Hospital Waiting Lists: Motion [Private Members]

Deputy Billy Kelleher

I move:

That Dáil Éireann:

notes:

— the sharp increase in the numbers on hospital waiting lists since the start of 2014;

— the abandonment of the eight month target for treatment on the adult in-patient and day case waiting lists and the twelve month target for an appointment on the hospital out-patient waiting lists;

— that the new eighteen month targets have not been met; and

— that the most recent figures indicate a further deterioration in the figures and prolonged times patients are on trollies in emergency departments;

further notes:

— the continuing difficulties for patients and staff in hospital emergency departments;

— that the April initiative by the Government has not yet been financed or in any way improved the situation;

— the increase in the number of patients waiting on trolleys during July and August 2015 by comparison to the same months in 2014; and

— the difficulties in the emergency departments are exacerbating the delays in scheduled hospital treatments;

agrees that:

— overcrowding in hospital wards and delays in scheduled treatments pose a risk to patients;

— the most recent announcement of 300 extra beds is not sufficient to meet the demand of the service, in particular for the winter period;

— there is a need for more units to be reopened with an increase of frontline medical and nursing staff to meet demand; and

— health service funding is inadequate to meet the needs of the Irish public; and

calls on the Government to:

— increase further the number of beds and frontline staff so that the overcrowding can be eased;

— restore the National Treatment Purchase Fund to ensure that patients receive needed treatments in a timely manner; and

— fund the health services adequately and honestly so that the demands from the sickest in the country's society are met in a safe manner.

The reason the motion is before us is simply because we feel that after four and a half years of the Government's tenure the difficulties people face accessing health care in this country have got progressively worse. There is no denying the fact there was great fanfare in 2011 when the Fine Gael Minister, Deputy James Reilly, took office. He was going to do an awful lot. Many commitments were made in advance of the general election of 2011, whereby there would be a radical overhaul of our health systems, the HSE was going to be abolished and there was going to be a move to universality and universal health insurance. These major policy decisions would then impact on the ability of the new health services to deliver health care and the Government would end the scandal of people waiting on trolleys. This was a slogan from the then Leader of the Opposition and now Taoiseach, Deputy Enda Kenny. He stated that if Fine Gael was elected it would end the scandal of people waiting on trolleys. The difficulty with all of this, of course, is that things have got progressively worse.

I like to keep debates in the House fair and reasonable and not get too personal, but it has not improved under the Minister's tenure. In fact it is getting progressively worse. The figures can be seen on a continual basis through the parliamentary questions we table and in replies to freedom of information requests. Under any matrix used to assess the performance of the health services they are getting progressively worse.

We now have the bizarre situation whereby the Minister applauded himself for moving the targets for outpatient and inpatient waiting lists from one year and nine months respectively to 18 months. He stated this was the right thing to do. On top of that we also find the Minister cannot even meet his less ambitious targets. Every hospital has huge increases in the percentages of people waiting for inpatient and outpatient appointments. What is happening now is people simply cannot access health services. They cannot even get an appointment to see a consultant to find out whether they will need surgical procedures or other forms of therapy. This is happening day in day out in our hospitals.

The outpatient waiting list increased a staggering 60% in the 12 months from August 2014 to August 2015. One or two hospitals have made moves to reduce their waiting lists, but overall the figure has increased by 60%. When we are in the House we throw out figures, but behind every one of those percentage increases are many people in pain and suffering who are waiting for treatment or even to be diagnosed to find out what is wrong with them. The Minister's answer is to move the waiting targets from one year to 18 months. He will be so compassionate that they will meet the new targets, but they are less ambitious and people will be waiting longer. This is what the Minister announced with great fanfare. He stated it would be a realistic target which would be met. The bottom line is any assessment or due diligence of the list shows the hospital system does not have the capacity to deliver on the targets the Minister has now set. As I have stated, these targets are less ambitious than those set by his predecessor. The number of children awaiting outpatient appointments for an inordinate length of time is more than 5,000. In the key areas identified by the Minister where there would be a progressive decrease in the number of people waiting it has simply not happened in any way.

All of this stems from the fact that last October, when the budget and the Estimates for 2015 were announced, the first thing the Minister did when he left the House was state he had achieved a realistic budget. It was far from realistic. It was a fallacy, a nonsense, a figment and a dead duck from the word go. It was never going to deliver the health services the Government had pretended it would with the money available. The Minister is now carrying a €500 million deficit. The health services are already short this much money to provide the care outlined in the HSE service plan for 2015.

No aspect of the Minister's pronouncements last year has been delivered. The trolley situation is at crisis point. Consultants, clinicians and front-line medical staff tell us our emergency departments are at breaking point and people are dying as a result of waiting on trolleys for an inordinate length of time. A patient suffering from cancer in a hospital in this country, who was almost 100 years of age, waited five days on a trolley. Patients wait for days on end in emergency departments throughout the country. Our front-line staff tell us it is unsafe. The Minister has stated he likes to listen to front-line staff and take into account their views and concerns and their expressions of concern about patient safety. The bottom line is the Minister has done very little, if nothing at all, to address the deepening crisis in our emergency departments.

Last December, when we were facing a crisis, the Minister announced the establishment of an emergency department task force. It met before Christmas with much fanfare and PR. The Minister strong-armed it and it was going to do an awful lot. It announced its plan in April. Its plan has fundamentally failed. Any assessment of the performance of our hospital emergency departments throughout the country shows they are underresourced and understaffed and do not have the capacity to deal with what presents.

More recently, the task force was reconvened. Again the Minister strong-armed it and it was going to do an awful lot. There was an announcement of 300 beds. Those 300 beds will come on stream at the end of this year, but at the start of the year it was patently obvious, to the Minister I assume, and anybody willing to listen to clinicians and those involved in hospital management throughout the country that there was simply not the capacity in our hospitals to address the overcrowding in emergency departments. There is a number of reasons for this. First and foremost is the number of people stuck in acute hospital settings because they simply cannot transfer to nursing homes, stepdown facilities or supported living in the home through home care packages, home help and other community services. This is still a major problem. Day in day out, more than 500 beds are taken up in a hospital by people who do not want to be there and should not be there, but we simply do not have the capacity or ability to organise a seamless transfer from our acute hospital settings to stepdown facilities or supported living in the home. Is it beyond us, the Minister and the emergency department task force to assess and address this very fundamental blockage in the acute hospital system throughout the country?

As I mentioned, the announcement was for 300 beds to be made available, which will come on stream at the end of the year. Of course, the question that follows is whether these will be additional beds or just the opening of wards that had been temporarily closed. Will we have the usual massaging of figures for the number of hospital beds taken out of the system, the numbers being closed on a temporary basis and those which are being refurbished or which do not have enough staff to manage and support beds?

