Home > Dail Eireann debate. Written answer 1436 - Health services provision [26134/16].

[Oireachtas] Dail Eireann debate. Written answer 1436 - Health services provision [26134/16]. (16 Sep 2016)

1436. Deputy Thomas P. Broughan asked the Minister for Health  if his Department has examined the possibility of setting up community-based interventions similar to those in the UK to treat drunk persons in a setting other than an accident and emergency department; the amount such interventions would cost; and if he will make a statement on the matter. [26134/16]

Minister of State at the Department of Health (Deputy Marcella Corcoran Kennedy):  Alcohol related harm is a major public health concern. Alcohol is causing significant damage across the population, in workplaces and to children in families. It also carries a substantial burden to all in Irish society. The Government has agreed proposals to tackle alcohol misuse which aim to reduce alcohol consumption in Ireland to 9.1 litres per person per annum by 2020 and to reduce the harms associated with the misuse of alcohol. The Public Health (Alcohol) Bill addresses the underlying causes of alcohol misuse i.e. affordability, availability and attractiveness. The Steering Group on a National Substance Misuse Strategy contains a number of recommendations for the provision of treatment and services to those suffering from alcohol addiction.


  The HSE has advised that every patient who presents to an Emergency Department (ED) is legally entitled to as comprehensive an assessment as is necessary and that medical and nursing staff are vocationally bound to deliver this care without judgement or prejudice. A key challenge in dealing with undiagnosed and acutely distressed patients in an ED environment is to distinguish between distress that is the result of illness and/or injury and that which is due to understandable anxiety. This challenge is magnified in the case of deciding if someone is simply intoxicated or has a serious medical problem that became manifest after drinking alcohol. The management of patients who have a head injury but also happen or appear to be intoxicated is just one example of why extreme caution and diligence is required in this area. The HSE has also advised that, if, after the appropriate level of assessment, a person is found to have no medical reason to be in the ED and are causing disruption, they will be asked to leave. Should they not do so, all necessary steps, up to and including enlisting the assistance of An Garda Síochána, will be taken if necessary, so long as doing so does not affect the care of other patients awaiting treatment.


  There are a number of initiatives underway in the HSE which may assist in reducing the number of intoxicated people in Emergency Departments:


  - Clinical Decision Units are areas adjacent to the ED (in some larger EDs), that provides for a short period of observation, assessment or therapy for patients who have finished the ED phase of care, but are not yet fit for discharge. The fundamental purpose of the Clinical Decision Unit is to make safe clinical decisions on a patient who is not yet fit for discharge, but likely to be ready for discharge within 24 hours. Patients who require observation, including those whose need for observation arises from incapacity as a result of intoxication, are one such group who benefit from a stay in these units.


  - Some EDs have successfully run occasional initiatives, in conjunction with other emergency services, whereby appropriately qualified staff are placed in facilities in areas where it is known there will be a large number of intoxicated patients, usually in inner city areas during national holidays and other celebrations. This allows for the treatment of some injuries and other medical problems on the scene, leaving a satisfied patient and removing the need to attend the ED in some instances.


  - Such outposts are also very successfully deployed at large concerts, sporting events and, in particular marathons, where dehydration and hypo or hyperthermia may, in many instances be treated at the scene.

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