Charles Flanagan (Laois-Offaly, Fine Gael)
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Question 69: To ask the Minister for Health and Children the reason the Health Service Executive did not introduce the six hour target waiting time for relevant hospitals on 1 February 2007 as recommended by the accident and emergency task force; when this target will be implemented; and if she will make a statement on the matter. [17723/07]

Tom Hayes (Tipperary South, Fine Gael)
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Question 162: To ask the Minister for Health and Children her views on whether it is accurate to record patient waiting times at accident and emergency from the time a decision has been made to admit the patient, as opposed to the time the patient arrives at accident and emergency; and if she will make a statement on the matter. [17724/07]

Michael Creed (Cork North West, Fine Gael)
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Question 169: To ask the Minister for Health and Children the reason the Health Service Executive did not introduce the 12 hour waiting time target for accident and emergency on 1 January 2007 as recommended by the accident and emergency task force; when this target will be implemented; and if she will make a statement on the matter. [17722/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The final outturn on Vote expenditure for the Health Service Executive showed a capital saving of €114 million, of which €42 million was used to offset a revenue overspend and a further €47 million was used to offset a shortfall in projected appropriations-in-aid. This left a balance of €25 million to be surrendered to the Exchequer.

The Health Service Executive's appropriation account for 2006——

Charles Flanagan (Laois-Offaly, Fine Gael)
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With respect, the Minister is reading another reply.

Brendan Howlin (Wexford, Labour)
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I am afraid the Minister has proceeded to Question No. 70. I called Question No. 69.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I beg your pardon, a Leas-Cheann Comhairle.

Brian Hayes (Dublin South West, Fine Gael)
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The Minister was anticipating Deputy Sheehan.

Brendan Howlin (Wexford, Labour)
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Deputy Sheehan has just arrived. I understand two other questions are being taken with QuestionNo. 69.

Brian Hayes (Dublin South West, Fine Gael)
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It relates to the accident and emergency task force.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am sorry. I think we dealt with that in Priority Questions.

P J Sheehan (Cork South West, Fine Gael)
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Is it Question No. 70?

Brendan Howlin (Wexford, Labour)
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It is Question No. 69. I welcome Deputy Sheehan to the House.

Liz McManus (Wicklow, Labour)
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A new boy.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I beg the House's pardon, but one of the difficulties in having priority questions is that one ends up reading out the same answer.

Brian Hayes (Dublin South West, Fine Gael)
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The Minister has all these Ministers of State now.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The answers certainly do not change. It is not like, with a student of mathematics, where the questions might change but the answers do not.

Brendan Howlin (Wexford, Labour)
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We are eating into the time.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I apologise. I propose to take Questions Nos. 69, 162 and 169 together.

Improving the delivery of accident and emergency services is the Government's top priority in health. Our objectives are to reduce the numbers waiting for admission, the time spent waiting for admission and the turn-around time for those who can be treated in accident and emergency departments and who do not require admission.

In March 2006, the HSE established a dedicated task force to facilitate the implementation of the HSE's framework for addressing the problems arising in the delivery of emergency department services. The report of the task force was published on 1 June.

The task force report noted that the majority of the hospitals which were identified as experiencing difficulties in the delivery of emergency department services have for some time been meeting the initial performance targets set by the HSE. There are a small number of hospitals that have experienced particular difficulties in seeking to achieve the targets.

The task force report recommends that revised targets should be set to ensure that no patient waits longer than 12 hours for admission to an acute bed, once the decision to admit has been made. The ultimate objective is a total wait time target of six hours from the time a patient presents at the emergency department to the time he or she is either admitted to an acute bed or is treated and discharged home. The task force acknowledged that further work is required on the establishment of total wait time targets. Key issues to be addressed by the HSE in this context are the standardisation of processes and models of care within emergency departments and the standardisation of waiting time measurement.

The HSE has announced that it intends to introduce revised performance targets in October next. The basis for the timing of the introduction of the revised targets is to take account of key infrastructural developments, including the commissioning of 700 additional public long-stay beds. In addition, a number of emergency department developments, including admission lounges and acute medical units, are to become operational in 2007 and at the start of 2008. These developments are designed to deliver improvements in terms of the clinical decision-making within emergency departments and to address dignity and privacy issues for patients awaiting admission to an acute bed.

