Topical Issue Debate

Education and Training Provision

Deputy Pat Deering

I thank the Ceann Comhairle's office for selecting this matter, which was brought to my attention during the Christmas recess. St. Catherine's community services centre in Carlow runs a Moving On local training programme targeting new mothers with lower second level education. During the ten months of the course from September to June, participants complete nine Quality and Qualifications Ireland, QQI, level four modules, which leads to an award equivalent to the leaving certificate. The profile of the participants is young women who are unable to continue mainstream education because of substantial personal needs for social support. During the lifetime of this extremely important programme, hundreds of participants have achieved personal, social and educational development and been empowered to progress to employment and further education. These successful outcomes are possible because of the high level of support offered to participants in the programme. As well as assisting them towards their educational attainments, they are supported with advice and information on housing, welfare, financial management and physical and mental health.

All of this is crucial for their personal well-being, persistence and resilience and for the future development of their children. Each participant is assigned a key worker who regularly supports her on a one-to-one basis in respect of personal education issues. The personal growth and development of participants is measured by means of specific mechanisms and encouraged by means of the soft outcomes universal learning, SOUL, training model. I understand that Carlow and Dundalk are the only two locations in the country at which the needs of single mothers in this regard are dealt with.

Prior to January 2014, participants on the SOLAS training course who were in receipt of the one-parent family payment received an additional training allowance of €108.20, together with their social welfare payments. This training allowance ceased in January of last year. The participants on the Moving On training and service programme at St. Catherine's during 2013 and 2014 were the last to receive the allowance. Of the 20 who started on the programme, 16 completed it. Of these, 15 gained major awards. Fifty-five applications were received in respect of the 20 places on offer on the programme for the 2014-15 year. Unfortunately, a lack of financial support - namely, the training allowance - meant that 27 of the potential participants who secured places on the programme during the summer months declined them on the grounds that they would not be able to afford to attend at St. Catherine's. The level of demand for the course was more than double the number of places available. Although the course is free of charge, the personal cost of attending was seen as prohibitive by the majority of potential participants. As a result, for the first time since the course's inception, only 15 participants commenced the programme in September 2014. An application to the Department of Social Protection for out-of-pocket expenses was refused on the grounds that this is a 40-week programme and that such expenses only apply in respect of 26-week programmes.

The major issue arising relates to the fact that those who participate on this programme are the underprivileged in our society. It costs such individuals between €15 and €30 week to have their children looked after. They are also obliged to pay travel expenses. Most of the people to whom I refer live in rural areas and may be obliged to ask someone to transport them to St. Catherine's or to make other arrangements. In general terms, the cost relating to running the programme is €13,000. Given that there are only two such programmes on offer in the country, this means that a total of €26,000 is all that is required to ensure that both will remain in existence for the next period. As already stated, we are talking about some of society's most marginalised individuals - namely, young women who are single parents or otherwise and who want to develop personally in order to ensure that they will enjoy a favourable future. I ask the Minister of State to consider reviewing the position with a view to reinstating the training allowance to which I refer.

Minister of State at the Department of Education and Skills (Deputy Damien English)

I thank Deputy Deering for raising this matter and for giving me the opportunity to clarify the position in relation to the payment of allowances to participants on the Moving On training initiative. This initiative is part of the local training initiative programme funded by my Department through SOLAS and the education and training boards. The latter, in collaboration with local community organisations, provide flexible local training initiatives for unemployed persons. In Carlow, such initiatives are provided at St. Catherine's for young mothers who are unemployed and who are seeking pathways back into work. The local training initiative programme is designed to provide opportunities for marginalised learners who are unable to participate in other education and training board training interventions for personal, social or geographical reasons.

The programme enables local communities to carry out valuable and necessary projects of benefit to their communities, while at the same time training participants in areas related to the project work in order that they can go on to gain employment or progress to further training. Unemployed people, primarily those between 16 and 35 years of age, who have no formal qualifications or whose secondary level qualifications are incomplete and who are experiencing some form of disadvantage are eligible to apply. The local training initiative programme supports many organisations engaged in a wide variety of activities, including genealogy, environment, heritage, tourism, arts, sports and leisure. It received over €33 million from my Department in 2014.

