Joe Costello (Dublin Central, Labour)
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Question 62: To ask the Minister for Health and Children when she will provide urgently needed step down beds in the Dublin area in order that patients in acute hospitals who are ready to be discharged to such beds can be transferred, relieving pressure on the accident and emergency departments, particularly the Mater Hospital accident and emergency; if she will introduce other measures to address the overcrowding that is causing such suffering to patients; and if she will make a statement on the matter. [16253/08]

Máire Hoctor (Tipperary North, Fianna Fail)
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The Deputy will be aware that operational responsibility for the management and delivery of health and personal social services was assigned to the Health Service Executive under the Health Act 2004. Therefore, the Executive is the appropriate body to consider the particular matter raised by the Deputy in respect of step-down beds in the Dublin area. My Department has requested the Parliamentary Affairs Division of the Executive to arrange to have the matter investigated and to have a reply issued directly to the Deputy.

With regard to issues around delayed discharges and overcrowding the HSE is working closely with those hospitals which are experiencing difficulties. The focus is on improving and streamlining hospital processes and patient pathways to ensure that care is provided in a more timely, appropriate, and efficient manner. Targeted initiatives include:

setting up consultant led Clinical Decision Units and Acute Short Stay Units with a dedicated number of beds,

integrated discharge planning implemented on a 7 day basis, including nurse facilitated discharges,

updating the bed management system and processes with a focus on improved discharge planning,

reducing inappropriate referrals from GPs to Emergency Departments,

reducing admissions with the duty medical registrar deciding on admissions,

standardising assessment processes,

enhancing diagnostic capacity.

One of the most effective strategies for reducing total patient journey time is to focus on the bottlenecks in both the admission and the discharge process. The greatest variation is typically in the number of discharges carried out. The HSE established a National Working Group last November to bring forward recommendations and proposals for an action plan to deliver key goals.

Key features of the proposed new approach are that:

all patients have an expected date of discharge within 24 hours of admission;

the expected date of discharge is actively managed on a daily basis against the treatment plan and any changes are communicated to the patient;

patients can be discharged in a more proactive manner at weekends;

there is an increased emphasis on nurse facilitated discharges;

ward rounds are scheduled in a way that facilitates a more timely review of treatment plans.

A draft national code of practice for integrated discharge planning is now at final stage of development and includes national standards, guidelines, policies and recommended practices. This is due to be completed in May 2008.