Jan O'Sullivan (Limerick East, Labour)
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Question 2: To ask the Minister for Health and Children the number of cases of children at risk who have not been allocated a social worker; if she will address the shortage of social workers to keep children safe; if she will implement the recommendation of the Monageer inquiry that a social work service should be available out of hours in order that there can be effective intervention in crisis situations; and if she will make a statement on the matter. [20739/09]

Barry Andrews (Dún Laoghaire, Fianna Fail)
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According to a 2008 HSE survey, 6,473 cases were unallocated at the end of 2008. However, all such cases are managed by a social work team leader or principal social worker. The majority of unallocated cases are also receiving input from other members of the staff in that department, such as family support workers. All child abuse reports are subject to a phased process of initial screening and assessment by a social worker under the supervision of a team leader and I am informed by the HSE that all cases where there is an immediate and serious risk to the health or welfare of a child are provided with services.

Regarding staffing levels, social workers are exempted from the Government's moratorium on recruitment. Proposals for an ICT system to support social work services for children has received HSE approval and is with the Department of Finance for review. If approved, the objective is to have this system operating as quickly as possible to enable better exchange of information and improved communication between relevant staff throughout the HSE.

As regards out of hours services, the HSE is putting in place a nationwide system, whereby gardaí can access an appropriate place of safety for children at risk out of hours. This service aims to ensure that such children are provided with an appropriate emergency place of safety, thereby reducing or eliminating social admissions of children in an acute hospital setting.

In addition, and instead of developing a stand alone social work out of hours service, it has been agreed to develop alternative proposals based on a more integrated multidisciplinary approach, which builds on the HSE's existing out of hours services, including GPs, acute hospital services and mental health services, with access to specialist staff working in areas such as mental health and suicide prevention.

Jan O'Sullivan (Limerick East, Labour)
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We heard the dreadful litany of abuse in the last day or two, with the release of the report on the Commission to Inquire into Child Abuse. We do not have that kind of abuse any more in schools or institutions because, thankfully, we have learned lessons and moved on.

However, with more than 6,400 children at risk without an allocated social worker, I must put to the Minister of State there is a danger that in future we will find the scandal of child abuse will be in family homes and other places where children live because there are not adequate resources for social workers. Does the Minister of State agree? The Sophia McColgan case is an example of where, if the powers that be do not intervene in families, we could have similar situations going on.

Will the Minister of State and the Government reconsider not having a proper out of hours social work service in place? The proposal under the Childcare Act that gardaí would move children into foster homes is not adequate. How can it be adequate? One listens to foster parents saying they do not have access to social workers whom they need. Putting children into foster homes who do not have access to social workers simply will not work. Will the Minister of State reconsider that decision?

In his reply, he referred to the fact that if children are at immediate or serious risk, there will be intervention. How does one know children are at immediate or serious risk if they do not have a social worker working with them?

Barry Andrews (Dún Laoghaire, Fianna Fail)
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I share with Deputy O'Sullivan the horror everybody who has read parts of the report to which she referred feels. It makes for extremely harrowing reading.

On her question on an out of hours service, 12 months ago a case came to light regarding a child that was in a Garda station overnight in Cork. At that time, many people asked why there was no service where a phone could be picked up and a child placed appropriately until social work services were available. That will be in place from next month.

It does not mean a child will be placed in ordinary foster care families, rather, he or she will be placed in specially trained foster facilities until social work services are available. They will be very short placements and it is not intended that such placements, made under section 12 of the 1991 Act, would last for more than two or three days before normal working hours resume.

The Deputy also asked if we could be satisfied that these events will never happen again. Anybody will agree that the circumstances which pertained in the 20th Century are left behind us. We have a vastly improved system of child care compared to what happened before. There are extremely dedicated staff and much better facilities. The vast majority of children in care are in foster families.

The details and recommendations of the report to which the Deputy referred underline the fact we have no cause for complacency. It is an issue and area of great sensitivity. It is emotive and we have to apply every resource, to the best of our ability, to this area.