The payment of allowances for training, including that relating to the local training initiative programme, is aligned to people's social welfare entitlements. A number of changes have been made in this area in the context of budget decisions taken in recent years. These changes have largely been driven by the economic situation that obtained in the country in recent times. As part of the decisions to which I refer, the payment of dual allowances to certain participants on training courses was ceased. I refer here to new participants, as the payment would have continued in the case of existing participants. The dual allowance model is where certain participants, such as lone parents, retained their social welfare payments and also received the standard training allowance while participating on training courses. The payment of an additional training allowance of €31.80 to the long-term unemployed was also ceased on a gradual basis in recent years. I understand it is to this allowance that the Deputy refers.

The budget changes to which I refer had an impact on all education and training board training programmes that attracted training allowances. The core purpose of these additional allowances was to act as an incentive to participation in training during a period of high employment levels. They were never meant to be an additional support; rather, they were designed to attract people to the relevant courses during the good times. I accept, however, that over time they came to be viewed as an additional support, and that is probably where the problem lies. There is no doubt that attending the courses to which I refer involves a cost to participants. The additional training allowances were never intended to address the cost of participation in training. Separate arrangements, such as those relating to meals, travel and child care, were always in place for that purpose. The nature of the payments - an incentive rather than as a measure intended to meet the cost of participation - is demonstrated by the fact that they was not available to all people in receipt of payments from the Department of Social Protection. In other words, only certain individuals qualified for them. The changes in question reflect the entirely different employment situation that now obtains, as well as the very difficult budgetary position in which the Government finds itself at a time when we are endeavouring to protect the overall level of provision of education and training.

The Deputy referred to child care and the cost of travel. Quite a number of participants on these schemes may qualify for either full-time or part-time subsidised child care places. It would be worth his while checking the position in this regard under the child care employment and training support scheme. I imagine that some of those to whom the Deputy refers would be entitled to support, and I will certainly check the position as well. Certain participants on courses are paid travel costs on the basis of the distance they reside from the location at which the course is on offer. These payments range from €4.60 to €32.60.

The overall issue which arises is whether the cessation of the training allowance constitutes a barrier to education. Part of the work SOLAS will do in the coming year will involve examining the position with regard to barriers to participation. I give the Deputy a commitment that we will consider the matter he has raised in the context of the SOLAS review.

Deputy Pat Deering

I thank the Minister of State for his detailed reply. I fully accept the need for a complete review of a number of these schemes. However, the programme to which I refer is extremely important. It deals specifically with a very marginalised group within society, which appears to fall between the two stools of the Departments of Education and Skills and Social Protection. The members of that group are pushed from one Department to the other from time to time and are losing out in the general scheme of things. I welcome the Minister of State's commitment to review the overall position.

The Minister of State referred to the fact that people need to be attracted to these programmes.

Deputy Damien English

That was the case in the good times.

Deputy Pat Deering

We need to continue to attract them in order that they might have the opportunity to move on and better themselves. There is no way we will attract people if they are going to be left out of pocket. Those to whom I refer are marginalised and they need to be provided with incentives in order that they might be attracted to programmes of this nature. If they are going to be obliged to pay for child care and travel - some of the women to whom I refer are obliged to travel from rural areas of County Carlow into the town centre at a cost of €30 or €40 per week - then they are going to remain at home.

The Minister of State has indicated that some of those in question may qualify for subsidised child care. I understand that such child care is only available between the hours of 9.30 a.m. and 12.30 p.m. This would immediately rule out many women. I accept that they could have their children cared for in the mornings, but what will they do with them if they are obliged to attend courses in the afternoons? There are a number of barriers in place and these must be addressed. If the young women to whom I refer want the opportunity to progress, they must be given it.

Those in Carlow who qualified for the scheme last year all progressed to the next level of education and some of them are currently obtaining work experience. This has been the position for a number of years. There is a good level of progression among these young women, and that is important in the context of all of these very worthwhile schemes.

Deputy Damien English

I understand that subsidised child care is not just available in the mornings. After-school care is available under the child care employment and training support scheme and I presume that child care is also available. I will check the position for the Deputy. The Minister for Children and Youth Affairs, Deputy Reilly, announced a major review of this area in recent days.

When I used the word "incentive", I was not referring to people needing incentives to attend courses. We actually want people to engage with such courses. In the boom times, however, additional incentives were sometimes required in order to encourage people to re-engage.

