Liz McManus (Wicklow, Labour)
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Question 131: To ask the Tánaiste and Minister for Health and Children, further to a promise made on 26 January 2005 to deliver real and measurable improvements to the accident and emergency crisis within months, her views on the fact that one year later, with reports of over 400 patients on trolleys across the country, the accident and emergency crisis has worsened and that the ten-point plan has failed; the steps she intends to take to address this crisis; and if she will make a statement on the matter. [3281/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not accept that the accident and emergency action plan has failed. On the contrary, a wide-ranging approach has been adopted by the Health Service Executive to improve access to accident and emergency services, improve patient flows through accident and emergency departments, reduce waiting times, free up acute beds and provide appropriate longer-term care for patients outside the acute hospital setting. A particular focus of the action plan has been placed on those patients in acute hospitals who have completed the acute phase of their treatment and are ready for discharge to a more appropriate setting.

The HSE has made considerable progress and is continuing to make sustained efforts in this regard. A range of measures, including the provision of high dependency beds, intermediate care beds in private nursing homes, additional beds in public nursing homes, home care packages and enhanced subventions, have facilitated approximately 1,500 patients to leave acute hospitals. In addition, €6.6 million is targeted at increasing the level of home support available in the community, which should assist in keeping people well in their homes and thus avoid the necessity for presentation at accident and emergency in many cases.

Within the context of the action plan, the HSE undertook an audit of efficiencies and process. The study was conducted in ten hospitals, and its conclusions point to a number of areas for further improvement. These include strengthened discharge planning processes, improved clinical decision making at every stage and better co-ordination of and access to diagnostic services. A key action for 2006 for all hospitals with accident and emergency departments will be the full implementation of the efficiency audit recommendations. In tandem with this, a programme of financial incentivisation will be introduced, aimed at rewarding those hospitals that are meeting agreed performance targets and facilitating overall improved performance.

The HSE will continue to maintain a focus on the implementation of system-wide measures to further improve the delivery of accident and emergency services.

Liz McManus (Wicklow, Labour)
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The Taoiseach recently stated publicly:

People say so what, what about Joe and Mary down in A&E. They shouldn't be on a waiting list. I think it's a pity that people are so unintelligent, actually.

Does the Tánaiste agree with him?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I was abroad when the Taoiseach gave the interview. To be fair to the Deputy, I do not know whether she is quoting him out of context. However, the Taoiseach is more than aware of the difficulties and pressure in accident and emergency units. He may have been suggesting we should put matters in context, although that is not to justify what happens from time to time — on too many occasions.

Each day, approximately 4,000 people present at accident and emergency units. Even on the worst days — there was a very bad day two weeks ago — fewer than 10% of those who presented were on a trolley overnight, although that figure is still far too high. All our efforts are focused on finding alternatives, particularly for those who have been medically discharged from the acute phase to better settings — they are better for a host of reasons — and improving access to diagnostic facilities. Work is underway in that regard, although the facilities have not been put in place. We have gone to tender with regard to improved primary care, particularly on the north side of Dublin, as this is an issue which is placing huge pressure on some of the hospitals on the north side of the city.

I assure the Deputy that the Taoiseach is very sensitive to the difficulties being experienced by too many patients at accident and emergency level in some of our hospitals.

Liz McManus (Wicklow, Labour)
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I would hate to see the Taoiseach not being sensitive if that is the kind of statement he can make about distressed relatives.

Let us deal with the real and measurable improvements the Tánaiste promised would occur within months of her statement last January. How many minor injury units and chest pain and respiratory clinics have been provided and where are they located? Is the MRI scanner for Beaumont Hospital in place and, if so, for how long has it been in place? How many of the acute medical units promised by the Tánaiste are in place? Is the Tánaiste aware that the one hospital that has managed to provide this kind of unit, St. Luke's in Kilkenny, was penalised and fined by the Tánaiste during the past year?

What is the delay with regard to the out-of-hours service in north Dublin, which was promised over one year ago? While there was an urgency about it at that time, there does not now seem to be any urgency from the Tánaiste. Why has the service not been put in place? There is clearly a desire among general practitioners in north Dublin to provide it. What is happening that the Tánaiste cannot even provide that simple measure? At what locations is GP access to diagnostics available and how many GPs can access diagnostics in this new and desirable way? What improvements have been made with regard to palliative care and where have they been made? All of these matters were contained in the Tánaiste's ten-point plan.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Absolutely. With regard to acute medical units, AMUs, to which the Deputy referred, a number of hospitals, including St. James's Hospital in Dublin, have them. A number of other hospitals sought to completely over-spec what the HSE and the Department felt was required. If people in the health care system think a pot of money is available, they sometimes feel they have to go for the largest possible slice of that money as a cure for all their ills. The HSE made a decision, with my support, that until we knew the outcome of the mapping exercise, which was examining all the internal functions of the hospital, we would not allocate additional funding to be spent in the same way. That exercise, which will be published shortly, hospital by hospital, details a significant number of interesting facts. For example, in some hospitals 100 staff work in accident and emergency units and deal with 100 patients a day, a ratio of one staff member to one patient. A patient must often go through a number of layers before he or she can get near a staff member to treat him or her.

The doctors on the north side of Dublin submitted a tender which the HSE felt was not adequate to provide the service. I understand the HSE is in discussions with the doctors on the north side of Dublin. Professor Drumm recruited Dr. Sean Maguire, who set up the first out-of-hours facilities in the UK and, subsequently, in Ireland. He is a doctor with huge experience in this area and is currently spearheading the discussions on the out-of-hours facilities with the doctors on the north side of Dublin, which I understand will be completed soon.

The MRI scanner for Beaumont is a second scanner. I understand a mobile facility was to be acquired. The hospital is in a position to make that happen very quickly.

As the Deputy is aware, public procurement means that although a decision may be made today, unfortunately it takes many months before some of these developments can happen, for good public procurement reasons.

The focus on accident and emergency services is thorough and robust. I had a meeting with the Health Service Executive yesterday which dealt with many of these issues, particularly care of the elderly. A package worth €150 million has been made available for this purpose. If this money is used to support people at home, it will have a major impact on the flow of patients through hospitals.