There are still about 400 patients in beds in the main Dublin hospitals who no longer need acute care but who have yet to be transferred to other accommodation, one of the top healthcare administrators has acknowledged.
Director of the National Hospitals Office Pat McLaughlin told trade union leaders and staff representatives at the inaugural meeting of the Partnership Forum on Accident and Emergency Services last week that greater public co-operation would be needed in facilitating the movement of these patients out of general hospitals either back to their homes or to step-down care.
It is understood health authorities have encountered difficulties in some cases in persuading families of people who no longer need acute care to allow the patient to return home or be transferred to an available nursing home bed.
These patients are sometimes referred to as "bed-blockers", although the health service prefers to describe them as "medically discharged patients awaiting alternative care placement".
The "bed-blocker" problem has been identified as one of the causes of overcrowding in accident and emergency departments.
Last year the Government launched a multi-million euro initiative to pay for hundreds of additional homecare packages and to contract private nursing homes to provide intermediate or step-down care for patients who no longer needed treatment in public hospitals.
Mr McLaughlin told the meeting that decisions would have to be taken. A spokeswoman for Health Service Executive (HSE) said the new partnership forum would look at this issue.
The continuing problems in accident and emergency services will be one of the main issues facing Prof Brendan Drumm, who takes up office today as the first chief executive of the HSE.
Medical and nursing unions, as well the opposition, have forecast that overcrowding in accident and emergency departments this winter will be as bad as last year, despite the major initiative taken in this area by Tánaiste and Minister for Health, Mary Harney.
Fine Gael health spokesman Dr Liam Twomey has recently said that the numbers of patients on trolleys around the State was frequently more than 200 - a level which he maintained was unprecedented for summer when pressure on accident and emergency services generally eases.
Prof Drumm will also have to tackle an impending cash crisis in public hospitals. The Irish Times reported last week that the main Dublin hospitals had warned the HSE they were facing a collective €100 million shortfall if forced to operate within their official financial allocation for the year.
It is understood the HSE has offered in the region of €70 million in additional funding on the basis that the hospitals make up the difference through additional value-for-money and efficiency measures. Talks to deal with this financial problem are continuing.
Prof Drumm will also have to deal with the impasse with GPs over the introduction of the long-awaited doctor-only medical cards for about 200,000 people above the current financial threshold for conventional medical cards.
