Mary Harney (Dublin Mid West, Progressive Democrats)

I move:

That Dáil Éireann,

—commends the Government and the Tánaiste and Minister for Health and Children for their commitment to improving care for patients in our hospitals;

—recognises and supports the necessity for a substantial reform to accompany the unprecedented level of resources being invested in our health services and in hospitals in particular;

—acknowledges and supports the commitment of the Government to providing increased resources to accompany reform; and

—supports the substantial actions being taken to address the problems in Accident and Emergency (A & E) Departments, including:

—the comprehensive range of initiatives under the 10-Point Action Plan to deal with the many factors impacting on Accident and Emergency Services;

—the introduction of new measures to build on the Action Plan, including the setting of performance targets for individual hospitals;

—the establishment of a dedicated A & E Task Force to advise on how further improvements can be made to the efficiency and effectiveness of A & E Departments;

—the opening of new A & E Departments in Cork University Hospital, Connolly Memorial Hospital and St. Vincent's University Hospital;

—the provision of additional long-term care beds in private nursing homes and home care packages to facilitate the discharge of patients who have completed the acute phase of their care;

—the provision of admissions beds and appropriate facilities to ensure that patient privacy, dignity and comfort are preserved while awaiting admission to an acute bed; and

—the renewed emphasis on hygiene in our hospitals through the second national hygiene audit which is currently taking place.

I welcome the opportunity today to set out some facts about the actions under way to improve patients' experience at the accident and emergency departments in the country where there are problems and delays.

I reiterate to the House the Government's total commitment to achieve sustained results by working with the Health Service Executive to address all the issues that cause problems at certain accident and emergency departments. These are complex problems which require a full spectrum of actions to address them. The problems will be solved with a combination of reform, resources, management actions and improved efficiency, tailored to each individual hospital.

The Government takes the responsibility to lead reform for real improvements and we are giving this priority. We are providing all necessary funding. We have empowered HSE management to act and we will support and back up its actions.

We plan to recruit many new consultants in the coming years. We are providing funding for new beds in hospital wards, in accident and emergency areas and in the community. We urge all concerned to contribute to solutions and we will continue to work to get this right.

Last year, more than 1.2 million people attended accident and emergency departments nationally, an average of nearly 3,300 a day. On average, 75% of these patients are treated and discharged without the need for admission to an acute hospital bed. Not every hospital has problems with its accident and emergency services; some of the accident and emergency departments function very well.

There are 53 acute public hospitals in the country; 35 of these have accident and emergency departments and a minority of these experience consistent problems. The problems are different in each hospital and this is the reason the solutions are hospital-by-hospital. The bottom line for all of us is that no old person should have to sleep overnight on a trolley in a corridor. This has to stop and I am determined that it will.

We also have to speed up our accident and emergency services for everybody. I said I wanted the accident and emergency situation to be treated as an emergency, so as to up the pace, so to speak, in achieving better outcomes for patients. It is entirely appropriate for the Minister for Health and Children to exhort maximum effort and speed from all concerned to improve care for patients.

The actions in the ten point plan which started in 2005 continue to be implemented. I will update the House later on each of them. This time last year, the HSE had no permanent CEO. Professor Brendan Drumm is now leading the management focus on accident and emergency solutions, hospital by hospital. This focused and consistent management action would never have been possible when we had the old health board system.

The HSE is setting targets for each hospital to drive continuous improvement in waiting times. Consistent with international standards, its ultimate objective is to ensure no patient will wait any longer than six hours to be admitted after the clinical decision to admit has been made. This will be a ceiling, not a floor. It is to be bettered and is currently bettered for many of the 1.2 million accident and emergency patients annually in our hospitals. Our challenge is to support these hospitals to ensure they maintain this standard and bring all hospitals up to the same level of performance.

The HSE is taking the following approach on a hospital by hospital basis. It is developing specific time-based targets in relation to accident and emergency and delayed discharges, it is putting in place financial and other incentives linked to performance which is a new development in accident and emergency in our health services and it is developing targeted initiatives aimed at delivering immediate and sustained impact in attendances, delayed discharges, and efficiency.

