Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Question 42: To ask the Minister for Health the position regarding his plans to alleviate the escalating trolley problem in accident and emergency units here; if it is his intention to review plans for the downgrading of accident and emergency units in smaller hospitals in view of the worsening problem; and if he will make a statement on the matter. [33484/11]

James Reilly (Dublin North, Fine Gael)
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Immediately following my appointment, I set about establishing the special delivery unit, SDU, to unblock access to acute services by improving the flow of patients through the system. The SDU was established in June and quickly began work with the HSE to put in place a systematic approach to eliminate excessive waiting in emergency units. The SDU is establishing an infrastructure based on information collection and analysis, hospital by hospital, so that we know what is actually happening in real time. This will allow us to begin to embed performance management in the system to sustain shorter waiting times. I reiterate to the House that we can now see what is happening where previously we were in the dark. We used to find out months later what had happened but we can now tell what is happening in accident and emergency units at any given time. We can tell each consultant's waiting time on a weekly basis and it allows us to address those who are not performing to the level they could.

The SDU has identified the hospitals that account for the greatest number of trolley waits, which will benefit from intensive support between now and the end of the year. Liaison officers are working proactively to support these sites. As alluded to in a previous question, I have also agreed that some additional funding may be provided, on a strictly once-off basis and based on specific proposals from the hospitals, to reduce waiting times. We have identified the problems and we asked the hospitals to tell us what they would like to do to address the issue and what they feel the solution is. We will then sit down with the hospital and price the solutions. If it is a reasonable value for money initiative, we will support the hospital's idea.

Our problems did not arise overnight and they will take time to resolve, but they are being tackled in a systematic and relentless fashion through the SDU. I do not minimise the scale of the task before us but I am very confident that the SDU will facilitate real performance improvement in the hospital system and I already alluded to some of those in respect of Cork.

Additional information not given on the floor of the House

I also want to ensure that as many services as possible can be provided safely in smaller, local hospitals. A joint HSE-departmental group is developing a framework for the future development of smaller hospitals. Consultation with all the key stakeholders, including patients and public representatives, will be an integral part of the process.

The organisation of hospital services nationally, regionally and locally will be informed by the clinical programmes being developed and implemented by the HSE and by the framework for the development of smaller hospitals. These interrelated programmes aim to improve service quality, effectiveness and patient access and to ensure patient care is provided in the service setting most appropriate to individuals' needs. I expect to be able to report to the Government and this House on these important developments before the end of the year.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Some 366 people were on trolleys yesterday, with 34 in Galway, 38 in Drogheda, 31 in St. Vincent's, 27 in Beaumont and 24 in Mullingar. Some 20 people were on trolleys in Wexford before they realised the Minister, Deputy Howlin, was coming down. Additional staff were magicked into the hospital and another ward was opened to get people out of the Minister's way so that it looked nice when he got there. In some ways, that demonstrates the real issue. Behind all the talk of fair care and reconfiguration, reform and special delivery units, accident and emergency units throughout the country are in absolute chaos. None of this spin and jargon can mask-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Can I have a supplementary question from Deputy Boyd Barrett?

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Is it not the case that they are in chaos and are not working? The idea that we get more from less when it comes to accident and emergency units is nonsense. We get less for less and we get more chaos. The only beneficiary of this are the people I hear day in, day out on the radio, such as the Blackrock Clinic and the Beacon Clinic, advertising for people to come to their private accident and emergency units. The policy of-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We will not have time for any supplementary questions.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Ceann Comhairle did not interrupt anyone else like that.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputy Boyd Barrett cannot make statements.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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These are questions.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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They are not questions.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Is it not the case that money follows the patient in a situation where there is this level of chaos in accident and emergency units? The patients will walk out of public accident and emergency units, which are being slashed by cuts, and they will be encouraged to walk into private hospitals and public money will follow them. If the Minister wanted to do something about this and make some real savings-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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It is Question Time. I ask Deputy Boyd Barrett to ask some supplementary questions.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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-----he would cut the €500 million or €750 million that is going in subsidies to private consultants-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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This is Question Time. It is not a time for statements.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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That is a question. Would it not be better - that is a question - if, instead of cutting staff and budgets in our public accident and emergency units, we cut the subsidies going to private consultants and other private health care providers?

James Reilly (Dublin North, Fine Gael)
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I am not aware of subsidies going to private consultants. I want to correct Deputy Boyd Barrett. The figures he alluded to are an improvement on the 569 people in our accident and emergency units in January. We are going about this in a systematic way. As I said, we cannot change things overnight. I have told the House that no man is an island and, in the same way, no part of the health service operates on its own. One cannot fix the problem in the emergency department without fixing the problem in respect of inpatient beds and having more community facilities, including home-care packages, home helps and the provision of long-term care in order that people can leave hospital. One cannot fix it unless one fixes the problem in the primary care system to allow it to address more of the problems, including providing greater access to diagnosis and chronic illness care in the community, in order that people do not fall ill and end up in hospital. It is all interlinked. All of the hospitals to which we have given special support in the last week have included a combination of all these items as part of their initiatives, including an increased number of home-care packages, long-stay beds and short-term convalescent beds in associated hospitals, as well as more staff and beds in specific areas.

Much and all as we would love to be able to flick a switch and turn things around, that is not the way things operate. Since the orthopaedic initiative was introduced, for hip and knee replacements, we have saved in the region of €6 million. We did this by insisting on patients being admitted on the day of the procedure, not the night before.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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May I ask a supplementary question?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I am sorry, but we are over time. That is what I was trying to tell the Deputy - the more statements he makes, the more time he uses up for supplementary questions.