It was felt unnecessary to continue with this in recent years and, in fact, we could not afford to make such an incentive available. It was never meant to subsidise the cost of attending the course.

I accept there is an additional cost associated with attending the course, and that why there are child care and travel expenses. Perhaps some of the Deputy's clients could avail of these. The overall cost of attending is a barrier. I have given the Deputy a commitment here that SOLAS's further education and training strategy will identify and address the barriers to participation on the courses and examine them as part of the review. I will ensure the case in question is considered also.

In general, over 200,000 people are involved in further education and training courses. There are a range of subsidies and supports for them all. The one in question applied across the board. The incentive had to be removed for the groups in Carlow and Dundalk. The additional incentive was removed across the board a number of years ago. People had probably become reliant on it but, as I stated, it was removed only for new participants on the course. That is my understanding. We will have it reviewed under the SOLAS review. I hope that will help.

Water Supply Contamination

Deputy Michael P. Kitt

I thank the Ceann Comhairle for allowing me to raise this issue, and I commend the people of Williamstown for raising it and bringing it to the attention of the national and local media in a very professional way. The matter was summed up very well by a headline in The Irish Times on 5 January: "Galway Community may face two years on boil water notice". The article refers to "a contaminated water supply in County Galway which could affect about 1,000 people for two years." The powers that be have a considerable responsibility to find a quick solution to the contamination of the water supply in Williamstown, County Galway. The contaminant is cryptosporidium, which was in the Galway city water supply some years ago.

This boil water notice is supposed to be dealt with by brining water from Lough Mask in County Mayo. I heard the Taoiseach state this in the House. If this happens, it will take two years, although I welcome any development to alleviate the problem.

Local people have been told to boil water before using it for drinking, food preparation and even brushing teeth. Therefore, it is now important that we examine another solution in the meantime. I refer to a local solution, perhaps using the other water treatment plants in the area. There are a number of different water schemes in the area. If access could be gained to their water temporarily, it would deal with the difficulties that have to be addressed. I hope this will happen. It is felt that Irish Water's proposal to bring water from Lough Mask is a long-term option. Irish Water has been in contact with the community in Williamstown. I was glad to receive an invitation to meet Irish Water representatives in Williamstown next Friday. The local elected representatives will be able to listen to the proposal.

It is only right that I should put on record the fact that the boil water notice is a very serious issue. In The Tuam Herald today, a headline reads: "Williamstown group to tour contaminated water plant". This is the tour we are talking about. What amazed me was the fact that many people were not told about the boil water notice. One family has spoken about how they all got sick from the water, except for a young girl who had the flu injection because she has a heart condition. The other members of the family were all very ill because they only saw the boil water notice in the general practitioner's surgery. There is certainly a problem with communication, as it transpires that people did not know about the fact that there was contamination of the water.

I was glad to see in The Tuam Herald this week that, following the placement of an advertisement in that newspaper, a caretaker will be appointed for the Williamstown and Glenamaddy water schemes. This is most important, because it is very difficult for one caretaker to look after a huge area of north Galway. That the position is now being advertised is very welcome. However, the main point I am raising today is that we need a solution now. We cannot wait for two years for the people in Williamstown to see water coming from Lough Mask in County Mayo to solve their problem.

Minister of State at the Department of Agriculture, Food and the Marine (Deputy Ann Phelan)

I am taking this Topical Issue matter on behalf of the Minister for the Environment, Community and Local Government, Deputy Alan Kelly. I thank the Deputy for providing me with an opportunity to outline the current status of water services in Williamstown and the plans to address the issue that has led to a boil water notice.

Modern water and wastewater services infrastructure is vital to this country. Since 1 January 2014, Irish Water has had statutory responsibility for all aspects of water service planning, delivery and operation at national, regional and local levels, including the delivery of water service capital infrastructure. Irish Water has been established to take a national approach and raise greater investment to address weaknesses in the water system, including high leakage rates, varying quality standards, such as at Williamstown, and disruptions to supply. Addressing the problems of water supply schemes where boil water notices are in place is a key priority for Irish Water. The position specifically in Williamstown is that the existing water treatment plant cannot cope with seasonal changes in raw water quality.