The board and the management of the Health Service Executive are fully focused on accident and emergency improvements as their priority. The HSE board agreed that the allocation of hospital budgets for 2006 would include financial incentives linked to specific, time-based performance improvements. In addition, specific funding is being set aside for projects to advance innovation and reform in the areas of efficiency and throughput. This is a welcome and effective initiative in public hospital funding. Hospitals and organisations respond to positive incentives. Another result of having the HSE for the first time is that each hospital network manager has been instructed to treat accident and emergency as his or her top operational priority and to deliver a measurable improvement in accident and emergency services. It is intended that this will be reflected in the performance-related pay scheme. This is also new and welcome in our health service.

Responsibility for delivering measurable improvements in accident and emergency services has been assigned to each hospital CEO or a named senior alternative. The performance targets for individual hospitals relate to the numbers of patients on trolleys awaiting admission, and the time those patients spend waiting. The HSE will begin now to publish waiting times at accident and emergency units next week — another first in our health services — so that improvement can be monitored and encouraged by all concerned. The hospitals will be assisted in achieving their targets by the task force which has been established by the HSE.

I applaud the commitment of those who are voluntarily giving their expertise to the task force. They include emergency department consultants, a consultant geriatrician, a respiratory physician, a director of nursing, a hospital CEO and full-time representatives from the national hospitals office and primary, community and continuing care services. The task force will advise on how improvements can be made to the effectiveness of some emergency departments.

We will also free up hospital beds by helping people leave hospital as soon as they are medically ready. We are providing more care in the community, in step down beds and nursing home places. There is no question of discharging people who are not medically fit for discharge but people who are medically ready to leave hospital should be able to avail of appropriate care outside a hospital setting.

This year the Government is providing funding for the largest ever expansion of services for older people — €110 million in 2006 and €150 million in a full year. Under this funding, we will treble the number of home care packages, some of which will be used to assist older people who would otherwise have their discharge from hospital delayed.

Care at home is still the preference of the vast majority of our older citizens. Long-term nursing home care is also necessary for some patients after their hospital treatment.

I have made it clear that the HSE should go ahead and use as many public and private nursing home beds as required to free up beds for patients awaiting admission. The acute beds that become available as a result of this initiative will be ring-fenced for those patients awaiting admission in accident and emergency departments.

It is important that patients' comfort and dignity are fully safeguarded while they wait for admission to a ward bed. We are providing more appropriate facilities for patients awaiting admission. The 33-bed transit unit in the Mater Misericordiae Hospital has been operational since January last and is working well.

Transit units are being fast-tracked now with capital funding in Tallaght, where a 40-bed transit ward is being developed and is scheduled for commissioning by July of this year, in Cavan General Hospital, Wexford General Hospital, Our Lady of Lourdes Hospital in Drogheda and elsewhere. These initiatives are designed to provide immediate support to accident and emergency departments. However, it is essential that they are supported by significant changes within and outside the hospital system in capacity, the optimal use of capacity, practices and procedures and non-acute hospital services.

There are continual calls for more hospital beds as the solution to the accident and emergency problems and, it seems sometimes, to all problems. Let me state clearly to the House that we have provided more acute hospital beds, we are providing more acute hospital beds at present and we will provide more hospital beds in the future to cater for a growing and ageing population. There are now 13,255 beds in public acute hospitals and 1,800 in private hospitals. Since 1997, the number of public acute hospital beds has increased by 1,528, up from 11,727. Most of the increase — over 900 — comprised inpatient beds.

Our five year capital investment programme includes provision for 450 more acute beds. We also are encouraging the private sector to invest to create new public beds by moving 1,000 of the existing private beds out of public hospitals.

The HSE is reviewing the long-term acute bed requirement nationally. It is my view and that of the HSE that it would be an inefficient use of taxpayers' money to put additional beds into an unreformed acute hospital system, effectively to compensate for inefficient processes. Therefore, as we plan for additional acute hospital beds, we intend to address the underlying processes and wider service issues that impact on the services provided in accident and emergency departments.

The HSE commissioned a process mapping exercise across ten acute hospitals. The project focused on the maximum utilisation of existing acute capacity and, in particular, the blockages, causes and potential solutions in the patient's journey through the hospital, from the decision to admit through to discharge.

The exercise has shown that a patient arriving in an accident and emergency department with a letter from a general practitioner can have up to five separate contacts with medical personnel before eventually being admitted to a bed. Some hospitals have simplified this process with very positive results. We need to examine the processes and procedures in other hospitals to make sure that they operate in the most efficient way to avoid wasting time and resources.