Charles Flanagan (Laois-Offaly, Fine Gael)
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The Minister will recall setting up this task force in March 2006, when she heralded its inauguration in the context of there being a national emergency in the accident and emergency sector. Where stands that statement now? Does the Minister still accept that is a national emergency or is she prepared to row back on that in the context of publication of the report?

In the context of an earlier question to which she delivered a reply to Deputy Brian Hayes, when the Minister stated that this report forms part and parcel of a jigsaw, I put it to her that the most important aspect of anybody engaging in putting together a jigsaw is the matter of setting targets, that one will never finish a jigsaw unless one sets a completion hour in which to put it together. Does she accept that is the fundamental flaw in this report? As well as the report casting a poor reflection on the accident and emergency facilities and performance in seven of the country's major hospitals, it does not identify the targets. It is merely a catalogue of failure and a cosmetic exercise. When one considers the substance of this report, one sees failure after failure.

Having been out of the House for the past few years I have noticed a total remove by the Minister from the health services, illustrated in her semi-detached reply. The Minister receives the report in a semi-detached manner. I regret that the Minister does not appear to have any role in this. If she has a view on setting targets perhaps she could inform the House of the nature of her involvement.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I welcome the Deputy back to the House. In March 2006, when the number of patients on trolleys awaiting treatment for a number of hours hit 500, I stated that it must be treated by the HSE as if it were a national emergency. In other words, we had to apply a focus as if we had a national emergency. That was the appropriate way to treat the difficulties that had arisen. Everyone, including the Irish Nurses Organisation, the IMO and others, has acknowledged that we have seen major improvements, particularly in five hospitals. Different practices have resulted in great improvements for the benefit of patients. Challenges exist in other places, some of which relate to the physical capacity of facilities in places such as Drogheda. Money is being provided this year to provide new facilities there.

The initial target was 12 hours, which I accept is a long time. The next target will be six hours. Setting a target is not a sensible idea if one does not have the wherewithal to measure it. The HSE is setting up procedures so that a target of six hours can be set in October. I hope this can be reduced further.

More than 90% of people who present do not require admission and go home. Those people may still have long waiting periods before being treated and leaving. The target applies not just to those who must be admitted to an acute bed. We also need a target for the period between arrival time and the time one is dealt with, by being admitted or sent home. I look forward to that target being set in October.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What is being done to expedite the implementation of the task force recommendations? Recently, I asked if the Minister had received the report of the Irish Association for Emergency Medicine, Health and Safety Standards for Irish Emergency Departments. I was surprised at the Minister's reply yesterday, stating she had not yet received a copy. I have made a copy and would be happy to pass it on to the Minister. The report states: "The persistent overcrowding in Irish EDs fundamentally contravenes this duty of care and as a result both patients and staff are exposed to significant risk on a daily basis." Does the Minister recognise the urgency for action to relieve overcrowding in our accident and emergency units? What further action and funding will she provide?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The implementation of many recommendations of the task force is already under way. Many concern capacity in various hospitals. These began during the gestation period of the task force report. Overcrowding is something of a jigsaw. We need more consultants on duty in hospitals, more access to diagnostics and more measures taking place at community level. All of these make an impact on accident and emergency units. Until relatively recently, there was one hospital on call in one part of the city and one hospital in the other. Now, we have accident and emergency units everywhere.

In those years they were for genuine accidents and emergencies. Today our accident and emergency departments are dealing with people who have chronic illness because it is not being appropriately managed in the community or with people who need diagnostic care because they are waiting so long. That is why, in time, the other measures that have been put in place by the HSE will have a significant impact. When I had a long meeting last week with Professor Drumm — whom I had not met since prior to the general election being called — he informed me of a number of initiatives that had been put in place by the HSE in the intervening weeks to help hospitals to achieve the kind of targets we are talking about.

James Reilly (Dublin North, Fine Gael)
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Gabhaim comhghairdeas don Leas-Cheann Comhairle faoin a phost nua.

Brendan Howlin (Wexford, Labour)
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Go raibh maith agat.

