Thursday, 10 February 2005
Accident and Emergency Services.
Question 3: To ask the Tánaiste and Minister for Health and Children if it is proposed to proceed with the configuration of accident and emergency services in the State's hospitals as proposed in the Hanly report; if so, the way in which it will be put into effect in each region; the timetable for such implementation; the status of the report; and if she will make a statement on the matter. [4317/05]
The Government has already undertaken specific investment measures to provide new and improved accident and emergency departments in hospitals, to increase the number of emergency medicine consultants and to provide additional funding to move patients from the acute hospital system to a more appropriate care setting. The Government will continue to focus on the measures required to improve the delivery of accident and emergency services, recognising that we must not look at accident and emergency departments alone to find solutions. We must also develop primary care, sub-acute care and community care so that patients can be treated in the most appropriate setting.
The report of the national task force on medical staffing — the Hanly report — emphasised the importance of ensuring that we treat emergency or life-threatening conditions at the most appropriate location. Treatment should commence at the scene, typically by trained ambulance personnel, and the patient should then be taken to the nearest hospital that is best equipped to meet his or her needs.
The Hanly report also pointed to the need for further development of ambulance services, increases in the number of acute beds and a reorganisation and resourcing of primary care so that patients, wherever they live, have equitable and rapid access to high quality emergency care.
The Hanly report is a significant contribution to the development of acute hospital services and I have asked the National Hospitals Office to progress its recommendations accordingly.
What is the status of the Hanly report? The Minister's response repeats remarks she made last Monday to the effect that the Hanly report is a significant piece of work. She did not, however, make clear, then or now, what parts of the report will be implemented.
It seems the Government would like to give the impression that the implementation group has been wound up as a result of public pressure and opposition rather than because of the consultants' boycott. The Minister may clarify that. Does the Tánaiste agree with the report which states: "In local hospitals there should not be a requirement for on-site medical presence overnight or at weekends"? Has she any appreciation of the dire consequences of this, not only for local hospitals but communities throughout the jurisdiction? If this were acted upon, the consequences would be dire.
Does the Tánaiste agree that the majority of smaller hospitals throughout the State would not be able to provide accident and emergency facilities on an ongoing basis in any capacity because all inpatient services have a requirement of 24-hour medical care? If we are to lose one, we will lose all and it will have a fatal result for hospital services. Does the Tánaiste accept that the fate of Monaghan General Hospital in regard to the loss of critical services is the fate that awaits many smaller local hospitals throughout the jurisdiction?
The key recommendation in the Hanly report is that we need more manpower at consultant level throughout the country. Although the genesis to the Hanly report was the working time directive, its remit goes way beyond this. We need to move from having approximately 1,940 consultants to 3,600 if we are to provide regional self-sufficiency as far as is possible.
From a patient care perspective, a patient must be taken to the most appropriate hospital if he or she is a serious accident and emergency case. The sooner a patient gets there the better. For example, if one has serious brain injury, Beaumont Hospital is the national centre. A small country with 4 million people cannot have a centre in every region. While there are issues in regard to where a potential second centre should be, nobody has argued we should have a centre in every region.
The same applies in other complex areas. Services can only be provided on a national basis for a population of 4 million or on a regional basis depending on the speciality. We must make progress because of patient safety concerns. If patients are not cared for in a safe environment, lives or the chances of making a full recovery are put at risk.
That is why the establishment of the health information quality assurance authority, which will deal with accreditation and standards and provide information, is important and involves priority legislation which we hope to publish in the near future and take through the House by the summer of this year. The board has been appointed on an interim basis and will hold its first meeting in Cork at the beginning of March.
Some 85% of accident and emergency cases will still be dealt with in smaller hospitals. Many accident and emergency cases dealt with in accident and emergency departments could be dealt with in a localised hospital environment. However, more complex cases must go to the bigger hospitals where a multi-disciplinary team of specialists and greater resources are located. The Deputy knows one cannot provide in each county the range of services we would all wish to have. The best we can achieve is sufficiency at regional level.
To take the mid-west, which was part of the pilot study for the Hanly report, until recently the region had no rheumatologist, although one third of women in the country suffer from arthritis, and no plastic surgeon, which it still does not have. There are serious deficiencies in the regions and we must deal with the problem on a regional basis, which was the genesis of the Hanly report.
We would not add value by having the same group travel the country interviewing all those who work in health care. Some 95% of those the Hanly group interviewed, who were working in health care, agreed with the recommendations. We need to get on with increasing manpower, particularly at consultant level. The sooner we complete the negotiations with the Irish Medical Organisation and the Irish Hospital Consultants Association the better so we can have a more flexible, modern contract of employment, suitable to the needs of 2005.
We all accept that we cannot have every service and speciality on each of our hospital sites. However, does the Tánaiste agree that the Hanly model represents an over-centralisation and will spell a diminution of services at hospital sites throughout the country? I speak with some experience of this. The Monaghan experience is the template that is being and will be applied if the outworking of the Hanly report is to proceed at other hospital sites throughout the country.
Does the Tánaiste agree that closing all inpatient beds in smaller hospitals is the opposite of what should be happening because there will clearly be a need for more inpatient beds as time goes on? We addressed this matter earlier today. There is continual need for investment not only in regard to beds but front-line cover in terms of acute hospital services. What will happen to our local hospitals?
The Tánaiste should be specific because we want to know what exactly will happen in regard to the outworking of the Hanly report. Will it be introduced by stealth or in a clinical cut following the next general election, as happened in the past in regard to hospital service provision?
The two counties have a population of probably 120,000 to 140,000, and both have a hospital. In that context, it is not possible for both hospitals to have all the resources and specialties we would wish.
There are many hospitals. We need to learn from our experience and best practice, and we need to bring services as close to people as possible in a safe environment. This is what we are trying to achieve. The Hanly report is not about centralisation but regional autonomy. Currently, there is an over-centralised system. Many people must come to the Dublin area for treatment that could be administered at regional level.
No, it is for many specialties. One cannot provide a regional service with one consultant or, in some cases where they visit on an outpatient basis from time to time, no consultant.
The purpose of the reform agenda is focused on priorities regarding increased numbers and increased usage of beds. Following a survey of 4,000 patients, Dr. Conor Burke of James Connolly Memorial Hospital recently stated that if patients had been discharged when they were ready for discharge, there would not be an accident and emergency problem. We need to learn from the examples provided by such world leaders in their fields.