Tim O'Malley (Limerick East, Progressive Democrats)

It should be clear by now that the Tánaiste has put accident and emergency services at the top of the Government's agenda. The Government is totally committed to improving the public's experience of accident and emergency departments.

Accident and emergency services present a particular challenge to individual hospital managements. In many instances, accident and emergency departments are the only areas in which the wider public receive hospital services and, as such, hospital managements must regard the accident and emergency departments as the shop window for hospitals. While the accident and emergency service is but one aspect of acute hospital services, people judge our health services by their experience of accident and emergency services. While it is not a complete measure of health services, it is understandable that people view accident and emergency services in this way. A much more customer oriented approach must be adopted by hospital managements, consultants and nursing and other professional and support staff.

The actions to improve the delivery of accident and emergency services take a wide-ranging approach and are aimed at improving access to accident and emergency services, improving patient flow through accident and emergency departments, freeing up acute beds and providing appropriate longer-term care for patients outside the acute hospital setting.

Delivery of hospital emergency services is interdependent on 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 in addressing the current problems is a whole systems approach which addresses the needs of people on a timely basis in the most appropriate setting.

The safety and security of staff in accident and emergency departments has been and is a continuing priority for health service management. An independent review of security arrangements in accident and emergency departments of all hospitals in the State providing accident and emergency services was undertaken in 2002. The review recommended the introduction of a range of measures aimed at enhancing security arrangements in accident and emergency departments. The Department of Health and Children provided €2.35 million in 2002 to the then Eastern Regional Health Authority and the health boards towards the cost associated with the enhancement of security arrangements. Earlier this year all hospitals with accident and emergency departments were contacted regarding the review of security that took place in 2002. The review showed that the recommendations made in 2002 were largely in place. One of the key recommendations of this review was that all acute hospitals should actively participate in the Garda hospital watch programme.

The recommendations on security included closer liaison with local gardaí in regard to advice on security measures. Modern hospitals have good accessibility and provide services on a 24-hour basis. Because of their sheer size and openness there is potential for crime to take place. Crime committed in a healing and caring environment can be doubly traumatic for patients, visitors and staff, and hospitals are making every effort to prevent and reduce the opportunity to commit crime.

The hospital safety and security programme known as hospital watch is similar to neighbourhood watch. It acts as a crime prevention programme, using the knowledge and alertness of staff, the development and introduction of good security practice and regular communication between the staff and the local gardaí to minimise the opportunity for crime within hospitals. This programme helps make these vital and vulnerable hospital environments a safer and less stressful place for everyone. I am happy to report that the majority of acute hospitals now have a hospital watch programme in place where there is ongoing liaison with local gardaí.

The Government set out to improve the physical infrastructure of acute hospitals, particularly accident and emergency departments. A number of new units in acute hospitals throughout the country are in the process of coming on stream. New accident and emergency departments have also been provided under the capital investment programme. Last Monday the Tánaiste officially opened a new purpose-built accident and emergency department at Cork University Hospital. New accident and emergency departments and new hospital buildings were also provided at Connolly Hospital, Blanchardstown, and Naas General Hospital at a total capital cost of €100 million and €75 million, respectively. A new accident and emergency department was provided at Roscommon General Hospital at a capital cost of €6 million. New accident and emergency departments are expected to open this year at St. James's Hospital, Dublin, and at South Tipperary General Hospital, Clonmel. Major capital projects at Tullamore General Hospital and St. Vincent's Hospital, Dublin, will also result in new accident and emergency departments being provided. These developments, together with new day facilities, theatre and diagnostic capacity, will result in improved patient flows through the hospital system and make better use of existing inpatient beds.

The need for additional acute beds in the hospital system has been well documented. The Government is now well on the way towards building up the acute bed capacity in the acute hospital system. Since the publication of the health strategy in December 2001, funding has been provided to hospitals to open an additional 900 beds.

For the benefit of the House, I will set out the current status of the initiatives under the Tánaiste's ten point plan for accident and emergency services. First, on the development and expansion of minor injury units, chest pain clinics and respiratory clinics in hospitals to relieve pressure on accident and emergency departments, the HSE eastern region has had very positive discussion with both public and private sector providers for the development of additional minor injury facilities in Dublin. The HSE eastern region has initiated an exercise due for completion this month to assess minor injury attendances at accident and emergency departments and the potential of having these patients treated elsewhere. The results of this exercise will inform decisions regarding the scope of minor injury and diagnostic initiatives and also the evaluation criteria.

Second, it is expected that the second MRI for Beaumont Hospital will be available by the autumn. Third, there will be provision of acute medical units for non-surgical patients at Tallaght, St. Vincent's and Beaumont hospitals. The relevant hospitals are finalising their proposals for the HSE. The national hospitals office is in the process of seeking tenders from companies expert in the area of workflow management to identify how processes for patient services can be improved and made more efficient. Final decisions on the design of the acute medical units will be taken in light of this work so that resources are used most effectively, hospital by hospital.

Fourth, 100 high dependency patients will be transferred to suitable private nursing home care. The tender process for the provision of high dependency beds for 100 patients in private nursing homes is in the final stage. The essential site inspection visits have been completed. Decisions on which nursing homes to be awarded contracts will be taken shortly.

Fifth, there will be negotiation with the private sector to meet the needs of 500 people annually for intermediate care of up to six weeks. The tendering process is completed and successful applicants have been notified. A total of 90 beds have been procured nationally to allow an annual throughput of 500 patients. Some 64 patients from hospitals in the eastern region and 23 patients in the Cork region have already been discharged as a result of the intermediate beds being available.

Sixth, there will be expanded home care packages to support 500 additional older people at home. Additional home care packages for patients in each of the six major acute hospitals in the Dublin area have been made available. An additional 100 home care packages have been allocated to hospitals outside of the eastern region. To date, some 51 patients have already been discharged from acute hospitals in the eastern region and discharge arrangements are being finalised for a further 45 patients.

Seventh, there will be provision of more out of hours GP services to keep people's need to attend accident and emergency to a minimum. Some 150 GPs on Dublin's northside have agreed in principle to the establishment of out-of-hours services. Discussions in this regard are progressing positively.

Eighth, there will be dedicated cleaning services and security measures for accident and emergency departments. The director of the national hospitals office is finalising arrangements for the establishment of a national audit and an inspection process to measure cleanliness in all acute hospitals. Funding is available to hospitals to improve security measures and to take whatever measures are necessary to ensure patient and staff safety. The director of the national hospitals office has written to all hospitals in regard to the report of the Health and Safety Authority in this regard.

Ninth, there will be further expansion of palliative care facilities. An additional six palliative care beds will be made available in Blackrock Hospice, Dublin, as soon as the necessary staff are recruited.

Tenth, there will be measures to enhance direct access for GPs to diagnostic services. It has been agreed to explore entering into local arrangements with the private sector to match capacity with needs. Negotiations are ongoing. In regard to inpatient diagnostic services, discussions are advanced with two private hospitals in the eastern region on MRI and CT.

I am confident the actions taken by the Government, including the provision of new beds and capital investment under the Capital Investment Framework 2005-09 will, over time, generate an appropriate, multi-faceted and multi-dimensional response to the accident and emergency problem.

The problems of alcohol abuse are very real and go much wider than their impact on accident and emergency services for patients. Unfortunately, the Opposition's motion is not real in regard to this aspect. It displays no evidence of practical thinking about the practical realities of dealing with people with alcohol-related problems at accident and emergency. To ask Dáil Éireann to approve a motion calling for "hangers on" to be "rounded up" shows no real appreciation of the legal, medical or civil rights requirements.

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