Áine Brady (Kildare North, Fianna Fail)

I wish to support my colleague, the Minister for Health and Children, Deputy Mary Harney. In particular I wish to address the issue of acute hospital services and emergency departments.

Emergency departments are the front line for our health services and have a higher public awareness profile than virtually any other service. Approximately 1.2 million individual presentations were made through the doors of 33 emergency departments during 2010 and almost one third of the people who presented were admitted to hospital. As the Minister has already stated, the early weeks of this year have seen too many people waiting for an unacceptable period of time in emergency departments. The Minister has met the HSE and has impressed upon it the need to improve waiting times in emergency departments so all patients are assessed, treated and discharged or admitted without unnecessary delay.

The HSE has taken specific steps to cope with the increase in activity that has been experienced this year, including opening beds which are normally closed for seasonal reasons. Other actions taken by hospitals include increasing the number of ward rounds, including at weekends, to ensure that any patients who are ready to go home are discharged with support as necessary from community-based services.

In addition, the HSE has recently carried out a specific performance improvement project in certain hospitals which have experienced particular problems. Teams working in conjunction with the hospital management have provided reports and recommendations to the hospitals aimed at improving the work of their emergency departments. The HSE is putting in place improved frameworks to manage and closely audit the implementation of the recommendations arising from this project. The HSE has continued to closely monitor and address the situation. Weekend discharge ward rounds continue to take place and priority is given to access to senior decision makers in emergency departments from on-call admitting teams.

The problems of long waiting times and access to hospital beds cannot be solved within the emergency department or hospital alone. Solutions lie in the wider health care system. For this reason, the HSE has undertaken a number of initiatives such as the winter initiative programme, the code of practice for integrated discharge planning and actions to reduce the number of delayed discharges, including the introduction of the fair deal. Other innovations undertaken by the HSE include the development of emergency care networks and regionally governed services such as acute medical and assessment units, rapid access clinics and minor injury units.

The HSE continues to focus on a system-wide approach to improving access to hospital. A key initiative is the new acute medicine programme and related programmes which seek to channel patients quickly to the service best suited to their needs and to reduce the usage of emergency department services by those who can be best treated elsewhere. Following implementation of the acute medicine programme and its related programmes, medical patients presenting to an acute medical unit will be seen by senior medical doctors within an hour. These doctors will have access to the relevant diagnostic services, which will enable them to make decisions about the admission, care and treatment required for patients in the shortest possible timeframe. The goal of the programme is to reduce the admission rate of medical patients to hospitals and generate medical bed day savings while maintaining the quality of outcomes for patients.

There has been some discussion around the number of beds available within the hospital system. The clear focus of the health service is, and must continue to be, on the number of patients we treat and how we treat them, not on the number of beds in the public system. The 2011 national service plan commits the HSE to treating people more effectively by reducing costs and reforming the way services are provided without reducing access to appropriate services. We are treating more patients each year within the available resources and we are measuring and improving patient outcomes, which will continue over the coming years.

The HSE's actions are focused on protecting front line services, in particular emergency services, maintaining the quality and safety of services and achieving service plan targets. The HSE's commitment to national programmes, such as the acute medicine and surgical programmes, will support the achievement of these targets in 2011. I am confident that this is the correct approach and will allow the HSE to address the impact of planned health service budget changes signalled over the next few years while maintaining the number of patients treated and improving patient outcomes.

The key to addressing the emergency department challenge is an integrated proactive management by all concerned throughout the system. The Minister has asked the HSE to ensure that minimising waiting times in emergency departments is a key priority in its service to patients.

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