James Reilly (Dublin North, Fine Gael)
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Question 78: To ask the Minister for Health and Children the progress made to improve the situation within accident and emergency departments with regard to her ten point plan for accident and emergency services, her description of the accident and emergency crisis as a national emergency in March 2006, the establishment of a task force on accident and emergency services and the subsequent publication of the emergency department task force report; and if she will make a statement on the matter. [24455/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Improving the delivery of accident and emergency services continues to be a top priority for the Government and the Health Service Executive. Our objectives are to further reduce the numbers waiting for admission, the time spent waiting for admission and the turnaround time for those who do not require admission. The Health Service Executive continues to report a significant reduction in the number of patients awaiting admission as compared with the same period 12 months ago. During the first nine months of 2007 the average number of patients awaiting admission each day was 91. This compares with an average of 165 patients during the first nine months of 2006, representing an average reduction of 45%. The initial target waiting time of 24 hours from decision to admit is now being met by the majority of hospitals and the HSE has introduced a revised target of 12 hours since the beginning of this month. 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.

Following publication of the emergency department task force report on 1 June, the HSE has commenced a formal process of engagement with the Irish Association of Emergency Care Medicine. The association has agreed to work with the HSE on a range of issues, including the standardisation of patient processes and pathways within emergency departments.

James Reilly (Dublin North, Fine Gael)
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Does the Minister accept that the HSE's method of measuring waiting times in accident and emergency departments does not bear scrutiny? The waiting period should commence from the time the patient arrives in the accident and emergency department. However, the clock does not start until a decision has been made to admit the patient. That is not the truth, because the time starts when the SHO or the registrar from the medical team comes downstairs to confirm the admission. The consultant in the accident and emergency department has already made the decision and the waiting period should be measured from that time. As the Minister admitted, the 12 hour target is not being met and I would like to know when it will. Furthermore, what is the timeframe for meeting the six hour target? Where is the acute medical unit for Beaumont Hospital which was supposed to speed up patient waiting times? The unit in Navan hospital started today. How late is that? The number of patients on trolleys in the accident and emergency department in Galway has increased because of the cutbacks. The Minister mentioned Ennis and Galway but the medical board is convinced that with the cutbacks, there will be fewer beds and more patients on trolleys in accident and emergency departments and as a consequence, longer waiting times. Does the Minister accept the closure of the orthopaedic unit in Navan, with a resultant loss in procedures, will cause more people with complications from long-term medication use to attend at the accident and emergency department?

The national plan was introduced because there was a national emergency. Is there still a national emergency? There are 100 more patients on trolleys this month than there were this time last year. How does the Minister intend to address the problem?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I think I said the aim was to have patients treated within six hours from arrival time. The period should be measured from the time a patient arrives rather than the time he or she is eventually seen by a doctor. An issue in the negotiations on the consultant contract is having more consultant cover to ensure patients will be seen by key decision-makers quicker than is the case currently. We must accept there have been significant improvements, but in addition to improvements at hospital level, we are trying to refocus on primary care — I know the Deputy is an expert in this area — and community care. However, one cannot switch it around overnight. Too many end up at accident and emergency departments who need not be there if we had appropriate out-of-hours cover and, in particular, if general practitioners had access to diagnostics. Many end up going through accident and emergency departments unnecessarily in order to access diagnostics. The HSE is working around a number of these issues. The 24-hour target was set about 18 months ago. The 12-hour target is now being set and we hope to have a six-hour target, but I cannot say when that will happen.

When the figure hit 500, I said the HSE had to deal with the matter as if it were a national emergency and focus totally on it. I am happy to say it has. By and large, each day 95% to 96% of patients who present do not have to endure a long wait on trolleys, but there are still too many who do.

James Reilly (Dublin North, Fine Gael)
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The key decision-maker in the accident and emergency department is the consultant. Therefore, waiting for a member of the medical team to come down from upstairs just does not wash.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I agree.

James Reilly (Dublin North, Fine Gael)
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When will there be a realistic availability of diagnostics to general practitioners?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I agree with the Deputy that the key decision-maker in the accident and emergency department is the consultant, but there are only 52 such consultants. It is no fault of the consultant that we cannot provide cover for longer and until we recruit more consultants on a new contract. The HSE procured some diagnostic services for general practitioners in Dublin last year at the Charter Medical Centre and perhaps others. I want to see this project area expand in order that there will be no necessity to refer through accident and emergency departments or to the acute system for a general practitioner to access appropriate diagnostics. I hope we will see more progress on the issue next year.