Jan O'Sullivan (Limerick East, Labour)
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Will the Minister of State listen to all the expertise and views out there that we need an out of hours social work service? Will the Government reconsider the decision it made in that regard? It seems to be about money. It is a relatively small amount of money. I understand it is €15 million. The HSE spent €17 million on consultants in the last year.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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The overall policy of the Office of the Minister for Health and Children, in line with the HSE, is to try to move towards early intervention and prevention. If there were 50 or 60 social workers employed, as would be required under the proposal made regarding an out of hours service, I would love to put them into the families most at risk and try to avoid a situation that leads to children coming into care. There is not enough throughput to justify employing 50 or 60 social workers who would receive very irregular phone calls about children at risk.

Jan O'Sullivan (Limerick East, Labour)
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I am sure it could be done in a different way.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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The appropriate response is, first, to provide a place of safety, as outlined in section 12, and then tie in, under the HSE reconfiguration, to the primary care system, so we can also tie into the acute hospitals and the out of hours services that are available.

James Reilly (Dublin North, Fine Gael)
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Question 3: To ask the Minister for Health and Children her views on the high numbers of patients waiting on trolleys in accident and emergency departments here; the date the Health Service Executive six hour target waiting time for all patients attending accident and emergency from arrival to admission or discharge will be recorded; and if she will make a statement on the matter. [20551/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Last year, hospital emergency departments treated 1.15 million people, of which 368,000 were admitted to hospital. In 2005 the average number of patients on trolleys awaiting admission each day was 259. The average to date in 2009 is down to 141, and figures to date in May show a further reduction to 116. Data collected by the HSE over recent months indicates that the vast majority of those patients requiring admission are transferred to the ward areas without undue delay.

We need to continue to reduce waiting times for all patients presenting as emergencies to our hospitals. With this in mind, the HSE has set a lower waiting time target of six hours for all patients in its 2009 service plan. The aim is that all patients, irrespective of whether they are admitted or not, will be assessed, treated and discharged or admitted within six hours of arrival.

The HSE is working to measure and report on the time it takes to manage each patient's care from the point of arrival in the emergency department until they are discharged or admitted. As an interim measure, a sampling approach is being adopted at a selected time period each day, which involves collecting registration, admission and discharge data from emergency departments at all hospitals, either electronically or manually.

Preliminary results from the HSE's performance monitoring reports for March 2009 for a sample of 19 hospitals indicate that of all patients who did not require admission, 92% were seen and discharged within six hours. Approximately one third of patients who attend emergency departments are admitted to hospital. Currently, almost half of these patients are admitted to the ward within the new maximum target time of six hours. The challenge for hospitals is to ensure this new target is reached for all patients.

I am confident the introduction of the fair deal in September this year will have a positive impact on the number of patients in hospital whose discharge has been delayed. As a result of the introduction of the new scheme, nursing home care will be more affordable and acute beds will be freed up for acute patients.

There have been significant improvements and we will continue to work for more progress by reducing inappropriate admissions, reducing average length of stay and moving activity from inpatient to day case procedures. These measures will be essential in further improving the experience for patients attending emergency departments.

James Reilly (Dublin North, Fine Gael)
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It is now three years since the Minister, Deputy Harney, declared the problems in accident and emergency should be treated as a national emergency. She set up an accident and emergency task force and its report was published in June 2007, notwithstanding the fact it was completed in 2006. It set a date of 1 February 2007 to have determined a timeframe from which a maximum wait of six hours from arrival at accident and emergency to admission or discharge will apply.

What the Minister has just told us beggars belief. She is trying to tell us the situation has improved. The INO figures show it has not improved, but has disimproved. At one stage last month there were 398 people on trolleys. In the last week a very ill patient of mine sat on a chair for 18 hours awaiting admission and was then put onto a trolley. I do not know how many more hours she spent on a trolley because I have not checked.

