Dáil Éireann Debate, Thursday - 11 February 2010
1 Deputy James Reilly asked the Minister for Health and Children the action she will take to tackle the number of patients waiting on trolleys in accident and emergency, which was recorded by a union (details supplied) at a high of 500 during January 2010; and if she will make a statement on the matter. [7227/10]
Amharc ar fhreagraA number of emergency departments have been recording high numbers of patients waiting to be admitted to hospital in recent weeks. However, detailed sampling from 24 hospitals, which began in February last year, to the end of December indicate that 87% of all patients attending an emergency department were either discharged or admitted within the maximum target of six hours, and 94% of all patients who did not require an admission were discharged within this time.
I do not believe that the "trolley count" figures for patients awaiting admission are an adequate indicator of performance in emergency departments as they only record the waiting time from when a decision has been taken to admit. From the end of March, the HSE will record waiting time from when a patient arrives in the emergency department. This will be a far more meaningful record of patients' experience in emergency departments.
I have been monitoring the situation in emergency departments very closely. I met with the chairperson, CEO and members of the HSE management team recently to review progress and to ensure that all possible steps are being taken to minimise the waiting time for patients awaiting admission. I asked the HSE to streamline the administrative processes for dealing with applications under the fair deal so that the discharge of patients to a suitable long-stay facility is not delayed unnecessarily.
The HSE has put several actions in train including escalation plans to enable patients to be moved to wards, additional ward rounds to take place daily to help earlier discharges from hospitals and ensuring access to additional diagnostic facilities such as imaging to allow earlier decisions about admission or discharge. At my request, the HSE is also putting in place a system of early warning measures so that corrective action is taken as soon as problems in a particular hospital are identified. Hospitals have also been instructed to ensure that all escalation measures are implemented and reviewed as necessary and that appropriate liaison arrangements with primary and community services are in place.
I thank the Minister for her response. I welcome the fact that, not before time, the waiting time will be counted from the time the patient attends the accident and emergency department. To be frank, it is nonsensical to have any other system.
The reality is that during January the figure reached 500 people on trolleys. It is a number of years since the Minister declared that this would be treated as a national emergency. It is not a blip. Last week, the Minister said on "The Pat Kenny Show" that it was a blip and that there will always be people on trolleys in every health care system and every hospital in the world. I have to disagree. I stood in a busy hospital in Holland where there were no patients in the corridors and no patients on trolleys in accident and emergency. Patients were seen within ten minutes of coming into the hospital, and admitted and discharged within a couple of hours. That is what we should have and there is no reason that we should not have it.
This is reality for people. I have an e-mail from a constituent——
A question, please.
I will ask a question. I want to ask about this constituent, whose father is aged 85 and lay on a trolley from Sunday night until last night. He has now been moved to a bed but he is still in an annex to accident and emergency in Beaumont Hospital.
The recent contention of Professor Brendan Drumm that 30% of patients, because they are only in hospital for 48 hours, do not really need to be there is utter rubbish. I have spoken to my colleagues about this. There is not a single patient admitted into Beaumont, the Mater, the James Connolly or any of the other hospitals who does not need to be admitted.
Does the Minister accept she has failed to solve the accident and emergency crisis, that the plans she has put in place have been a dismal failure and that a new approach is required?
First, I do not accept that everybody who is admitted to a hospital should be there. We know from the bed utilisation study that a large percentage of patients should not have been in hospital in the first place. As Professor Drumm said at the committee the other day, many people are admitted in order to get access to diagnostics. Not only is that an issue for the public health system, it is also an issue for insurers. I am engaging with private insurers to make sure we do not support bad practice, which is that we financially support inpatient activity when it is not necessary.
We know a large percentage of patients who enter from accident and emergency are admitted when senior decision makers may not be available to deal with their issue. I spoke to a consultant friend recently who told me that when he was working in accident and emergency one weekend, he was able to discharge a large number of patients who were down for admission and refer them to his clinic the following week. That is an issue. The new consultant contract, with clinical directors and the huge new powers we have given, including nurse prescribing, will lead to a more immediate response.
Second, I am not aware of any hospital in the world, and I have visited some of the best, where there are not trolleys in accident and emergency.
The Minister should visit Holland.
I had an experience in an accident and emergency department in County Waterford a number of years ago, where I was on a trolley while tests were done. I am not aware of a hospital anywhere in the world where trolleys are not used if the staff are doing blood tests or other tests.
The issue is how long people are waiting before they are either discharged or admitted. A number of years ago, we did not measure that. The issue is not whether it is 200, 300 or 500 patients; it is how long any individual patient is waiting. Last year, only 40% of patients who were being admitted were admitted within the six hours. This has now increased to 52%. I accept there are still 48% who are not admitted in that six-hour period, which is unsatisfactory. However, we never measured against a six-hour target until recently and, from the end of March of this year, hospitals will have to measure from the time patients arrive.
If somebody was waiting six days, I would like to get the details of the individual case. That is totally unsatisfactory. If the Deputy would give me the details, I would like to pursue the matter.
I did not refer to six days today but I will get the Minister the information, which relates to another person.
I thought the Deputy referred to six days. Perhaps it was three days.
We all get disorientated in here. It happens to the best of us. With regard to the Minister's semantics about somebody lying on a trolley, we all know what we mean by trolleys in accident and emergency and the length of time people have to wait. There is no question about that. What the Minister describes is something that will happen into the future. The reality is that people are lying on trolleys now, and they were there yesterday, the day before, last week and last year because they do not have access to the diagnostics to which the Minister referred because they are not being provided. There is no point talking about utopia and how things will change until those measures are put in place.
Professor Drumm and the Minister gave a great performance at the committee earlier in the week about all the things that will be done. Until they are done and until we see the primary care rolled out, we have a real problem. The bottom line remains that the Minister must accept responsibility. For the past three years, despite announcing her plan, despite the money that was spent on it and despite saying this would be treated as a national emergency, it has not happened. After three years, the public do not believe it will happen under the Minster's jurisdiction.
I have a lovely graph which I will send across to the Deputy. I do not want to hold it up in the Chamber and be accused of using a banner. The graph shows performance in 2005 as against now. By any yardstick, there have been considerable improvements. While I am by no means saying the situation is ideal, there have been steady improvements.
I genuinely believe the clinical directorate model which is now in place is making a huge difference. I also strongly support the escalation policies. I have been reading material from other countries, even since the committee meeting earlier in the week, which confirms what the chief medical officer said. The fact is that when there is an issue in an emergency department, it is not just an issue for the emergency department but for the entire hospital. The entire hospital must deal with it seriously, as happens in many hospitals throughout the country — Waterford hospital has a very good track record in this regard, as does Kilkenny hospital and many other hospitals.
There are hospitals, particularly in the greater Dublin area, that currently have issues around late discharges, and the introduction of the new scheme has caused initial delays because it is very new and must be signed off on legally and in some cases by the courts. However, when those 7,000 applications are processed, this will have a huge impact on late discharges.
