Seán Power (Kildare South, Fianna Fail)

The Deputy knows but he does not want to listen to what anyone else knows. The point I want to make is that the number of beds in public acute hospitals has increased by 1,528 since 1997. There was no reduction.

The Tánaiste outlined to the House this morning the wide range of actions which are being taken to address the problems associated with accident and emergency services. This issue will continue to receive the Government's priority attention until the problems have been resolved. We will continue to work with the Health Service Executive to tackle the problems that are occurring in some accident and emergency departments through a combination of reform and investment tailored to each individual hospital. Additional resources are being provided, reform is happening, targets are being set and incentives are being put in place.

While many of the country's accident and emergency departments operate very effectively, we recognise that the difficulties experienced in some accident and emergency departments cause distress for patients and their families as well as for the staff working there. There are 53 acute public hospitals, 35 of which have accident and emergency departments. The majority of those departments do not have difficulties and the difficulties that exist in a minority of departments are a cause of concern to the Government. We have put in place a number of measures to try to deal with the situation.

Accident and emergency departments are not stand-alone services. They are a critical part of a complex health care system. Their ability to function efficiently and effectively is heavily dependent on maximising the use of the beds and facilities in each hospital, well functioning practices and processes within acute hospitals and the availability of integrated primary and community services. The HSE is focusing on reforming the health system to ensure that the right care is delivered in the right place by the right people at the right time.

Every day approximately 3,300 patients attend accident and emergency departments. On average approximately 25% will require admission to an acute hospital bed. In some accident and emergency departments, these patients will wait for a number of hours, sometimes overnight, to be admitted. This situation is not confined to this country. Such difficulties are being experienced at present by many modern health services in other parts of the world. However, such delays are unacceptable to the Government. There has been much discussion on how to address the difficulties that arise from the delays and the fundamental issues that are causing them to occur in the first place.

The Tánaiste has outlined the many benefits that have accrued and continue to accrue to patients through the measures implemented under the accident and emergency action plan. It is accepted that there is a need to focus on building on the achievements of the plan. The HSE has developed a framework for improving the efficiency and effectiveness of accident and emergency departments that has three key strands, reducing and diverting accident and emergency attendances and admissions, reducing delayed discharges and improving efficiency and throughput across the whole hospital, not just in accident and emergency departments.

The HSE is focusing on those hospitals that are seen to be experiencing difficulties in the provision of accident and emergency services and has set individual hospital performance targets to be achieved, maintained and, in due course, surpassed. The short-term priority objectives are that no patient is to wait for longer than 24 hours before being admitted to an acute bed, no accident and emergency department is to have more than ten patients awaiting admission and the privacy and dignity of patients awaiting admission is to be preserved. The long-term objective is to ensure that no patient will wait longer than six hours to be admitted after the clinical decision to admit has been made.

To assist the identified hospitals to achieve their targets, the HSE has established a dedicated accident and emergency task force. This force will oversee the implementation of the HSE framework and will work closely with the hospitals to establish clear targets for performance improvement and develop tailored solutions aimed at delivering sustained improvement in accident and emergency services. Not all hospitals have problems with accident and emergency services and where hospitals have problems they do not always arise from the same source. The task force will assist each hospital to identify the particular challenges it faces in the delivery of its services and to identify the potential solutions appropriate to their particular circumstances. It will work with the hospitals to introduce a system of "whole hospital" performance measures to improve the patient's journey not alone through the accident and emergency department but through the entire hospital system from admission to discharge.

In the immediate term the HSE is facilitating the freeing up of acute hospital beds by making more appropriate facilities available for those patients whose discharge from hospital is being delayed because they cannot, for a variety of reasons, return to their homes. The acute beds being vacated by these patients will be ring-fenced for use by patients who are waiting in accident and emergency departments to be admitted. The HSE is also fast-tracking the introduction of admission beds and other facilities to allow patients to await admission in comfortable surroundings outside the busy accident and emergency environment to ensure their privacy and dignity is preserved. These facilities will also enable the work of the accident and emergency department to flow more freely and the department to operate more effectively.

The achievement of improvements in accident and emergency services is dependent on fundamental changes in hospitals and in other areas of the health service. It requires improvements in the processes and procedures in hospitals to ensure that they operate in the most efficient and effective way, the introduction of rigorous admission and discharge planning processes, the broadening of access to diagnostic facilities and the enhancement and development of primary and community care services. We must ensure that all the existing beds and facilities in acute hospitals are being utilised fully and appropriately by ensuring that beds are occupied only by those who require acute care. We must also ensure that essential diagnostic facilities are available when required, not just during normal office hours. We need to better integrate primary and community care services to allow people to be treated, where appropriate, outside the acute hospital system and to put in place the necessary supports to avoid unnecessary hospital admission.

There is no single, simple solution in dealing with problems in accident and emergency. For example, on one day in March there were 411 patients in Dublin hospitals who had been medically discharged but were still occupying beds. We have put in place measures in a number of areas in an attempt to provide step-down facilities so that patients are not occupying beds after being discharged. The increase in the provision of home care packages will assist greatly in that regard. Last year there were 1,100 home care packages and this figure will increase by an extra 2,000 before the year is out.

Deputy English referred to the experience of a constituent of his. The case he outlined is not one of which we can be proud and it cannot be tolerated. However, to improve the delivery of services in accident and emergency departments we have assigned to each hospital a chief executive officer or other named person whose responsibility it is to deliver an improvement in accident and emergency services.

A few years ago the health service was judged on the length of time it took people to have an operation, whether they spent six, 12 or 24 months on a waiting list. We established the National Treatment Purchase Fund, which has dealt with that very effectively. Now the health service is judged purely on how accident and emergency services work.

I have had the pleasure of visiting hospitals around the country, and one that I have visited several times is St. Luke's in Kilkenny, where staff have provided their own medical assessment unit and work very closely with local GPs. They would admit that they do not have the best facilities in the country. It is not all about resources but about teamwork and introducing modern practices to meet challenges that exist today but were unheard of before. While it is very important to have an efficient and effective admissions policy, that on discharges is equally important. We must learn from best practice and what has worked well. Managers of hospitals throughout the country should consider St. Luke's in Kilkenny and see if they can imitate what it has done very successfully.

We acknowledge that there are difficulties in accident and emergency departments, and many of those who have had a family member waiting on a trolley will realise the difficulties and embarrassment caused to them, patients and staff. However, we have put in place several measures to address the situation, which receives top priority.

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