Irish Water has advised me that it has a constant programme of water quality testing, and this identified a potential risk with the Williamstown water treatment plant. Owing to the poor-quality raw water in the Williamstown area, there is a risk to the water supply during certain weather events. For this reason, a boil water notice has been imposed.

Within 48 hours of the imposition of the boil water notice in Williamstown, Irish Water had identified a technical solution. This solution involves the construction of a major pipeline that will extend the Lough Mask scheme from Ballyhaunis in County Mayo to Williamstown. This is a significant project and is due for completion by the end of 2016.

Lough Mask regional water supply scheme in Mayo has the strategic capacity to provide a long-term sustainable public water supply to the entire area. Lough Mask currently serves 20,000 people, and currently it has spare capacity of 7,000 cu. m, with plans to increase this. The short-term option being considered for Williamstown includes the urgent advancement of a pipeline extension from Lough Mask to Williamstown. This would be the first phase of a significant expansion of the Lough Mask regional water supply scheme, ultimately providing the long-term solution to both Williamstown and also Castlerea and its hinterland in Roscommon. Irish Water is satisfied that the Lough Mask scheme will make full provision for present and future needs in the supply area, including the planned extension.

I wish to mention the position regarding water charges for households, which commenced on 1 January. It is important to note that where a boil water notice is in place or where customers are subject to a drinking water restriction notice, affected customers will receive a 100% discount to the water supply element of their water charges bill for the duration of the restriction.

Deputy Michael P. Kitt

I am raising this issue not because of water charges but because people will be subject to a boil water notice for two years. It is very fair to say that when there was cryptosporidium contamination in the Terryland and Lough Corrib areas of Galway, steps were taken to deal with it. However, I cannot understand why it will take to years to deal with a very serious situation. I have given the example of a family whose members have been very ill.

I noted what the Minister of State said about Lough Mask. I heard the Taoiseach himself refer to this when questioned in the Dáil.

Lough Mask supplies the water to Ballyhaunis, County Mayo, which is 20 km from Williamstown. There is a lot of work to be done to get the water as far as Williamstown. In fairness to the people in that area, there should be an opportunity to provide water for Williamstown in a far shorter time.

I hope I have highlighted the information that Irish Water and the HSE have given on the seriousness of the position. I have told the Minister of State, Deputy Ann Phelan, what they have stated water cannot be used for, and it is a major concern. I hope that we will learn more from the officials of Irish Water on Friday when they visit the treatment plant in Williamstown and when they go to Lough Mask to show what is available there.

This is a most serious situation. The Tuam Herald highlighted today that the people in Williamstown will get a chance to get more detail on this. I hope Irish Water can give us a more short-term solution.

Deputy Denis Naughten

Two years is unacceptable.

Deputy Ann Phelan

I again thank Deputy Michael Kitt for raising this extremely serious issue. Addressing boil water notices is a key priority for Irish Water. It has published a capital investment plan for 2014 to 2016 and this is available online on Irish Water's website. The plan includes projects which will address the needs of customers who are subject to boil water notices.

One of the primary reasons Irish Water was established was to provide for an increase in capital investment in the water infrastructure. This increased investment is needed to address the significant deficiencies in the public water infrastructure, to address legacy issues, to invest for the future and to provide for consistent customer service throughout the country. Irish Water needs to invest approximately €600 million every year.

I welcome the work that Irish Water is undertaking to address the situation regarding boil water notices, and the capital investment that is being made will deliver real benefits for the people of the areas affected. I take the point Deputy Kitt raised about the communications and I will pass that on directly to the Minister, Deputy Kelly.

Accident and Emergency Departments Waiting Times

Deputy Terence Flanagan

I thank the Ceann Comhairle for the opportunity of raising this most important issue and I thank the Minister for Health for being present for this Topical Issue matter.

Fast and effective action is needed to address the ongoing hospital crisis as a matter of urgency. There is a serious problem with overcrowding and patients waiting on trolleys in accident and emergency departments throughout the country. In particular, I refer to Beaumont Hospital, as it is in my constituency of Dublin Bay North, which I visited recently. I am appalled at reports that terminally ill patients have been left on trolleys. It is shocking to think that people are being subjected to this treatment.

