Joe Costello (Dublin Central, Labour)
Link to this: Individually | In context

I am grateful for the opportunity to raise this important issue of the need for the Minister for Health and Children to outline her plans for resolving the bed and space crisis in the accident and emergency unit of the Mater hospital.

The position has been fairly dire for many years. The circumstances in very many accident and emergency units are unacceptable in normal health terms. They are located in prefabricated buildings. The space area is inadequate and they are very often in corridors. Trolleys are used as beds and people are in chairs. The existing set-up in the Mater hospital leaves much to be desired but a worse state of affairs will be reached with the announcement that 60 beds are due to close, with the possibility of an additional 20 beds closing. A bottleneck has been continuing for many years and in terms of the number of people on trolleys or chairs, the trolley count is always in the high twenties. It used to be quite low in mid-summer. In the past it might have been in the high twenties in the middle of the winter, but in the summer months the trolley count is as bad as it was some years ago in the winter.

The position is not improving. It is deteriorating by the day. There are continual delayed discharges. People are coming in at one end but they are not leaving at the other, and the reason for that almost beggars belief because the thrust of the Minister's policy was to ensure there would be step-down facilities in the community. The Minister, who is six years in her position, promised that from the outset in her ten point plan. The problem is that the number of delayed discharges continues to rise. Bed blockages are increasing in number and the promised step-down facilities have not been delivered. Neither is there any relationship with the local authorities to ensure that necessary adjustments to homes are made in time to allow people move back into the community and into their own homes. The position is dire.

I had a call today from the daughter of an 88 year old woman who told me her mother had been attending the fracture unit in the Mater hospital for 13 days. She eventually got a bed tonight but the staff in the fracture unit made it clear that they needed the bed for hospital treatment. That type of treatment, or lack of treatment, for somebody as elderly as that woman, and the pain and suffering they are put through, is wrong, and eventually they end up in the accident and emergency department waiting to be received.

I will give the Minister some examples. Yesterday, the acute unit in the Mater hospital could only contain nine patients at any given time. There are only nine beds. The staff got a call that somebody had been sent up from Sligo and now they were being sent back to Sligo because a bed was not available for them. That type of operation is expensive. It is poor treatment and bad medical practice. It is a case of constant overcrowding and confusion.

Everybody recognises that when people get in, the quality of the services from the doctors and the nurses is superb. The problem is the mismanagement, the failure to do anything about it and the fact that it has been going on so long, yet there is still no light at the end of the tunnel.

Pat Carey (Dublin North West, Fianna Fail)
Link to this: Individually | In context

I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Deputy Costello for raising this matter.

The HSE and the Government are determined that patients will continue to have emergency services that are accessible and responsive to their medical needs, and integrated with other hospital and primary care services.

Accordingly, the Minister has been monitoring the position in emergency departments very closely. While there have been clear improvements in most hospitals in the past few years, a small number of emergency departments continue to regularly record relatively high numbers of patients waiting over six hours and thus fall short of the current target set by the Health Service Executive of having patients registered in emergency departments either admitted or discharged in under six hours.

The Minister met with the chairperson, chief executive officer and members of the HSE management team earlier this year to review progress and to ensure that all possible steps are being taken to minimise the waiting time for patients awaiting admission. She asked them to focus on seven hospitals. Each of those hospitals, one of which is the Mater hospital, have developed hospital specific action plans to drive performance improvements. Those plans have been agreed by senior hospital management and clinical directors. The plans have also been assessed and approved in conjunction with the quality and clinical care directorate.

A key component of the Mater's action plan is the operation of the pilot Mater Smithfield rapid injury clinic, which acts as a satellite service to the Mater hospital's emergency department and has the capacity to reduce significantly patient waiting times as it has the potential to cater for 30% of the cases which have been presenting to the hospital's main emergency department.

Since it opened last April, this dedicated injury clinic has treated over 1,700 patients, with access on the basis of public eligibility. The clinic, which is allowing the Mater's emergency department to concentrate more on managing serious illness and major trauma, is staffed by a team of specialist emergency nurse practitioners and doctors and led by the Mater consultants in emergency medicine. The clinic opens on Monday to Friday from 8 a.m. to 6 p.m.

On 17 June last, the Mater hospital reported 70 delayed discharge patients, which is a reduction from a high of 121 in June 2009. Many of those delayed discharges can be addressed by way of the fair deal scheme.

The Minister, Deputy Harney, has also asked the HSE to streamline the administrative processes for dealing with applications under the fair deal scheme to ensure that patient discharges to a suitable long-stay facility are not delayed unnecessarily.

The most recent weekly report for emergency department activity at the Mater hospital indicates some improvement in performance. For the week ending 20 June, at 2 p.m. each day no patient was waiting in excess of 24 hours for admission following the decision to admit them compared to five for the same period in 2009. The numbers waiting between 12 and 24 hours was 18, compared to 30 for the same period last year. The hospital continues to focus on process improvement to facilitate the discharge of patients at the earliest point possible.

At the Minister's request, the HSE is also putting in place a system of early warning measures to ensure that corrective action is taken as soon as problems are identified. The Mater has been instructed to ensure that all escalation measures are implemented and reviewed as necessary and that appropriate liaison arrangements with primary and community services are in place.

In the longer term, the Mater hospital is engaged in a significant building programme, which includes the provision of a new emergency department built to modern standards of functionality and space. The building programme also provides for 12 new operating theatres, providing a net increase in theatre capacity, and a new radiology department. These facilities will significantly address operational efficiency issues within the emergency department. The building programme is due to be completed in 2012 and is currently on schedule.

The overall task for the health services this year is to meet patients' needs and deliver the best possible services within the resources made available from taxpayers. The Minister and her Department will continue to engage with the HSE, and especially hospitals experiencing significant problems in this area, to secure improvements in the emergency department performance.