Hospital Emergency Departments: Motion (Resumed) [Private Members]

The following motion was moved by Deputy Billy Kelleher on Tuesday, 10 November 2015:
That Dáil Éireann:
agrees that:
— prolonged waiting times in emergency departments are associated with poorer outcomes for patients;
— the safety and quality of patient care must be a primary focus and timeliness is a crucial component of quality care;
— patients should receive a high standard of treatment irrespective of when or where they seek emergency care and they should not experience excessive waiting times in emergency departments;
— elderly patients, in particular, should not be waiting more than six hours; and
— consultants are obliged and entitled to highlight conditions that may jeopardise patient care;
recognises that:
— last month was the worst October on record with 7,971 admitted patients cared for on trolleys; and
— over the first 10 months of this year almost 80,000 admitted patients were on trolleys;
notes that:
— the April 2015 initiative, while reducing waiting times for the fair deal and the number of delayed discharges, has not reduced the overcrowding in emergency departments; and
— the introduction of a system of fines to penalise hospitals that do not meet non-emergency care targets could further aggravate the difficulties in emergency departments;
calls for the Government and the Health Service Executive to:
— ensure safe, adequate and consistently available staffing levels for all emergency departments;
— recruit additional designated staff to look after admitted patients who are on trolleys;
— ensure the total patient time spent in the emergency department is less than six hours;
and
further calls for:
— the recommendations of the 2012 Health Information and Quality Authority report (entitled Report of the investigation into the quality, safety and governance of the care provided by the Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital [AMNCH] for patients who require acute admission) to be fully implemented; and
— the strategy to improve safety, quality, access and value as set out in the 2012 national emergency medicine programme to be implemented.
Debate resumed on amendment No. 1:
To delete all words after “Dáil Éireann” and substitute the following:
“acknowledges:
— that improving waiting times in emergency departments, EDs, is a key priority 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 care in EDs;
— the difficulties which overcrowding in 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 director general of the HSE is co-chairing the ED task force implementation group from now until March 2016. This is to ensure that all relevant parts of the health service, including acute, social and primary care, are optimising resources to deal with the particular challenges associated with the winter months;
— 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 567 on 3 November and the average number of patients waiting greater than nine hours on a trolley in October was 115, 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 three to four weeks;
— transitional care funding has continued to support 3,000 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;
— in addition, 65 short-stay beds opened in Mount Carmel Community Hospital in September;
— 270 of 300 additional beds funded under the winter capacity initiative will open by the end of November. The remaining 30 will open in February 2016; and
— 129 hospital beds which had been closed for refurbishment or for infection control purposes during 2015 will be reopened by the end of November;
— the HSE has provided over 1,400,000 inpatient and day case treatments and over 2,400,000 outpatient appointments up to the end of September this year – an increase of 8% inpatient and day case treatments and 2.3% 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; and
— a series of campaigns are ongoing to attract front-line staff in order to meet patient care requirements;
— in the past 12 months there are over 500 more nurses working in the health service;
— since September 2011, over 300 additional consultants have been appointed to acute hospitals around the country, including 78 consultant appointments this year;
— the number of non-consultant hospital doctors employed in the health service has increased by 338 since last year; and
— ED consultants have increased by 30 since 2007; and
supports the Minister for Health in his continued determination to bring about improvements in urgent and emergency care services.”
- (Minister for Health).

The Technical Group has the next slot and has ten minutes in total. I call Deputy Clare Daly.

I will take the first slot.

Ireland's reduction in health expenditure in recent years was the most dramatic in the OECD, with the exception of Greece. The OECD stated recently in a report that in 2013, after Greece, Ireland's expenditure on health declined most out of all 33 members. Between 2005 and 2009, Ireland was increasing the amount it spent on health care at an average rate of 5.3% per annum. However, from 2009 to 2013 the rate of increase decreased by 9.3 percentage points to -4%. In total, the 33 OECD countries spent €737 billion on drugs in 2013. The Irish bill was the seventh highest, with €600 million spent on over-the-counter and prescribed medicines in 2013. In 2014, the European Commission called on Ireland to spend less on patent medicines after a report found that the amount of public moneys being spent on drugs was well above the EU average. The drug companies have been tackled and some concessions have been granted on prices, but the statistics show that a more aggressive approach will have to be taken by the Minister to put prices on par with those in the United Kingdom and other EU countries.

