James Reilly (Dublin North, Fine Gael)

I did not interrupt the Senator. He has asked me to come here to talk to him so he might at least extend to me the courtesy of listening.

I stated previously that the waiting times for admission of patients attending emergency departments in many hospitals are unacceptable. I am determined to have this addressed. In this regard, we have established a special delivery unit and have assigned to it as a priority task the addressing of the issues arising in emergency departments. I have said on many occasions that, in respect of acute emergencies, one must start with the sickest people, namely, those waiting on trolleys in emergency departments, and then proceed to address the long waiting lists for inpatient treatment, after which one should tackle outpatient treatment.

The Senator must accept that one cannot turn a huge oil tanker like the health service around overnight. Years of dysfunctionality and mismanagement under successive Governments under the Senator's party's control have led us to the sad and sorry state we are in. Owing to our being left by the Fianna Fáil Government with a €70 million overrun in the hospitals and a wild overrun in the first three months of this year, with budgets way out of kilter, and our being in a financial morass, again left by the Fianna Fáil Government, we have to take nearly €1 billion from the health budget. On the back of these considerations, we must try to maintain a service and at the same time reform it. We are determined to do so and will do so. A special delivery unit is very important in this regard.

The clinical director and group general manager are fully engaged in the hospital in regard to scheduled and unscheduled care with the help of Dr. Martin Connor of the special delivery unit. In the short time he has been here, he has done something the Fianna Fáil Government never did, that is, shed some light on the matter and given us some information. Before now, we could not see what was happening in the hospitals. There were returns at the end of the year. We have put in place an information system that allows us to see and track patients daily in real time in our emergency departments. We can now track, in real time and on a weekly basis, the waiting list of each consultant. We can now do what we wanted to do. We can talk to people and hold them to account. If surgeon 1 has a waiting list of two months and surgeon 2 has a waiting list of two weeks, we will go down and have a little chat with surgeon 1. We will not send a cardiologist or administrator to talk to him but a surgeon. It is a case of like meeting like. We will help those concerned to address their problems, including through retraining, if necessary. If they are intransigent and refuse to change their ways, there will be consequences for them.

Our Lady of Lourdes Hospital is currently implementing a two-pronged approach to the overcrowding in the emergency department. First, it is working closely with the special delivery unit to improve capacity planning throughout the hospital. Second, it is actively engaged in the implementation of the HSE's national clinical care programmes, which will focus on extending hospitals' acute medical assessment unit facility.

Our Lady of Lourdes Hospital is operating a proactive, three-tiered response based on the level of overcrowding. In response to the numbers of patients who have presented at the emergency Department over the past week, the HSE has arranged additional theatre time in order to facilitate the treatment of additional surgical cases. Additional diagnostic capacity has been provided to allow the medical assessment unit to enable the provision of treatment and diagnostic capacity for ten spaces this morning for patients in the emergency department.

For the past week, the medical assessment unit and day ward have opened at night to accommodate the extra patients from the emergency department. The pathway of each patient is reviewed each morning by 8 a.m. and also at regular intervals throughout the day, particularly when the escalation policy to deal with this issue is in place. Additional ward rounds are also undertaken throughout the day and on-call physicians and surgeons are met to review their treatment plans for patients. Where blockages are identified, the hospital management engages with the relevant service to expedite the provision of this service to patients.

In the emergency department earlier today, there were 21 patients awaiting admission. When I rang at 4 p.m., there were 18. Further decreases in this number are expected during the course of the day.

While the issue of overcrowding and waiting times in emergency departments that are symptoms of broader hospital issues are a source of concern, it is important to note that when a patient comes into an emergency department, his treatment begins in accordance with the priorities identified by way of the triage process. Anyone requiring urgent care receives it.