Brian Lenihan Jnr (Dublin West, Fianna Fail)

The Tánaiste and Minister for Health and Children has outlined her action plan to improve the delivery of accident and emergency services which will significantly improve patients' experiences of accident and emergency services. The Government has devoted significant attention to, and investment in, accident and emergency and related services. Last October, Comhairle na nOspidéal published a report on accident and emergency services. A key finding was that a hospital-wide response was needed to meet the requirements of accident and emergency services and this recommendation has informed and underpinned our approach. Improving the care of patients through emergency departments via minor injuries units or medical assessment units is an important aspect of the hospital-wide response needed, but not the only one.

Delivery of the emergency service at hospital level is interdependent with the inpatient elective service, day and outpatient care, and community services. The effective delivery of emergency services, therefore, cannot be dealt with in isolation from the delivery of all hospital-based services. The key point in addressing the problems is a whole system approach which addresses the needs of people on a timely basis in the most appropriate setting.

This approach is also consistent with the report of Capita Consulting which was commissioned to carry out a national review of the bed management function by the Health Service Employers Agency. Capita reviewed 23 selected pilot sites where 24-hour, seven day a week, accident and emergency services existed. The report identified system-wide problems as affecting bed and patient management in acute facilities, including shortage of acute beds; a high rate of bed occupancy; acute beds blocked by patients who are ready for discharge and capacity problems for long-term care.

Capita also identified a wide range of issues at hospital level that had a serious impact on bed utilisation. One clear message that comes through from the various analyses of hospital services is the need to address the problem of acute bed capacity. The Government is well on the way to building up the acute bed capacity in the hospital system. We are committed to increasing acute hospital bed capacity as set out in the health strategy which identified the need for an additional 3,000 acute beds in the period to 2011. Following publication of the strategy in December 2001, funding was provided to open an additional 700 beds.

Last September, the previous Minister for Health and Children, Deputy Martin, approved the commissioning of 200 beds in several new units in acute hospitals throughout the country, funded under the national development plan. These developments will provide modern health facilities particularly for cancer care, medical assessment units and accident and emergency departments. New day facilities, theatre and diagnostic capacity will result in improved patient flows through the hospital system and ensure better use of existing inpatient beds. These new units will open during 2005. Health agencies are recruiting the additional staff required to operate these new units.

Last week I had the honour of officially opening the new hospital development at the James Connolly Memorial Hospital, Blanchardstown, which was one of the new units announced in September 2004. This new development is a good example of the Government delivering on its promises to improve health infrastructure and expand hospital capacity.

Building at Blanchardstown began in October 2000 and a phased opening of the new facility began when the coronary care and cardiac unit, the therapeutic psychiatry of old age unit, the day hospital and the rheumatology service transferred into the new building in September 2003. In September last year, the Minister approved funding of €10.7 million for the commissioning of further services to the new wing of the hospital, including the new surgical block, the accident and emergency department and the critical care unit and operating theatres, all of which transferred to the new building in the latter months of 2004.

I would like to focus on the new accident and emergency department at the hospital. It is a state of the art facility, incorporating a chest pain assessment unit and observation area, a resuscitation unit and a minor injuries area in line with recent trends in emergency medicine. Other facilities include a plastering bay for orthopaedic injuries, an eye injury room with specialist eye equipment, an ENT room, ultra sound facilities and a procedures room for suturing. Since the new department opened there has already been an increase in activity of 8%. It is projected that this could grow as much as 20% this year, resulting in an increase in the number of new attendances at the department from 30,000 to 36,000. This emergency department in Blanchardstown now has the lowest waiting time in the eastern region. Its core team of dedicated doctors and nurses is supported by the work of advanced nurse practitioners, patient liaison officers and local general practitioners who attend on a regular basis.

As a Deputy representing the area and as a Minister of State at the Department of Health and Children, I keep a close eye on developments at the accident and emergency unit. It is important we work on ensuring that accident and emergency units develop the procedures, protocols and staffing arrangements that ensure overloading does not take place. It requires a major intellectual, social, management and, above all, staff effort to guarantee that overloading does not take place.

The hospital will now also have a new theatre suite with two additional theatres bringing the total number to five. These include a specialist clean air orthopaedic theatre with state of the art facilities. The provision of additional beds in the intensive care unit and in the coronary care as well as the provision of additional day beds is good news for patients and will result in greater numbers receiving treatment and care. This hospital is also well known for its care of the elderly services and the progressive day hospital operates a rapid access service helping to reduce admissions to the emergency department.

One of the most important projects being implemented in that hospital is the respiratory pilot project. This is an associated development intended to also have an impact on accident and emergency services. The project was approved in July 2004. It is a major development for the hospital and will see it become a centre of excellence for the provision of respiratory care. The project will ensure that respiratory patients are seen quicker, that there will be a reduction in the average length of stay, that there will be improved liaison with general practitioners and that all respiratory patients will be under the care of respiratory consultants.

There are also other developments in the system. The Tánaiste and Minister for Health and Children will open the new medical assessment unit at the Midland Regional Hospital in Mullingar tomorrow. The new accident and emergency department at Cork University Hospital is expected to open in March of this year. A new accident and emergency department is under construction at St. James's Hospital. New hospital buildings will also be provided at St. Vincent's Hospital in Dublin and at Tullamore General Hospital.

I trust that I have shown in my contribution that improving the delivery of accident and emergency services is a top priority for the Government. In the Department of Health and Children we will continue to work in the best interests of patients and staff. I am confident that we can and will improve the delivery of accident and emergency services so that patients receive the appropriate treatment as quickly as possible.

Since the appointment of the Tánaiste as Minister for Health and Children, she has clearly signalled her determination to tackle these issues. She has set herself clear deadlines in that respect. From the basis of her political record, I know that she is determined to produce results in this area. It is not something that can be done overnight. We all know the difficulties that exist. In the Tánaiste's tenure in the Department to date she has shown a determination to tackle these issues. I have no doubt her efforts will result in success.

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