Wednesday, 11 May 2005
Accident and Emergency Services.
Question 57: To ask the Tánaiste and Minister for Health and Children the steps being taken to address the serious situation identified in the recent Health and Safety Authority report on a number of accident and emergency departments, particularly the warning that persons seeking treatment were being put at risk of injury, infection and violence; and if she will make a statement on the matter. [15480/05]
I have already welcomed the recent report of the Health and Safety Authority. It adds further impetus to our drive to improve the delivery of accident and emergency services. The authority's report arises from its inspection of 11 accident and emergency departments and its analysis of risk assessments carried out in all hospitals. This is the first nationally co-ordinated analysis of all accident and emergency departments. It is, therefore, critical that action is taken following the recommendations of the Health and Safety Authority. I am pleased the Health and Safety Authority has acknowledged that the hospitals are fully engaged in the process of addressing health and safety in their accident and emergency units.
The Director of the National Hospitals Office has issued interim advice to chief officers-chief executives-hospital managers on the preliminary findings of the Health and Safety Authority audit and the National Hospitals Office's own assessment of the audit. In particular, the Health and Safety Authority recommended that the Health Service Executive should determine, on a hospital by hospital basis, after undertaking the necessary risk assessment and staff consultation, whether extra capacity can be achieved within existing units. The National Hospitals Office has advised hospital managers to examine the potential for using the total hospital capacity, including inpatient wards for patients who require admission. It is a matter for each individual hospital to exercise its own judgment on how to reduce risk within particular hospitals.
The National Hospitals Office has also written to each trade union-staff association requesting that the issue of accident and emergency departments, including the issue of health and safety, should be dealt with by way of a working partnership group between management and trade unions. I urge staff representatives to fully engage in this process.
Both the Health and Safety Authority and the Health Service Executive reports have found violence and aggression to be one of the main risks in accident and emergency departments. Much of this relates to the prevalence of cases of alcohol and drug misuse.
The National Hospitals Office has requested the immediate implementation of guidelines issued by the Health and Safety Authority on dealing with violence and aggression in the workplace. The National Hospitals Office is also examining current policies against workplace violence and will issue a clear policy statement of intent which will recognise the importance of efforts to eliminate workplace violence. I find it totally unacceptable that front-line health care workers might be subjected to threats or abuse. My colleague, the Minister for Justice, Equality and Law Reform, Deputy McDowell, is also determined that everything possible should be done to tackle disorderly behaviour and, in particular, assaults on emergency workers, such as the staff of hospital accident and emergency units. I am fully supportive of the Minister's efforts in this regard.
Will the Tánaiste accept that there is a certain irony in her words, considering that she refused to accept the motion which will be put tonight by Fine Gael on drunkenness in accident and emergency departments? While she welcomed the Health and Safety Authority's report, she did not commission it. Will she tell us when accident and emergency departments will be made safe? What is the timeframe for delivery? Regarding the contentious issue of providing extra capacity by adding beds to hospital wards, how many hospitals have undertaken to do this?
Safety in accident and emergency departments is a matter for the individual hospitals. I do not intend to micro-manage each hospital as they have their own management teams. Hospitals must examine their own circumstances and put in place the best management system taking into account all the risks. This will increase safety. I share a view with others, including accident and emergency consultants such as Dr. Aidan Gleeson, that accident and emergency services must be seen as a wider hospital systems issue. Escalation policies and moving beds from accident and emergency units to wards is sometimes preferable to leaving patients on trolleys overnight.
Virtually every hospital I am aware of spends considerable resources on security. If these resources are inadequate due to the manpower being employed or the scale involved, the matter must be examined by the hospital. Hospitals will receive an extra €387 million this year to run their operations, which is almost half the total increase in health spending for 2005. If a wider hospital systems issue is addressed, including activity in respect of private patients, many of the matters I spoke about yesterday and the problems in accident and emergency units can be dealt with.
We have not ruled out the possibility of addressing the issue of people who present intoxicated as they pose the greatest threat to staff. Everyone presenting, including those who are intoxicated, must be dealt with by accident and emergency units. Someone else could be seriously injured. We cannot move a person out of the way without establishing whether they are intoxicated. Subject to appropriate medical and legal advice, we are open to using innovative approaches to deal with people who have presented in this state to provide a disincentive. As I said last night, 30% of those who appear in the accident and emergency unit of the Mater Hospital are intoxicated.
The Minister for Health and Children veered away from the question. How many hospitals have decided to move additional beds into their hospital wards? The Minister sees this as a good idea but how many hospitals agree and how many are adopting it? Regarding an individual hospital's requirement to make a provision that is beyond its control, surely the Minister has a role there. Nobody expects her to micro-manage our hospitals but many of the problems in accident and emergency departments are outside the management team's control. What provisions will be made to ensure managers can manage their hospitals?
The Deputy's point is fair. Clearly, issues exist with the volume of people who present if there is no access to general practitioner services or any provision of patient appointments. They often end up on hospital beds awaiting tests. However, hospitals can take many actions, such as through their discharge policies. I have cited the respiratory physician at James Connolly Hospital, Dr. Conor Burke, previously. He said that, if everyone was discharged in his hospital when they were medically fit to be discharged, no one would be on a trolley. Discussions are taking place in individual hospitals on the issues of discharge policies and freeing up beds to allow those who require admission to be taken. I do not know how many hospitals have decided to put beds on wards, although some have. I recently met the——
I understand the Mater Hospital has made this decision. I met with the managers of the Dublin teaching hospitals a couple of weeks ago and put this issue to them. They were to consult on it and most felt that, before the Health and Safety Authority's report, it was probably safer on balance from a patients' safety point of view and a health perspective to put an extra bed on a ward from time to time than to keep patients on trolleys overnight. We want innovative solutions customised around individual hospitals if at all possible.