Dáil debates

Wednesday, 26 April 2006

Priority Questions.

Accident and Emergency Services.

1:00 pm

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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Question 52: To ask the Tánaiste and Minister for Health and Children if the state of emergency in relation to accident and emergency will continue for the foreseeable future; her views on whether the lack of bed capacity is the main cause of the accident and emergency crisis; the status of her ten-point plan; the reason she has failed to deal with the accident and emergency crisis; and if she will make a statement on the matter. [15634/06]

Photo of Mary HarneyMary Harney (Tánaiste; Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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The Government's top health service priority is to tackle the difficulties with accident and emergency services. I said I wanted the accident and emergency situation to be treated as an emergency to increase the pace with which better outcomes are achieved for patients. The Government's objectives are to reduce the number of people waiting for admission, the amount of time they spend waiting for admission and the turnaround time for those who can be treated without requiring admission. As the Minister for Health and Children, it is appropriate for me to exhort maximum effort and speed from all concerned to improve care for patients. The HSE, which is continuing to implement the ten-point action plan, is also implementing other initiatives, including the establishment of performance targets for individual hospitals and the development of financial incentives which are linked to performance. In the immediate term, the HSE is introducing a series of measures to improve facilities for patients and staff in accident and emergency departments. Long-term care beds are being secured from the private sector to facilitate the discharge of patients who have completed the acute phase of their care. Additional acute beds and day places have been provided in recent years and more beds are in various stages of planning. I share Professor Drumm's view that the achievement of improvements in accident and emergency services depends on fundamental changes being made in hospitals and in other areas of the health service. It is not just a question of putting extra acute beds in place. The measures being examined by the HSE include improvements in hospital processes and procedures to ensure they operate more effectively, the introduction of rigorous admission and discharge planning processes, the broadening of access to diagnostic facilities and the enhancement and development of primary and community care services.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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I asked the Tánaiste whether she thinks the state of emergency in accident and emergency services will continue for the foreseeable future. What does she consider to be an acceptable number of patients on trolleys? When will she declare the state of emergency to have come to an end? What is an acceptable number of people on trolleys? I think the Tánaiste said at one time that it was not acceptable for anybody to be on a trolley. At what stage will she declare that the state of emergency is finally finished? Can we expect it to continue for the next 12 months, until the general election? When the Tánaiste published the ten-point plan, she said we would see tangible results in 2005, but the problem has got much worse since then. When will we see the results of the ten-point plan?

James Breen (Clare, Independent)
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We will see results when there is a change of Government.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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It is just not happening. Deputies have received a number of replies from the Tánaiste in response to questions about beds. She said this afternoon that 1,000 public beds will be freed up as a result of her privatisation proposals. Was she referring to 1,000 public beds? She said at another stage that she was talking about 1,000 beds which could be used by private and public patients. Does she see the proposal as a genuine option? Why is she continuing with this policy when she and Professor Drumm have said that beds are not the main source of the problem?

Photo of Mary HarneyMary Harney (Tánaiste; Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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I remind Deputy Gormley that the conversion of 1,000 private beds into public beds is not privatisation. He does not seem to understand what is privatisation. It would be privatisation if I was doing the reverse, by converting some public beds to private beds.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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What are they?

Photo of Mary HarneyMary Harney (Tánaiste; Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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I wish to make that clear.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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Are they public beds or private beds?

Photo of Mary HarneyMary Harney (Tánaiste; Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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There are 2,500 private beds in our public hospitals at present. That some 46% of the elective work at Tallaght Hospital last year involved private patients does not cast any reflection on its catchment area or on its accident and emergency activities. The beds in question were entirely funded and are 40% subsidised by the taxpayer. The wages of the nursing and other staff are paid by the taxpayer.

I want to reduce the amount of private activity in public hospitals so patients are seen on the basis of medical need. Ireland has more beds pro rata than Finland or Sweden and the same number as Britain, even though 18% of the population of Britain is over the age of 65 and just 11% of the population of Ireland is over the age of 65. It almost does not matter how many beds one has if they are not being used efficiently. The results of the process mapping exercise at Cork University Hospital, which were published last week, highlighted that 2,280 bed days were lost at that hospital because people who were fit to be medically discharged were not discharged for all kinds of reasons. Very few people are discharged from our hospitals, particularly those in Dublin, on Saturdays or Sundays. If one is not seen by a consultant until late in the evening, one will not be able to go home until the following day.

We need to change many aspects of how we use our beds. While there are fewer beds in Finland than in Ireland, there is more hospital activity in that country than there is here. When one talks about beds one has to consider how they are used. The number of procedures carried out on a day case basis doubled from 250,000 in 1997 to 500,000 in 2004. That means there should not be as much need for inpatient beds. Deputy Gormley asked me to outline the extent to which it is acceptable that there are patients on trolleys. People will always be treated on trolleys — that is a fact throughout the world. Many treatments are performed while patients are on trolleys. We are trying to ensure that people who are waiting to be admitted to acute beds in hospitals do not have to wait for more than six hours. That is the aim and the ambition. In autumn 2005, there was a reduction of 20% in the number of people waiting on trolleys.

The care of the elderly is one of the issues that arises in this regard. Approximately 4.5% of those over the age of 65 are in long-term care, which is in line with the international average. Some people who are in care could be at home if a set of measures had been in place in the past to support such people. We do not have such supports, however, and it will take some time for us to catch up. We are putting them in place at present because we understand that over the next few years we will have to expand the services we provide to older people in the community. We need to provide home help and home support and to recruit additional chiropodists, physiotherapists and other professionals who can help people to stay in the community. I have given the HSE additional resources to procure beds for older people in the acute system. There were approximately 440 such people in the Dublin area a few weeks ago. Older people who have been medically discharged are being moved from the acute system to alternative settings. That will continue for the rest of this year. It will have a major impact on accident and emergency services as the year progresses.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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The Tánaiste is saying that six hours is now the benchmark as far as she is concerned.

Photo of Mary HarneyMary Harney (Tánaiste; Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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I said that earlier but the Deputy was not listening.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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It does not matter to the Tánaiste, therefore, if there are 450 people lying on trolleys as long as they are there for no more than six hours. Is that okay as far as she is concerned?

Photo of Mary HarneyMary Harney (Tánaiste; Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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Such targets are in place in the best health care systems in the world. Under our system, before a patient even gets to see a doctor, he or she can have to wait quite some time. Many of the processes within accident and emergency departments can, I hope, expedite the time period before a patient gets to see a doctor. Remember that 75% of those presenting at accident and emergency departments do not need to be admitted to hospital. Equally, we want to ensure that these patients are dealt with quickly. It is not just a question of the people being admitted to hospital. We want to see more rapid responses as regards all activity in accident and emergency departments.