The situation in the accident and emergency departments is not fair, but it is also not fair on the medical staff who must work extremely hard in a pressurised environment, day in, day out. They should be commended on the brilliant work that they continue to do under such difficult circumstances. The overcrowding at Beaumont Hospital has become so bad that the nurses have voted in favour of industrial action on 27 January. They are clearly concerned about the situation - the excessive workloads and the conditions in which they must work every day. As the Minister will be aware, nurses held a protest today outside the Dáil to voice their concerns, one which I supported. Nurses are running from patient to patient in hospitals. They do not have time to take the patient's name and they are concerned about the Minister's recent comments that nurses need to work even harder. With such comments, they wonder what world he is living in.

The solutions to deal with the accident and emergency crisis include the need to open additional beds as soon as possible to address the crisis temporarily, but it is more recruitment in the nursing profession and permanent positions rather than temporary contracts that are needed. We need to get some of the medical staff who are abroad back into the country as well as being a lot more efficient regarding discharging patients from hospitals, dealing with home care packages and the fair deal scheme.

Deputy Finian McGrath

I welcome the fact that the Minister is in the Chamber because it is an important issue. This is a major crisis in accident and emergency departments and it is important that the Minister understands that. There is a national emergency. I am not talking up this issue. This has gone on for many years, but in recent days and weeks there has been a massive problem in the accident and emergency services.

The first point I would make to the Minister is that his brief is that of Minister for Health. He should focus on health and the Members in this House will support him when it comes to supporting services in the health service. It is important that the Minister gets that message.

I also attended the protest outside the gate of Leinster House and I met the nurses. They all are concerned about hospital overcrowding, but they also have solutions. They have been presenting solutions to many of us for the past number of months.

We must deal with the capacity issue. There is a shortage of beds and resources have to go into staffing the health service and providing the beds. If we deal with the issue by providing in the region of 600 beds, it would have a major impact. We need to focus on that issue. I hear Ministers state there are other issues, that it is this, that and the other. It is a capacity issue; it is a beds issue. That is the important point in starting to implement solutions.

It is easy for us to come in here and try to score political points, but I do not want to be jumping up and down, as it were, about people on trolleys, as the Minister's predecessor, the Minister, Deputy Reilly, did when in opposition during the term of the previous Government. I want solutions and I want the Minister to listen to the solutions provided.

We also must focus on and think about patients. There is a considerable personal cost on patients when they sleep on trolleys or chairs. They lose their personal dignity and they lose a lot of the social networks.

I would say to the Minister to focus on the issue, which is capacity, beds and resources, and he will have the support of Opposition Members. When it comes to tax cuts for the wealthy, the Government should park those and give the funding to those in the hospitals.

Deputy Richard Boyd Barrett

Yesterday, a shameful 601 people who had been admitted to hospital were left lying on trolleys. A record 601 people, who needed a bed and appropriate care, were put through the indignity and needless suffering of being left on a trolley in an overcrowded accident and emergency unit. Nurses, absolutely at the end of their tether and run off their feet, have now been forced by the Minister to protest and take industrial action because of the inaction of the Government to deal with this crisis. As professional health workers, they now feel that it is safer to turn people away from accident and emergency units than to admit them.

Contrary to years of the Government mantra about how it is all about efficiencies and it is not about throwing money at the health service, the INMO is categorical. What is needed is for the 2,000 beds that are closed in the system to be reopened. Thousands of nurses need to be recruited to provide the care for those who will occupy those beds. The INMO states that 523 beds which are closed could be reopened tomorrow if the resources and nurses were provided and that the other 1,500 beds could be opened fairly quickly if the Minister recruited the nurses. That means demanding of the Minister for Finance, Deputy Noonan, and the Taoiseach that the budget for the health service, which is utterly inadequate, be raised to reverse the damage of thousands of beds and thousands of nurses being taken out of the health service and to put those back in to deal with this crisis.

The international best standard is hospital bed occupancy of 85%. We are running at 100%, and we have unloaded more on top of that from the small accident and emergency units that have been downgraded and closed. That is the crisis. The Minister has been told what he could do to address it. Will he do it?

