Richard Bruton (Dublin North Central, Fine Gael)
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Question 206: To ask the Minister for Health and Children if a follow up study has been undertaken of the major hospitals to see the progress that has been made in factors critical to the efficiency of the operation identified in a consultants report some years ago; and if she is satisfied with the progress being made in the management of accident and emergency caseloads. [43545/08]

Richard Bruton (Dublin North Central, Fine Gael)
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Question 207: To ask the Minister for Health and Children the practical changes in the operation of accident and emergency departments that will be possible as a result of the implementation of the new consultants contract; if consultants from all specialties will play a role in speeding up the flow of patients through accident and emergency on a 24 hour basis; and if she will make a statement on the matter. [43546/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Question Nos. 206 and 207 together.

The Health Service Executive constantly works at improving efficiency across the hospital system and closely monitors progress in this regard. There have been considerable improvements made since 2005 in improving the delivery of services in Emergency Departments. For example, the average daily number of patients awaiting admission at 2 pm fell from 179 in 2005 to 92 in 2007. The figures over the first eleven months of 2008 show an increase to 107 in the numbers awaiting admission.

Findings from a recent second National Bed Utilisation Review indicate some improvements with regard to bed utilisation in hospitals. However, there is still significant scope to improve the way in which beds in the acute hospital system are managed. The Review shows a slight reduction in the numbers admitted that could potentially have been cared for elsewhere (13% down to 12%). There has been a more significant reduction in the number of people in hospital who could potentially have been cared for in an alternative care setting (down from 39% to 34%). There has been a significant increase reported in the number of elective surgical patients admitted on the day of surgery (up from 25% to 41%). While there was an 8% increase in evidence of discharge planning, there has been no change in predicted dates of discharge.

Hospitals need to further improve their admission and discharge processes, to ensure that people are appropriately admitted and that their care is efficiently managed, both during their hospital stay and their follow up care in the community. Steps are being taken to ensure that patients have an expected date of discharge within 24 hours of admission, that patients are discharged in a more proactive manner at weekends and that communication between the hospital system and primary care services is improved. Implementation of a new Code of Practice on Discharge Planning has commenced. This should help to deliver further improvements in overall bed utilisation.

As part of the Winter Initiative, Hospital Managers have been asked to develop an action plan to reduce the average length of stay in hospital of patients, based on the findings of the Bed Utilisation Study and to increase the rate of Day Surgery in line with best international practice. The HSE is also working to increase long-stay capacity and to free up beds in acute hospitals over the Winter period. This is being matched by an intensive focus on improved processes and efficiency.

I believe that setting clear targets for improvement and measuring performance against these targets helps to drive further improvements in services. My Department has asked the HSE to set a revised maximum waiting time target of no more than 6 hours from registration to admission or discharge in 2009 for all patients attending Emergency Departments. The HSE has also been asked to introduce a measurement system in 2009 to record the total waiting time for all such patients.

New contractual arrangements for medical consultants were agreed with their representative organisations (Irish Hospital Consultants Association and Irish Medical Organisation) earlier this year following more than four years of protracted negotiations. The contract addresses the operation of the hospital, rather than a single department such as the Emergency Department. Consultants will work a 37 hour week in an extended span of the working day from 8 am to 8 pm where appropriate, Monday to Friday; and a scheduled attendance of up to five hours where required on Saturday, Sunday and Public Holidays. The extended hours will also facilitate the discharge process, thereby improving the flow of patients through hospital departments, including the Emergency Department. The introduction of new private practice provisions are designed to improve the position of public patients in terms of their access to the public health system.