Brian Lenihan Jnr (Dublin West, Fianna Fail)

I am responding to this matter on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. Deputy Costello is aware, as he indicated in his contribution, that there have been particular pressures on accident and emergency services in recent weeks. A number of factors have contributed to these pressures, including increases in the number of attendances and the rate of admission at accident and emergency departments, an increased incidence of influenza and the winter vomiting virus and an increase in the number of patients awaiting discharge from acute hospitals. The winter vomiting virus has had the added complication of closing acute beds to new admissions and slowing the discharge of patients to a number of sub-acute facilities.

Particular difficulties were experienced over the recent bank holiday weekend when 27 patients were in the accident and emergency department of the Mater Hospital awaiting admission. Latest available figures for the hospital show that 14 patients were awaiting admission at 2 p.m. yesterday.

Prior to the more recent difficulties experienced in accident and emergency, the Mater Hospital had shown a reduction of over 20% in the numbers waiting in accident and emergency at 2 p.m. when comparing January 2005 and 2006 figures. This reduction in numbers waiting in the Mater Hospital accident and emergency department was achieved through the opening of the 33-bedded transit ward in December 2005 and the sustained focus on tackling delayed discharges. A total of 45 patients were discharged under this initiative in late 2005, 92 patients benefited in 2005 under home care packages and a further 153 patients were discharged to intermediate care.

The Health Service Executive and the Mater Hospital are working closely together to alleviate further pressures in the accident and emergency department and in this regard, the HSE has announced an initiative to contract 250 long-stay beds in the private sector to facilitate discharges from the acute hospitals. This initiative is to free up capacity in acute hospitals, including the Mater Hospital. It is expected that patients will begin to move from acute hospitals in the coming weeks.

In the broader context of accident and emergency services, the Taoiseach, the Tánaiste and Deputies on all sides of the House agree it is unacceptable that elderly people in particular should have to wait for long periods at accident and emergency units or sleep overnight on trolleys rather than in beds. Every available action that can be taken will be taken to improve patients' experience of care. These include a continuation of the steps in the ten-point plan. For example, the HSE will continue to provide many more long-term beds, step-down places and home care packages. These actions are recognised as essential by all concerned. In particular, the HSE's management actions are focused on attendances and admissions, delayed discharges and improving efficiency and throughput.

In terms of implementation, the following approach is being taken: tackling the issue hospital by hospital, developing hospital-specific time-based targets for accident and emergency and delayed discharges, development of financial incentives linked to performance in these areas and development of targeted initiatives aimed at delivering immediate and sustained impact in the areas of attendances, delayed discharges and efficiency. A dedicated team has been established by the HSE to drive the implementation of this framework.

In terms of immediate action it is critical that all hospitals take appropriate steps to ensure that patient privacy, dignity and comfort is preserved. In this context, funding is being made available within the capital programme to develop admissions lounges or transit units to ensure that patients are treated in an acceptable environment. Discussions are already under way with hospitals in this regard and detailed proposals will be agreed within the coming weeks.

The HSE has been asked to undertake a bed capacity review in light of changing demographics and proposals for the development of community services. This work will be conducted as a matter of priority and reported on at the earliest possible time. The HSE will undertake, as a matter of priority, an assessment of the future requirements for long-term care residential capacity.

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