Difficulties in accessing diagnostic services outside normal working hours also contribute significantly to delays for patients. The HSE is clear that access to diagnostic facilities will be broadened so that they operate 12 to 15 hours a day as a rostered service. In addition, private sector diagnostics will continue to be used where they can contribute to faster patient services.

Consultants play a pivotal role in the efficiency of hospitals across virtually all departments. They are the senior decision makers, and the importance of their clinical decision-making skills in speeding up the patient's journey through the hospital system cannot be overstated. We need to have far more consultants available at all times, both in accident and emergency departments and in hospital wards.

Consultants are very much part of the solution and I want to hear their ideas for practical measures that will help improve services to patients. I very much welcome the comments of Professor John Higgins of Cork at the IMO conference where he encouraged his colleagues to be innovators and problem solvers in the health service.

Hospitals cannot be the only setting for medical care. Many people with chronic illnesses such as diabetes or heart disease regularly attend hospitals but could, with a well developed community service, get most of the treatment they need from their general practitioner and primary care team. With enhanced primary care services, patients can get local care from health professionals such as physiotherapists, who otherwise would require hospital referrals.

The HSE is establishing community intervention teams in Cork city, west Dublin, north Dublin and Limerick. These teams will provide services to enable dependant people to remain at home rather than be admitted to hospitals or other care facilities. Nationally, all general practitioners have been invited to become involved with the HSE in the further development of primary care services and there has been a very positive response to this invitation.

I referred earlier to the ten-point action plan for accident and emergency and it would be useful to mention some of the measures taken under the plan. These actions continue. I have not heard anyone argue that any of the actions in the ten-point plan are mistaken or should be abandoned.

A particular focus of the plan, which is continuing, is on those patients in acute hospitals who have completed the acute phase of their care and are awaiting discharge to a more appropriate setting. I want to outline some of the measures that have been taken under the ten-point plan.

A number of the new accident and emergency departments commissioned in 2005-06 provide for minor injury clinics, including Connolly Hospital, Blanchardstown, Cork University Hospital, St. Vincent's hospital in Dublin and St. James's Hospital. Outside of Dublin, funding was provided for the expansion of minor injuries services at St. John's Hospital in Limerick, and the provision of a minor injuries unit at Waterford Regional Hospital.

A second MRI scanner is due to be commissioned in Beaumont Hospital by the end of 2006. Following a tendering process, interim arrangements with a private provider have been put in place. Additional capacity is also available at weekends to deal with urgent inpatients and 320 patients have benefited under this initiative since November last.

The planning for the provision of acute medical assessment units, AMAUs, in Beaumont Hospital and St. Vincent's hospital is under way. In Beaumont Hospital, planning is under way for the development of a 29-bed AMAU, to be ready for commissioning by the end of the year. In St. Vincent's hospital the unit is partially developed. The aim is to have 20 beds fully operational by the end of June next.

A number of patients with very demanding care needs have been discharged to high dependency beds contracted from private nursing homes.

Intermediate care beds were provided to allow the discharge of 560 patients from acute hospitals in 2005. Some 270 patients have been discharged to intermediate care beds so far this year.

Additional home care packages facilitated the discharge of 409 patients from acute hospitals in 2005. Some 182 patients have been discharged to date in 2006.

The HSE hopes to have an out-of-hours general practitioner service for north Dublin in place by the summer.

The first national hospital hygiene audit took place in all 54 acute hospital sites during July and August 2005. The audit was carried out by a UK based contractor. The report of the audit was published in November last. The second hospital hygiene audit is under way, using the same methodology as last year. The results of the audit will be available in June or July.

Palliative care services have been developed at Our Lady's Hospice, Harold's Cross, and have been in operation since October last.

Arrangements were put in place with private providers for the commissioning of CT scans and MRIs to facilitate direct access to diagnostics for general practitioners. During 2005, more than 1,000 CT scans and 100 MRI scans were carried out under this initiative. Every piece of the jigsaw to address accident and emergency department problems is in place: the analysis, the resources, the reform programme, the management, the targets, and the incentives. Implementation at local level in each hospital and in the community services in its locality is the key to success, as there is no other way. I urge all involved in medical and other organisations to contribute to the implementation of ideas and actions to improve these services for all our families. The Government and the Health Service Executive will continue to give this top priority. I am confident the actions will result in the sustained improvements that patients and their families deserve.

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