Dáil debates
Wednesday, 23 March 2005
Other Questions.
Accident and Emergency Services.
1:00 pm
Michael D Higgins (Galway West, Labour)
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Question 8: To ask the Tánaiste and Minister for Health and Children her views on the situation in accident and emergency units in view of the decision of the Health and Safety Authority to order a safety inspection of all such units; the steps being taken to ensure that such units comply with relevant safety requirements; and if she will make a statement on the matter. [9406/05]
Richard Bruton (Dublin North Central, Fine Gael)
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Question 16: To ask the Tánaiste and Minister for Health and Children her views on the health and safety of staff in hospital accident and emergency departments; and if she will make a statement on the matter. [9447/05]
Gerard Murphy (Cork North West, Fine Gael)
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Question 20: To ask the Tánaiste and Minister for Health and Children when the MRI scanner for Beaumont Hospital will be commissioned; and if she will make a statement on the matter. [9525/05]
Michael D Higgins (Galway West, Labour)
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Question 22: To ask the Tánaiste and Minister for Health and Children the measures implemented to date in regard to the package of measures announced in the Estimates for 2005 to improve accident and emergency services; the timetable for the implementation of each other planned measure; and if she will make a statement on the matter. [9405/05]
Olivia Mitchell (Dublin South, Fine Gael)
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Question 70: To ask the Tánaiste and Minister for Health and Children her views on the health and safety of patients waiting on trolleys in accident and emergency departments; and if she will make a statement on the matter. [9448/05]
Enda Kenny (Mayo, Fine Gael)
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Question 99: To ask the Tánaiste and Minister for Health and Children the progress to date on her ten-point plan for alleviating the accident and emergency crisis; and if she will make a statement on the matter. [9486/05]
Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 8, 16, 20, 22, 70 and 99 together.
The House is aware of my opinion on the problems being experienced in acute hospitals which provide accident and emergency services. I have announced a number of initiatives aimed at improving the delivery of such services. Progress is being made on each of the ten actions I announced earlier this year. The Health Service Executive has given the Department of Health and Children an update on each of the actions. I will outline to the House some of the progress that has been made.
The HSE has had positive discussions with public and private sector providers about the development of additional minor injury facilities in Dublin. It is expected that the second MRI for Beaumont Hospital will be available from August 2005. Planning is continuing on the provision of acute medical units at Tallaght, St. Vincent's and Beaumont hospitals, which have been asked to deliver interim arrangements pending the construction and commissioning of the new units.
The tender process for the provision of high dependency beds in private nursing homes is being examined and is at an advanced stage. The final tenders were opened this week and it is expected that the process will be concluded in the coming weeks, after analysis, evaluation and site visits have taken place. Contracts will be awarded in the coming days for the provision of intermediate private nursing home care for 500 patients per year.
Additional home care packages for patients have been made available in each of the six major acute hospitals in the Dublin area. A steering group of general practitioners, based on the north side of Dublin, is examining the requirements, locations and arrangements for the establishment of an out-of-hours GP service. The director of the National Hospitals Office is finalising arrangements for the establishment of a national audit and an inspection process to measure cleanliness in all acute hospitals. Regarding access for GPs to diagnostic services in the Dublin area, it has been agreed to procure a range of diagnostic services from private hospitals and negotiations are ongoing in that regard.
I welcome the recent intervention of the Health and Safety Authority. We all want to ensure that patients and staff working in hospitals have a safe and healthy environment. The authority asked hospitals to conduct a comprehensive risk assessment of their accident and emergency units. The authority said it is satisfied with the good level of response to its letter. It has decided to pursue a targeted programme of inspections, with visits taking place to 11 units by 8 April. The authority's review is expected to inform priorities for action by the National Hospitals Office on health and safety issues.
The wide-ranging actions to improve the delivery of accident and emergency services are aimed at improving access to accident and emergency services, improving patient flows through accident and emergency units, freeing acute beds and providing appropriate long-term care for patients outside the acute setting. We would like to see more immediate solutions and to that end we are working with hospitals to deliver the measures and to ensure that the investment produces sustainable and long-lasting solutions.
