James Reilly (Dublin North, Fine Gael)
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Question 38: To ask the Minister for Health and Children her views on the fact that a number of ambulances are out of service for several hours at a time because their trolleys are being used for patients in accident and emergency departments; her further views on the fact that on 25 May 2010 eight Dublin Fire Brigade Ambulances were detained at the Mater Hospital, one of which was tied up for more than seven hours; if she will put in place cabins which will house additional trolleys at hospitals allowing ambulances to be freed up; and if she will make a statement on the matter. [26182/10]

Mary Harney (Dublin Mid West, Independent)
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The emergency ambulance service in the greater Dublin area is provided by Dublin City Council in the first instance. When operational circumstances so require, the HSE national ambulance service provides supplementary capacity to ensure that the necessary cover is maintained. Where necessary, this involves the use of available ambulance resources from other counties in the region. Staff and management take specific measures to ensure ambulance cover is maintained, with patient safety the utmost priority. This is what happened on 25 May last.

On that day delays at the Mater Hospital occurred at 4.30 p.m. After contact from the HSE liaison officer, all vehicles, but one, were released rapidly. At 8.30 p.m., there were eight ambulances held. The eight ambulances comprised six of the Dublin fire brigade's and two HSE vehicles. The national ambulance service liaison immediately addressed the situation, including consultation with the emergency department staff, the CEO on call and the nursing administration. By 9.30 p.m., four ambulances were released. By 10.30 p.m., all ambulances were available. One ambulance was at the hospital in excess of six hours, owing to the clinical circumstances of the particular patient concerned.

I am advised that the option of storing additional trolleys at hospitals has been considered in the past but not adopted because of significant patient safety, insurance and health and safety concerns. The HSE is, however, in discussion with the major Dublin hospitals with a view to identifying safe and effective measures which will help to minimise the period for which emergency ambulances are held at hospitals after arriving with patients.

James Reilly (Dublin North, Fine Gael)
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Last week "Prime Time" dedicated a programme to accident and emergency departments. It was very distressing to watch disorientated and seriously ill patients waiting for days on trolleys and chairs in cramped and overcrowded accident and emergency departments. In 2004, the Minister issued a ten point plan to sort out accident and emergency departments and in 2006, she said it would be treated as a national emergency.

At one point in January 2010, the number of people lying on trolleys in accident and emergency departments reached 500. As of yesterday, there were 236 people on trolleys. This is the middle of June with some of the finest weather we have had.

To make matters worse, elective surgery is being cancelled and-----

Brendan Howlin (Wexford, Labour)
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A question.

James Reilly (Dublin North, Fine Gael)
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The Minister does not seem to understand that one cannot fix accident and emergency departments unless one fixes the entire system. If one tries to fix accident and emergency departments in isolation, one moves the problem to the wards or back into the community.

Will the Minister explain why in almost six years in the job she has been unable to address this issue, why she has reduced the number of beds rather than increase the number which she said she would do and why she has failed to meaningfully roll out the primary care strategy which at the rate of the current roll-out, nobody in this House will be alive to see its completion?

Mary Harney (Dublin Mid West, Independent)
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We did not measure anything six years ago, so we did not how we were doing. Today we know 1.3 million people attend accident and emergency departments and that 94% of them are dealt with in six hours. We know that 54% of people who attend accident and emergency departments must wait more than six hours to be admitted. I accept that is too long but we never had targets before. In fact, we started with 24 hour targets which went down to 12 hour targets.

I agree it is a hospital wide issue. In the case of some hospitals, escalation policy needs to be implemented as it is in every good hospital in the world. If one reads the British newspapers, one will read about the challenges they face with their accident and emergency departments where escalation policies are implemented. We also need to look at what is happening in those particular hospitals. We now have the fair deal scheme which is processed in two weeks in some parts of the country but, unfortunately, in other parts, it is taking somewhat longer and that is placing an undue burden on Beamont Hospital, in particular, and, to a lesser extent, on the Mater Hospital.

Under HealthStat, which I am sure the Deputy reads, we need to look at the mix of public-private activity in these hospitals. I am not satisfied that there is an appropriate mix in accordance with the consultant contract. We need to address that also. I am confident the clinical directors who have been appointed under the new contract and who are working with Dr. Barry White on new clinical pathways for patients will help to greatly alleviate this further this year.

In more than 20 hospitals, we do not generally have any issues with accident and emergency. We have issues in six or seven hospitals which are now the focus of considerable attention from the HSE.

James Reilly (Dublin North, Fine Gael)
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Unfortunately, this considerable attention is not helping patients. In Beaumont Hospital, even with the fair deal scheme, the Minister freed up 30 odd beds but closed 52 beds making the situation worse. I do not accept the Minister's contention that there are health and safety reasons for not having a cabin full of trolleys. The real reason is that if those trolleys were made available, ambulances would be out bringing in more patients and there would be even more crowding in accident and emergency departments.

Brendan Howlin (Wexford, Labour)
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A question.

James Reilly (Dublin North, Fine Gael)
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Why can these trolleys not be stored in accident and emergency departments? Why are there not enough beds in the hospitals to accommodate the number of emergency patients who regularly need admission? It is not about the number of people attending accident and emergency departments but about the number of people lying on trolleys waiting for admission and urgent medical care, which they are not getting. They are not proper conditions for people to work in and they certainly do not do the dignity of patients any good. There is a major issue here. Why is the Minister still closing beds when we clearly have a capacity issue?

Mary Harney (Dublin Mid West, Independent)
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I do not agree with the Deputy that beds are the answer to everything. If we were to follow that, we would have approximately 25,000 beds.

James Reilly (Dublin North, Fine Gael)
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The Minister should not rephrase the question, which she is excellent at doing.

Mary Harney (Dublin Mid West, Independent)
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It is about how one uses the beds. For example, in some Dublin hospitals, only 30% of people undergoing surgery are admitted on the same day. That should be closer to 70%. We know that many patients are not discharged home before 11 a.m. Good practice is that they should be able to be discharged by 11 a.m. in order that those who require admittance from the accident and emergency department may be accommodated.

I recently opened a new minor injury facility for the Mater Hospital, which is being funded. It has seen 1,700 patients which has greatly improved conditions in the Mater Hospital accident and department.

James Reilly (Dublin North, Fine Gael)
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The Minister should address the question and not everything else.

Mary Harney (Dublin Mid West, Independent)
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We must deal with facts. There are huge improvements. I am not taking away from the challenges that exist in approximately seven hospitals which are being addressed.

James Reilly (Dublin North, Fine Gael)
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The Minister should tell that to the patients waiting on trolleys.