James Reilly (Dublin North, Fine Gael)
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The target to which the Minister alluded was a six-hour target which the HSE has set itself that starts from the time the decision has been made to admit the patient. However, even here there is disingenuity because the decision to admit the patient may well have been made by the doctor in accident and emergency but the clock does not start running until the admitting doctor from the various specialties within the hospital can make that decision. This can often take many hours, as I know only too well.

The Minister alluded to the 5% capital fund and spend in this country being second only to Norway in the OECD, yet we have the second lowest expenditure on health and education in the OECD. As I stated in last night's debate, our GNP last year contained a 7.2% spend on health. It has been acknowledged that we have fallen behind in health spending due to the many cutbacks in the 1980s and 1990s and that we are playing catch-up. Will the Minister outline how we can possibly catch up when we are still spending less per capita than the European average, which is 8.6% and Germany and France which are at 10%?

I am pleased to hear the Minister is looking outside accident and emergency services because this area is merely the symptom of the problem. A bottleneck has been caused by a lack of beds and inappropriate use of beds on the one hand and a lack of diagnostics, to which the Minister has alluded, but also the lack of a proper preventative medical scheme. Fine Gael had promoted the latter, in addition to a chronic illness scheme prior to the general election to keep people out of hospital and identify illness early. It is well known that for every euro one spends on prevention, one saves €20 on treatment.

I recall the Minister referred to the accident and emergency crisis as a national emergency but I do not recall when she declared that was no longer the case. Perhaps she will inform the House of when she made that announcement.

Where are the acute medical admission units that were promised? One such unit was promised for Beaumont Hospital on the north side of Dublin. This would have alleviated the situation in accident and emergency departments. GPs are highly experienced doctors who, when they have seen patients and examined them, know whether they need admission. It is regrettable to have to route patients through accident and emergency departments and for them to have to put up with all the unpleasantness that goes with that kind of experience in the current poorly-funded health system.

Brendan Howlin (Wexford, Labour)
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Normally one minute is allowed for supplementary questions but latitude can be given. Deputy Reilly is very welcome to the House.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I object to Deputy Reilly's statement that our health system is totally underfunded. I cannot remember the exact words he used. I do not know whether he referred to GDP or GNP. He may be referring to 2005 figures. If one takes the spending in 2007 and compares it on a per capita basis with purchasing power, parity and so on with many other countries, including France, the United Kingdom and Northern Ireland, we compare most favourably. The issue we have all recognised in Ireland over the past decade as we multiplied public spending on the health system fourfold, is that spending alone would not resolve the challenges without changing how we do business.

When the figure of 500 patients on trolleys was reached on a particular day for the first time in March 2006, I said the HSE had to apply itself to the task of resolving the challenges in accident and emergency services as if it were a national emergency, which it did. We have seen improvements of 40% to 60% over the past 12 months. That has been acknowledged by an organisation of which Deputy Reilly is a member, as well as the INO and others.

Admission lounges and facilities are being put in place. I do not have the date of when this will happen in Beaumont Hospital but during the remainder of this year and next year, huge——

James Reilly (Dublin North, Fine Gael)
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They are not acute medical assessment units.

Mary Harney (Dublin Mid West, Progressive Democrats)
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That is what I meant. There are two types of unit. I understand Tallaght Hospital has just got an admission lounge and other hospitals are getting acute assessment medical units.

I fully agree with Deputy Reilly that we need to have the kind of measures in place which I know he would like from a general practitioner perspective, in particular for the management of chronic illness in the community. Many patients, especially older people who thankfully are living longer, have chronic illnesses such as diabetes and if such illnesses can be managed, we will relieve pressure on the acute hospital system.

Brendan Howlin (Wexford, Labour)
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While Members are anxious to reach Deputy Sheehan's question, two Deputies have indicated and I will take brief supplementary questions from both. I will call Deputy Shatter first, followed by Deputy Charles Flanagan.