The 300 additional beds are a start but this issue would have been quite obvious as soon as the Minister took up residence in the Department of Health at Hawkins House when he was made Minister in July 2014. He was told that the fair deal scheme and an inability to move people into nursing homes, step-down facilities, community care or support in the home was a fundamental problem. Almost nothing was done to enhance and increase the capacity of the fair deal scheme to handle the number of people in hospital when they should not be. It took a crisis where people were waiting 18 or 20 weeks for assessment to be granted access to the fair deal scheme before there was any waking up to the problem on behalf of the Minister. The Minister's hands-off approach and aloofness to the difficulties being faced every day are simply not acceptable any more. It is time for the Minister to get involved on a day-to-day basis to ensure hospitals can have the support, capacity and funding to carry out their functions and duties.

The Minister has announced he will penalise hospitals if they do not perform in certain areas. Of course, what the Minister will end up doing is robbing Peter to pay Paul. If hospitals are being penalised because people are waiting on trolleys because of a lack of capacity, the hospitals will simply cancel or postpone elective surgeries. That will happen across the hospital system. There might be a reduction in the trolley numbers in accident and emergency departments but there will be a corresponding increase in the number of cancellations. Cancellation numbers to date have been alarming in outpatient, inpatient and day cases. There have been 12,000 cancellations for day cases or inpatient appointments for the first six months of 2015, and by any yardstick that is a catastrophic failure. Other issues also come to mind. People are waiting inordinate periods, in pain and agony, yet all these mantras were propagated by the Minister and others in opposition. Since 2011, almost nothing has been done, other than the outlining of grand plans and great visions, with no substance in the basic commitments to our public health system.

That system is becoming inaccessible to many people. Our front-line staff are demoralised, we cannot recruit consultants and there have been major increases in waiting lists for speech and language therapy and many other areas across the health services. This is where people should be able to access the basics in health care and it comes under the Minister's watch. He can spin this any way he likes in talking about realistic budgets, achieving a lot and strong-arming the managers in hospitals and all those willing to listen to or bow down to him. The difficulty is that in every matrix that can be adjudicated or judged with respect to whether health services are capable of delivering, the result points to the fact that they are underfunded, under-resourced, lack capacity and simply do not have enough staff to deal with the demands being presented daily.

The National Treatment Purchase Fund was cancelled some time ago and to this day I cannot understand the logic behind that. It was a scheme that was efficient and cost-effective and which dealt with the delays in people accessing health care, specifically inpatient or day cases. It purchased the treatment from a private source but at least people were not waiting the extraordinary lengths they are now waiting. That must be examined as there is no point in continuing this pretence. The Minister should announce what is happening and proceed in a proper, structured way to re-establish the treatment purchase fund. Such a scheme would be able to access health care for the people waiting an inordinate period on lists throughout the country.

When we put down this motion we wanted to highlight the difficulties that people face throughout the country but we do not have to highlight the issue beyond stating the facts. We do not have to exaggerate or speak with emotive language. All one has to do is visit a hospital, speak to a public health nurse or doctor working at the coalface or listen to patients and their families who are simply fed up of waiting great lengths to access basic health care. In the meantime, the Minister is pretending that the Government has a plan for how to fund health care, and in particular that we will move to universal health insurance. The idea is the scheme will be rolled out to address every issue. Deep down in the Minister's heart he knows well that this has been abandoned but the Government does not have the decency to admit it. The Government has no intention of moving to universal health insurance but it does not want to be seen announcing a U-turn at this stage. The bottom line is that even the building blocks are not in place to move to universal health insurance. It is also a flawed model that undermines public health and the concept of a public service, and it would hand over our health system to private operators. Instead of the Minister rationing the health service and health care, those private operators would decide what health care would be available to people depending on the public health system.

For all those reasons, much more needs to be done to be honest about the issue by assessing our difficulties and trying to address them. Public relations spin and a pretence of having grand plans simply will not wash any more. We need definitive action that will target key areas and difficulties in our hospital system. Consultant recruitment is an obvious issue and we need more nurses, front-line staff and clinicians across the hospital system. Our primary care system is falling apart. The Minister should know, with his professional competency, that a key cornerstone of all stated policies of parties here and stakeholders outside Leinster House is the need to shift resources and fund primary care in order that it can be meaningful in delivering health care in this country, keeping those with chronic illnesses out of the acute hospital setting and shoring up community-based services. This would ensure people would not present in acute hospitals day in and day out. Unfortunately, general practice just does not have the wherewithal and support to take that on board. These people are willing and - more important - able, but the Minister must become an advocate for primary care rather than pretend it is okay. Our GPs are leaving this country and heading to Canada or the UK, so it is not okay. It is a sad indictment of this country that we are forcing the best and brightest out of it when we need them most to deliver primary and community care.

There is a lack of public health nurses and we are incapable of supporting elderly or sick people in their homes. We are diminishing home help hours and our home care package assessment system is simply not efficient. People have to beg to try to secure home care packages. There is no seamless transfer from the acute hospital system through to community or home care. The process is simply not working. Rather than a pretence of a plan, we need to accept the failings and deal with them in a targeted and focused way. The Minister must be the first to accept that primary care has been starved of resources, leading to a diminished capacity to deliver meaningful health care in this country.

Our motion also agrees that "overcrowding in hospital wards and delays in scheduled treatments pose a risk to patients".

People are dying because they are waiting on trolleys. That is a fact. People are dying and people are in pain and in agony because they cannot access inpatient or outpatient appointments. People are under huge stress and anxiety because they may be waiting a long time for a diagnosis. That is wrong and it is being exacerbated on the Minister's watch in recent times.

The motion goes on to call on the Government to increase the number of beds and front-line staff so the overcrowding issue can be eased. We accept that there are huge challenges. We do not expect it to be delivered overnight but we would like to see the people behind the figures being dealt with in a reasonable timeframe. The idea that targets should be shifted to make oneself look good because they cannot be met is simply wrong and that must be acknowledged quickly. The motion also calls on the Government to restore the National Treatment Purchase Fund, as I referred to.

This is the Minister's last chance in terms of honesty in the health budget. He must fund the health services adequately and honestly so that the demands from the sickest in society are met in a safe manner. Last year, the Minister walked out of this Chamber and went on a tour of the radio stations to pronounce that he was the first Minister to get a realistic budget in the last few years and that it was an honest budget, which would address all concerns. This was a fallacy from the beginning. What we need him to do this year is to become an advocate for public health at the Cabinet table, to argue for a realistic budget and, in arguing for it, to present what he will do with the funds he will get. Rather than chasing the grand plan that is a figment of his imagination, the Government must commit itself to the public health system, to funding and to resourcing it and to bringing in staff to ensure it can operate efficiently. For all those reasons, this is an opportunity for the Minister to grab between now and budget day, to point out to the Ministers for Finance and for Public Expenditure and Reform that there is a gaping hole in the budget, year after year. The pretence that the Government has adequately funded the health services must stop and it must commit itself to the health services.

Acting Chairman (Deputy Derek Keating)

I thank the Deputy.

