Seán Power (Kildare South, Fianna Fail)

The motion which has been tabled requested that the Tánaiste and Minister for Health and Children take immediate action to address problems in the accident and emergency units of our hospitals.

It should be clear by now that the Minister has put accident and emergency services at the top of her agenda. As has previously been mentioned, the Minister has, in cooperation with the Minister for Finance, provided targeted funding to address the most pressing accident and emergency issues in a targeted and systematic way. The Minister has acknowledged that it will take some months for the measures to be fully implemented but nevertheless actions have already been put in train to achieve a measurable effect in improving the patient's experience and the conditions of staff working in accident and emergency departments.

The recent surge in attendance at accident and emergency departments is attributable, in part, to the high number of patients presenting with circulatory, respiratory and viral conditions especially amongst the elderly population, and seasonal winter pressures. However, these abnormal patterns will not deflect us from dealing with accident and emergency problems.

The issues relating to accident and emergency demand a whole-system approach. In this regard the advent of the Health Service Executive as a unitary health services management organisation will ensure that a coherent and consistent approach is developed in relation to accident and emergency services.

It is most important that accident and emergency services are not used as a political football or as a means to promote particular interests. The Government is committed to both improving the public's experience of accident and emergency departments and also improving staff morale in these departments. It is extremely important that highly qualified and specialised staff continue to be attracted and retained in this most important front-line hospital area.

Accident and emergency services present a particular challenge to individual hospital management. In many instances, accident and emergency is the only area in which the wider public experience hospital services. As such hospital management must regard accident and emergency departments as the "shop window" for the services which hospitals provide. Essentially a much more customer-oriented approach must be adopted by hospital management, consultants, nursing and other professional and support staff. In this regard, I am sure the Health and Safety Authority review will provide a valuable opportunity for hospitals to review their operational policies to ensure that they are effective and safe from both patient and staff perspectives. This review may well point to the need for additional improvements in services for those who attend at accident and emergency departments, thus building on action which has already been taken.

Management of accident and emergency services requires active management of patient flows. It is quite clear that much more innovative and alternative pathways are needed to ensure that only those patients who should be in accident and emergency departments actually end up there. Proper management of accident and emergency services demands an integrated approach across hospital services and beyond. In this regard, particular initiatives are required in relation to general practitioner services and meeting the medical needs of the elderly.

Before Christmas I had the pleasure of visiting Kilkenny Hospital where I was very impressed with its wonderful approach to dealing with this issue. It has been very successful in targeting services and implementing new ideas and dealing with issues in a very common-sense way with everyone in the hospital involved. The question of morale was mentioned earlier. I would say there is not a hospital with better morale than Kilkenny Hospital. Other hospitals might follow the lead Kilkenny Hospital has given in this regard.

In the context of my particular responsibilities for services for older people I would add that our policy on older people is to maintain them in dignity and independence at home in accordance with their wishes, and to provide a high quality of hospital and residential care for them when they can no longer be maintained in dignity and independence at home.

My Department has been encouraging health agencies to introduce personal care packages and home subvention for older people as an alternative to long-stay residential care. Personal care packages are specifically tailored to meet the individual's needs and could include the provision of a home help service, home subvention payments, arrangements for attendance at a day centre or day hospital and other services such as twilight nursing and occupational therapy.

In addition, a range of service initiatives have been supported in the current year. These include the nursing home subvention scheme, home care grant scheme, home help service, elder abuse programme and support to voluntary organisations.

I am confident that the actions being taken by the Minister, including the provision of new beds, will over time generate an appropriate, multifaceted and multidimensional response to the accident and emergency problem.

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