A welcome initiative

Emergency departments

The announcement by Minister for Health Leo Varadkar of additional funding to implement the hospital emergency department (ED) task force's action plan has been broadly welcomed. Some €44 million is to be allocated to the Nursing Homes Support Scheme, which will provide an additional 1,600 places and should reduce the waiting time for approved Fair Deal applicants from the current eleven weeks. Extra temporary contract beds will be funded by another €30 million, some of which will also provide for more permanent community care beds.

The combined measures should see patients whose acute care has been completed being discharged more promptly from hospital. The number of delayed discharges had reached 850 earlier this year which had the knock-on effect of preventing the elective admission of patients in some of the worst-affected acute hospitals. This in turn increased attendances at emergency departments, leading to a slowdown in the public hospital system. It is significant that the Minister referred to the additional funding as "strictly ring-fenced". The reference is an acknowledgment of past poor practice by the Health Service Executive (HSE), which has a track record of diverting funds from their allocated target to cover deficits elsewhere. He also acknowledged the need for a reform of practices and processes in the health service to better utilise existing resources.

The additional funding does not appear to include a direct provision for additional supports to enable people to be discharged to their home. Latest figures show some 17 per cent of those experiencing delayed discharge were waiting to return to their own homes but had yet to receive the necessary support in the form of home care packages and home adaptations. Other elements of the ED task force plan will help. In particular it recognises the need to move away from a fire-fighting approach by the HSE by developing pathways of urgent care that do not require hospital admission, such as the “frail elderly pathway”. But older people and their relatives will primarily be relieved by the additional funding for Fair Deal.