Deputy Derek Nolan

I thank the Minister for attending in the Chamber to respond to this Topical Issue. He is aware that nurses in Galway have announced they will work to rule from 3 February onwards. This is not the first time they have raised conditions in the accident and emergency unit in Galway. They had a one-hour protest in September, at which time I engaged with them and we have been trying to come forward with a number of solutions. In fairness to the hospital, it has taken some steps. There has been limited recruitment but not enough. At the time I raised the matter in the Dáil with the Minister. One of the concerns related to the physical infrastructure in the emergency department, ED. The Minister accepted that the emergency department in Galway is simply not up to scratch. I am aware he will do his very best to get the hospital on the capital plan.

Another issue I raised with the Minister that has been put forward by the nurses as a practical solution is that they would really like to get an independent person from outside University Hospital Galway who could examine the way in which the ED works; whether they are doing triage right and if they have the correct ratio of nursing care assistants to nurses in order to put in place a temporary plan they could buy into to get them over the hump before they are in the position of having a new emergency department at which time more medium and longer term measures could be taken on board.

Among the nurses to whom I spoke, some are coping well who have been working in the system for a very long time and they are hardened, but others are broken by the system and what they see when they go into emergency departments because of the empathy and sympathy they feel for people who are on trolleys, some of whom are terminally ill or otherwise extremely ill and have worried families around them. The former CEO of the Saolta University Health Care Group said they were not offering dignity to their patients. That is not something we can allow to continue. If we can do things in the interim such as exhausting the panel of nurses that have been identified and bring in external people to see what we can do in a cost effective way in order to do something different, then we should do so now.

Deputy Jonathan O'Brien

I do not need to explain to the Minister the crisis in the emergency departments, in particular in the past week or so, and the record number of patients lying on trolleys. There is a number of reasons why that is happening. In the vast majority of hospitals the number of people awaiting discharge but who do not have the necessary step-down facilities is ever increasing, be it due to the lack of home care plans or the delay in the fair deal scheme. In Cork, a public nursing home has beds that are currently closed, which could take some of the people who are at present taking up beds in Cork University Hospital, CUH, and the Mercy University Hospital, MUH. The reality is that we have healthy people in beds who are waiting to be discharged and we have sick people on trolleys. The situation must be rectified.

I do not believe that it is all down to finance. Other issues also arise such as planning, co-ordination, integration, and staffing levels, which all need to be addressed in a comprehensive and holistic way. The ED task force, which was designed to address some of the issues, is not working. I do not know the reasons why that is the case. The Minister will have a better knowledge of why the task force is not delivering what he hoped it would deliver. We cannot continue with the situation. We have beds that are closed which could be opened. I accept that will require finance, planning and co-ordination in addition to staff. If we could get to a situation whereby we discharge healthy people more quickly then we would have fewer people waiting on trolleys. The matter must be addressed.

Minister for Health (Deputy Leo Varadkar)

I thank the Deputies for raising this issue. It will also be discussed during Private Members’ business tonight and tomorrow and at committee tomorrow as well.

At the outset I emphasise that the Government regards trolley waits of more than nine hours to be unacceptable and acknowledges the difficulties which any overcrowding in EDs causes for patients, their families and the staff who are doing their best to provide safe, quality care in very challenging circumstances.

As of this morning at 8 a.m. the TrolleyGAR update from hospitals indicated that there were 298 patients on trolleys. The figure includes patients on trolleys in regular wards but not those in day wards. The figure fell to 217 at 2 p.m. today and 131 of those were on trolleys for more than nine hours. Most such patients will be in beds tonight but of course more patients will come in the meantime. While 298 people waiting for a hospital bed is nothing to be proud of, we should all acknowledge that through the hard work of staff, hospitals working together, supported by HSE services, management and my Department, we have significantly reduced the numbers.

The nurses' union trolley watch number this morning, at 268, was the lowest in seven years for the equivalent peak Wednesday in January. The last time it was lower was in 2007. This morning's SDU TrolleyGAR figure stood at 298. That is the lowest figure recorded for the equivalent peak Wednesday in the four years of recorded hospital statistics. When recording started in 2012, the figure for the equivalent peak Wednesday in January was 355.

All hospitals have escalation plans to manage patient flow and patient safety in a responsive, controlled and planned way that supports and ensures optimal patient care. Triage is used to prioritise patients in order that those with the most acute needs are seen and treated as soon as possible. Senior clinicians are a key part of the process. As part of their everyday duties, they work closely with hospital management to minimise potential risk and ensure the safest possible care.