Liz McManus (Wicklow, Labour)
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Is the Minister aware of how bad the situation has got? There were 34 people, an unprecedented number, on trolleys at the University College Hospital in Galway last night, even though 68 beds in the hospital were closed. Although the Minister visited the hospital recently, I am not convinced that she is aware of the real situation in Galway. It is symptomatic of the real and persisting accident and emergency crisis, which has led a nursing organisation to decide to embark on a series of protests. There are serious problems in Wexford and an accident and emergency consultant in Cork has described the conditions there as "total bedlam". Following the response of the Minister, who is full of good intentions, the Irish Nurses Organisation has declared that there is "a terrible inertia" again.
The Minister made it clear many months ago when she made her initial announcement that real improvements would be evident by this month, or by April at the latest, but we have not seen any significant changes. We are seeing the same pattern of chronic overload in accident and emergency departments. People in Galway have threatened to close the service altogether.
The Minister mentioned the war zone in Sarajevo, and the term "walking wounded" has been used by the medical profession, rather than by politicians, when discussing the accident and emergency crisis. The walking wounded are being turned away from accident and emergency units because more severe emergency cases have to be treated. The Minister has not delivered on the commitments she made when she came to the Department of Health and Children. Ten-point plans are all very well, but the product has not been delivered. The crisis is being prolonged unnecessarily, even though it should be abating now that the winter period is over.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I have always made it clear that there are no instant solutions. I did not undertake that all the solutions would be put in place during the first three months of this year.
Liz McManus (Wicklow, Labour)
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The Minister said there will be a significant difference.
Mary Harney (Dublin Mid West, Progressive Democrats)
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Yes, there will be a significant difference. I have said that the Department is about to announce that it has succeeded in acquiring intermediate beds for 500 patients, which will greatly alleviate the pressure on accident and emergency services. Facilities for 100 high-dependency patients, who are currently in the acute hospitals system, will be developed in the next week or so. It is clear that such developments will free many beds which can be used for accident and emergency services. The difficulty we face at present is that the controversy about nursing home charges is making it more difficult for the management of hospitals to encourage people to move to more appropriate settings. That is an issue. I understand that the wards in Galway have been closed because of an outbreak of flu in the hospital.
Mary Harney (Dublin Mid West, Progressive Democrats)
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It is not satisfactory that wards or beds in any public hospital should have to be closed, other than for reasons relating to health care.
Liz McManus (Wicklow, Labour)
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That is not why they were closed.
Mary Harney (Dublin Mid West, Progressive Democrats)
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We will spend over €12 billion this year on the delivery of health care to our relatively young population of over 4 million people. We have to do better with that money — that was the purpose of establishing a new unified system. The allocations for this year, which will be made to individual hospitals soon, will be based on performance and results, which was not the way money was allocated in the past.
Liz McManus (Wicklow, Labour)
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I understand that the wards in Galway have not been closed because of an outbreak of flu. It would be possible to open a certain number of beds if cleaners were employed to ensure that hygiene standards are maintained to a high level. That would relieve significantly the pressure on the hospital. I do not know whether the Minister has studied the number of hospital beds which have closed throughout the country. It might be interesting to assess the capacity within our key services. The circumstances in Galway are unprecedented. The Minister's comment that the beds will be available at some time in the future is not a sufficient response to a crisis that has caused nurses to take to the streets at a time when they should be caring for their patients.
Mary Harney (Dublin Mid West, Progressive Democrats)
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If health care workers take industrial action of that kind, patients will be the only people to suffer.
Mary Harney (Dublin Mid West, Progressive Democrats)
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That is the sad reality, as I said to the doctors.
Liz McManus (Wicklow, Labour)
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They do not need lectures about their duties.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I remind Deputy McManus that the ratio of nurses to patients is higher in this country than anywhere else in the European Union. I mentioned that fact to the INO.
Mary Harney (Dublin Mid West, Progressive Democrats)
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One of the aspects of the ten-point plan——
Mary Harney (Dublin Mid West, Progressive Democrats)
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We are trying to ensure that there is a sufficient number of staff to deal with patients.
Dan Neville (Limerick West, Fine Gael)
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The Tánaiste should say that to the Ruddle family.
