Dáil Éireann díospóireacht -
Tuesday, 23 Apr 2002

Vol. 552 No. 3

Written Answers. - Hospital Services.

Bernard J. Durkan

Ceist:

121 Mr. Durkan asked the Minister for Health and Children the measures he proposes to take to improve the quality of service to patients and working conditions for staff at accident and emergency departments in all hospitals throughout the country with particular reference to the need to provide an efficient, effective and satisfactory service; and if he will make a statement on the matter. [12395/02]

Minister for Health and Children (Mr. Martin)

The hospital system in general is experiencing increased pressure on available beds due to a number of factors, including the growth in population and increasing number of elderly people who have a higher than average length of stay. Available data indicates that about 70% of all hospital admissions are through accident and emergency departments. This Government has taken a number of initiatives to improve services in accident and emergency departments. A €40.63 million investment package was provided in the winter of 2000-01 aimed at alleviating service pressures and maintaining services to patients, particularly in the acute hospital sector. This investment package provided for the recruitment of additional 29 accident and emergency consultants and for the contracting of additional private nursing home places for patients whose acute phase of treatment has been completed but who require additional care in an alternative setting. The ERHA and the health boards contracted more than 700 beds under this initiative in the winter of 2000-01. This level of funding was repeated over the period October 2001 to March 2002 and has been of significant benefit to health agencies in responding to the high level of demand for hospital beds over the winter periods.

I have also provided funding to the ERHA and the health boards to support a further range of initiatives in accident and emergency departments. These include: £5.19 million towards the development of accident and emergency facilities at St. James's Hospital; the provision of minor injuries units in Beaumont, Mater, James Connolly Memorial, St. James's and Tallaght Hospitals; development of accident and emergency department at the Mater Hospital; extension to the accident and emergency department at St. Columcille's Hospital; development of pilot services for deep venous thrombosis in Beaumont Hospital; provision of a chest pain service at St. James's Hospital; the provision of a pilot discharge lounge in Beaumont Hospital; the recruitment of discharge planners and patient liaison personnel at accident and emergency sites in the eastern region; development of new accident and emergency department at St. Vincent's Hospital, Elm Park; development of new accident and emergency department at the Children's Hospital, Temple Street; planning of a new accident and emergency department for Cork University Hospital; development of accident and emergency department at Galway University Hospital; development of accident and emergency department at Castlebar General Hospital; development of accident and emergency department at Tullamore General Hospital; development of a new accident and emergency department at Portlaoise General Hospital; appointment of a design team for the development of a new accident and emergency department at Roscommon County Hospital; and the upgrading of accident and emergency facilities at Our Lady of Lourdes Hospital, Drogheda, Monaghan General Hospital and Our Lady's Hospital, Navan.

My Department, in conjunction with the Department of Finance and in consultation with the social partners has conducted a comprehensive review of acute hospital bed capacity needs. On foot of that review, entitled Acute Hospital Bed Capacity – A National Review, the Government has decided to provide an additional 3,000 beds in acute hospitals over the next ten years. I announced on 16 January a €65 million investment package in the current year for the commissioning of 709 of these 3,000 beds in acute hospitals. My Department has been advised, by the ERHA and the health boards that 98 of these beds have been commissioned, that an additional 23 beds will come on stream by the end of April 2002, with a further 49 beds by the end of May 2002. The balance will be introduced on a phased basis during the rest of the year.

A major re-focus on primary care services, marked by the introduction of new models of care involving core multi-disciplinary primary care teams, which will work with a wider network of health and social care professionals and which will offer 24 hour cover to patients, has taken place. This will also help to reduce demand from and treat appropriately patients who would otherwise have to attend at an accident and emergency department. This sector will therefore take on a pivotal role in helping to reduce pressures in accident and emergency departments. A sum of €17.29 million is being invested in the development of this service in 2002.

Other initiatives have been identified in the health strategy which are designed to improve the operation of accident and emergency departments. These include: the establishment of minor injury units to ensure appropriate treatment and management of non-urgent cases; the use of chest pain clinics, respiratory clinics and in-house specialist teams to fast-track patients as appropriate; the re-organisation of diagnostic services to ensure increased access to, and availability of, services at busy times in accident and emergency departments; the appointment of advanced nurse practitioners, ANPs – emergency, in acute hospitals; the use of admission protocols to ensure that emergency patients will be the only group of patients admitted to hospital through accident and emergency departments; the appointment of additional personnel to liaise with patients while they await diagnosis and treatment at accident and emergency departments; and the introduction of information systems that record comprehensive, comparable and reliable data on activity in accident and emergency departments. Such information will provide staff with a valuable tool in structuring services to meet the needs of patients.

At my request, Comhairle na nOspidéal has undertaken a review of the structures, operation and staffing of accident and emergency departments. The report entitled "Report of the Committee on Accident & Emergency Services" not only deals with the staffing of accident and emergency departments at consultant level but also links reform of accident and emergency departments with the need to look critically at hospital processes and patient flows through the hospitals. The report provides valuable advice on the structure of our emergency services and the necessary linkages which will be required to eliminate delays in emergency departments.

The Deputy will be aware that action was recently taken by nursing staff employed in accident and emergency departments order to highlight difficulties being experienced in service provision. Proposals put forward by the Labour Relations Commission aimed at resolving the difficulties which had arisen were accepted by all parties. Proposals in the agreement included a requirement that a full security assessment would be undertaken, in each accident and emergency department in the country and that a national A&E nursing staffing structures review group will be established to carry out an immediate examination of existing structures and staffing levels in accident and emergency Departments. I am pleased to inform the Deputy that considerable progress is being made in implementing the proposals put forward by the commission.

On 13 February this year, I announced the establishment of an accident and emergency forum to identify steps that can be taken immediately to alleviate current problems in accident and emergency services. The forum, which had its first meeting on 20 March 2002, was chaired by Dr. Danny O'Hare former president of Dublin City University. There were approximately 80 participants, representing hospital management, members of the medical and nursing professions, para-medical and non-nursing personnel, staff representative associations and unions, patient advocacy groups and other interested parties in attendance at day one of the forum. Day two of the forum is scheduled to take place on 1 May. The work of the forum will help to build on the existing and proposed policy framework for accident and emergency services as set out in the national health strategy. I am pleased with the response to the forum and I am confident that its work will contribute significantly to advancing the existing and proposed policy framework for accident and emergency services as set out in the national health strategy.

Question No. 122 answered with Question No. 113.