I thank Senators for raising the issue. I apologise for being a few minutes late but when I turned on the television in my office I saw the Statute of Limitations (Amendment) Bill debate was ongoing. I was in the middle of a meeting but I came here immediately. I thank Senators Jackman and Fitzpatrick for their contributions. I found Senator Fitzpatrick's contribution fascinating in terms of the practicalities of the health service. This is an important and welcome debate.
Government health policy impinges in a significant way on the overall quality of life enjoyed by us as a society. It is little wonder that the subject generates much interest and debate, particularly in relation to the quality and availability of acute hospital services which are called on in critical circumstances on a 24 hour basis, 365 days a year. Against this background, I am glad of the opportunity to publicly acknowledge the high quality service overall that is provided in our acute hospitals. I also want to place on record the Government's strategy for its further development and continued improvement to the benefit of patients and potential patients everywhere.
The Fine Gael motion put to the House this evening attempts to portray a hospital service that is under-performing and that is failing to make full use of the resources available to it, to the neglect of thousands of people. This suggestion does a great disservice to the many thousands of skilled doctors, nurses and other health care professionals and the management of the hospitals and needs to be addressed head on at the outset.
In the first instance, it needs to be recognised that the acute hospital system delivers a service that is ever growing in terms of its volume and complexity. A rapid pace of medical and technological change and ever increasing expectations of quality challenge the system itself and all those working in it on an ongoing basis. Within this highly dynamic and complex environment, the hospital system is producing constantly improving patient outcomes which are facilitated by the ongoing introduction of new services, the development of existing ones, the introduction of new technologies and treatments and an unparalleled commitment to continual professional development by staff at all levels of the service.
Aside from the many qualitative improvements that are being made, in pure volume terms more people are benefiting from services in our acute hospitals now than at any time in the past. The numbers being treated continue to grow, year on year, each year. The latest figures available show that for the first ten months of 1999 almost 2.5 per cent or 16,000 more people were discharged overall and almost 10 per cent more people were treated on a day case basis in our hospitals than in the same period in 1998.
The overall volume of activity delivered is the most basic measure of performance of the system. Over the course of this year, more than 1.2 million people are likely to avail of accident and emergency services, almost 2 million people will be seen in out-patient departments and more than 800,000 people will be treated on an in-patient or day case basis.
It is in this context that temporary closures of beds should be viewed. The number of bed days lost in the system through temporary closures represented just 2.73 per cent of the overall bed days available in 1999. The bottom line is that the 97 per cent plus of the total available bed days that were used, enabled a volume of service that was approximately 2.5 per cent up on that provided in 1998 to be delivered.
Temporary closures do occur for good reason and have been a feature of the bed management function in acute hospitals for many years. Hospital and health board managers have a primary responsibility to ensure that the agreed volumes of service set out in the annual service plan are delivered upon. There is an important onus on them to achieve this within the resources available, be they of a physical, human or financial nature.
Periods of annual leave for consultant and other staff have traditionally led to temporary closures on a seasonal basis. The vastly increased funding that has been made available through the capital programme under this Government over the past two years has meant that major projects and minor refurbishment works are underway in hospitals all around the country. This year £231 million is available under the capital programme as against £100 million in the year that the previous Government left office. These works, which are aimed at the improvement of facilities for patients, obviously involve unavoidable periods of disruption and temporary closure of facilities while under way.
There are also, as Members will be aware, specific problems relating to the recruitment of staff, especially nurses, that have necessitated temporary closures in the eastern region in particular. Specific measures are being taken to address that problem which is a function of wider social and economic issues that are not confined to the health sector alone. The key point is that more than ever before the acute hospital system is delivering more service and a higher quality service. Shortening average lengths of stay and an increasing delivery of services at a day case level reflect ongoing advances in medicine that benefit the patient hugely and mean that the resources available can be used to better effect in a manner that suits the clinical and social needs of patients.
While it is very important to make these points, I am very aware that the issue of access to ser vices for those who are not deemed to be an emergency or in immediate need of care remains a focus of considerable dissatisfaction. Yesterday I announced the waiting list figures for the end of the December 1999 period which showed that the numbers waiting had risen in the final quarter of last year and are now back close to the level they were at this time last year.
I have already publicly expressed my dissatisfaction with the figures. I realise that the 36,855 people on public hospital waiting lists represent less than one-twentieth of the total numbers admitted annually for treatment in the hospital system. Yet, it is a matter of genuine concern that many patients, whatever proportion they represent, have to endure lengthy waits for access to elective procedures.
I am aware that waiting lists are an international phenomenon and fully appreciate the complexity of achieving a solution to the problem. Substantial resources have been made available. This year £23.5 million is available under the waiting list initiative. Some £90 million in total was provided under the initiative between 1993 and 1999, yet, the problem of unsatisfactory access remains.