Measures to manage ED surges involve the health service as a whole, including primary, community and continuing care. The aim is to ensure that all available capacity and options are utilised and brought to bear on the situation. Some of the measures taken to reduce overcrowding include opening additional overflow areas and community and transition beds - hundreds of beds have been opened in the past week; the curtailing of non-emergency surgery, which unfortunately will impact on waiting lists later in the year, but it must be done; the provision of additional diagnostics; and a focus on discharge planning and additional home care packages as well as fair deal nursing home places – 400 of the former and 300 of the latter were approved in December but, unfortunately, they did not all come through until January.

Members will all be aware that I convened the emergency department task force to develop lasting solutions to overcrowding by bringing a new focus to the challenges presented by this chronic problem that has been ongoing for 15 years. The task force comprises stakeholders such as senior doctors, lead hospital consultants, GPs, HSE national directors, union representatives and senior officials from my Department. The task force will meet on a monthly basis to develop and oversee the implementation of effective measures to improve access to acute hospital services. It works in partnership with primary, acute, community and ambulance services.

I attended today's ED task force meeting. I take this opportunity to welcome the appointment of Mr. Liam Doran as co-chair of the task force. An important point to make because the task force is not the only thing happening in this regard is that conference calls among several HSE staff and hospital group chief financial officers, CFOs, are happening daily, twice daily and sometimes three times a day since the beginning of the year. I have participated in some of the conference calls.

I am aware that the INMO is threatening industrial action as a response to this very difficult situation. I am also aware that seven out of 26 hospitals are affected by the threat of industrial action, which is a most unfortunate situation. While I am assured that a work to rule will not affect patient care, I was present in hospitals and working there for previous work to rule situations and I am aware of their impact which will make life harder for other front-line staff, in particular junior doctors. The issues currently experienced across EDs require co-operation across all areas. Only by working together can we give patients the services they need.

I reassure the House that we are all working hard to find solutions to the management of emergency care, with optimal patient care and patient safety at all times remaining a Government priority. I am out of time but I will respond to some of the Deputies’ points when responding to supplementary questions.

Deputy Terence Flanagan

I thank the Minister for his response. I accept that he has inherited a significant issue and crisis. He will be aware that ten reports have issued on the matter since 1997 setting out the solutions to the crisis. At this stage action is required as that will speak much louder than words alone.

Nurses are at breaking point due to the conditions in which they work. Nurses and patients are under pressure and are stressed. The situation is shocking. As a medical person I am sure it is not something the Minister can stand over. The immediate solution is to provide more beds and to ensure that nurses and other medical professionals are put on permanent contracts rather than temporary contracts. They will not remain in situ on temporary contracts as they need security in order to have proper employment and to pay their bills.

Deputy Finian McGrath

The bottom line is that this morning, 298 patients were on trolleys and as the Minister outlined, at 2 p.m. today, there were 217. This is not good enough. We need a lasting solution. We have put forward proposals and part of the solution is that we need to deal with the issue of beds and the issue of resources. We also need to look at the implementation of many of the constructive ideas put forward by nurses and doctors. I welcome that Liam Doran has been asked to act as a co-chair. This is a sensible proposal. However, we need to listen to the people on the ground and we need to ensure that our patients are treated with respect and our senior citizens are looked after in a fair way. That is the way to deal with the issue. The Government needs to put in the resources and stop giving away the extra resources from this year's budget to wealthy people. The resources should be put into our health services. That is the way to deal with this issue.

Deputy Richard Boyd Barrett

I acknowledge the positive decision of the Minister to bring Liam Doran onto the task force. However, what the INMO and any medical professional says is that we need more beds and more nurses and this requires more resources. What we are dealing with now is an absolutely unacceptable and unprecedented crisis in accident and emergency departments. It is a case of the chickens coming home to roost, of 5,000 nurses being taken out of the system, of 2,000 beds being taken out, of 2.3 million home care hours being cut. Neither a health service, hospitals nor accident and emergency departments can be run on that basis or on the basis of 100% bed occupancy, because this means there is no room for manoeuvre if there are any surges and then a crisis immediately ensues. The international best standard is 85% occupancy. The beds must be re-opened and more permanent nursing staff must be employed and extra resources and money must be provided in order to do so. If the Minister does not grasp that nettle, if the Government does not get that message, this crisis is just going to continue.