Deputy Billy Kelleher

I might take a little more time because we only have two Deputies who will be speaking, so I have 20 minutes left. They are quite happy with five minutes each.

That is something the Minister has to do. I cannot accept that he can walk out of the Chamber again this year and pretend, as we face into a general election, that he has another realistic budget when I know and everyone else will know and deep down he will also know, that unless he gets adequate resources that will target specific areas we will be in the same position next August-September of 2016, with a huge hole in the budget and the Government scrapping around, cutting services and managing panic to try to keep hospitals in budget.

I would like the Minister to think through the idea of fining hospitals again because he will force hospitals to make choices about who they treat. If their budgets are not adequate and if they do not have the capacity to deal with all those who present themselves in hospitals, they will be making choices and there will be a continual cancelling of people who are scheduled for elective surgeries. The figures are a damning indictment not just of the health services but, more importantly, of the person who is responsible for funding them, namely, the Minister.

I referred to the National Treatment Purchase Fund. The Government must bring it back in a proper capacity, rather than slinking out from time to time to massage the figures downward, purchasing from the private healthcare sector. Why not do it properly? Establish it, put it up and running, and disband the special delivery unit and the former Minister's Gestapo team, which is heading around the country, pretending it is doing things, when the reality is that all it has been doing was observing the carnage and chaos in our emergency departments because of inadequate funding, not only in the context of our emergency areas but throughout the hospital system and into the step-down facilities and the fair deal nursing home areas.

The Minister has spoken a few times about funding public health services and the need to put money into our public services in general versus tax cuts. I hope he is true to his promise. Choices will be made. Fine Gael will be off with its focus groups doing its research, doing its surveys and finding out what resonates with certain sectors of the electorate, but at some stage it will have to be honest with the people. The issue of underfunded public services is having a devastating impact on people. It would ill-behove anybody in this House to stand up here and applaud the Minister for Finance in a few weeks' time and shout to the high heavens that this is a great budget if we are going to fund tax cuts to certain sections by leaving a child waiting an inordinate length of time for a speech and language assessment, to fund tax cuts for the wealthy and leave an elderly woman lying for three days on a trolley or leave elderly people in a home without proper homecare packages and cut home help hours. The Government should at least be honest and say it publicly, rather than putting a grand spin on it, that everybody will be looked after in the budget. The Government will make choices and the choices to date have affected the vulnerable, the old and the sick in our society. It is not just an Opposition Deputy standing up and highlighting that, it is a fact. The budgets to date have been regressive and they have attacked those who most need State support.

When the members of the Government are all applauding the tax cuts but somebody else telephones to say they cannot get their mother into a hospital, they cannot get their child an assessment with a speech and language therapist, or cannot even find a speech and language therapist in some places, or that their 13 year old daughter cannot see an orthodontist for months or years, it is because the Government has made choices. It made those choices knowing full well that many areas of society do need public services. They depend on public services and public services depend on a Government that is willing to support them. What I have seen today in terms of the Government's decisions on cuts and on taxes tells me that it is more interested in focus groups and the results of focus groups, or what the electorate likes to hear and what groups will or will not vote for it. I find abhorrent the idea that it will fund its vote-buying budget by letting people wait day after day on trolleys, by not funding proper health services, by leaving people waiting an inordinate length of time to access the fair deal scheme and where people are walking around in pain waiting for hip and knee replacements. I am sure that if the Government wants to face the electorate in an honest and meaningful way, at least it will fight for a better health service, something that we all demand but, more importantly, that many people need.

Acting Chairman (Deputy Derek Keating)

I call on Deputy Ó Fearghaíl. Based on the time that is left, he and Deputy Aylward have approximately seven minutes each.

Deputy Seán Ó Fearghaíl

I begin by complimenting Deputy Kelleher for tabling this motion. Health is an issue that needs to be kept centre-stage at all times. At this stage in the electoral cycle it is vital that health is seen to be a number one priority for us. That said, over the years, I have observed that the adversarial politics we practise in this country has been very bad for public health. The sort of tit-for-tat, Jack and Jill kind of politics we practise has not delivered for the public the sort of public health service the public is entitled to.

I was very interested earlier, in the debate on the motion of confidence in the Government, where one Minister came in to say that we should not be talking about the Fennelly report but rather about jobs, health and so on.

What was noteworthy in the contributions made by the Government side in that debate was the emphasis placed on what was happening in the economy, the sense of hope coming from the Government side that the economy is on the upturn and, I suppose, that sense of hope that the upturn, which is very much a regionalised upturn at present, may spread across the country in time. What was also noticeable was an equal lack of hope in terms of the necessary improvements in the area of health care. That is one of the greatest difficulties we have in this country. One of the greatest challenges for personnel working in the health services is that sense of despair, that sense that matters are not being seen to get any better and there is no great sense that anybody anywhere has a vision that will deliver the necessary reforms and improvements.

Deputy Kelleher referred, quite correctly, to budgeting. The Minister's predecessor, I must say, was scathing over a period of years in his condemnation of his predecessor, Ms Harney. I had the privilege of chairing the Joint Committee on Health and Children in previous years, and never did that man lose an opportunity to excoriate Ms Harney during her tenure. I never was a great admirer of the Progressive Democrats, but certainly, in my view, she was a fairly competent Minister for Health and Children. Deputy Reilly did not exactly impress anybody during his tenure, and Deputy Varadkar came in then as the great new hope. We wish Deputy Varadkar well. While his predecessor's budgets were clearly bogus, Deputy Varadkar's are not bogus, but they are certainly not adequate. As Deputy Kelleher has said, the Minister will have the support of everyone in this House when, on behalf of the Department of Health, he fights with the Minister for Public Expenditure and Reform for an additional slice of the cake, because that is something that must be delivered.

The waiting list situation is quite scandalous. The Minister's actions in extending the waiting period beyond what is regarded as best international practice is nothing more than a form of chicanery. In my local hospital in Naas, the outpatient waiting list has increased by 85% and the inpatient waiting list has increased by 122%. In County Kildare, we depend heavily, as Deputy Durkan will be aware, on Tallaght hospital. In Tallaght, there are 5,267 adults and 1,357 children waiting for outpatient attention and there are 3,000 adults and 479 children waiting for inpatient attention. That is not an acceptable situation.

I commend the Minister on the fact that he intends to open 300 additional beds, but unless he is in a position to put the staff in place to service those beds, the beds will not be brought on stream in anything like the time that is required to meet public demand. I do not see anything happening in terms of how the HSE conducts its business of staff recruitment. The system of staff recruitment is antediluvian. It does not serve the public need. It is not fit for purpose and it needs to be radically changed. If we are to achieve anything in this debate tonight, I hope it will be to impress on the Minister the need to effect radical change, not only in how the HSE implements its staff recruitment policy but in how it retains staff. It has always struck me as particularly peculiar - I was a member of the old Eastern Health Board, as was Deputy Durkan - that we operate a system in the nursing profession in this country in which it is extremely difficult for applicants to gain access to university - previously training hospitals - and those who failed to gain access here for the most part went to Britain to qualify. When applicants qualified in Britain, we went over to Britain and tried to bring them back, having refused them access to training opportunities here.

