James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Question 34: To ask the Minister for Health and Children her views on the situation in hospital accident and emergency departments in view of the fact that almost 400 patients are lying on trolleys throughout March 2009; her plans to address this problem or if she is resigned to seeing patients continue to lay on trolleys; and if she will make a statement on the matter. [13410/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

The average number of people waiting admission to hospital during the month of March was 137 people. It is my intention to continue to reduce waiting times for all patients presenting as emergencies to our hospitals. The HSE has set a lower waiting time target of six hours for all patients. The aim is that all patients, irrespective of whether they are admitted, will be assessed, treated and discharged or admitted within six hours of arrival. Up to now, the focus has been on waiting times for those awaiting admission to hospital.

The Healthstat data published by the HSE last week measures a number of elements of hospital activity which directly affect emergency departments. One of the Healthstat measures the number of patients who are given a discharge plan from the hospital. The target for this is that 60% of all patients should have such a plan and a discharge date. This will allow for increased efficiency and certainty regarding bed usage in hospitals. The most recent bed utilisation study, taken in June 2008, indicates that, of the patients surveyed, 48% had evidence of discharge planning, while only 16% had a documented date of discharge.

Another element of hospital efficiency on which I expect to see improvements is the number of elective patients who are admitted to hospital on the day of their procedure. The international target for this is 75%. The current national average in Ireland is approximately 30%. The majority of our hospitals need to make significant improvements on this front. The acute hospital bed capacity review of 2007 indicated that up to 140,000 beds a year could be freed up if Ireland was to reach best practice standard in this regard.

The HSE's service plan commits to reducing inappropriate admissions, reducing average length of stay and shifting activity from in-patient to day case procedures. I am confident that these measures will ensure more efficient use of available capacity and facilitate further improvements in the delivery of services in the emergency departments.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

The Minister stated the average number of people waiting admission was one hundred and something. I do not know where she gets her figures. The INO figures indicate that some 340 people are on trolleys today while on 27 March some 305 people were on trolleys. On 24 March, some 387 people were on trolleys while the figure on 20 March was 304 people. The figure does not dip below 300. Therefore, five years after the Minister's ten-point plan, we still have a mess with regard to patients on trolleys. It does not matter how one dresses up the figures or how we dispute them in the House because the reality, irrespective of whether we like, is that people are lying on trolleys in accident and emergency units for two and three days at a time. No amount of gloss can change that.

We hear today of plans to address this issue rather than of actual results. In 2006, the authorities in Northern Ireland set up a system to deal with the matter. In March 2008, one year ago, 92% of patients were seen within four hours of arrival. We are still counting waiting times and the number of people on trolleys from the time a decision to admit is made rather than from the time of arrival at the hospital. The two measures are entirely different.

Why, after five years, does the crisis continue? Why are the numbers still so high? Even using the Minister's own numbers, one cannot say there has been any real decrease since the time she said the problem should be treated as a national emergency. Where has all the money gone? Why have we not done what we said we should do, that is, address the bed capacity issue with regard to beds occupied by those whose acute phase of treatment is over and who have nowhere to go in the community?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I agree with the last point the Deputy made. The Fair Deal, which will be implemented later this year when legislation is enacted, will play a very important role in facilitating patients, particularly older ones moving from the acute setting to long-term care, because we will have a fair system of funding for all persons.

We are measuring time of arrival now. We are considering this measure and not just the time of the decision to admit a patient. This involves a six-hour timeframe. There has been a reduction of 20%. Measuring patient statistics at 8 a.m. is not appropriate, as the Deputy knows. The measurement that is taken by the HSE is at 2 p.m. every day and, according to this, there has been a 20% improvement. This continues to be the case.

Issues do arise within the hospital system. There have been serious infection issues in Beaumont Hospital, St. Vincent's Hospital and others. During the months of February and March, these issues have affected some of the targets we have set. Notwithstanding that, there has been an enormous improvement with regard to the number of people waiting to be seen in emergency departments, certainly in recent years. We are beginning to see a drop off in the number attending emergency departments because individuals are instead going to primary care facilities, which practice I know the Deputy supports.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

How can the Minister possibly hope to improve circumstances when she plans to cut another 600 beds from the system this year after having cut 500 last year?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

The emphasis must be on how we use the beds. As I stated, we should have a national standard whereby 75% of those admitted for surgery would be admitted on the day of surgery. This does not happen. We do not have discharge plans for the vast majority of our patients.

The new HealthStat system, which will drive the performance of our hospitals, will be enormously beneficial in helping hospitals to do better with their existing stock of beds. I refer in particular to moving to more day-case activity, which is in line with the service plan that has been submitted to me by the HSE.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

The Minister had the information for two years.