Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I will begin with your question, Chairman. I will ask Liam Woods to comment in a moment as the director of the acute hospitals division. Bed capacity is one of the issues contributing to the trolley situation in Limerick, but there are others. Bed closures or bed capacity not being opened in nearby hospitals, where they are available but where there is a staffing issue, is another contributing factor. Possibly, the primary care Shannon Doc configuration could be a contributory factor as well. Certainly, I am concerned that it could become a contributory factor. Another challenge in Limerick relates to the capacity of the emergency department - I am referring to the physical capacity. I was struck by this when I visited the building. I realise plans are under way for a new emergency department and staff will be moving in to it early next year.

We have opened a further 53 beds as part of this year's winter initiative. I will ask Liam Woods to comment on that in a moment. We are going to carry out a bed capacity review in general for the country. I am keen for the bed capacity review to be complete in time for the Government's capital plan review. Obviously, there is a cost associated with accommodating and physically fitting in to our hospitals more beds and for this to be done in time for the capital review.

It is important to consider several points when we are discussing trolleys. Specific hospitals have specific problems and there is no disputing that whatsoever. It is important to discuss the figures in context. We still have a situation whereby despite emergency department attendances being up, on average, in the system by approximately 5%, the number of people on trolleys this year is still down by approximately 4%. I accept this is not a defence of the point and the figures are still far too high and unacceptable, but it means almost 4,000 fewer people have been on trolleys in the health service this year to date than for last year for the same period. This is simply a contextual comment.

Deputy Durkan asked several questions. I will ask the Minister of State, Deputy McGrath, to address some of them and I will ask the Minister of State, Deputy McEntee, to deal with mental health and older persons questions.

The Deputy raised specific issues regarding structures and the HSE structure in particular. I get the impression that we have been talking about the structure and model of the health service since God was a boy. I am sceptical about whether our patients have benefited significantly from such academic and deep discussions. That is why we need to have consensus. What we do not need is for Ministers to arrive and start tinkering with structures and models and ending up all over the place for a period, only for a new Minister to come in to do more tinkering and re-modelling. This is why the Oireachtas cross-party Committee on the Future of Healthcare has to come up with a vision for our health service that is owned not by me or the Department of Health but by the Oireachtas and all parties within it. I look forward to receiving the report of the committee.

Deputy Durkan is right in respect of his comments on primary care. I have been consistent in the view that primary care is about more than bricks and mortar, although bricks and mortar are important. Figures available to me indicate that approximately 30% of the minor surgical procedures currently carried out in our acute hospital settings could be undertaken in general practice. That represents a sizeable number of people. Much of this needs to be addressed in the context of the general practitioner contract, although some work has been done in this area. Under a pilot project on minor surgery in general practic, we have seen 4,263 minor surgical procedures carried out. Approximately 55% of these were carried out on medical card patients. We now have a comprehensive accreditation system for GP surgeons. Practices have been tested in what we are calling the minor surgery pilot study. A final report on the project has been published and we are now planning to progress it further and to extend it to more practices. Patient satisfaction as well as outcomes is important and 96% of patients who had surgery carried out in the GP practice rated the overall experience as very good or excellent. A similar project in respect of the provision of ultrasound services in primary care is under way. This started as a pilot in 2005. Funding of €700,000 was provided in 2015. A further amount of €13.5 million of held-back funding for primary care developments was provided for access to diagnostics this year. I have visited several places. I was in Tipperary recently in a centre where people are now getting an ultrasound done in the GP practice rather than going to the hospital in Clonmel.

I agree with the views expressed.

We need to do more and the general practitioner contracts are important in this regard.

I will make a final point on older people. I agree with the views expressed in this regard as well. If an older person comes into our hospital system, he or she needs to be dealt with in a particularly sensitive and careful manner. While the debate about specific hospitals is probably for another day, we can develop the pathway of care for older people. The first place should always be at home in the community. The point made is right. That will not always be possible. Under the winter initiative this year, we have piloted a new development for older people whereby there is a specific place where the older person comes in on entry to the hospital. A specific nurse will be on hand to deal with the older person. Sometimes older people have acute needs and are in a fragile situation. Our older people should not have to go through the general milieu of the emergency department. I am watching carefully the project we are about to initiate in St. Luke's General Hospital in Kilkenny with a view to further learning.