There are a multiplicity of areas in which we need to see reform. I believe the Minister has the ability to effect that reform, but we have not seen much of it happening to date.

Deputy Bobby Aylward

The health service in this country remains in a state of panic. Day after day, I and my staff are inundated with calls from constituents suffering with significant medical conditions who are being forced to live in pain as they await treatment. The sick people of Ireland's standard of living is being completely diminished by the lack of action this Government is taking to mitigate the health crisis.

What is even more damning is the length of time that patients must wait before they receive the necessary treatment to alleviate their pain. In June, I was contacted by a mother who was distraught about her daughter's situation. Her daughter suffers from a rare neurological disorder known as Rett syndrome and is categorised as high priority for spinal surgery in Our Lady's hospital. She was placed on the waiting list in June of 2014. Between June 2014 and June 2015, her daughter's scoliosis progressed so rapidly that she was left with severely compromised lung function. The poor child could hardly walk or mobilise herself as a consequence. The mother told me of her utter heartbreak as her daughter continued to suffer, and she learned that the pre-operative MRI, which is needed in order to proceed with a crucial scoliosis procedure, would not take place until November 2016. I submitted a parliamentary question to the Minister on this specific case and I received a response stating that I must wait for an answer from the HSE, which offered little comfort to this family when it was eventually received. Thankfully, my office has managed to mitigate the situation, and the MRI scan will now take place in October of this year.

To put it simply, the current Government has been a disaster for the health service. I commend my colleague, Deputy Kelleher, on his introduction of this Private Members' motion, which seeks to highlight the current crisis in health care. The facts speak for themselves, as the latest figures show that, despite the diminished expectations, realistic targets are not being met. Despite the additional measures announced in April, the situation in emergency departments is worse now than at the same time in 2014. No amount of Government spin can conceal the stark reality that, year upon year, the number of people waiting an inordinately long time on the lists has increased, with a five-fold increase in the number of inpatient day cases waiting more than a year. For outpatients, the number waiting more than a year is up almost 60% year on year.

The Taoiseach must share a portion of the blame with his Minister for Health, as he promised two years ago that he would take personal charge of the situation. Since then, we have seen a Minister sacked or moved aside, waiting lists have soared, and emergency trolleys have become a constant feature across the country.

In my locality, the waiting lists for Waterford Regional Hospital, as of May 2015, were truly shocking. For outpatients overall, there were 26,553 on the waiting list in Waterford Hospital, but what is really appalling is that 10,886 people were waiting more than a year to see a consultant. April saw a small decrease, but it is still up 1,744 since January, and up 7,767, or almost 250%, since May 2014. These are shocking figures of which the Minister must take note.

We also have the ludicrous situation whereby Kilcreene Orthopaedic Hospital is in danger of being downsized or even closed as the HSE considers centralising elective orthopaedic surgery at Waterford University Hospital. I call on the Minister to give a strong commitment to the hard-working staff in Kilcreene that orthopaedic services will be maintained at this first-class facility indefinitely.

I have personally heard grave concerns from staff at one of the most efficient rural hospitals in the country, St. Luke's in Kilkenny, regarding the trolley crisis, from which we never suffered for years until now. The Government must fund the health service adequately so that the demand from the sickest in society can be met.

As a support mechanism for our tireless front-line staff, the Government must increase staff numbers so that overcrowding can be eased. The continuing difficulties endured by our patients and staff in hospital departments must be addressed as a matter of urgency as the busy winter period eerily approaches. The Minister has an opportunity now. There is a budget coming up and we hear much about the goody bags that are being handed out every day and announcements day in, day out about what is being done over the coming months, and everyone has great expectations. What more could we expect than that the patients in hospitals and on waiting lists will get a fair deal? The Minister has an opportunity to go back to the Government and make a demand for adequate funding to get rid of these waiting lists on which thousands of people have been waiting for well over a year for elective surgery. I ask the Minister to do it and to try to make a change for these people who have been waiting for so long.

Minister for Health (Deputy Leo Varadkar)

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

acknowledges:

— that improving waiting times for scheduled and unscheduled care are key priorities for Government;

— the wide-ranging set of actions which are being put in place by the Health Service Executive (HSE) to achieve improvements in the delivery of both scheduled and unscheduled care;

— the difficulties which overcrowding in Emergency Departments (EDs) cause for patients, their families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances; and

— that optimum patient care and patient safety at all times remain a Government priority;

notes in particular that:

— the Minister for Health convened the ED Task Force last year and the publication, in April 2015 of the ED Task Force action plan, with a range of time defined actions to (i) optimise existing hospital and community capacity; (ii) develop internal capability and process improvement and (iii) improve leadership, governance, planning and oversight;

— the significant progress made to date on the ED Task Force plan is as follows:

— delayed discharges are reducing steadily from 830 in December last year to 586 on 15th September, and the average number of patients waiting greater than 9 hours on a trolley in August was 97, down from 173 in February;

— waiting times for Nursing Home Support Scheme (NHSS) funding have reduced from 11 weeks at the beginning of the year to 4 weeks;

— transitional care funding has continued to support 1,903 approvals, which is significantly above the original target of 500;

— over 1,200 additional home care packages will have been provided by the end of 2015;

— 149 additional public nursing home beds and 24 additional private-contracted beds are now open; and

— in addition, 65 short-stay beds have opened in Mount Carmel Community Hospital, which was officially opened in September;

— in June, the HSE reported a performance against the Minister’s 18 month maximum permissible waiting time of 99.6 per cent for inpatient and daycase treatment and 92 per cent for Outpatients’ Department (OPD);

— in order to maintain progress and make further improvements to achieve a 15 month maximum waiting time by end year, the HSE has directed that hospitals which breached the 18 month maximum waiting time in August are to be fined. The fines will be calculated on the basis of the activity-based funding cost of each procedure and are being imposed from 1st September;

— the HSE has provided 1,004,329 inpatient and day case treatments and 2,176,365 outpatient appointments up to the end of August this year - an increase of 3,461 inpatient and daycase treatments and 39,879 outpatient appointments compared to the same period in 2014;

— the provision of additional funding in 2015 to relieve pressures on acute hospitals is as follows:

— €74 million in April 2015 which has supported significant progress to date on reducing delayed discharges and lowering the waiting time for Fair Deal funding, as well as providing additional transitional care beds and home care packages to provide viable supports for those no longer needing acute hospital care; and

— €69 million in July 2015 - €18 million to support the acute hospital system over the winter period by providing additional bed capacity and other initiatives to support access to care and €51 million to ensure achievement of the maximum permissible waiting times for scheduled care;

— this additional funding came on top of measures already taken in Budget 2015, when the Government provided €25 million to support services that provide alternatives to acute hospitals;

— all of the funding referred to above is additional to the welcome increase in the total financial resources made available to the HSE by the Government in 2015;

— a series of campaigns are ongoing to attract frontline staff in order to meet patient care requirements:

— since January this year, around 500 more nurses are working in the health service;

— since September 2011, almost 300 additional consultants have been appointed to acute hospitals around the country, including 57 more this year;

and

— the number of Non-Consultant Hospital Doctors (NCHDs) employed in the health service has increased by over 250 since last year;

— the National Treatment Purchase Fund (NTPF) as it operated under the previous Government did not succeed in eliminating long waits;

— Fianna Fáil’s alternative budget last year provided only €300 million for health, which is much less than will be provided by the Government; and

supports the Minister for Health in his continued determination to bring about improvements in urgent and emergency care services and in hospital waiting lists.

