James Reilly (Dublin North, Fine Gael)

Immediately following my appointment, I set about establishing the special delivery unit, SDU, to unblock access to acute services by improving the flow of patients through the system. The SDU was established in June and quickly began work with the HSE to put in place a systematic approach to eliminate excessive waiting in emergency units. The SDU is establishing an infrastructure based on information collection and analysis, hospital by hospital, so that we know what is actually happening in real time. This will allow us to begin to embed performance management in the system to sustain shorter waiting times. I reiterate to the House that we can now see what is happening where previously we were in the dark. We used to find out months later what had happened but we can now tell what is happening in accident and emergency units at any given time. We can tell each consultant's waiting time on a weekly basis and it allows us to address those who are not performing to the level they could.

The SDU has identified the hospitals that account for the greatest number of trolley waits, which will benefit from intensive support between now and the end of the year. Liaison officers are working proactively to support these sites. As alluded to in a previous question, I have also agreed that some additional funding may be provided, on a strictly once-off basis and based on specific proposals from the hospitals, to reduce waiting times. We have identified the problems and we asked the hospitals to tell us what they would like to do to address the issue and what they feel the solution is. We will then sit down with the hospital and price the solutions. If it is a reasonable value for money initiative, we will support the hospital's idea.

Our problems did not arise overnight and they will take time to resolve, but they are being tackled in a systematic and relentless fashion through the SDU. I do not minimise the scale of the task before us but I am very confident that the SDU will facilitate real performance improvement in the hospital system and I already alluded to some of those in respect of Cork.

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I also want to ensure that as many services as possible can be provided safely in smaller, local hospitals. A joint HSE-departmental group is developing a framework for the future development of smaller hospitals. Consultation with all the key stakeholders, including patients and public representatives, will be an integral part of the process.

The organisation of hospital services nationally, regionally and locally will be informed by the clinical programmes being developed and implemented by the HSE and by the framework for the development of smaller hospitals. These interrelated programmes aim to improve service quality, effectiveness and patient access and to ensure patient care is provided in the service setting most appropriate to individuals' needs. I expect to be able to report to the Government and this House on these important developments before the end of the year.

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