000 in acute hospitals was 315. This represents 2.6% of the total number of designated beds in the public acute hospital system which amounts to about 12,327. In summary, of the 315 beds out of use, 105 or 33% of those were closed due to nursing shortages, 27 or 9% were closed because of bacterial infection and 183 or 58% were closed due to ward refurbishment.
With regard to nursing shortages, I have recently announced details of a £5 million package of incentives aimed at attracting nurses and midwives back to work, retaining nurses and midwives in the public health service, and addressing shortages in specialist areas, including accident and emergency.
I do not intend to go through the details of that because it is on the public record. In addition, after a successful recruitment campaign in the Philippines and the graduation of student nurses, Beaumont Hospital has appointed 57 extra nurses which will allow the hospital to open all beds by next month.
In relation to the vancomycin resistant enterococcus, VRE, virus which is now present in the haematology-oncology unit in St James's Hospital, VRE is a so-called "super-bug" which is becoming a problem in similar units in other developed countries. The hospital has decided that, in order to protect the health of patients currently undergoing treatment for leukaemia and cancer, to stop admissions to the national bone marrow transplant unit and to curtail admissions of cancer patients. It is expected that the unit will reopen early in the new year and we are putting very considerable investment into the new unit. This was announced several months ago as Deputies know and patients are being treated abroad as well.
In considering the delivery of service in the acute hospital sector, it is appropriate to examine the overall level of service provided in the sector rather than to focus on issues like the number of beds available at any given time. Whilst ward closures due to necessary refurbishment are inconvenient, they reflect the continuing intensive investment in the hospital sector. An unprecedented level of investment is now taking place in acute hospital facilities under the current capital programme. In line with my strategy for the development of acute hospital services on a regionally self-sufficient basis, the process of investment is aimed at developing a strong network of regional and local general hospitals. In 2000 alone, a total of £23I.5 million under the national development plan has been provided for capital investment in the health services, a significant proportion of which has been directed into the acute hospital area.
Additional information The initiative on nursing shortages includes the following: a new scheme of flexible working arrangements for nurses and midwives in the public health service which will come into operation on 1 February next; the abolition of fees for “back-to-nursing” courses with immediate effect. In addition, nurses and midwives undertaking such courses will, for the first time ever, be paid a salary. The intention behind this initiative is to remove all financial obstacles in the path of nurses and midwives who wish to return to practice. From the current academic year, all nurses studying for the post-registration higher diploma in sick children's nursing will have their fees refunded. They will also receive an enhanced salary while in training. The number of available places on specialist nursing courses is being expanded. In order to encourage more nurses into specialised areas of clinical practice, nurses undertaking specific courses will now receive full pay while doing so. They will also have their course fees paid in return for a commitment to continue working in the specialist area for a specified period following completion of the course. Funding is being provided to the HSEA to employ a nurse manager to co-ordinate the pro vision of supervised clinical placements for nurses recruited from abroad. Finally, a major advertising campaign aimed at attracting qualified nurses and midwives back to work is under way. This campaign is making use of radio and print media advertising to market nursing as a career with the specific objective of encouraging nurses and midwives back into the system.
Significant progress has also been made on the phased commissioning of new units completed under the capital programme. In 2000, a total of £14.218 million has been provided to meet the revenue costs associated with doing this. This is enabling major new facilities such as those completed under phase 1 at University College Hospital, Galway and phase 1 at the Mercy Hospital, Cork to be fully staffed and brought into service this year and has allowed significant progress to be made on the phased completion of commissioning the major developments at Limerick Regional Hospital. The total discharges, both in-patient and day case, in the acute hospital system in 1999 was 827,093. At out-patient level, the figures show that 1,992,365 attendances were recorded in that period.
In general terms, the hospital system is delivering a significant level of activity. In the first six months of 2000 overall discharges, in-patient and day case, are up over 3.2% over the same period in 1999. Within this overall increase, day case work has increased by almost 6.63%. Allied with the reduction of 7,198 or some 19.5% achieved on in-patient waiting list numbers in the target specialities over the first nine months of this year, I am satisfied that effective use of available resources is being made in the delivery of hospital services.
|
Health Board/Health Authority |
Number of Beds Out of Use |
|
Eastern Regional Health Authority |
35 in Beaumont Hospital due to nursing shortages.27 in St James's Hospital in the Bone Marrow Transplant Unit due to the outbreak of Vancomycin Resistant Enterococcus (VRE), an antibiotic resistant bacteria.8 in the Mater Misericordiae Hospital due to nursing shortages16 in St Michael's Hospital due to ward refurbishment and temporary relocation of beds to A & E Department (4). |
|
Midland Health Board |
0 |
|
Mid-Western Health Board |
4 in Nenagh General Hospital due to refurbishment. |
|
25 in the Regional Orthopaedic Hospital due to ward refurbishment. |
|
|
North Eastern Health Board |
29 in Monaghan General Hospital due to refurbishment of a medical ward.41 in Our Lady of Lourdes Hospital, Drogheda due to nursing shortages.21 in Our Lady's Hospital, Navan due to nursing shortages. |
|
North Western Health Board |
12 in Sligo General Hospital due to renovation works. |
|
South Eastern Health Board |
0 |
|
Southern Health Board |
35 in Cork University Hospital due to ward refurbishment. |
|
Western Health Board |
62 in University College Hospital Galway due to ward upgrade. |
|
Total |
315 |
A cynic might well suggest that perhaps we could get a Minister for Health from the Philippines as well because we certainly have some sort of a problem.