I welcome the opportunity to update the House on what the Government is doing to improve access to services in our acute hospitals and to address the significant pressures they are experiencing. There can be no dispute that too many people are waiting too long, and many emergency departments experience overcrowding. This causes difficulties and distress for patients and their families at the moment they need access to our health service. It also makes the working day much harder for staff. That is why dealing with the problem or, at least, alleviating it is a key objective for the Government.

This is not a new problem. Long waiting times and trolleys have been features of our system for many years and are the most immediate and obvious indication of the pressures on our health service and the poor organisation and variability in practice and excellence. When Deputy Martin was health Minister with a budget and staffing levels that increased exponentially every year little, if anything, was done to address these problems or, at least, nothing that had a lasting impact. Waiting times and trolleys are not the same problem, and people often conflate them. However, increased emergency presentations can lead to scheduled activity being displaced, while delays in diagnosing or treating illnesses can result in a greater need for emergency intervention. There are also links with services and capacity in primary and community care, which support people to move out of hospital to home or residential care, or to stay out of hospital in the first place by getting the service they need in a more appropriate setting, such as a primary care centre or in another community setting.

That is why dealing with these problems will not be done merely by targeting one area. It needs a combination of immediate measures to target the pressure areas, and also long-term, sustainable solutions. These include addressing: the unacceptably long times that some patients have to wait for outpatient clinic appointments, procedures or diagnostics; emergency department overcrowding; delayed discharges; winter planning to increase capacity in hospitals; and recruitment into the health service. Before I talk about these, it is worth acknowledging the sheer volume of activity in our acute hospitals. This year, so far, over 1 million inpatient and day-case treatments have been provided, more than the same period last year. There have been nearly 2.2 million outpatient attendances, nearly 40,000 more than last year. Rather than being cut back, our health services are expanding and activity is increasing. Unfortunately, demand is also increasing.

The fact that activity has not only kept pace with but improved on last year should be welcomed. However, waiting times for many patients remain far too long. In January, I put in place maximum permissible waiting times for routine inpatient and day-case procedure and outpatient appointments of 18 months by 30 June and of 15 months by year end. These are not targets. The targets remain as they were before, and the international standard is that nobody should wait for longer than six months. These are maximum permissible waiting times, which is a different thing. These are not good enough either, and I am the first to say it, but they are realistic and reflect the need to focus on dealing with the longest waiters. Emergencies and urgent cases always have priority over routine ones.

I am pleased to say that in June, the HSE reported a performance against the 18-month maximum of 99.6% for inpatient and day cases and of 92% for outpatients. We always acknowledge that for certain sub-specialties in particular where the capacity does not exist either in the public or private sector, it would be difficult to achieve. However, what was achieved was achieved by working with the hospital groups to focus on maximising internal capacity and, where necessary, on targeted initiatives. It is important to understand that when we count numbers on waiting lists, they include a large number of duplications and people who have already been treated or no longer require treatment. A hospital recently did a validation exercise of its waiting list and found that between 25% and 30% no longer needed treatment or had had it elsewhere.

Although I need to confirm this and examine it in more detail, when the party opposite was in office and waiting lists were calculated, it did not include people who had been waiting less than three months. They were not counted. This changed in 2011. This adds hundreds of thousands of people who would not have been included in the figures before 2011. While I want to get confirmation of it, if what I believe to be correct is correct, I will certainly come back to the Deputy on it.

Deputy Kelleher specifically raised the issue of a patient with cancer who waited on a trolley for four days. I asked for a report on it, it was investigated and we cannot confirm it. A patient was found to have spent three days in an individual room in an emergency department. The patient was admitted for other reasons than cancer and the doctors took a decision on clinical grounds that it would be better for the patient to stay in that room than be on a ward with other patients. Sometimes, the stories one reads in the newspapers are not true, particularly regarding horror stories in health. Very often they are true, but not always. I ask Deputy Kelleher, as an experienced Deputy and former Minister, to bear this in mind. Last week, there was a story about two wheels falling off an ambulance. Although I do not yet know exactly what happened, I know two wheels did not fall off the ambulance. This is par for the course, unfortunately, in our health service. Maybe some people believe it improves matters; it does not.

The Deputy also raised the NTPF and how it worked. It did not work. We had the NTPF for a very long time, and there are still people waiting very long periods of time - years in many cases - because the NTPF was self-selecting. People would telephone after a number of months on a waiting list and some went privately. Many perverse disincentives were connected to it. It never succeeded. Many people received treatment under it and it had a massive budget of €100 million at one stage. However, it never succeeded in eliminating long waiting lists. The more targeted approach we have now is to identify those who have been waiting for very long times and find solutions for them.

The HSE is working with hospital groups towards the new maximum waiting time of 15 months by year end. It has also directed that, from September, hospitals which breach the 18-month maximum waiting time will be fined. The cost of individual procedures and appointments will be diverted away from non-performing hospitals to a hospital where the procedure or appointment can be performed, principally in public or voluntary hospitals. It is essentially money following the patient. An additional €51 million provided by the Government to achieve these targets, on top of the funding already provided, demonstrates the absolute priority we place on improving waiting times. All hospital groups are engaging with the HSE on finalising their plans.

For the small number of specialties where it is not possible to meet the maximum waiting time because of a shortage of specialist staff in both public and private sectors or the availability of appropriate pre or post-surgical supports, alternatives such as outsourcing are being pursued, including the potential of outsourcing abroad. For example, capacity in Dublin public and private hospitals has been identified to address particular pressures in scoliosis surgery capacity, which the Deputy mentioned. Some are being done in Blackrock and Tallaght, not just in Crumlin. A new theatre is under construction in Crumlin to allow us to increase capacity from March next year. There is continuing collaboration to identify further external capacity to ensure the 15-month maximum waiting time for these patients is met. This is in addition to the specific measures already in place which include observing the national waiting list protocol, prioritising day-of-surgery admission where clinically appropriate and adhering to the relevant HSE national clinical programmes guidelines. The clinical programmes have a central role in working with hospitals and other service providers on initiatives that will provide safer, more cost-effective services, reducing the amount of time patients have to stay in hospital and enabling the management of chronic conditions outside of hospital settings, thus freeing up capacity for those who require acute care.

