Mary Harney (Dublin Mid West, Progressive Democrats)

This takes time and that is why we have given top priority at the Cabinet committee on health to improving accident and emergency services. This is why I have brought forward a fully-funded ten-point plan for accident and emergency services for this year. There is €70 million in current funding and €10 million in capital funding allocated for it. This plan builds on the wider investment in health that has been made since 1997.

We are bringing the greatest focus possible to improving accident and emergency services. Each factor that has caused delays in accident and emergency units is being addressed and each action is being implemented. With the single Health Service Executive now in place, the lines of reporting and accountability are clear. I have asked for and I am receiving frequent and detailed reports on the implementation of each action. We will continue to focus on accident and emergency services throughout the year. We will monitor actions and results and if further decisions and actions are required, we will take them also.

I am sure Deputies are aware that the effective delivery of emergency services cannot be achieved in isolation from all hospital services. It is necessary to take a whole-system or system-wide approach involving primary care, acute care, and sub-acute care and community care in tackling the problems in accident and emergency departments.

I will outline the range of measures to be taken and give the House an update on progress in the first weeks of the year. In this regard, consider the new minor injury units, chest pain clinics and respiratory clinics. The benefits of locating these within accident and emergency departments is well-established, as has been mentioned by a number of Deputies. Specialist medical and nursing staff provide a rapid assessment and treatment service for patients in these units. These units will be established or developed in hospitals to improve care for patients through the accident and emergency department and this in turn will reduce the waiting time for patients with minor conditions.

On MRI scanning, rapid access to high-quality diagnostic services are key to diagnosing and treating patients. The provision of a second MRI scanner at Beaumont Hospital will greatly improve access for patients to the latest diagnostic technology. The tender process is currently being finalised. I have asked that the hospital examine options for accelerating the delivery of this additional key service.

Comhairle na nOspidéal's report on acute medical units, which I launched last October, examined the role, organisation and staffing of acute medical assessment and admission units. The report concluded that there exist good reason and real scope to manage effectively and streamline the process of assessment and/or admission of patients who are acutely medically ill. One of the key recommendations was that acute medical units should be developed in all acute general hospitals receiving acutely ill medical patients. We intend to act on this. Acute medical units should provide rapid assessment, diagnosis and treatment of patients referred for urgent medical assessment and/or admission. Acute medical units will be put in place at Tallaght, St. Vincent's and Beaumont hospitals as soon as is logistically possible over the next year. The funding will provide for the required staff and equipment.

Other patients will have higher dependency requirements for nursing home care. Tenders will be sought from suitable private nursing home providers to accommodate up to 100 high-dependency patients. I expect that the notification to tender for these high-dependency beds will be published in the coming days. The scope for using greater numbers of private nursing home beds to alleviate pressure on acute hospitals will also be actively pursued by the Health Service Executive.

We will offer intermediate care for patients with lower dependancy needs who have completed their acute phase of treatment. These are older people who are awaiting discharge to nursing home care or who are going back to their own home with appropriate supports. This arrangement will provide intermediate care for up to six weeks to patients as they prepare to go home. It is expected that about 500 people will benefit from this initiative annually. Invitations to tender to private nursing home providers have been published in the EU Official Journal and the national media in the past few days. I have asked for an accelerated process to be put in place to ensure that these beds are available as soon as possible.

Most older people who need care prefer to live in their homes and communities, if at all possible. Care in the community is preferable from many points of view. The success of initiatives in the Dublin area such as Slán Abhaile has allowed older people to live independently at home in dignity and comfort. Expanded home care packages will be put in place to support 500 additional older people at home. I have asked the Health Service Executive to accelerate the provision of these packages in line with the assessed needs of individual patients.

Very successful out-of-hours general practitioner services are in place in many areas throughout the country. This service can reduce the number of inappropriate attendances at accident and emergency departments. It has long been recognised that the absence of an out-of-hours service on the north side of Dublin has placed additional pressure on the accident and emergency departments of Beaumont and the Mater hospitals. I have asked the Health Service Executive to bring forward plans to develop a general practitioner out-of-hours service to meet the needs of specific areas. Already general practitioners in north Dublin have responded positively for this renewed focus on achieving reliable out-of-hours services. The model that works will be implemented.

We are all aware, particularly patients and their families, that accident and emergency departments do not always meet the standards of cleanliness that we rightly expect. There can be no excuse for dirt. The Health Service Executive will work with hospitals to ensure effective management and monitoring of standards of cleanliness. The key issue here is not funding, it is pride, standards and management. There will, however, be some funding to cover necessary refurbishment or redecoration of existing facilities.

It is also totally unacceptable that patients and staff do not, at times, feel safe in the caring environment of an accident and emergency department. Therefore, funding is being made available to hospitals to improve security measures and to take whatever other measures are necessary to ensure patient and staff safety.

The further expansion of palliative care facilities, particularly in the Dublin region, will ensure that terminally ill patients can spend their remaining time in the most appropriate environment thereby freeing acute hospital beds for incoming patients from accident and emergency or other planned admissions.

General practitioners have highlighted the need for access to diagnostic services. While the establishment of acute medical units will improve access for general practitioners to these services, additional arrangements will be put in place to enhance direct access for them to diagnostic services. The Health Service Executive and my Department will progress these arrangements. These are the ten actions that I set out at the publication of the Estimates for 2005. I expect real and measurable improvements to take place in the coming months in the delivery of accident and emergency services. To ensure that the measures I have outlined are implemented, a high level accident and emergency steering group is being established to include senior representatives from the Health Service Executive and the Department of Health and Children.

As an aid to progress, I welcome the recent intervention of the Health and Safety Authority which has a clear statutory role in regard to health and safety in the workplace. This is not the first occasion on which it has intervened. We all want to ensure that patients and staff working in hospitals have a safe and healthy environment.

The Health and Safety Authority has investigated specific incidents in hospitals in the past and has worked with the hospital authorities to ensure that satisfactory mechanisms are put in place to safeguard health and safety. The authority has asked hospitals to carry out a comprehensive risk assessment of their accident and emergency departments. This will be done with the co-operation of management and staff in each hospital.

In addition to the ten-point plan, at the end of 2004, my Department requested that the then Eastern Regional Health Authority and the health boards take action on several key areas in the management of accident and emergency departments and processes. Health agencies were requested to undertake a detailed analysis of patient flows in order to identify patient profiles, bottlenecks and improved ways of treating patients; to review work practices, particularly in the nursing, radiology and laboratory areas, in a partnership context; to roster medical and nursing staff in accident and emergency departments to match peak patient attendance times; to ensure that ward rounds by consultants or registrars are undertaken regularly to facilitate prompt discharge of patients and or transfer to other services; and to enhance information collection to measure performance regarding the provision of service to accident and emergency patients. This should include measurement of the length of time from triage to see a doctor, the length of time from the decision to admit to being placed in a bed and the overall waiting time in the accident and emergency department.

The agencies were also asked to give renewed attention to streamlining discharge arrangements for all patients, including the young chronic sick and high dependency patients, to reduce or suspend the admission of elective patients where there is a high level of pressure in the accident and emergency department and to implement escalation policies if there is a surge in accident and emergency demand. The Health Service Executive which was established on 1 January 2005 will pursue these actions.

Accident and emergency departments form a litmus test for me, the Government and the people of whether the health reform is working. By focusing our analysis, funding and energy on this area, we will achieve tangible improvements. I look forward to keeping the House and the Oireachtas Joint Committee on Health and Children well informed of our progress.

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