They would do a better job.
The Minister has unprecedented resources available to him. Would the Minister agree that of the resources made available between 1994 and 1990, according to evidence given to the Committee of Public Accounts, almost 60% were consumed in existing salaries? Throwing money on its own will not solve the problem. Could the Minister tell the House how many beds the health system needs to get the 30,000 people on the waiting list and those waiting to get on the waiting list into hospital? He told how many there are – how many do we need?
That is a ridiculous question in one way because one does not just need beds to get operations carried out but people to carry them out. One needs back-up facilities, nursing and staff.
I know all that.
The Deputy does not because to ask the question in isolation is not valid.
The Minister is speaking Filipino to me now. He should speak English.
I would also like the Deputy to clarify what he means by throwing money at the health service. If that is his view, could he suggest to me the areas where I should not spend money that I intend to spend next year?
When I am Minister for Health and Children, I will answer the questions. He is the Minister for Health and Children – how many beds do we need?
I am answering the question and with respect to the Deputy, I would appreciate it if the Deputy would allow me the opportunity to reply.
I will allow the Deputy to follow up with a supplementary question.
The Minister is there to answer questions.
The Deputy is wasting time. The Minister is in possession.
With respect, a Cheann Comhairle, I did not interrupt the Deputy during the comments he made.
The Minister should answer the question he is asked.
I will answer the question. I do not have the exact figure but it is a ridiculous question.
It is not a ridiculous question.
It is. It is idiotic.
The Minister for Health and Children should know how many beds we need.
That is an idiotic question. The Deputy knows himself.
The Minister should know—
The Deputy should cease interrupting.
The day before yesterday when we debated Supplementary Estimates I indicated that we were undertaking a very significant, comprehensive bed review capacity.
After four years does the Minister not know how many beds the health service needs?
A Cheann Comhairle, I protest that I am being constantly interrupted in my attempts to answer the questions.
The Deputy must stop interrupting.
We will have completed by March a very comprehensive bed review capacity but a bed review capacity is not about waiting lists. It is about the specialties and the targeting of beds. We have a global figure in terms of the preliminary and initial phase 1 of the bed review capacity at hand and I can give those figures to the Deputy.
How many?
We will have the final figures in and around March—
How many?
—which will give us the amount of beds per specialty which is the key issue because we do not want, to use the Deputy's own phrase, to throw beds at the system, we want a structured and strategic approach to the provision of additional beds, not just on the waiting list issues. The waiting list issue is not about beds alone, we do a great many procedures now on a day case basis which do not require beds. Where we need the beds is in areas such as intensive care, in terms of rehabilitation, step down and so on, not just for the waiting lists alone. We will have figures by March which will be comprehensive and will enable us to be strategic in terms of the investment that will be required.
It is very clear from the Minister's reply that he does not know the number of beds the health service needs. I would have thought that any Minister who was strategically in charge of a Department, if he was competent enough to be paid his salary, would at least know the answer to that question. The Minister is incompetent if he does not know that question.
The time is up now on that question.
Does the Minister agree that in the private hospitals there is 100% bed occupancy, in public—
We must move on to Question No. 4.
If I could just reply—
The Minister is incompetent.
We must move on to Question No. 4.
The Deputy is ignoring the Cathaoirligh. I am not going to engage—
The Chair has called Question No. 4. We must proceed.
4 Ms McManus asked the Minister for Health and Children the action that is being taken to address the situation in the accident and emergency department of Beaumont Hospital, Dublin 9, as a result of which nursing staff have served notice of industrial action; and if he will make a statement on the matter. [29062/00]
I am aware that in recent times hospitals providing accident and emergency services, including Beaumont Hospital, have experienced some increased activity. However, it is important to note that while patients may experience delays in accident and emergency departments, appropriate medical treatment is provided at all times.
As the Deputy will be aware, the Eastern Regional Health Authority assumed responsibility for all health service issues in the eastern region from 1 March 2000. I have made inquiries of the regional chief executive and have been advised that the accident and emergency service in Beaumont Hospital has recently experienced some additional pressure. While overall activity in the A&E department for the year to date is marginally down on last year, nevertheless the hospital has experienced an increase of 10% in the number of emergency admissions this year and new attendances by ambulance rose by 7%. This was against a background where the hospital had to close 64 beds due to the shortage of nursing staff. After a successful recruitment campaign in the Philippines and the graduation of student nurses, the hospital has appointed 57 extra nurses which will allow the hospital to open all beds by next month.
In addition, and in order to build on the success of such recruitment campaigns, I recently announced details of a £5 million package about which I spoke earlier. The ERHA has been engaged in a review of A&E services for the eastern region. The purpose of this review is to develop a comprehensive policy on A&E services.