There is always a requirement to manage the balance of scheduled and emergency activity in hospitals. This will be the case as long as hospitals have emergency departments. Particular problems can arise in hospitals that provide specialist services, where it is necessary to prioritise not only emergency and trauma surgery but also cancer and complex non-urgent cases.

Inevitably, this will affect waiting lists. The challenge is to manage the impacts. New patient care pathways such as medical assessment, minor and local injury units and urgent care centres and the provision of care in non-hospital settings are increasingly used to support the efficient use of hospital resources. The national clinical programmes have a key role to play in this work and are working with the Irish hospital redesign programme which was established recently to drive local change and innovation.

Clearly, the number of delayed discharges in hospitals has an impact on the availability of beds for elective and emergency admissions. In December I established the emergency department task force, which comprises senior doctors and lead hospital consultants, union and patient representatives, senior executives from the HSE and officials from my Department. In April a plan was published, which sets out a wide range of actions for both immediate and longer term impacts. Based on the task force action plan, the Government provided additional funding of €74 million to alleviate delayed discharges. This came on top of the €25 million provided in budget 2015 to support services that provided alternatives to and relieve pressure on acute hospitals. This additional funding underlines the strong priority we are placing on this issue. Delayed discharges are reducing steadily. The latest figure is 586, which is a seven-year low and compares with a high of 830 in December. It means that we have freed up 250 beds a day that can now be used by acutely ill patients but which were previously unavailable.

There will always be a certain level of delayed discharges. The figure will probably always come to several hundred. Those who have worked in hospitals and elderly care services can explain why that is the case. It takes a few weeks to set up a home care package. The home adaptations that are sometimes needed can take a few weeks or months, even when this is done quickly. Patients who need to go to nursing homes have the right to visit various facilities with their families in advance of being discharged from hospital - they should be able to see one or two, at least - in order that they can decide which is the right nursing home for them. If someone is going home to a carer who needs to give up his or her job or change his or her working conditions, that carer will have to give notice. Of course, issues can arise regarding wards of court. It will never be the case that there will be no delayed discharges. That does not happen in any country in the world of which I am aware.

Deputy Billy Kelleher

Some €2.50.

Deputy Leo Varadkar

-----and Fianna Fáil's proposals, with Deputy Kelleher as health spokesperson, provided only an additional €94 million for health. We will spend multiples of that by the time we get to the end of this year. They also managed to cut €1.5 billion from health between 2008 and 2011 while we held it steady and now that the economy is recovering we are increasing it. A strong economy is a prerequisite for better funded services which is why it is so important that we stay the course with our economic policies and the economy remains strong and is not handed over to those who would wreck it again.

The Sinn Féin plans for 2015 had austerity written all over them. Sinn Féin proposed no increase at all in the Exchequer allocation for health and no provision for GP care for those aged 70 or over. By all means let us have a debate about the health service but let us have an honest one and a grown up one.

Deputy Billy Kelleher

Hear, hear.

Deputy Bernard J. Durkan

I am glad to have the opportunity to speak on this very important issue. I feel sorry for the Opposition which raised this issue but I thank it for giving us the opportunity to assess and examine what is a very challenging situation, that of the provision and delivery of health services in this country. This has been challenging for some considerable time, no more so than during Fianna Fáil's own term of office, when all of the issues that have been raised tonight and which will be raised tomorrow evening regarding bed occupancy, waiting times, patients waiting in hospital corridors and so forth were also of concern. The difference then was that it was in the middle of an economic boom when money was falling out of the sky. The sad fact is that the incoming Government had to take up the challenge where the outgoing Government left off, having failed to deliver in a boom and having pretended that the incoming Government could expand and do the impossible.

The sad part of it, from its point of view, is that the incoming Government did just that. The progress that has been made is extraordinary given the very challenging circumstances that this country and Government have faced over the past four and half years. It is to the eternal credit of the people in the health services that they have managed to provide a service of such quality in that period. We all realise that waiting times are unacceptable, that patients waiting in corridors and waiting for elective surgery for long periods of time is unacceptable. It was always unacceptable but I remember dealing with such situations, as do all Members of this House, five, ten and 15 years ago. I refer particularly to elderly patients awaiting surgery who are in severe pain. It is all very fine for us to stand up and say we will do something about this and members of the Opposition to say they will do a great deal about it when we know they can do nothing about it because they did nothing about it in the past. The self-same pain was suffered by many patients during their period in office - severe pain. We all had patients coming to our clinics asking if we could do anything about it. All that we could do was put down a parliamentary question to try to ascertain when something might happen.

I want to compliment the Minister and his predecessor for the attempts they have made, in a time when there was no money, to address the issues of increasing demand, a growing population and an increasing number of requirements in terms of surgical and medical procedures. The Minister has referred to recent initiatives which I saw in action in my own local hospital in Naas. In January the accident and emergency department was vastly overcrowded, with many patients on trolleys. There was a reason for that. Quite simply, there was a reduction in the number of beds available. Fortunately, it was possible for the hospital to set about recommissioning a number of beds that had been decommissioned some years previously. That is now achieving results. The results are visible. The Minister correctly identified the necessity of recruiting more staff which is being done at the present time. Those kinds of practical actions will have the effect of alleviating the concerns of patients and their families as well as the burden on the health service providers in trying to meet increasing demands and needs.

It is not really possible to deal with this issue in a short few minutes. I would like to see more step-down beds in both the public and private sectors. We should never eliminate the possibility of having healthy competition between the public and the private sector in the context of step-down beds. Indeed, we should encourage healthy competition between the public and private sectors in all areas of medicine and hospital care. If we do that, we will have achieved a great deal.

I want to compliment the Minister on the work done so far. I am quite certain that if he is allowed to continue, the achievements of the past four and a half years will be increased tenfold in the time ahead.

Deputy Derek Nolan

I am particularly delighted to be able to speak on this very important motion. I thank the Opposition parties for tabling it because we should be debating our health services and discussing the real concerns that people bring to our attention at our clinics and on the doorstep, as well as the everyday experiences of our family members, friends and people we know in the community. When we talk about the health service, those of us on the Government side should not speak with bombast or vitriol or with any kind of holier than thou attitude. It is our job - particularly those of us supporting the Government - to be realistic and not to engage in cynical tactics. However, that is not to say that the Opposition has not got a case to answer for the wreck that it left the place in. That is not for me to point out; that is for the public to draw their own conclusions on.

