Michael D Higgins (Galway West, Labour)
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Question 148: To ask the Tánaiste and Minister for Health and Children if, in regard to the package of measures announced on Estimates day to improve accident and emergency services, she will list those measures implemented to date; the timetable for the implementation of each other planned measures; if she has satisfied herself with the rate of progress having regard to the serious problems that continue to be experienced in many accident and emergency departments; and if she will make a statement on the matter. [15317/05]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The actions to improve the delivery of accident and emergency services take a wide-ranging approach and are aimed at improving access to accident and emergency services, improving patient flows through accident and emergency departments, freeing acute beds and providing appropriate longer term care for patients outside of the acute hospital setting. While we all wish to see more immediate solutions, the Health Service Executive, HSE, is working with hospitals in order to deliver these measures and to ensure that the investment produces sustainable solutions. There are also additional actions that are needed which relate more to the management, work practices and processes in hospitals. These too will be addressed by the Health Service Executive.

The following is the current position regarding the ten point action plan which I announced to improve the delivery of accident and emergency services: (i) Development and expansion of minor injury units, chest pain clinics and respiratory clinics in hospitals to relieve pressure on accident and emergency departments: The HSE's eastern region has had very positive discussions with both public and private sector providers for the development of additional minor injury facilities in Dublin. The HSE's eastern region has initiated an exercise due for completion this month to assess minor injury attendances at accident and emergency departments and the potential of having these patients treated elsewhere. The results of this exercise will inform decisions regarding the scope of minor injury and diagnostic initiatives and also the evaluation criteria; (ii) Provision of a second MRI at Beaumont Hospital: It is expected that the second MRI for Beaumont Hospital will be available by the autumn; (iii) Provision of acute medical units, AMU, for non-surgical patients at Tallaght, St. Vincent's and Beaumont Hospitals: The relevant hospitals are finalising their proposals for the HSE. The national hospitals office is in the process of seeking tenders from companies who are expert in the area of workflow management to identify how processes for patient services can be improved and made more efficient. Final decisions on the design of the acute medical units will be taken in the light of this work so that resources are used most effectively, hospital by hospital; (iv) The transfer of 100 high dependency patients to suitable private nursing home care: The tender process for the provision of high dependency beds for 100 patients in private nursing homes is in the final stage. The essential site inspection visits have been completed. Decisions on which nursing homes to be awarded contracts will shortly be taken; (v) Negotiation with the private sector to meet the needs of 500 people annually for intermediate care of up to six weeks: The tendering process is completed and successful applicants notified. A total of 90 beds have been procured nationally to allow an annual throughput of 500 patients. Some 64 patients from hospitals in the eastern region and 23 patients in the Cork region have already been discharged as a result of the intermediate beds being available; (vi) Expanded home care packages to support 500 additional older people at home: Additional home care packages for patients in each of the six major acute hospitals in the Dublin area have been made available. An additional 100 home care packages have been allocated to hospitals outside of the eastern region. To date, some 51 patients have already been discharged from acute hospitals in the eastern region and discharge arrangements are being finalised for a further 45 patients; (vii) Provision of more out of hours GP services in order to keep people's need to attend accident and emergency units to a minimum: Some 150 GPs on Dublin's northside have agreed in principle to the establishment of out of hours services. Discussions in this regard are progressing positively; (viii) Dedicated cleaning services and security measures for accident and emergency departments: The director of the National Hospitals Office is finalising arrangements for the establishment of a national audit and an inspection process to measure cleanliness in all acute hospitals. Funding is available to hospitals to improve security measures and to take whatever measures are necessary to ensure patient and staff safety. The director of the National Hospitals Office has also written to all hospitals with respect to the report of the Health and Safety Authority in this regard; (ix) The further expansion of palliative care facilities: An additional six palliative care beds will made available in Blackrock Hospice in Dublin as soon as the necessary staff are recruited; and (x) Measures to enhance direct access for GPs to diagnostic services: It has been agreed to explore entering into local arrangements with the private sector to match capacity with needs. Negotiations are ongoing. As far as inpatient diagnostic services are concerned, discussions are advanced with two private hospitals in the eastern region regarding MRI and CT.