Micheál Martin (Cork South Central, Fianna Fail)

Some of these units are already partially in use as they are replacing old and outdated facilities. My Department will continue to work with the Department of Finance to identify a timescale for the full commissioning of new facilities.

In terms of primary care, the strategy, Primary Care: A New Direction, recognises that the Irish health system places considerable reliance on hospital care and that an appropriately developed primary care system can meet 90-95% of all health and personal social service needs. This strategy sets out a new direction for primary care as the central focus for the delivery of health and personal social services. It promotes a team-based approach to service provision which will help to provide a fully integrated primary care service. A properly integrated primary care service can lead to better outcomes, better health status and better cost effectiveness. Appropriately developed, primary care services can help prevent or reduce the impact of conditions that might later require hospitalisation and can also facilitate earlier hospital discharge. Overall, a strengthened primary care system can have a significant impact in alleviating demands on specialist services and the hospital system, particularly accident and emergency and outpatient services.

The motion refers to difficulties in accident and emergency. I am concerned about the current situation and the difficulties being experienced by patients. Patients should be treated with dignity and respect. The problems in accident and emergency cannot be dealt with in isolation as many of the difficulties and delays being experienced by patients reflect system-wide issues, which demand a multi-dimensional approach. In order to deal with the current pressures on acute services both in the shorter and longer term I would like to briefly outline some of the key actions I have taken.

It has been widely documented that there are a number of patients in acute hospital beds who have completed their acute phase of treatment and are ready for discharge to a more appropriate setting. The availability of suitable sub-acute beds is a particular problem in the eastern and southern areas. In this regard I have provided additional funding of €17.6 million to the Eastern Regional Health Authority and to the Southern Health Board to facilitate the discharge of patients from acute hospitals to a more appropriate setting, thus freeing up acute beds. This funding allows for the funding through the subvention system of additional beds in the private nursing home sector and ongoing support in the community. I have been informed by the Eastern Regional Health Authority that nearly 300 patients have been discharged so far from acute hospitals as a direct result of this funding. The Southern Health Board has reported that some 350 patients from the southern region have benefited from the initiative. It is a different initiative as up until now, we have been pumping money into nursing homes to make up the slack. In Dublin, there is an historical lack of district hospitals, many of which were closed in the 1980s and early 1990s along with the community nursing units.