Joe Costello (Dublin Central, Labour)
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I appreciate that the Ceann Comhairle selected my issue for discussion. It is not new and relates to the Health Service Executive, accident and emergency services and the hospital system. I have raised it on a number of occasions and I am doing so today because of an incident which occurred last weekend.

I called into the accident and emergency department at the Mater Hospital at about 1 p.m. on Saturday where I met a number of people who had been in the department overnight. I was particularly concerned about one family whose elderly mother, afflicted by Alzheimer's disease, was sitting on a chair. She had pneumonia and had been in the department since 1.30 p.m. the previous day. The family wished that she would get a bed but there was no sign that this would happen. I contacted them later that evening and she still had no bed. During the evening she had wandered around looking for the toilet, but got lost and was not found for some time. I spoke to staff in the bed management section of the hospital who indicated there was little that could be done because there were no beds available. The family telephoned me the following day and the situation was the same. At one stage on Saturday the woman in question had been in second position for a bed but on Sunday she had sunk to fifth in line. Eventually she was given a bed at 9 p.m. that evening, having spent almost three days sitting on a chair or lying on a trolley. She was not given a permanent bed but rather a bed in the admissions lounge, a halfway house between the accident and emergency department and the area where she would be given a permanent bed where she could be treated on a regular basis. She is still in the admissions lounge, a kind of limbo to where patients can move from the purgatory of the accident and emergency department without going to the heaven of an actual ward where they can be treated properly.

Clearly, it is very unsatisfactory that anybody should be placed in these circumstances, particularly an elderly person suffering from Alzheimer's disease and pneumonia. It is not satisfactory from the point of view of the staff either because they wish to treat patients properly. In order for them to do this a bed is required; otherwise patients suffer and staff are unable to carry out their duties properly.

That is the case of an individual who presented last weekend. Although she forms part of the statistics, she is a person. We receive statistics every day, Monday to Friday, from the HSE, indicating no one is in an accident and emergency department for more than 24 hours and that very few are there for more than 12 hours. Weekend arrivals are not included in such statistics, when the backlog and bottlenecks are evident. From that perspective, what we are getting is a series of statistical works of fiction rather than the facts. The Minister has had a number of years to resolve this problem. She reminded us at one stage that Rome had not been built in a day and told us that she would sort the issue out. Clearly, her solution has not worked. She must provide the necessary beds in public hospitals and stop talking endlessly about the fine beds she will provide in the private sector on public hospital grounds.

Máire Hoctor (Tipperary North, Fianna Fail)
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I will be taking this Adjournment matter on behalf of my colleague the Minister for Health and Children, Deputy Mary Harney, who is not in a position to attend.

The Department has made inquiries today of the Health Service Executive and is advised that the person concerned presented at the Mater Hospital last Friday afternoon. A decision was made later that day that she required admission to an acute bed but due to the lack of a suitable bed, she was obliged to remain in the accident and emergency department until Sunday night when she was admitted to a bed in the admissions unit. It is a matter of particular concern that the patient is an elderly woman and, as the Minister has previously stated to the House, unacceptable for older people to have to wait on trolleys for such a length of time.

There are currently 15 beds closed in the Mater Hospital due to construction work taking place at the hospital relating to the building of an essential new unit. Although it will be of no comfort to the lady concerned — I regret very much she had bad experience last weekend — improvement of accident and emergency services continues to be a top priority for the Government and the Health Service Executive. There have been considerable improvements.

Our objectives are to reduce the numbers waiting for admission, the time spent waiting for admission and the turnaround time for those who do not require admission. The HSE continues to report a significant reduction in the number of patients awaiting admission as compared with the same period 12 months ago. Over the first nine months of this year, the average number awaiting admission each day was 91.

Joe Costello (Dublin Central, Labour)
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Not at the weekend.

Máire Hoctor (Tipperary North, Fianna Fail)
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This compares with an average of 165 patients over the first nine months of 2006, representing an average reduction of 45%. There has also been a significant reduction in the number of hospitals reporting patients waiting frequently for admission in excess of 24 hours. However, as this case indicates, hospitals can still experience difficulties in meeting the needs of those who attend accident and emergency departments. The HSE is continuing to work closely with hospitals, particularly those in the greater Dublin area, to bring about sustainable improvements in the delivery of accident and emergency services. As part of this process, an action plan for hospitals on the north side of Dublin is being prepared and due to be implemented in the coming months. The initial target waiting time of 24 hours from decision to admission is being met by the majority of hospitals but as this case indicates, we must see further improvements to ensure no patient waits for an unacceptably long period before he or she is admitted to an acute bed.

At the beginning of this month, the HSE introduced a revised target of 12 hours within which a patient should be admitted following the clinical decision to admit. The ultimate objective is a total wait-time target of six hours from the time a patient presents at the accident and emergency department to the time he or she is either admitted to an acute bed or is treated and discharged. A system-wide approach is required if the revised target and the ultimate target are to be achieved. Such an approach will include a movement to best in Ireland standards in average lengths of stay, an increase in day surgery rates in line with international practice, a change to the way in which patients are admitted, particularly for surgical procedures, and a major drive to increase the efficiency in discharging patients from hospitals.

Following the publication of the emergency department task force report, the HSE is working with the Irish Association of Emergency Care with a view to further lowering the target waiting time, which will include the standardisation of patient processes and pathways within accident and emergency departments throughout the country. The programme for Government contains a number of new commitments in respect of the improvement of accident and emergency services. These are as follows: to increase the number of accident and emergency consultants available around the clock, to further develop chest pain and respiratory clinics to ease pressure on accident and emergency services and to establish a national network of local injury clinics. The target regarding the latter is 20 clinics within five years.

The HSE recently announced the approval of 60 additional consultant posts under the 100 plus performance incentive scheme. It expects that the additional posts will increase the number of senior decision-makers available in accident and emergency departments, as well as improving GP access to diagnostics and speeding up the delivery of diagnostic results. The additional consultants will also enable the relevant hospitals to streamline their internal processes, including discharge planning, to enable accident and emergency departments to operate at their most efficient.

The development of additional fast-track specialist consultant-led clinics was identified by the HSE emergency department task force as having the potential to improve services for patients within accident and emergency departments. An analysis of the number and optimum location of the additional clinics will need to be undertaken. Consideration must also be given to the role that might be played by the private sector in further developing the service.

The programme for Government indicates a commitment to ensure that only those in need of the high level of expert attention available at an accident and emergency department should attend for treatment and that patients should be assessed immediately and treated quickly. The development of local injury clinics is intended to help in achieving this objective.