Mary Harney (Dublin Mid West, Progressive Democrats)

Improving the delivery of accident and emergency services continues to be a top priority for the Government and the Health Service Executive.

There have been considerable improvements made over the last two years in the delivery of services in accident and emergency departments. The number of patients awaiting admission to a hospital bed from accident and emergency departments reduced by 50% between December 2005 and December 2007, from an average of 155 to 78 a day. However, there was an increase in the numbers in recent weeks which the HSE attributes to a number of factors, including increased levels of virulent norovirus, winter vomiting bug; increased levels of influenza and chronic obstructive pulmonary disease; and an increase in the number of delayed discharges, particularly in the Dublin area. These are patients who remain in hospital although they have finished the acute phase of their treatment.

The HSE is working intensively with the hospital system to bring about further sustainable improvements. One of the key issues being addressed is the system of discharge planning. A major focus is being placed on ensuring that all patients have an expected date of discharge within 24 hours of admission; the expected date of discharge is actively managed on a daily basis against the treatment plan and any changes are communicated to the patient; patients can be discharged in a more proactive manner at weekends; there is an increased emphasis on nurse-led discharges; and ward rounds are scheduled in a way which facilitates a more timely review of treatment plans.

The HSE is also working closely with a number of hospitals reporting significant numbers of patients awaiting admission. This includes a specific focus on the establishment of clinical decision units and short stay units to accelerate the throughput of patients who present at accident and emergency departments. Additional measures are also being put in place to deal with the issue of delayed discharges.

In light of the successful conclusion of talks regarding the new contracts for consultants, I hope that progress will be made in advancing the recruitment of additional consultants under the 100 Plus initiative previously announced by the HSE. The initiative is designed to reward hospitals which are operating in line with established performance targets. The additional consultants are to be employed in specialties which can alleviate the problems which manifest in accident and emergency departments.

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