Mary Harney (Dublin Mid West, Progressive Democrats)
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Hospital cleanliness is one of the matters addressed in the ten-point plan. We are paying the top price to have our hospitals cleaned. Many cleaning contracts have been outsourced to big contractors, who are receiving huge amounts of money. Nobody is supervising the cleaning work in some cases, but that will change.
John Gormley (Dublin South East, Green Party)
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Hospitals are filthy.
Mary Harney (Dublin Mid West, Progressive Democrats)
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No hospital bed should be closed because of a lack of cleanliness. Everybody is paying big money to have hospitals cleaned. I have asked the director of the National Hospitals Office to introduce a new inspection and audit approach to ensure basic cleanliness in our acute hospitals, which is not too much to expect.
I agree that many more people can be treated if hospital beds are put to better use. Dr. Conor Burke, a respiratory physician at the Mater Hospital, demonstrated in a paper he published recently that if all patients at James Connolly Memorial Hospital in Blanchardstown were discharged when they were medically fit to be discharged, the hospital would have no problems in its accident and emergency department. It is not a question of more beds, nurses or doctors, but of ensuring that those who are fit to go home are moved to an alternative facility. We need to ensure that happens when it should happen. We have to learn the lessons of reports of that kind, produced by experts like Dr. Burke. We need to use our acute hospital system efficiently and effectively.
Liam Twomey (Wexford, Fine Gael)
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We should always aim to set high standards rather than minimum standards. Is it true that a specified minimum space of approximately 1.62 m should be kept between beds in hospital wards? There is a contradiction in requiring a fixed distance between beds on wards when patients are practically stacked on top of each other in accident and emergency departments while they wait on trolleys. We must examine why there are 20 to 30 trolleys in accident and emergency departments. Something seems to be wrong.
Will the Tánaiste to provide more information on the cleanliness of our hospitals. Patients are very unhappy and persistently complain that facilities are not clean. Will the Tánaiste confirm that 450 cases of MRSA septicemia have occurred? These cases did not involve the infection of people's skin, but of their bloodstreams. Given the mortality and morbidity rates associated with MRSA, it is a very significant number of cases.
Most of the Tánaiste's ten-point plan to address the accident and emergency crisis focuses on the Dublin region in which the incidence of trolley use is highest. However, can she explain why a level one trauma unit which caters to the whole south of the country had to close its accident and emergency department to walk-in casualties last week? Is it not ridiculous that the second largest city had to close its major accident and emergency department to walk-in patients for any period, even if it was only four or five hours?
I presume the MRI scanner at Beaumont Hospital is there to cater for patients who have been transferred from hospitals nationwide out of hours and require emergency scans. Will the Tánaiste explain what she will do about the switching off of CAT scanners throughout Ireland at 4 p.m. or 5 p.m.? Why is there no proposal in her ten-point plan to deal with CAT scan machines throughout the country which are not operational 24 hours per day, seven days per week?
Will the Tánaiste provide more detail on the out-of-hours co-operative on the north side of Dublin city? What is its structure? While the co-operative represents an important, positive move forward, like all such facilities it must be established in a way which ensures it operates with maximum efficiency.
It is disingenuous to say that patients suffer when nurses go on strike as patients are already suffering as a result of our failure to deal with the health service crisis. I worked in the hospital service until ten years ago, including the accident and emergency department in Cork to which I have referred and the Meath Hospital in Dublin. While things were bad then, there were only between ten and 20 patients on trolleys in Dublin city. There are now up to 300 patients on trolleys here. Nurses do not strike because, as the Tánaiste said, there are too many of them. They do so because the service continues to disimprove remarkably. Accident and emergency staff operate in circumstances of significant stress, which the Tánaiste should take on board. She should visit an accident and emergency department on a Saturday night to witness the behaviour of people who have had too much to drink.
Mary Harney (Dublin Mid West, Progressive Democrats)
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There is no doubt that the volume of activity in our hospitals has increased significantly. While we must be fair and acknowledge that there are problems in accident and emergency services, they are part of the wider problem in the health system. Some people access hospitals through accident and emergency departments because they cannot access an appropriate outpatient department. There are many factors which must fit together. Increasing the number of consultant posts, especially in certain specialties and at regional level, is part of the solution in the medium term. The measures being taken are aimed at dealing with the crisis as we see it.