Deputy Derek Nolan

I thank the Minister for his response. I am sure a number of the issues he outlined will have a positive impact. I am slightly concerned about what we consider to be normal practice, which nowadays means having large numbers of people on trolleys at any one point. We need to get away from that. Some of the topics discussed by the Minister are focused on the national situation. One of the issues I encounter in talking to nurses in Galway is the sense that local management is not willing to engage and to have the type of relationship and task forces at local level for which we strive at a national level, so that the nurses, doctors and health care assistants can contribute in order to make the best of what we have.

We will need to look beyond getting over the annual busy periods and to have a more long-term plan for dealing with the regular flow of patients and putting in place a plan on how the ideal is to be reached. We must work towards limiting the time spent in accident and emergency departments.

Deputy Jonathan O'Brien

I thank the Minister for his reply. As I said in my initial contribution I do not believe it is just a question of finances because it is also down to the need for planning, co-ordination and integration to achieve a solution. The purpose of the emergency departments task force was to examine the situation in a holistic manner and to come up with long-term solutions. However, short-term solutions are needed. Whether it is a case of the lowest number of people on trolleys today compared to the same day over the past number of years, the fact remains that more than 200 people are currently sitting on trolleys while healthy people are taking up beds because the step-down facilities are not in place to allow them to be discharged and in the meantime, sick people are waiting on trolleys. This situation needs to be addressed as a matter of priority.

Deputy Leo Varadkar

I thank Deputies Jonathan O'Brien and Derek Nolan for their constructive contributions. I thank Deputies Boyd Barrett and Finian McGrath for their contributions.

Deputy O'Brien is correct that delayed discharges are part of this problem, numbering 850 in December which we have reduced to 750 currently. However, the difficulty is that 110 new delayed discharges come in every week while only 100 are discharged. We need to get ahead of that and stay ahead of it for a sustained period of time.

Deputy Nolan's suggestion with regard to Galway is very good. We have external people in Tallaght hospital at the moment who are working on a hospital redesign project. They will move on to Our Lady of Lourdes Hospital in Drogheda. If there is a willingness - because willingness is essential - by everyone in Galway to embrace it there is no reason they cannot be included in that external review and hospital redesign process.

Deputy Boyd Barrett's information is not correct. There may well have been 2,000 beds closed in the system over the past ten years but these are not all acute beds because some of them are community beds. Many of them have been demolished, many are not HIQA compliant and many have since been turned into radiology departments and endoscopy suites and so on-----

Deputy Richard Boyd Barrett

Five hundred and twenty-three-----

Deputy Leo Varadkar

-----and they cannot be turned back into acute beds. Of the 500 that could potentially be opened, more than half of that number are currently open and where possible, we will open some more. However, there are issues to do with decanting, with fire certificates, electrical issues and with staffing in some cases.

Beaumont hospital has had a problem with overcrowding for over ten years. I visited there in the past couple of weeks. I worked there for four months as a senior house officer, SHO. I met some of the staff who were working there when I worked there and they are still working there. Quite frankly, it is a very great tribute to them that they stick it. I understand their anger and their frustration. I never, ever said that nurses have to do more work so I do not know where that comment comes from. What I did say is that everyone has to be part of the solution, which is quite a different thing. Everyone needs to be part of the solution.

I do not think for one second that additional nursing staff or a change in contracts from temporary to permanent will in itself solve the problem. More nurses and more nurses on a different type of contract does not discharge anybody any quicker nor does it create a single bed. It may be part of the solution but it is probably a relatively small part of the solution.

In the case of Beaumont, the hospital currently has 100 delayed discharges and approximately 30 people on trolleys. In theory, if the delayed discharges were reduced from 100 to 50, there should be nobody on trolleys. However, I know full well that the way that hospital is currently managed and organised, this would not be the case. What would happen is that discharges would slow down and electives would be increased and we would still have people on trolleys in the emergency department, as has been the case every day, except Christmas week, for the past 15 years. There is a more fundamental problem in a number of our hospitals than merely money and staff, although I accept that money and staff may well be part of the solution.

Deputy Michael Healy-Rae

Ye promised a lot.

Dáil Éireann debate - Wednesday, 14 Jan 2015