There are some astounding figures pertaining to patients on the outpatient waiting list. Over 404,000 are currently on that list. Some 68,000 are waiting for inpatient or day case treatment. These are the up-to-date figures. The problem is rampant and I ask that it be addressed. The Minister is trying to address it by outsourcing over 20,000 appointments to the private sector. However, to be fair, these are astronomical figures, and it is inexcusable that they have been allowed to escalate to this level.

Vincent Browne had a People's Debate in Wexford on Monday night. A man called George McAnaspie stood up and said that when his wife Mary had gone to Wexford General Hospital in December 2014 with pneumonia, she had waited 12 hours in the accident and emergency department before being told it would be another four hours before she could be seen. The couple missed their bus back to Ferns. Mary was too sick to wait any longer in the accident and emergency unit and left to go to her sister's house. The couple went to Florida a few weeks later in December to see their children and Mary collapsed with heart failure. She had a triple heart bypass operation in America, followed by an operation to install a pacemaker a few days later. Pneumonia resurfaced three weeks ago on 15 October and Mary ended up having to spend ten days in Wexford General Hospital with congestive heart failure and pneumonia. At that time, her husband received letters stating their medical cards were under review. He sent off two letters outlining the details of Mary's condition. He arrived home to find two GP visit cards in the post. He went to the pharmacy to buy monthly medication and was informed that the medical cards had been stopped while under review and replaced with GP visit cards, which cannot be used to purchase medication. Mary's medication costs between €500 and €600 every month and the couple cannot afford it. The medical card application is currently under review and the couple expects a decision in the next week or so. I do not need to add very much other than the fact that the HSE is seriously dysfunctional and may be beyond repair.

I commend Deputy Kelleher on the motion. Accident and emergency units around the country are chronic at the moment. I am not saying it is not a question of money but I firmly believe it is a question of organisational skills. There has to be a full root-and-branch analysis of what is being done. In response to any letter representing a person in need of a hip replacement, a Deputy gets the same waffle back. It is stated that if the person deteriorates, he should go to his doctor, and that if it gets worse the Deputy should contact the HSE. It would be better off if the officials wrote, "Leave him in pain". It is as simple as that; that is what they are saying to us.

There is a three-year waiting list for orthodontic treatment for young children. That is the reality of what we are dealing with. With regard to hearing and eyesight tests, there is a state of disarray. Two children in my constituency need a spinal operation but nobody is listening to them or examining them. With regard to trolleys, the service is in chaos. The hospitals in Ballinasloe and Galway have patients out the door.

We have to start with a root-and-branch analysis of the health service. When we train a doctor, are we to let him or her go to Australia or not? If €500,000 is spent on training a doctor, are we to say to him or her, "Away with you and good luck to you". Should there be no patriotism or payback to one's country?

Why do we not consider the circumstances of general practitioners? Their representatives were in last week. A general practitioner could take over a rural practice at present but would not get the rural allowance. There should be a full analysis of where we are going in the health service.

For Deputies, what is happening is frustrating and disgusting. I am sick to the teeth of getting back lovely one-liners stating that the Minister is not responsible for the issue raised. When one writes to the Minister highlighting an issue, one is told the HSE is responsible. When one writes to the HSE, one gets another letter in response. I am sick of seeing the names of the same people writing the same stuff in response. All one has to do is put a name at the bottom, and the same words come in every letter. That is disgusting. We are going nowhere.

Someone has to start calling the shots. As I stated, I do not believe it is a question of money. We are putting layers of bureaucracy in place. I heard of a case where there was a problem but, instead of solving it, we added another layer of management. Front-line staff are not being put on the ground. If this continues, we will see chaotic scenes in the hospitals around the country in January of next year. No one wants to see that.