It is not acceptable that people should spend days on trolleys before being admitted to an acute hospital bed. Nobody could be happy with such circumstances. It may have been understandable in the mid-1980s when we had less resources and cutbacks were made in health because the economy was unable to sustain public spending levels but there is no explanation for it today.
I agree with Deputy Twomey about the more efficient use of facilities over longer hours. Part of the difficulty relates to industrial relations issues and the manner in which people are paid. We must therefore ensure greater flexibility in the way people are paid and facilities are used. It does not make sense for the taxpayers to spend millions of euro to buy equipment for hospitals if it is not used to the maximum capacity. We must deal with the factors which have resulted in the current scenario. As we know, it is often the case that people occupying hospital beds do not need to be there but are admitted while they await particular tests. If greater use were made of existing facilities, people would not have to avail of inpatient services to access appropriate tests. That is a fact.
I understand a number of initiatives are being undertaken on the north side of Dublin. A group called Touchstone has undertaken an initiative to provide general practitioner services in Mulhuddart. I understand doctors on the north side have come together and done very productive work on an out-of-hours facility. They will shortly be in a position to make an announcement. Existing general practitioners wish to provide the service themselves and I would be very supportive of that. They are engaged in intense discussions with Angela Fitzgerald to whom I have given responsibility for the implementation of the ten-point accident and emergency plan.
Dan Boyle (Cork South Central, Green Party)
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I notice the Tánaiste did not answer Deputy Twomey's question on the closure of the accident and emergency department at Cork University Hospital a fortnight ago. While 30 people were on trolleys in the department, dozens more were turned away. The senior consultant at the department, Mr. Stephen Cusack, described the scenario as one involving the sending away of walking wounded. Does the Tánaiste find it acceptable that not only did this occur, there continues to be great uncertainty about the new accident and emergency facility which has been built on the hospital's grounds and remains unopened despite statements by her party colleagues that it would be opened this very month? Will the Tánaiste provide definite information as to when the accident and emergency problems in the major hospital in the southern region will be alleviated?
Mary Harney (Dublin Mid West, Progressive Democrats)
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I apologise for failing to deal with that aspect of Deputy Twomey's contribution. I visited the new accident and emergency facility in Cork. The reason it has not opened has nothing to do with the failure to make resources available but with logistical issues. A date has been set for the opening of the department to which I will ensure Deputy Boyle is invited. If memory serves me correctly, it will open on the morning of 7 April. I am subject to correction. Clearly, the facility will greatly improve services at Cork University Hospital. I also visited the new day bed unit at the hospital which will greatly enhance elective surgery services and alleviate pressure on the main hospital wards.
As the Deputy is aware, many initiatives are being undertaken at Cork University Hospital. It is not acceptable that as an accident and emergency service a department should be closed for even half an hour, never mind a number of hours. It is not a sustainable scenario or one over which anybody could stand.
Liz McManus (Wicklow, Labour)
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The information to be gathered by the Health and Safety Authority will be ready by 8 April. I presume the Tánaiste will publish the information in which there will be great public interest. Since she abolished the health boards we have had no forum to ensure that information of this type is disseminated. Will she ensure it is?
What is the position on capital projects for hospitals this year? Will they be announced by the Health Service Executive?
Séamus Pattison (Carlow-Kilkenny, Labour)
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The Deputy is widening the scope of the question.
Liz McManus (Wicklow, Labour)
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It is relevant to accident and emergency services and has direct relevance to my question.
Mary Harney (Dublin Mid West, Progressive Democrats)
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As I do not have responsibility for the Health and Safety Authority, I do not have responsibility for its report. If the report is made available to me, I will have no difficulty publishing it. I am sure it will be obtainable under freedom of information provisions. It is not a matter on which legal advice will need to be taken.
The capital programme is being finalised and will be announced in the next two to three weeks. It is hoped we will be in a position to make an announcement shortly after Easter.