Jan O'Sullivan (Limerick East, Labour)
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Question 68: To ask the Minister for Health and Children her views on the number of people who spend long hours on trolleys in hospital accident and emergency departments; the action she will take to relieve the situation this winter; if she will introduce some measure to provide alternative care for the 700 plus people who are ready for discharge but who have nowhere to go; and if she will make a statement on the matter. [45563/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The HSE has made considerable progress in improving the delivery of services in emergency departments. The vast majority of hospitals are now fully or substantially compliant with the 12-hour target for those requiring admission. The Health Service Executive introduced this target in October last year. Patient waits of longer than 24 hours, following a decision to admit, have been totally eliminated in 21 of the 34 hospitals concerned, while a further eight have infrequent waits of that duration. The HSE will continue to work closely with all hospitals to maintain their improvements and to address the remaining problems, which are largely confined to a small number of hospitals.

I have also asked the HSE to set a revised maximum waiting time target of no more than six hours from registration to admission or discharge in 2009 for all patients attending emergency departments and to introduce a measurement system in 2009 to record the total waiting time for all such patients. The HSE has committed to introducing those measures in its 2009 national service plan.

By the end of this year, 279 additional long-stay beds will have been made available to patients under the fast-track initiative. A further 503 new long-stay beds will be provided under the initiative next year. In addition, in early 2009, the HSE will provide 245 additional contract beds to alleviate delayed discharges pressure on the acute hospital system.

During 2009, the HSE will review the existing arrangements whereby 11 hospitals in Dublin and three in Cork operate emergency departments 24 hours a day, seven days a week. The review will consider whether it is necessary to maintain full emergency department services in each hospital beyond the peak hours of operation and whether that represents the best use of resources. The HSE will also continue the work which is under way in reviewing the configuration of hospital services, including emergency department services, in the north east, mid-west and southern regions. That will include a review of the operation of emergency department services in hospitals with low volumes of activity in order to ensure that such services are configured in a way that optimises clinical outcomes for patients.

Jan O'Sullivan (Limerick East, Labour)
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The Minister has laid the HSE's plan before the House and it is on the Order Paper today. I find it extraordinary that it is not properly and publicly announced by the HSE or the Minister and that it is sneaked in on the list without any information to the public. It seems to me that is much of the problem with the health service currently.

In the plan the Minister intends to cut more than €500 million from the HSE's spending budget. Can she give a guarantee to the public that front-line services will be maintained in that context? Accident and emergency services are due to close down at various times in Dublin, Cork and other parts of the country. Given that yesterday, 339 patients were on hospital trolleys and, as Deputy Reilly indicated, even more patients are on trolleys today, how will accident and emergency services be provided when the problem has reached that level already? People on trolleys are unable to access acute hospital beds while other people occupy beds who could be cared for in the community. If services are to be cut next year with fewer hours of accident and emergency services available, how will it be possible to maintain services at their current level let alone improve the situation?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Jan O'Sullivan is familiar with the proposals tabled by the HSE to the various employee representatives. She was well briefed prior to the previous attendance of Professor Drumm at the Dáil committee. Essentially, the HSE has tabled a number of proposals requiring greater flexibility. We want to treat more patients next year on a day-case basis, in line with best practice not only in Ireland but internationally. Clearly, to do that we require changes in how people work. We need to reduce in particular the level of dependence on overtime by many staff in the health service and having people in hospital at weekends when they should be discharged.

The new consultant contract will be a key to the reform of how hospitals operate because for the first time consultants will work as part of teams with a clinical director, working days will be longer, structured cover will be in place at weekends and seven-day discharges will be introduced. All of those elements are important in order to ensure we optimise the use of the acute hospital system. However, I have made clear that there will be challenges next year.

Specifically in relation to A&E, we have three children's accident and emergency units open in this city 24/7. It is expensive to staff accident and emergency departments 24/7, but during the night I think it is something in the region of 20 visits is the average attendance, between the three units, between the hours of 8 p.m. and 8 a.m. It would be in all our interests if we can reorganise our services better during those night-time hours.

Many of the attendances at accident and emergency units are not strictly accident and emergency cases and could and should be dealt with at primary care level. As Professor Drumm indicated at the committee, the hope is that more activity will be switched to the level of primary, community care rather than the focus being constantly on hospital attendance.

Jan O'Sullivan (Limerick East, Labour)
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With due respect to the Minister, we cannot live on hope. It is a fact that people present themselves at accident and emergency units. What exactly will change? When people present at accident and emergency units they require treatment or to be dealt with in some fashion. If accident and emergency service hours are being cut back in some hospitals, how will they cope with the numbers of people presenting? The numbers of people presenting next year will not be reduced next year because the Minister has decided she would like them to. What exactly will happen?

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is a fact that in many hospitals in this city we have more staff than attendances on a daily basis at accident and emergency units. In some hospitals the ratio is 1:1. No health system in the world of which I am aware can sustain that ratio of staff level to patient care. In the context of next year——

Jan O'Sullivan (Limerick East, Labour)
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That is not the reality we are hearing about.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Separate issues arise that relate to safety, who is on-call, and volumes of activity that are being dealt with in the context of the mid-west and the north east. The reality is that patient safety issues arise in those places where there is a low level of throughput. I can supply the Deputy with the figures for each of the hospitals in Dublin on a daily basis. I can show her that in some cases we have more staff than patients. If we can reorganise accident and emergency opening hours, especially late at night and during the night, in consultation with staff representatives, which is the intention, in the first half of next year, we can deliver better patient care in a more cost-effective fashion and we can allow more of the elective activity to proceed that has to be cancelled due to the pressure on accident and emergency departments in those hospitals that might not be on-call during the night-time hours.