We get answers saying everything is fine and hunky dorey, and things are moving apace, but the reality for people on the ground is different. At one stage some weeks ago, 50 people were on trolleys in accident and emergency in Beaumont Hospital. Let us deal with reality.

Instead of talking about what she might do in the future, why does the Minister not use the existing beds available in the greater Dublin area for long-term care and alleviate the congestion? I have a newspaper article from last which refers to an approximately 50% increase in "bed-blockers", as it pejoratively refers to them. They are people who are inappropriately trapped in wards. Up to 757 patients a week cannot get discharged because there is nowhere for them to go. That is what is causing the backlog in accident and emergency departments. That matter is not being addressed. I wish to ask the Minister a simple, straightforward question. Why are we not using the existing long-term care beds that are available in the greater Dublin area to alleviate the problems of accident and emergency departments in Dublin?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I wish to offer a number of responses to what the Deputy said. Everybody in the country acknowledges there have been significant improvements, including the INO, which has said so to me. That is not to say challenges and difficulties do not remain, because they do. One of the challenges is long-term care. As Deputy Reilly is aware, a significant number of people in this city, in particular but not exclusively in Dublin, have finished their acute phase and have not yet moved to more appropriate settings. The fair deal will bring equality of treatment between those in public nursing homes and private nursing homes. I have no doubt it will greatly alleviate those pressure points. Many of the people in acute hospitals are waiting for the introduction of the fair deal. I understand Deputy Reilly's party opposed the introduction of the fair deal but nobody has put forward an alternative to it. That will help in particular in the autumn of this year.

James Reilly (Dublin North, Fine Gael)
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Our party has not opposed the fair deal yet. The Minister should correct the record.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I got some literature from a Fine Gael candidate in the constituency in which I live saying that the party will not proceed with the fair deal. I am not trying to make a political point. I was surprised to see that because, in fairness, I think Deputy Reilly is supporting it and it has great support from older people and their relatives. The introduction of the fair deal will greatly alleviate the pressure on acute hospitals. We do not have the money to procure more beds in the private nursing home sector for the kind of numbers that require them. It is not fair that 90% of the cost of care is paid for by the State if one is in a public bed or in a public facility but if one is in a private nursing home, on average, one has to pay 60% of the costs oneself.

We have a question later about primary care. There are a number of good pilot projects currently under way.

Brendan Howlin (Wexford, Labour)
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We must move on but I wish to allow Deputy Reilly to ask a brief supplementary question.

James Reilly (Dublin North, Fine Gael)
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I do not accept that we do not have the money. We are spending approximately €5,000 a head in this country on health care while the spend in Holland is €4,000. That country seems to be able to do it but we are not doing it. I can only attribute that to the Minister.

To what does the Minister refer in the context of the six-hour target? Does she mean six hours from the time of arrival in an accident and emergency department? That could not be true. Does she mean six hours from the time the accident and emergency doctor decides a person needs admission, or is it six hours from the time the admitting doctor comes from elsewhere in the hospital, which could be 12 hours from a patient's original arrival in accident and emergency? To which of the three does the Minister allude when she refers to patients being treated within six hours?

Mary Harney (Dublin Mid West, Progressive Democrats)
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In Holland, a visit to a GP is €24.80. If we could have a similar cost in Ireland we would be able to do far more.

James Reilly (Dublin North, Fine Gael)
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What is the cost?

Mary Harney (Dublin Mid West, Progressive Democrats)
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GPs receive €24.80 for a visit to their practice and the cost of a telephone consultation is €12.40. In comparing Holland to Ireland we need to compare like with like.

I was talking about six hours from the time of arrival, not six hours from the time a patient is seen. That is the new measurement tool. A total of 92% of patients who attend accident and emergency departments in the 19 hospitals who do not require admission are seen within that six-hour timeframe.

James Reilly (Dublin North, Fine Gael)
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What about the ones who require admission? They are the ones who are waiting on trolleys.