Jan O'Sullivan (Limerick East, Labour)
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Question 2: To ask the Minister for Health and Children her views on whether the national emergency which she acknowledged due to the number of patients on trolleys in 2006 has re-emerged in winter 2007 in view of statistics and of concerns expressed by the Irish Association of Emergency Medicine; the action that will be taken to address this problem; and if she will make a statement on the matter. [2782/08]

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.

There have been considerable improvements made over the last two years in the delivery of services in accident and emergency departments. The number of patients awaiting admission to a hospital bed from accident and emergency departments reduced by 50% between December 2005 and December 2007, from an average of 155 to 78 a day. However, there was an increase in the numbers in recent weeks which the HSE attributes to a number of factors, including increased levels of virulent norovirus, winter vomiting bug; increased levels of influenza and chronic obstructive pulmonary disease; and an increase in the number of delayed discharges, particularly in the Dublin area. These are patients who remain in hospital although they have finished the acute phase of their treatment.

The HSE is working intensively with the hospital system to bring about further sustainable improvements. One of the key issues being addressed is the system of discharge planning. A major focus is being placed on ensuring that all patients have an expected date of discharge within 24 hours of admission; the expected date of discharge is actively managed on a daily basis against the treatment plan and any changes are communicated to the patient; patients can be discharged in a more proactive manner at weekends; there is an increased emphasis on nurse-led discharges; and ward rounds are scheduled in a way which facilitates a more timely review of treatment plans.

The HSE is also working closely with a number of hospitals reporting significant numbers of patients awaiting admission. This includes a specific focus on the establishment of clinical decision units and short stay units to accelerate the throughput of patients who present at accident and emergency departments. Additional measures are also being put in place to deal with the issue of delayed discharges.

In light of the successful conclusion of talks regarding the new contracts for consultants, I hope that progress will be made in advancing the recruitment of additional consultants under the 100 Plus initiative previously announced by the HSE. The initiative is designed to reward hospitals which are operating in line with established performance targets. The additional consultants are to be employed in specialties which can alleviate the problems which manifest in accident and emergency departments.

Jan O'Sullivan (Limerick East, Labour)
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Does the Minister really believe the reasons given that the numbers have gone up again? Is she satisfied that the state of accident and emergency services does not amount to a national emergency similar to the one she indicated a relatively short time ago? The Minister gave very encouraging information about what is being done but can she equate the reality with what she just read out? Whether one goes by the Irish Nursing Organisation figures or the Health Service Executive figures, the number of people on trolleys is high. There were up to 400 people on trolleys on one day alone. The figures from the Irish Nursing Organisation tell us there was an increase of 89% in the number of people on trolleys in December 2007 compared to December 2006.

An ambulance driver who spoke on the radio this week said he has to sit around waiting for trolleys before he can move his ambulance away from the hospital because the trolleys are occupied in the accident and emergency units. A man in Wexford General Hospital in the constituency of the Leas-Cheann Comhairle stated on the radio that he waited from Thursday to Saturday to get a bed. While we heard something reassuring from the Minister, does she believe that is the reality and what will she do to ensure that the accident and emergency crisis is addressed?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I believe what I said and I believe the matter is being addressed. A number of factors must be taken into account and I have instanced some of them. If one takes the example of one hospital in Dublin where because of the performance in the hospital in regard to accident and emergency services and other matters, the Health Service Executive employed consultants to go to that hospital. The recommendations which were produced last September, if implemented, would lead to the freeing up of 64 acute beds. The Health Service Executive had to write to that hospital only last week to remind it of the measures it was to put in place by the end of March. I hope that hospital implements these changes because, if not, the Health Service Executive has stated in its letter it will have to make alternative arrangements for those patients with private providers and use the funding that would otherwise go to the hospital.

I got a report about another hospital in this city which has a patient there since 2006 who was fit to be discharged at the end of that year. There are issues there around long-term care which the new legislation setting up the fair deal scheme will address. A number of factors in particular influence late discharges. The affordability and availability of long-term care, particularly around the greater Dublin area, is a factor. With the new legislative process in regard to those matters we will certainly make enormous progress.

There are some places in the country like the north east where the rate of admission into the acute system is twice what it is in other parts of the country. Deputy O'Sullivan's area of Limerick, for example, rarely has a problem. I do not say it does not have pressures but in fairness to the hospital in the area it never has the kind of pressures experienced in some big hospitals because that hospital adopts a very good integrated approach with community primary care in the area. It also has better discharge policies and practices than others. We can learn from hospitals like that and Waterford Regional Hospital and other good performers such as St. Luke's in Kilkenny. It is not rocket science, it is already happening in this country and we want it to happen in more places.