I must say, as someone who is a representative of a constituency which has a number of people who will be on trolleys tonight, that the public health service that we have at the moment simply is not up to scratch. That is not a condemnation of those who are working particularly hard, including the Minister, to try to improve the service and make it better. It is simply an acknowledgement that the system we currently have and which we inherited is a mixture of public and private patients going through a hospital system that does not know whether it is public or private, that does not know who its ultimate master is or whether it has political, governmental, clinician or consultant leadership and which is not going in a direction which it ought to follow. However, we see that change is happening, for example, in my own area with the Saolta hospital group. We see that there is finally a sense of purpose in terms of what hospitals should be doing, what components of hospitals should be doing, what particular hospitals in a network should be doing and how we can better use our valuable and scare resources to provide a better service. That said, those lofty goals and good words mean very little to someone who is in the emergency department in Galway University Hospital today. That is a place I know only too well, having been there a number of months ago with my father who spent a night on a trolley. While there I watched the staff in the emergency department doing trojan work. They were literally running from patient to patient in the emergency department and were working in extremely difficult circumstances. They worked to the best of their ability and tried to provide as much dignity, care and courtesy to the patients under their care as possible. The staff must be given recognition for the work they are doing in all areas of the hospital network and in our health service generally.

It is for those of us in government to provide leadership and to provide a path out of the current mire and the current difficulties. Simply continuing to do as we always have done in the health service is not going to bring us to a position where things will change. I must commend this Government on promoting the idea that the hospital system cannot be the be-all and end-all of our health services. A hospital should be the place to which a patient goes as a last resort. We have introduced, in the face of staunch opposition from those on the opposition benches, universal GP care for children under six and people over 70, with the express intention of expanding that to include everybody, so that people never have to worry about having €50 to see a GP. That should never be a worry for people in this day and age. We are moving towards a new model of care.

We must resource doctors properly in order that they can do many of the things currently done by the hospital system at emergency level. We must resource primary care centres to ensure they have equipment that ensures people avoid having to present in emergency departments or avail of hospital services. According to the old adage, the purpose of medicine is to prevent rather than cure.

I could not let the moment go without acknowledging that the Minister has visited University Hospital Galway and spoken at length to staff, including consultants and managers. I commend him on taking the time to visit the emergency department and I am aware that he spent a good deal of time in the unit and it made an impression on him. I have also asked the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, to visit the hospital's emergency department, speak to management and observe the difficulties in the unit. The department is completely out of date, as the Minister is aware, and does not comply with Health Service Executive safety requirements. In addition, it does not offer patients dignity or meet the various requirements that emergency departments are obliged to meet.

I understand the capital plan for the health service will be published in the coming weeks and months. I plan to tell every Minister and Government party Deputy I meet that it is crucial that a new emergency department for University Hospital Galway is included in the capital plan. The existing run-down and broken facility must be replaced in order that patients, staff and everyone else who comes into contact with the department are treated with the dignity they deserve as citizens, patients and human beings.

Deputy Caoimhghín Ó Caoláin

Four and a half years after taking office and probably weeks from a general election, this Fine Gael-led Government, with the so-called Labour Party in tow, has demonstrated, as no Government before it, that no matter how one dresses it up or who one puts forward to front the health service, without a coherent health policy, the result will be a shambles, and so it is across key areas of the health system today. While so many work so hard, as must be acknowledged with great sincerity, and give of their very best and even more, we have a health system that is unable to cope or meet the needs of the population and is abandoning targets week after week.

The word "crisis" has become synonymous with the health service in the minds of hundreds of thousands of citizens. These are, in the main, people who are dependent on the public health system, most of whom cannot afford to buy fast-track access to consultations and necessary procedures. Many have had to suspend their working lives for months on end awaiting access to services and these waiting lists are set to continue and grow. Each and every one of us knows some of the people of whom I speak from our constituencies and communities. They are real people. From my observations, the designation of non-emergency or elective cases for certain conditions fails to take into account properly the debilitating reality for suffering patients - and suffer they do, as do their families, especially dependants, in many cases for long periods.

The figures for trolley use coming from many of the largest hospitals over the so-called summer months, now past, must ring alarm bells at hospital management and HSE governance level as well as within the Department. If, however, these bells are ringing, it is clear that no one is listening. Extra beds are not enough and the 300 recently announced beds would not even begin to address the problem, even if the necessary additional staffing were in situ, which it is not. The nurse recruitment campaign entitled "Bring them Home" is a dismal failure. We have lost a generation of Irish-trained nurses to hungry recruiters overseas and they are not coming back with the lifting of the embargo. Much more needs to be done to entice anywhere close to the required numbers to resettle here. While salaries are not everything, they remain a key consideration alongside working conditions, the hours to be worked and the career advancement pathways that many in nursing now seek.

We have a critical shortage of consultants across many specialties and we are unable to hold on to many locally trained doctors, resorting instead to recruiting in other countries. I regret to note that we do not always ensure the required communications skills of those so recruited meet our population's needs. That is often an issue presented to Deputies and other elected representatives at locations nationwide.

As with Irish-trained nurses, Irish-trained doctors measure the attractiveness of any employment prospect not only by the level of remuneration but also by working conditions, adherence to the European working time directive and the prospect of achieving career development and advancement, including to consultant roles across the network of hospital sites. We have a serious under-provision of consultant posts, notwithstanding the Minister's comments on this issue. Moreover, a significant number of approved posts remain unfilled. As the Minister and I both know, nurses, doctors and beds are the A, B and C stuff, yet four and a half years after taking office, the Government has failed to appreciably address these needs.

The serious lack of supports for older citizens, especially those who are challenged by dementia, including the serious under-provision of long-stay public nursing home beds, shows contempt for senior years members of our families and communities and is doubly contemptuous given that many of them, having been hospitalised, are retained in acute hospital beds for months and insultingly referred to as bed blockers by some political voices and commentators. We would all do well to remember that many of these older people have given a lifetime of work and service and contributed of their best to society and the economy.

Were it not for the initiative - I note the remarks made by the Acting Chairman, Deputy Durkan, when he addressed this issue - of the private sector in developing private nursing home opportunities, where would many of our loved ones be who are beyond living either alone or largely alone in safety and with their dignity intact?

As a State, we are abrogating our responsibilities to our older citizens and we are depending more and more on the private sector to bail us out of those responsibilities. Delayed discharges are a consequence of Government failure, and a failure of successive Governments. This, in turn, contributes to fewer beds being available for those who really need them. I have checked the statistics for the hospital group that covers my constituency area and there were 175 such beds across the RCSI group of hospitals as of 8 September 2015. I understand this is not the worst example across all the groups as of that date or indeed generally. That was 175 beds across the RCSI group of hospitals on that date that could have been taken up by people in our emergency departments awaiting access to hospital beds or those on trolleys or in other inappropriate placements. Emergency department overcrowding and, again, the inappropriate placement of patients on trolleys and in chairs along our hospital corridors are consequences of this failure. What is ahead of us with the winter months looming? We can only be facing into yet another winter of discontent with more and more patients on waiting lists, on trolleys and in distress. The greatest number of these will come from the more financially challenged sections of our society. With ever widening health inequalities in evidence, the time ahead will be difficult for those in need of care and those who are expected to provide that care. We need to listen to the alarm bells.

