Dáil debates

Thursday, 13 January 2011

2:00 pm

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)

There were a number of questions. We must become less focused on beds and more focused on activity. I say this for a number of reasons. If we compare the figures for 2010 to those for 2005, we will see that we are now treating an extra 100,000 patients in emergency departments, an extra million outpatients, an extra 250,000 day cases and an extra 20,000 inpatients. That is in addition to 16,000 extra births. This all represents additional activity with fewer beds than we had then.

The focus of the reform programme is on seeking to get more from less. In particular, hospitals are trying to deal with more day-case activity and same-day admissions for surgery. We have a list of 24 procedures which should be dealt with as day cases: same-day surgery with the patient going home the same evening. The list is based on the basket of 25 day-case procedures used in the UK, but because we do not have abortion in Ireland, the list contains only 24 procedures. The HSE is making great strides in this regard, although there is major variation across the country. If every hospital operated to the standard of the best in the country, there would be enormous improvements.

Let us take as an example St. James's Hospital in Dublin, the largest hospital in the country, or St. Luke's General Hospital in Kilkenny. Even last week, when there were major challenges, they were able to cope successfully. While I am not saying that all of the issues are the result of the internal functioning of hospitals, including Our Lady of Lourdes Hospital, I feel there is major room for improvement. The task of the teams that have now been appointed for Our Lady of Lourdes Hospital, Beaumont Hospital and Limerick Regional Hospital - the next will be Tallaght hospital - is to work with the hospitals in this regard. In the UK, a person with a lot of management experience was brought in, accompanied by a television camera. If one brings in a television camera one can achieve many changes.

Everybody, including nurses, must think about how he or she works. In particular, I want escalation protocols to be put into effect, as they have been all over the world. These protocols are highly successful. Advice from emergency consultants, as well as other medical advice available to me, strongly supports it. The Chief Medical Officer has provided evidence to the Joint Committee on Health and Children to show the effectiveness of these protocols when patients are moved from emergency departments up to the wards. Some 25% of patients are admitted within one hour and there is a major improvement over a four-hour period. These are the types of change I expect to see from nurses and others working in the system through the Croke Park agreement so that the stock of beds can be used as effectively as possible.

There will be major challenges this year; I am not going to pretend there will not. We have effectively taken €1 billion out of the public health Vote for 2011 compared to 2010. That is an enormous amount of money. Even with the major work practice changes we will achieve through the Croke Park agreement, there will still be enormous challenges. The commitment is to provide a similar level of service in 2011 to that provided in 2010 in terms of activity, although there will be some changes.

I mentioned swine flu earlier. I am not going to pretend this is the reason for the problem in accident and emergency departments, but it is having an impact. We now have two confirmed deaths, unfortunately, and the flu has consumed 72 intensive care beds and 393 hospital beds. It is not the reason for the crisis, but the incidence here is doubling every week. It has doubled this week compared to last week and it doubled last week over the previous week. I am sad to report that there have been two confirmed deaths in the Republic over the last week as a result of swine flu.

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