Beaumont Hospital is represented on the review by its A&E consultant. In light of this review, Beaumont Hospital is working closely with the medical and nursing staff to implement a number of short-term measures to help alleviate the situation. These include improved efficiencies in discharge processes to allow patients to be admitted to a ward from A&E as early as possible; the conversion of a five-day elective ward to a seven-day ward for A&E patients and the transfer of patients awaiting discharge and placement to step-down/convalescent facilities to a low intensity area in the hospital requiring minimal nursing and medical care.
Other initiatives have already been planned for introduction at the hospital over the coming months, including the opening of a new cardiac catheterisation laboratory in the next two weeks which will reduce the waiting periods for angiograms for in-patients; increasing the TIA – trans-ischaemic attack clinic from two days to five days per week; and the opening of new asthma and chest pain clinics.
Additional Information.In addition to the above, Beaumont Hospital, as part of the accident and emergency initiative, received an additional £200,000 in 1998, of which £170,000 was used to employ additional nurses and £30,000 for medical staff; and an additional £200,000 capital in 1999 specifically for revamping the accident and emergency department. The final cost of this project was £300,000. In 2000, an additional £240,000 was provided to replace and increase the equipment levels in the A&E department.
Allied to this is the authority's winter bed initiative which is aimed at providing an allocation of step-down and convalescent beds for patients being discharged from acute hospitals. Funding has been allocated for a total of 495 beds for the eastern region for the winter initiative, of which 240 beds have already been contracted. As part of this initiative, a total of 82 beds has been allocated to the northern area health board of which 35 beds have been allocated to Beaumont Hospital to date.
As part of a £25 million package of investment which I announced recently to alleviate service pressures on the acute hospital sector nationally, it is proposed to appoint an additional 27 consultants to work in accident and emergency hospitals. One of these posts is planned for Beaumont Hospital.
Under the national development plan, I have approved a major refurbishment and equipment replacement programme for Beaumont Hospital totalling £26.469 million over the next four years. Work has already commenced on this major programme.
The hospital is also reviewing a number of its policies, including the transfer of patients from other health board areas and the admission of patients through the outpatients' department. Continuing efforts are being made to improve the discharge planning process and the hospital has appointed three bed co-ordinators in this regard.
The local and national initiatives which I have outlined above should impact positively in reducing waiting times in the accident and emergency department at Beaumont and other major A&E departments. Local discussions between management and staff at the hospital are ongoing to address the issues in question and I would hope that the matter can be resolved quickly by this process in the interests of both patients and staff.
Is the Minister not very concerned by the fact that although we have not yet reached the worst part of the winter, some 30 patients had to sleep on trolleys at the weekend when the nurses began to discuss industrial action? The Minister did not address the question I asked. While I welcome Filipino nurses to this country, I hope the Minister does not view their arrival as a solution to the nursing crisis because if he does, we will not see any real progress on this matter in the future. Will the Minister assure the House that the industrial action voted on by 100% of nurses in the A&E department in Beaumont will not go ahead on 11 December?
Beaumont is a busy hospital and this is a busy time of year. The nurses have no real desire to take industrial action and do not want to withdraw service from their patients but they may feel they have to do so in an effort to resolve a problem. Will the Minister guarantee us that the problem has been solved and that the prospect of industrial action is off the agenda altogether?
I cannot guarantee that because discussions are ongoing. While I acknowledge that there is overall pressure on accident and emergency services throughout the country, certain local factors in Beaumont had an influence on the events which have unfolded in the hospital. We are putting huge investment into A&E services and will continue to do so.
A meeting of the hospital's board of management, which was scheduled in any event, was held immediately after the ballot result was announced. I am hopeful that we can avoid industrial action and appeal to all concerned not to take such action but to resolve the issues through dialogue. Industrial action would place enormous pressures on patients accessing services at this time of the year.
We will provide the hospital with any additional resources which it requires. We have already provided significant resources to the A&E section of the hospital. This year, some £250,000 was provided for the refurbishment of the A&E department, in addition to two allocations of £200,000 in 1998 and 1999 respectively.
Did the Minister provide any extra trolleys?
We have provided significant resources and if the hospital comes up with any further innovative ideas, we will respond to them. Contact has been maintained with the key people involved in this situation and I am hopeful that industrial action can be averted. Hopefully, there will be a positive outcome from the discussions later today.
If the Minister cannot guarantee that industrial action will be averted, will he at least give the House a guarantee on one local issue at the hospital? I refer to the fact that 30 patients had to sleep on trolleys in the hospital while 64 beds were closed in the same hospital. Bed capacity is available in the hospital but is not being used. Will the Minister even offer a guarantee in that regard to the patients and hard pressed nurses or does he intend to provide additional trolleys as the winter worsens?
We must proceed to Question No. 5.
We have provided additional beds under the winter beds initiative from which Beaumont has benefited. I am informed by the hospital that all wards will be open in the hospital from January onwards as a result of additional nurses coming on board. That should help to alleviate the situation.