Last Christmas, there was absolute uproar in Britain because waiting times were the worst in a decade, with only 88.7% of patients being seen within four hours. This motion is calling for a period of six hours, yet the Government cannot even accept that. What does that say about this Government? The reality is that, under its stewardship, we have seen a massive erosion of our health service. The drug payment scheme threshold has been increased by 37% and prescription charges have been increased fivefold. Some 600,000 home help hours have been cut. Home help is the very measure that could keep people out of accident and emergency units. The disability and carer's allowances have been cut, student nurses' pay has been butchered and so on.

In reality, the Government has made our public health system so unworkable and inefficient that people are being forced into private care. That is exactly the scenario that was highlighted by Gene Kerrigan on Sunday when he referred to when the Minister, Deputy Howlin, was Minister for Health. The latter explained at that time that he could not deliver a first-class public health service because, if he did, there would be no reason for sustaining a private system. The implication was that a hospital is not just a place where medics seek to preserve and repair our bodies and minds; it is an investment opportunity.

Chartered accountants JPA Brenson Lawlor boasted recently in a piece entitled "A lovely, simple business plan idea about a fabulous investment in old people" that it was an investment opportunity. It stated:

What about a nursing home investment that yields 15%? Lets look through the check list. There is demand for thousands of new nursing home spaces - check. The Irish population is ageing, guaranteeing a continuing long-term and rising level of occupancy - check. The country has a huge and continuing problem with hospital over-crowding, new nursing homes can fix that. We look at what you can get from a government bond versus what return you'd get from running a nursing home business. Come, talk to us; come along.

That is what we are talking about - rationing our health service and profiting from the misery of citizens. All the research and information shows that a single-tier public health service is by far the best for people's health and wealth and for the wealth and well-being of the nation. It is a disgrace.

The next group comprises Deputies Helen McEntee, Jerry Buttimer, Arthur Spring, Michael Creed, John Paul Phelan, Paul J. Connaughton, Mary Mitchell O'Connor, Liam Twomey and Peter Fitzpatrick, who are sharing time. Is that agreed? Agreed.

I welcome the opportunity to speak on this motion and I thank the Opposition for tabling it. Health is possibly one of the most important matters we can discuss in the House. While we discuss many important things, as the saying goes, "Your health is your wealth". Providing adequate support and funding to those who deliver services within our health system is equally important.

I am not sure the Opposition, including Fianna Fáil, have much room to criticise when it comes to a debate on our accident and emergency departments or any aspect of health. Their track record speaks for itself. The Minister for Health will be in the Chamber later and I do not envy his position. Since coming into Government, the health system has been a very difficult issue to deal with. We were handed something of a poison chalice. I am not talking about those delivering the services, but we have had a dysfunctional system for some time. While we do not want to see a cut in funding, for years money was pumped into the HSE and yet I do not believe the service then was superior to what we have now. It is certainly not perfect but huge strides have been made and many decisions have been taken to try to tackle the problems we face.

I thank the Minister for Health for visiting Navan hospital recently and clarifying, yet again, that Navan accident and emergency department is not closing, despite what many scaremongers are saying. I thank the Minister and his predecessor, Deputy Reilly, for listening to my concerns and those of many of my colleagues as well as the various unions and organisations representing hospital staff, including nurses and doctors. The Minister has tried to implement what has been asked of him. He has tried to allocate more funding when and where it is needed.

Without a shadow of a doubt in many areas we are starting to see where this is working. We are starting to see definite improvements with €117 million in additional funding being allocated to reduce overcrowding. As a result, we are seeing a reduction in delayed discharges while the fair deal waiting time has also been reduced. More than 220 beds are freed up every day and we can see additional improvements in areas that I could list.

The Minister said there are still too many people waiting on trolleys in accident and emergency departments. One of the biggest challenges we face is at Our Lady of Lourdes Hospital, which is not in my constituency but serves many people in my area. One of the biggest problems there is staff recruitment. On my local radio station I regularly discuss the health system, including accident and emergency departments. Every time I go on air I am asked what the Minister has done to try to address the problem since I was last interviewed on the station. In fairness, every time I have been on the radio I have been able to list a number of things and I have noticed the uptake in staff. Specifically for Our Lady of Lourdes Hospital, the INMO, the Department and the Minister agreed a series of provisions whereby additional beds were to be opened up, staff were to receive full pay and additional staff were to be taken on. After a number of months, a small fraction of that staff had been taken on.