Deputy Michael Colreavy

In a democracy, there should be dialogue between the policy decision makers and the people regarding the level of public services the population needs and wants and the extent to which the population is prepared to pay through taxation for those public services, including access to good education, access to safe warm homes, adequate income to raise a family and access to quality health care when needed. Since the beginning of austerity, our health services have been subject to death by a thousand cuts. I do not envy the Minister his job in trying to resurrect the health services again, which is what this is about. If the maxim of the hippocratic oath is to first do no harm, it is certainly not the maxim of our current political or governance systems. This is disappointing because following the 2011 election, we were promised there would be a democratic revolution, that things would be done differently and that there would be a caring Ireland in which the Government would do its utmost to ensure the well-being of its citizens. However, a different reality has emerged since 2011 and the Fine Gael and Labour parties have ensured that our health service has been downgraded.

Between 2008 and 2014, some €4 billion was cut from the service. It is an extraordinary amount of money. There are 12,000 fewer staff in the HSE compared to 2007. There are fewer people to care for the old, the young and the vulnerable. There are fewer people to deal with life-threatening illnesses and fewer to deal with those who have been in accidents. Since 2010, some 5,200 nursing posts have been cut. How can hospitals prepare to provide care for patients with cut after cut after cut? It is unfair on the excellent staff in our hospitals to expect them to cope. It is little wonder that morale is a big problem in our hospitals. Others have spoken about the situation of ill patients being placed on trolleys for days before being given a bed on a ward. They spoke of emergency departments where patients cannot be moved on because beds are not available. There are totally inadequate community services. How many people are in hospital who could be in the community if we had adequate community services?

I will be parochial for the minute I have left. Sligo Regional Hospital has an excellent emergency department with excellent staff but the numbers on trolleys are creeping up and up. God help us when the flu hits. There are 400,000 people on outpatient waiting lists. It is wrong and the Minister knows it is wrong that people should have to wait for up to four years to get a diagnosis let alone begin a course of treatment. The Minister is a straight thinker and a straight talker. I believe he would not deliberately mislead the Dáil or the people. It was not so in the run-up to the 2011 election. The candidates for the Fine Gael and Labour parties promised the people of Sligo, Leitrim, south Donegal and west Cavan that breast cancer services would be restored to Sligo General Hospital as it was then called. That promise was broken. They promised that mammography would not be taken from Sligo General Hospital but that promise was broken and mammography was taken from it. Now, Sligo Regional Hospital needs a cath lab if the people in the constituency I represent are to have the same right to health as the people south of the Dublin-Galway line. That does not seem to be happening at this point in time. That needs to happen for the people I represent.

Deputy Maureen O'Sullivan

We have a very significant health budget which one would imagine would translate into a state-of-the-art health service. While we have very professional, hard-working and committed staff and excellence in certain areas, including, I acknowledge in particular, in the treatment of cancer, the stark reality is that we do not have a state-of-the-art service and there are glaring deficiencies. I looked first at the Government amendment. I could accept certain aspects of it if we were at the start of a Dáil term and the Minister was setting out his aims and objectives to improve waiting times, the actions to bring about improvements in the delivery of care and the goal of optimum patient care and safety as a priority, but we are coming to the end of a five-year term and we must ask what has happened to those aims since March 2011 and what progress has been made. Looking at other aspects of the Government amendment, I note the reference to significant progress in relation to delayed discharges, nursing home support schemes, home-care packages, nursing home beds and waiting times. This brings us to the disconnect between what is presented as statistics and fact and the reality on the ground. The reality is that people are still waiting unacceptably long times for procedures. I am reminded today of a call from somebody for whom a hip replacement was recommended last March. She is still waiting on the appointment with the surgeon even to get the date, which will be even further on. In the meantime, her situation has worsened and she now cannot work. She is not working, she is not paying tax and she is not contributing to society but is a burden on it.

We know about the shortfall in staff and the crisis in attracting nurses, in particular our own trained and qualified nurses either to stay in or return to Ireland.

I spoke with a past pupil who trained as a nurse in DCU and went to Australia. While the monetary incentive was encouraging, her point was that the working conditions in Ireland would have been unacceptable at the hospital in which she worked in Melbourne. Given how much is spent on providing our nurses with excellent training, the amount spent on employing agency nurses is a waste of resources.

The Fianna Fáil Party's proposal focuses on waiting lists, particularly in accident and emergency units. I will discuss an aspect with which I am familiar, that being, addiction. Accident and emergency units are not the place for those presenting with drug and alcohol addictions. In many, although not all, cases, the behaviour of the addict can be threatening and aggressive. Accident and emergency units should not be dealing with those in addiction. It is not fair to the addicts, the other patients presenting or the staff. If we had a designated accident and emergency unit for those in addiction, there might be links and follow-ups for addicts to get them out of the cycle of addiction. Currently, an addict receives a blood test and, if necessary, X-rays, and he or she is put on a drip for a few hours before being sent back into society until the next fix goes wrong or the next binge. We know the difference that recovery makes. A designated accident and emergency unit could be the start of that.

Accident and emergency services are inadequate in another regard, that is, people with intellectual disabilities. There is no designated intellectual disability nurse in accident and emergency units to assist. I attended today's Irish Nurses and Midwives Organisation protest outside. I met people I knew who highlighted the cuts to intellectual disability services. The reduction of 9.4% in the budget translated into €160 million. There have been reductions in staff numbers, the respite care grant, the housing adaptation grant and speech and language therapy. People told me that more than 5,000 children with disabilities would require speech and language therapy for the first time in the next four years. This is not to mention the waiting list for occupational therapy and physiotherapy. For three days last week, people with physical disabilities campaigned outside the Dáil. At least they have their own voices with which to present their issues. Those with intellectual disabilities, many of whom also have physical disabilities, have serious and additional challenges. Last week's protest by those with physical disabilities was to highlight the inequalities and poverty that they faced. Mr. Martin Naughton, who led the campaign, asked the Taoiseach to listen to the voices of people with disabilities who wanted to live independently away from residential care. Self-determination was at the heart of their protest.

I wish to mention a point about hospitals that was not raised in the motion or the amendment, namely, food. An inordinate amount of money is wasted on the kinds of food presented in our hospitals. According to some studies, if a hospital gets the food right, other bills are alleviated. It is wrong that we have a health service in which it is safer to be out of hospital than in hospital. People who go to hospital should stay longer for more care, but they are told that it is safer and healthier for them to be out of hospital.

Debate adjourned.

The Dáil adjourned at 10.25 p.m. until 9.30 a.m. on Wednesday, 23 September 2015.

Dáil Éireann debate - Tuesday, 22 Sep 2015

Hospital Waiting Lists: Motion [Private Members]

Dáil Éireann debate -
Tuesday, 22 Sep 2015