In coming at the problem there is a need to look at options more creatively and flexibly throughout the system to achieve real progress. These options include more flexible working patterns through longer opening hours for day wards and operating theatres; the use of hostel or other accommodation for patients required to travel for minor procedures; greater utilisation of facilities during periods of low seasonal demand – we will be looking at this issue in the shorter term to increase utilisation even more; more use of cross-contracting arrangements to maximise overall capacity in the system; improved collaborative arrangements between different parts of the system to facilitate a smooth passage for patients, thereby freeing up acute hospital facilities for new patients more quickly; better flows of information between general practitioners and acute hospitals; possible direct access arrangements for GPs for certain services and ready access to step down and long stay beds for acute hospital bed managers.
While there is no one simple solution to this problem, the key task is to manage the different parts of the system in a more closely integrated manner. We need to move away from narrow perspectives where each part of the system seeks to address its own problems in isolation and towards management and organisational structures that support a shared objective across programmes of achieving improved access at all stages of care. I am confident that the new era of health services management under way from today in the eastern area with the launch of the Eastern Regional Health Authority will be a major catalyst for progress in that region. The integrated organisational framework now in place in the eastern region needs to be capitalised on and the arrangements should be developed upon elsewhere.
This integrated approach to the problem underpinned the recommendations of the expert review group on waiting lists which reported in 1998. That report set out a series of short, medium and longer term measures that are directed at addressing the underlying causes of the problem. The Government strategy in place on foot of those recommendations has real potential for success. The good progress made in achieving reductions in the first three quarters of last year provided encouraging evidence of this. I intend to drive the implementation of these recommendations with an even greater urgency, with the emphasis on achieving reductions in average waiting times rather than the less meaningful measure of overall numbers waiting. Progress made to date is being reviewed and, where necessary, I will be seeking to accelerate the introduction of the required measures through direct communication and action with the chief executive officers of health boards.
The integrated approach required will also be mirrored in the organisational arrangements in place within the Department for tackling the issue. I have already established an inter-divisional group under the chairmanship of the Secretary General for this purpose. We will be looking at short-term as well as medium and longer term responses.
In planning ahead there is a need to examine the factors that have led to variations in the relative performances of hospitals in achieving waiting list reductions. Certain initiatives have clearly yielded success in some settings and we need to look at the scope for replicating those elsewhere. By the same token, the constraints that have impinged on the performances of other hospitals need to be identified and addressed.
I propose to take a number of practical steps that can facilitate progress in improving waiting times for access to services. While I am aware that there are no easy solutions, there is a coherent strategy in place which, if actively and comprehensively implemented, provides the promise of real improvement in the way we manage our services, leading to significant reductions in waiting times for access.
In tandem with the shorter-term measures now being taken there is a need to gear up the system with longer-term demand issues associated with demographic changes and to put in place the infrastructural framework required to address some of the underlying causes of the problems now being faced in the acute system. Towards this end the Government is committed to the investment of £2 billion capital funding under the national development plan over the next seven years. Significantly, £1 billion of this will be directed towards the non-acute sector. This represents an unprecedented level of investment in the infrastructure necessary to ensure patients are given access to services in the setting they require. This development of non-acute and com munity based services should also absorb some of the load being carried by the acute hospital system. The hospital system will also see investment of an additional £1 billion over this period. Investment on this scale should show real results in addressing some of the bottlenecks and under-capacity in the system.
In tandem I am initiating an immediate review of overall bed capacity in the acute hospital sector. This review is committed to in the Programme for Prosperity and Fairness and will be undertaken by the Department in conjunction with the Department of Finance and in consultation with the social partners. It will specifically address the issue of bed capacity and projected future demand. The review will examine and assess the adequacy of day care facilities as well as the organisation and utilisation of other existing facilities. It will also look at issues arising in the areas of manpower planning and technology assessment to support future decisions on the provision of diagnostic and treatment equipment.
These measures form only part of the Government's overall strategy for the development of acute hospital services. As part of a planned, coherent approach major progress is being made on a number of fronts in improving the responsiveness of the service to meeting identified need and in ensuring a patient focused, quality based approach underpins the delivery of service at every level. This is being achieved through the implementation of the recently launched national cardiovascular strategy now under way at an anticipated full cost of £150 million; the ongoing major progress being made in implementing the national cancer strategy – £34 million has been invested to date under the Government; the development of renal services through a planned investment of £20 million over the next three years which will dramatically improve and change the environment for renal services and a wide range of initiatives aimed at improving quality, from addressing medical manpower issues through to developing hospital and laboratory accreditation, acute hospital governance, management development, clinicians in management and health technology assessment.
These strategic developments are being facilitated by the unprecendented levels of additional resources the Government is committing to the improvement of our health services. Development funding for the acute sector alone this year stands at well over four times what was provided in the previous Government's final year in office.
While there are issues remaining to be addressed, it should be borne in mind that there is no service sector, public or private, that deals with people in such large numbers day in, day out and has comparable demands placed on it in terms of complexity, quality and the need for sensitive treatment of individual patients and their families as the acute hospital sector. In terms of access, quality, effectiveness in the use of resources and the commitment and skill of staff, our acute hospital system compares extremely well internationally. The Government is committing the resources and we have the strategies in place to ensure the service can continue to respond to the demands it faces and continuously improve as we move forward in the new millennium.