Unfortunately, however, we have a double-edged sword here. We are constantly listening to reports about the desperate conditions hospitals are in, the overcrowding, unhappy staff and trolley lists. It is endless. If I were a young graduate leaving college, I would not want to work in that situation. The Minister, the media and everybody else needs to be more positive and needs to encourage people to come into our health system. If so, it would go a long way.

I welcome the Minister of State, Deputy Kathleen Lynch, and compliment her on the work she is doing to reform the mental health system and the area of disabilities. The Government is fixing the health service. It is extraordinary and a bit of a groundhog day when one reads the motion from the Members opposite. When Deputy Martin was Minister for Health, they ran out of Government and out of the Department. We should contrast his tenure in the Department of Health with what is happening today. The Government is fixing our health system despite enormous financial constraints.

We have had wide-ranging reform, including free GP care for older and younger people, and have delivered on a commitment to universal health care. In addition, we are moving chronic disease management of asthma and diabetes into a primary care setting. We are also working to improve patient safety while easing hospital overcrowding and reducing waiting times for public patients. Deputy McEntee referred to early discharges and delays being reduced in the fair deal nursing home support scheme. This is being done at a time when the population is increasing and ageing. We must press ahead with reforms and plan for the future, including a growing number of elderly in the population. The motion before us offers no roadmap in terms of a Fianna Fáil health strategy other than saying it will oppose the Government.

We are committed to delivering the new national children's hospital. In Cork city, we have seen the new mental health unit opened this year. For many decades, mental health was the Cinderella of the health service but it is now being given the opportunity to take centre stage in a new unit in Cork University Hospital. We must examine how we can deliver better governance and the hospital group will provide us with that opportunity. We need to bring about improvements in emergency response times in hospitals, but to that end we require a societal and attitudinal shift. In many cases, our first port of call is the accident and emergency department when it should not be.

People have a simple approach to the Fianna Fáil mantra on health. The former Minister for Health, Deputy Martin, commissioned 191 reports at a cost of €16 million to the Exchequer. He promised a lot but delivered very little, which illustrates the base they are coming from. Our health budget has been restored and more staff are being recruited. We have a journey to go in terms of how we can deliver real and tangible reform to reduce accident and emergency waiting lists. We must try to bring about better outcomes for patients, with patient safety being at the very heart of what we do.

The motion before us exemplifies what is worst about Private Members' motions in this Chamber. One side is saying what they have done and aspire to do while the other says we have not done enough and they did better when in government. I grew up in a medical household where my mother was a nurse and my father was a doctor. They would often say they were not expert enough to solve the medical problems that exist in society, although they had ideas about it. The real essence of it exists within the HSE, including hospital managers and consultants. I would not condemn anybody for commissioning reports but there are enough reports to choke a herd of donkeys.

The sentiment from all sides is appropriate. We are trying to improve the health service and give our view of what is going on in our localities. It is particularly relevant for me at the moment as Kerry General Hospital had a report issued yesterday concerning infectious threats. It was a HIQA report dated 8 July. The Minister of State has heard me speak about the need to safeguard Kerry General Hospital, but we need a capital infrastructure plan for our hospitals. We hear about plans to upgrade facilities that are more than 100 years old, which is ridiculous in a modern society. We will have an increasing number of health problems so we need to invest more money in the health service, but we also need to start looking after our own health a bit more as well.

In the event that 30 year old hospitals have had no capital infrastructure and there is a threat of diseases, as highlighted by HIQA reports, it is imperative for the Minister of State to look at the likes of Kerry General Hospital.

That hospital serves not only Kerry but west Cork and west Limerick as well. We need to copperfasten the integrity of such hospitals. They do not lose VHI patients to other private hospitals or lose public sector patients. They do not lose surgeons who want to come to places to develop their skills. The sentiment is right. It is about trying to find funds and ensure the goodwill is implemented by experts.

