Dermot Fitzpatrick (Dublin Central, Fianna Fail)

I am a member of the Oireachtas Joint Committee on Health and Children for my sins, and recently, Professor Drumm, the chief executive of the HSE, addressed the committee. He stated:

What needs to radically change are some of the outdated work practices which exist within our hospital systems, practices that do not serve our patients or staff and sometimes manifest themselves in people waiting an unacceptable length of time for diagnostics, outpatient appointments and both elective and emergency admissions. This is why we really have to ask ourselves why some hospitals are experiencing problems in their emergency departments and others are not.

Let us look, for example, at the process that occurs in some emergency departments. When somebody arrives with a GP letter, they can have up to five contacts with medical personnel before coming to the end of the process and a decision is reached on whether to admit them, threat them or transfer them. A patient can see an experienced senior nurse who then refers him or her to a junior doctor and, possibly, a registrar within the emergency department. If the patient is attending during normal working hours, he or she may be seen by a consultant. If there is a decision to admit, a junior doctor will be brought down from the ward in the main hospital to again assess the patient and this is despite the fact that the decision to admit has already been made by an experienced consultant. The junior doctor will then consult with his or her registrar to reassess the patient prior to admission.

Such work practices are unacceptable in 2006. Professor Drumm further stated:

Consultants highlight that they are on call and frequently attend for emergencies. This commitment is appreciated but is not sufficient to meet the needs of today's patients. For example, the majority of attendances at emergency departments take place between 5 p.m. and 1 a.m. We need emergency consultants and diagnostic personnel working during those hours when their expert decision making skills are most needed. We obviously have to be willing to pay for such a service from skilled professionals.

I agree with Professor Drumm in this regard. A hospital cannot have an accident and emergency department staffed by consultants between 9 a.m. and 5 p.m. and staffed by non-consultant junior doctors for the remaining time. As anyone who has worked in the medical profession in Dublin will know, such departments get busy between 10 p.m. and 3 a.m. This is when experienced, trained consultants should be on duty.

Professor Drumm stated:

I appreciate that emergency department staff can experience frustration with hospitals systems that need to become more efficient, for example, when admitted patients often have to remain in hospital awaiting diagnostic tests, which sometimes cannot be provided for a number of days because of excess workloads for X-ray and other departments. We need to extend the length of time that these types of services are available and, as a result, reduce the length of time people need to spend in hospitals. If we continue to put up with unwieldy and outdated practices in the health system, where patients and staff must navigate through cumbersome hospital processes, and do not address the gaps in our community and primary care, it is certain that we will need more acute beds. If we change our present practices and follow all those advanced health systems around the world, it is likely that we will have sufficient acute beds for our present population but we will naturally have to plan to accommodate our growing and, more importantly, ageing population.

Professor Drumm has told us we do not have to provide more beds but we need to be more efficient with our use of them. This can be done by extending the hours consultants and senior staff are on duty and ensuring experienced and expert cover is available during the most appropriate hours. He continued:

At present we have a shortage of publicly owned community long-stay beds. In addition, the spread of acute beds around the country may not be ideally balanced. The HSE is studying its overall bed requirements, particularly in light of growing numbers of acute beds being developed by the private sector and if a response is required, it will be based on patient need and evidence, not on inefficient processes.

In my constituency, a rapid access unit has been opened in St. Mary's Hospital where general practitioners can arrange to have elderly patients seen within 24 hours. This is one of the models we should follow.

I have been in practice for 35 years and my colleagues and I have never met the representatives of our local hospitals to discuss our mutual problems. We have never tried to arrive at a consensus on how to treat our patients expeditiously and with dignity. It is a communication problem again and I do not wish to blame any particular class for it.

See this speech in context