Dáil Éireann - Volume 509 - 13 October, 1999

Written Answers. - Accident and Emergency Services.

116. Mr. Gregory asked the Minister for Health and Children if his Department will assist with the difficulties being experienced by the Mater Hospital, Dublin 7, where some patients are obliged to wait in the casualty department for 48 hours or more until a bed is available; and if he will make a statement on the matter. [20130/99]

Minister for Health and Children (Mr. Cowen): I have had inquiries made of the hospital authorities regarding the difficulties currently being experienced in the accident and emergency department at the Mater Hospital and have been informed that the delays being experienced are due in part to the unusually large number of patients attending the department. The recent bed closures due to nursing shortages are further exacerbating the problem. The hospital management, conscious of these unusual factors, is managing the situation on a day to day basis. It has also put a number of initiatives in place in order to attract more nursing staff to the hospital.

As the Deputy will be aware, in November 1997 I approved phase one of a major re-develop[513] ment programme for the Mater Hospital campus, to include the accident and emergency, out-patient department, hospital sterile services department and operating theatres, at a cost limit of £25 million. In May 1998, I approved the appointment of the design team for the development and the planning is now under way.

With regard to problems in A&E departments generally, the levels of attendance at accident and emergency departments are complex and difficult to predict and, in this regard, all accident and emergency departments experience periods of exceptional demand which can result in delays for patients. However, it is important to note that appropriate medical treatment is provided at all times and that waiting periods are kept to an absolute minimum.

In 1998, I made an additional £2.3 million available for the development of accident and emergency services. This additional funding was used primarily for the launch by the Eastern Health Board of a national public education campaign aimed at persuading people with minor ailments to attend their family doctor rather than a hospital A&E department, and also the development of a range of initiatives in major A&E departments. Within this funding, the Mater Hospital received an allocation of £200,000. This funding was deployed for the provision of additional A&E staff to alleviate pressures in the A&E department.

This year I provided further funding of £2 million to enable major acute hospitals to implement various initiatives aimed at addressing some of the difficulties being experienced in our accident and emergency departments, particularly during periods of peak demand. These initiatives will include measures to free up beds for emergency admissions through the provision of alternative step down facilities for patients occupying beds in acute hospitals for lengthy periods. They will allow for the provision of enhanced staffing levels, the development of rapid diagnostic systems for common emergency presentations, continued development of treatment-observation areas in accident and emergency departments and an improved access for general practitioners to urgent specialist opinion.

As part of this overall funding, a sum of £210,000 was allocated to the Mater Hospital for A&E improvements. The hospital has undertaken a number of measures to improve systems for dealing with patients attending the A&E department and I hope they will provide a more acceptable environment for patients and alleviate some of the current problems.

The Deputy will be aware that I have also published the report of the review group on the waiting list initiative and am committed to ensuring that its recommended approach is implemented. The report is one of a number of measures which I have taken to address the question of long waiting lists and waiting times. I have provided a total of £20 million for waiting list activity in 1999. This is a 66 per cent increase over the amount pro[514] vided in 1998 and is two and a half times higher than the sum of £8 million provided by the previous Government in 1997. The report recommended the implementation of a range of steps to free up acute hospital facilities for more elective work. It pointed out that a significant proportion of acute hospital beds were being inappropriately used by patients who did not need, or who no longer needed, acute hospital care. This problem arises due to a shortage of places in the areas of “step-down” or convalescent care, rehabilitation facilities and community based services which reduce the need to use acute hospital care.

In an effort to address these problems, I have provided extra funding in 1999 of £9 million for services for older people. This funding will help to free up acute hospital beds which are currently occupied by patients who could be accommodated in more appropriate convalescent or extended care facilities or discharged home if adequate community supports were available. It will be used, inter alia, to improve the home help service, increase the number of nursing and paramedical staff in the community, provide support for carers, enable a number of new health board convalescent or extended care facilities to open and increase the number of private nursing home places either subvented or contracted by health boards. There are also a number of chronic sick in acute hospitals who have completed the acute phase of their illness and who are awaiting placement at a level of care more appropriate to their needs. The task of securing appropriate alternative care facilities for them is under way and this also will have a significant impact on freeing up acute beds in general hospitals over the coming months. I am confident that the measures I have outlined will contribute to improvements in availability of beds in the acute sector and ease pressures in accident and emergency departments in Dublin.