Press Release

C&AG Special Report on Emergency Departments


The Minister for Health and Children, Mary Harney TD, noted the publication today (12 February 2010) of the Comptroller and Auditor General’s Special Report on Hospital Emergency Departments.

The Minister said: ‘The report usefully highlights a number of important ways in which services to patients at the Emergency Department can be improved. A considerable number of actions have been taken to improve the delivery of services in Emergency Departments, many of which are consistent with the recommendations in this Report.

‘One of the most important factors in improving the Emergency Department experience is that patients need to be seen more quickly by senior clinical decision makers, that is, consultants, in the hospital.

‘The patients in the Emergency Department are patients of the whole hospital, not just of one department of the hospital.

‘Access to the relevant senior clinical decision makers of the hospital is critical at all times for patients.

‘Under the new consultants’ contract, we have now appointed clinical directors in every hospital; consultants are now to work in teams; and they have an extended working day and structured weekend work.

‘This means that the responsibility to achieve the best clinical care and improved patient experience for patients of the hospital at all stages of their care – including at the Emergency Department – is shared by the consultant team and the management of each hospital.

‘Improving patients’ experience at Emergency Departments requires a whole-hospital approach, as well as close working with long term care and primary care services.

‘It is also critical that each hospital should operate an escalation policy when over-crowding at the Emergency Department occurs, which should include the use of ward space outside the Emergency Department for better care for patients.

‘Clinical directors, consultants, management and nurse managers have been empowered to act to improve patient services. Many have taken up this responsibility and have shown what can be done to improve services for patients, including at Emergency Departments.

‘Many of the findings of the Report are being addressed in the HSE’s National Service Plan for 2010. There have been improvements in recent years in waiting times for patients. Some 94% of all patients who were not admitted from February to December 2009 were treated and discharged within the HSE’s maximum waiting target of 6 hours. 54% of those who require admission now meet this target, up from 40% last February.

‘It is important that we continue to set the standard to be achieved higher and that we measure in detail the areas to be improved, such as patient waiting times. The report from the C&AG fits in with the development by the HSE of detailed measurement and management of performance levels. Management action can only be properly focused and effective when there is detailed, constant and challenging measurement taking place of performance.

‘In the important area of access to diagnostics, the report highlights again the need for extending the hours when normal services are provided, that is, the need to have a rostered longer working day for allied health professionals. There should be no barrier placed in the way of these reforms.

‘Finally, I welcome the report’s emphasis on the use of resources, and the variation in resources at different hospitals. This indicates ways in which resources and staffing can be better balanced across the Emergency Departments of our hospitals and where efficiencies can be achieved. ‘

Recent developments to support improved services for patients at Emergency Departments

  • Clinical Directors have been appointed to each acute hospital, and will play a pivotal role in the organisation of effective ED services that meet patients’ needs without delay.
  • The new consultant contract is based on a consultant-delivered service, which will help improve access to senior clinical decision making and help patients move through the service as quickly as possible.
  • There has been significant capital investment in Emergency Departments to improve both the fabric of the units and their capacity to meet patients’ needs effectively. There has also been investment in the provision of Medical Assessment Units.
  • There has been substantial investment in services that reduce the need for hospital admission, including primary care teams, home care packages and home helps.
  • The Fair Deal will help reduce delays in discharging patients from hospital, alleviating pressures on beds. The Minister has provided a total of €152m for the scheme this year.