Seán Crowe (Dublin South West, Sinn Fein) | Oireachtas source

One of the worries I have, and we touched on it earlier, relates to the pilot programmes being put in place in different areas. We rarely ever hear about the successful ones. Scans in nursing homes were mentioned. Some people are worried about regionalisation, going back to the old heath boards structure, and everyone working in silos apart from each other. That is why I am concerned about where the decisions are made.

A number of programmes and projects are in place. I will mention some of them because it is important we put a little balance into this morning's debate. A number of projects and programmes have been used and tested as regards safety and effectiveness in reorienting acute care away from emergency departments, EDs. I am aware of a couple of them. The community paramedicine project is in operation in the Border region, where community paramedics provide care to ensure unnecessary ambulance journeys to EDs are reduced. Apparently, research there has shown that 85% of all patients served did not have to go to an ED. That is a major section of the patient group.

The pathfinder project is another. It covers Beaumont Hospital in north County Dublin, which sees advanced paramedics, physical therapists and occupational therapists attend older, low acuity 999 callers in their homes to ensure they do not have to be transported to Beaumont accident and emergency. In other cases, I am aware of paramedics calling to older people, where people are informed their mother or father would be better off staying at home. Paramedics do that test. A study of that project found that of 527 callers, 69% were supported to remain home and kept out of the ED.

The last project is the emergency department in the home service. St. Vincent's University Hospital ambulance service allows patients referred to it by a GP or through a 999 call from a nursing home to be assessed by an ED doctor and an occupational therapist at home. According to that project's figures, of 3,137 patients treated over the course of eight months in 2020, 2,909 remained in their homes, saving the hospital a massive 7.9 years of bed days. That saves millions and creates capacity and efficient pathways of care.

What is the HSE view of these programmes? We have heard about some of them this morning. These programmes appear to be successful. What plans are there to roll out those services? We have regionalisation. These are issues coming from different areas, including hospitals and whatever else. How are these programmes rolled out, duplicated and made common practice? One of the very important areas we do not focus enough on are the things we get right.