Máire Hoctor (Tipperary North, Fianna Fail)

This compares with an average of 165 patients over the first nine months of 2006, representing an average reduction of 45%. There has also been a significant reduction in the number of hospitals reporting patients waiting frequently for admission in excess of 24 hours. However, as this case indicates, hospitals can still experience difficulties in meeting the needs of those who attend accident and emergency departments. The HSE is continuing to work closely with hospitals, particularly those in the greater Dublin area, to bring about sustainable improvements in the delivery of accident and emergency services. As part of this process, an action plan for hospitals on the north side of Dublin is being prepared and due to be implemented in the coming months. The initial target waiting time of 24 hours from decision to admission is being met by the majority of hospitals but as this case indicates, we must see further improvements to ensure no patient waits for an unacceptably long period before he or she is admitted to an acute bed.

At the beginning of this month, the HSE introduced a revised target of 12 hours within which a patient should be admitted following the clinical decision to admit. The ultimate objective is a total wait-time target of six hours from the time a patient presents at the accident and emergency department to the time he or she is either admitted to an acute bed or is treated and discharged. A system-wide approach is required if the revised target and the ultimate target are to be achieved. Such an approach will include a movement to best in Ireland standards in average lengths of stay, an increase in day surgery rates in line with international practice, a change to the way in which patients are admitted, particularly for surgical procedures, and a major drive to increase the efficiency in discharging patients from hospitals.

Following the publication of the emergency department task force report, the HSE is working with the Irish Association of Emergency Care with a view to further lowering the target waiting time, which will include the standardisation of patient processes and pathways within accident and emergency departments throughout the country. The programme for Government contains a number of new commitments in respect of the improvement of accident and emergency services. These are as follows: to increase the number of accident and emergency consultants available around the clock, to further develop chest pain and respiratory clinics to ease pressure on accident and emergency services and to establish a national network of local injury clinics. The target regarding the latter is 20 clinics within five years.

The HSE recently announced the approval of 60 additional consultant posts under the 100 plus performance incentive scheme. It expects that the additional posts will increase the number of senior decision-makers available in accident and emergency departments, as well as improving GP access to diagnostics and speeding up the delivery of diagnostic results. The additional consultants will also enable the relevant hospitals to streamline their internal processes, including discharge planning, to enable accident and emergency departments to operate at their most efficient.

The development of additional fast-track specialist consultant-led clinics was identified by the HSE emergency department task force as having the potential to improve services for patients within accident and emergency departments. An analysis of the number and optimum location of the additional clinics will need to be undertaken. Consideration must also be given to the role that might be played by the private sector in further developing the service.

The programme for Government indicates a commitment to ensure that only those in need of the high level of expert attention available at an accident and emergency department should attend for treatment and that patients should be assessed immediately and treated quickly. The development of local injury clinics is intended to help in achieving this objective.

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