Targets set by a taskforce for improving conditions for patients in A&E units across the State have already been missed.
The A&E taskforce, in its report published yesterday, said the Health Service Executive should set a date in February 2007 for hospitals to reach a target of patients waiting no more than six hours in hospital emergency departments.
However, it has taken months to publish the report and as a result that deadline has already passed. The HSE denied publication of the report had been deliberately put off until after the election.
The report also said the HSE should immediately move towards having patients waiting no longer than 12 hours in any A&E unit from the time a decision to admit them had been made.
The HSE said yesterday it had decided all hospitals wouldn't have to meet this target until October.
And it could not give a timeframe for the implementation of the six-hour target. "We'll do it as soon as we can do it. It's as simple as that," John O'Brien, national director for winter planning with the HSE, said.
The report will cost at least €35 million to implement. About €15 million is already allocated and the HSE will be seeking extra funding in next year's estimates to cover the rest.
The taskforce visited 18 hospitals with problems in their A&E departments and found seven of them were unfit for their role. These included the Mater hospital and Beaumont Hospital in Dublin, Our Lady of Lourdes in Drogheda, Cavan, Letterkenny and Wexford General Hospitals and the Mercy hospital in Cork. A number of others, it said, were "less than optimal".
It will be mid-2009 before the Letterkenny unit will be fully fit, the HSE said, but it added that a new A&E would open at the Mercy hospital this summer, and improvements in Drogheda and Wexford will be seen next year.
The taskforce report says the core problem is hospitals routinely do not have beds available which results in patients who require admission spending significant periods in the emergency department.
"At the current time, a significant number of hospitals examined by the taskforce are operating at close to 100 per cent capacity against a well-established international evidence base that states that the optimum level is approximately 85 per cent occupancy," it added.
Furthermore, it said recently published studies from Australia, Spain and the US show an association between overcrowding in hospitals and emergency departments and increased mortality and morbidity.
It said it was vital that hospitals have full access to their existing beds. Up to one fifth of beds in Dublin hospitals could be taken up, it said, by patients whose discharge has been delayed as a result of there being insufficient long-term care beds.
"In Dublin there is an ongoing requirement for 46 long-stay beds per week to meet the needs of post-acute patients".
It also said there was "a clear requirement for an increased consultant workforce" and an extended working day in hospitals, with more senior decision makers in A&E and around the hospitals, in addition to improved access to diagnostics for patients seven days a week.
For example, it said it could take nine months for a patient referred by a GP to get a particular type of X-ray at Galway's University College Hospital and as a result many GPs were sending their patients to A&E instead. The taskforce also found IT within A&E departments was "poor nationally".
The taskforce was established in March 2006 and prior to addressing its first meeting, Minister for Health Mary Harney said the A&E problem had to be treated as a national emergency.
The Irish Association of Emergency Medicine last night welcomed the report but said it was concerned it had been left sitting on the desk of various mangers in the HSE for six months.