Joe Costello (Dublin Central, Labour) | Oireachtas source

I just have a couple of quick questions. First, I note the huge discrepancy between the two Dublin hospitals that are mentioned in terms of improvements or disimprovements in their emergency departments. The figure for James Connolly hospital is down by 18.2%, while that for St. Vincent's hospital is up by 46.7%. I wonder what the situation is at the Mater Hospital. Does Mr. O'Brien have any explanation for the huge discrepancy between those two hospitals? What I found most interesting about Mr. O'Brien's contribution was in the last paragraph at the bottom of page 5. Mr. O'Brien said:

We are also changing services to reshape and reduce demand on ED services by improving services in primary care. For example, the primary care focus is on strengthening existing alternatives to hospital emergency departments and on creating new options for patients and referring clinicians which do not necessarily require attendance at hospital emergency departments.

These include a whole range of desirable developments that would no doubt reduce the impact on, and the workload of, emergency departments, if all of them were to be implemented.

Twenty primary care centres are currently up and running and Mr. O'Brien expects to have 80 operational next year. Do the existing primary care centres have any significant impact on accident and emergency departments in terms of lessening the workload? If so, has Mr. O'Brien assessed this? For example, in his opening remarks, Mr. O'Brien said that 83% of patients were either discharged or admitted after nine hours. I presume the vast majority of those are discharged. Presumably, also, most of those did not necessarily need to attend a hospital emergency department. Does Mr. O'Brien have any idea of the percentage that need not have been at the hospital at all but could have been dealt with alternatively, particularly by primary care centres? There is currently one primary care centre in my constituency, out of four promised, which is on the Navan Road. Next year there will be a second one in Grangegorman. Is there any correlation between the opening of this care centre and admissions to James Connolly hospital or the Mater hospital, which are adjacent to it? Might an ambulance not alternatively take somebody to a primary care centre rather than to an emergency department if minor surgery such as stitching is required? It seems to me that that will be the eventual solution. I would like to see how it is working at present.

My second point is about delayed discharges. It is welcome that discharges are down from 830 to 568, which represents a 32% reduction. Do we have any clear figures on the delays? I have found one issue that is problematic.

There seems to be no real relationship with the local authority. My constituency has a great deal of local authority housing. Let us say that somebody has a stroke and needs a ramp or some adjustment to his or her home, he or she may have to wait six months in hospital on a delayed discharge until that is done. There may or may not be alternative step-down facilities available. What is the relationship with local authorities and how effective is the HSE in that regard? My understanding is that one is simply in another long queue waiting for attention rather than being given the emergency treatment one deserves.