Alan Shatter (Dublin South, Fine Gael)
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I will be brief. The Minister stated there are many pieces to the jigsaw when dealing with the accident and emergency services problem. Does the Minister agree and acknowledge that the major problem is the availability of acute hospital beds and, as she noted in reply to an earlier question, that beds are being used inappropriately? Moreover, does she acknowledge that beds are being used inappropriately because of the Government's total failure to provide necessary step-down facilities? I refer to those people who have been through the worst of their illness, are not sufficiently well to return home and who need continuing care but who do not require acute hospital care. Does she accept that the Government has contributed to the national emergency that was created last year and that the problems in accident and emergency will not be resolved until it takes up its obligations to provide the requisite step-down facilities? Does she accept that these are the facilities that should be provided within those hospitals now designated for co-location and the construction of private hospitals?

Charles Flanagan (Laois-Offaly, Fine Gael)
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A total of 222 people were on trolleys as recently as last Wednesday evening. As this figure does not include the number occupying beds that have given rise to the cancellation of day care procedures, the real figure is much higher. On the matter of targets, I am a little confused in respect of the six-hour and 12-hour targets to be set in October on foot of this report. It seems the Minister is missing the targets and is opting out of the placing of targets. Unless she sets clearly defined targets that will be met, this issue will not be dealt with in a satisfactory manner.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Government is providing step-down facilities. It has provided a couple of hundred such beds in recent years. I fully accept——

Alan Shatter (Dublin South, Fine Gael)
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Not enough.

Mary Harney (Dublin Mid West, Progressive Democrats)
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——it must provide more and more are being provided. A number of things must be done. Obviously, rehabilitation capacity is also important as many people in the acute system await rehabilitation. This is the reason the building of the new hospital and additional rehabilitation capacity is important. I understand that one of the co-location proposals, from Blanchardstown, may include step-down facilities.

As for trolleys, some people spend all their time, perhaps 24 hours, being observed on a trolley. Recently, a close friend of mine who would be known to many Members had such an experience in a Dublin hospital. He told me it was a very pleasant experience. There will always be people on trolleys and many people are treated on them. The issue is the length of time someone must wait to be dealt with in an accident and emergency department. Some of the private clinics that have opened in the Dublin area, which have been subject to much criticism, operate a target of one or two hours from the time one enters to the time one leaves. I accept they deal with minor injuries.

Charles Flanagan (Laois-Offaly, Fine Gael)
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The Minister should not suggest that the general experience of being on a trolley is pleasant.

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is for many people.

Charles Flanagan (Laois-Offaly, Fine Gael)
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I would use a different word to "pleasant".

Mary Harney (Dublin Mid West, Progressive Democrats)
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Many of the issues——

Charles Flanagan (Laois-Offaly, Fine Gael)
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Many people regard the experience as being much less than pleasant.

Brian Hayes (Dublin South West, Fine Gael)
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That is an extraordinary statement.

Brendan Howlin (Wexford, Labour)
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The Minister, without interruption.

Charles Flanagan (Laois-Offaly, Fine Gael)
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They regard it as being quite unpleasant.

Brendan Howlin (Wexford, Labour)
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If the Minister can conclude, we can move to the next question. An tAire, without interruption.

Mary Harney (Dublin Mid West, Progressive Democrats)
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May I inform Deputy Charles Flanagan——

Brendan Howlin (Wexford, Labour)
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Through the Chair.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I apologise. Through the Chair, some of the issues that arise concern privacy, as well as whether someone is on a trolley. Many issues exist, which is the reason that capacity improvements and creating a better environment, including the provision of toilet and other facilities, constitute part of what we seek to do.

As for the setting of targets, we never had them until some time ago when we set the 12-hour target. The six-hour target will be from the time one arrives and not simply from the time one is seen. I accept Deputy Reilly's point that it is not simply when the accident and emergency consultant decides that one may require admission but when someone else in the house comes down and so decides. In the first instance, we seek a target of six hours from the time one presents until one can either go home or be admitted to an acute bed.

Alan Shatter (Dublin South, Fine Gael)
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The Minister has missed the target.

Charles Flanagan (Laois-Offaly, Fine Gael)
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Have we got a target?

Mary Harney (Dublin Mid West, Progressive Democrats)
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That target has not been set. Incidentally, such a target is being met in many hospitals nationwide, including those located in Deputy Charles Flanagan's home region of the midlands.

Brian Hayes (Dublin South West, Fine Gael)
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Not according to the task force report.