Pat Carey (Dublin North West, Fianna Fail)

I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Deputy Costello for raising this matter.

The HSE and the Government are determined that patients will continue to have emergency services that are accessible and responsive to their medical needs, and integrated with other hospital and primary care services.

Accordingly, the Minister has been monitoring the position in emergency departments very closely. While there have been clear improvements in most hospitals in the past few years, a small number of emergency departments continue to regularly record relatively high numbers of patients waiting over six hours and thus fall short of the current target set by the Health Service Executive of having patients registered in emergency departments either admitted or discharged in under six hours.

The Minister met with the chairperson, chief executive officer and members of the HSE management team earlier this year to review progress and to ensure that all possible steps are being taken to minimise the waiting time for patients awaiting admission. She asked them to focus on seven hospitals. Each of those hospitals, one of which is the Mater hospital, have developed hospital specific action plans to drive performance improvements. Those plans have been agreed by senior hospital management and clinical directors. The plans have also been assessed and approved in conjunction with the quality and clinical care directorate.

A key component of the Mater's action plan is the operation of the pilot Mater Smithfield rapid injury clinic, which acts as a satellite service to the Mater hospital's emergency department and has the capacity to reduce significantly patient waiting times as it has the potential to cater for 30% of the cases which have been presenting to the hospital's main emergency department.

Since it opened last April, this dedicated injury clinic has treated over 1,700 patients, with access on the basis of public eligibility. The clinic, which is allowing the Mater's emergency department to concentrate more on managing serious illness and major trauma, is staffed by a team of specialist emergency nurse practitioners and doctors and led by the Mater consultants in emergency medicine. The clinic opens on Monday to Friday from 8 a.m. to 6 p.m.

On 17 June last, the Mater hospital reported 70 delayed discharge patients, which is a reduction from a high of 121 in June 2009. Many of those delayed discharges can be addressed by way of the fair deal scheme.

The Minister, Deputy Harney, has also asked the HSE to streamline the administrative processes for dealing with applications under the fair deal scheme to ensure that patient discharges to a suitable long-stay facility are not delayed unnecessarily.

The most recent weekly report for emergency department activity at the Mater hospital indicates some improvement in performance. For the week ending 20 June, at 2 p.m. each day no patient was waiting in excess of 24 hours for admission following the decision to admit them compared to five for the same period in 2009. The numbers waiting between 12 and 24 hours was 18, compared to 30 for the same period last year. The hospital continues to focus on process improvement to facilitate the discharge of patients at the earliest point possible.

At the Minister's request, the HSE is also putting in place a system of early warning measures to ensure that corrective action is taken as soon as problems are identified. The Mater has been instructed to ensure that all escalation measures are implemented and reviewed as necessary and that appropriate liaison arrangements with primary and community services are in place.

In the longer term, the Mater hospital is engaged in a significant building programme, which includes the provision of a new emergency department built to modern standards of functionality and space. The building programme also provides for 12 new operating theatres, providing a net increase in theatre capacity, and a new radiology department. These facilities will significantly address operational efficiency issues within the emergency department. The building programme is due to be completed in 2012 and is currently on schedule.

The overall task for the health services this year is to meet patients' needs and deliver the best possible services within the resources made available from taxpayers. The Minister and her Department will continue to engage with the HSE, and especially hospitals experiencing significant problems in this area, to secure improvements in the emergency department performance.

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