I regret to say that while Deputy Kelleher's motion is long on listing the shortcomings of the health service, it goes nowhere near convincing us that those in Fianna Fáil have learned anything from their years in government. During that time the stock response was to throw additional financial resources at the problem. That did not solve the problem then and it will not solve the problem now. That appears to be the stock policy response of Fianna Fáil not only in health but across a range of Departments.

I am keen to raise with the Minister of State, Deputy Lynch, the matter of care of the elderly. I welcome in particular the announcement recently of funding to improve HSE-controlled community hospital beds which are currently non-HIQA compliant. I am familiar with these cases because there is one in my home town of Macroom. There is a community hospital which is held in high regard locally, along with other community hospitals in Kanturk and Millstreet. These are part and parcel of the local community. The bar has been raised by HIQA, which is only right and proper, and we need to catch up. I am pleased a deal has been brokered. We need to be careful, however, about retaining the appropriate balance between HSE-controlled bed numbers for care of the elderly and beds controlled by private nursing homes. If we put the overwhelming majority of eggs in one basket and rely on private nursing homes to provide beds for public patients, ultimately we will be hostages to fortune and we will be asked to pay increasingly high prices for those beds.

In meeting new HIQA standards we should avail of the opportunity to bring change. Officials in the hospital in Macroom have appointed a design team to examine the hospital facilities to see how it can meet HIQA compliance while retaining current bed numbers. However, we should be more ambitious. Although we may not currently have the finances available, we should examine the campuses to establish how we can double or triple the number of beds available. In the long term this would ensure we can maintain the appropriate balance. It was the case that the cost ratio between those beds under HSE control and those in the private sector were out of line in so far as the private sector was providing more cost efficiency. However, this is an opportunity to address the matter by increasing bed numbers and thereby reducing the overall cost per patient. It is right and proper that HIQA standards should be met. People are living longer and we will need more beds.

There is a problem in the old Southern Health Board area of Cork and Kerry relating to home help. Rightly, much of the effort goes into ensuring those in acute hospital beds are discharged appropriately. They are, however, commandeering home help hours at the expense of those in the community. This, in turn, is having the knock-on effect of driving people in the community into nursing homes. We need to consider that as a matter of urgency.

I echo the comments of Deputy Creed on the motion moved by my esteemed colleague, Deputy Kelleher; it is long on aspiration but short on detail. I too wish to raise the issue of care of the elderly with the Minister of State, Deputy Lynch, since she is in the Chamber. I echo Deputy Creed's points on the HIQA standards, which are important. It is important that the standards are met. I welcome that there is a serious conversation under way and the possibility of funding for the provision of new publicly-controlled beds for geriatric patients in future.

In my part of the world, Thomastown in County Kilkenny, St. Columba's Hospital is a fantastic facility with almost 90 beds. The number has reduced from more than 100 beds some time back because of these self-same HIQA standards but it is an outstanding facility. It is public and it is particularly renowned for its rehabilitation services. It is important that the facility be maintained in future. The same applies to Castlecomber District Hospital.

Yesterday evening I tuned in to the start of this discussion when Deputy Kelleher moved the motion. Deputy Keaveney was the second speaker. He took my name in vain, so to speak, in reference to a previous discussion on the financial emergency measures in the public interest legislation, which we discussed in the House recently. He spoke about the difference between those in Fianna Fáil and the rest of us in terms of their aspiration for social spending. He managed to misquote and mis-reference me several times, but finally he offered the correct quote. What I said was that the economy and taxation need to be central to the major discussion that will take place in any election. In the previous discussion, and again last night, Deputy Keaveney gave the impression that funding for public services can simply fall out of the sky. Unless we have an economy that functions properly and a taxation system that is efficient, the funding for public services will not materialise.

Deputy Keaveney's views are echoed in the motion from Fianna Fáil. They have learned nothing from the cliff they drove the country off seven or eight years ago in terms of the economy. Everything we discuss in terms of public expenditure is contingent on the fact that we have a functioning economy. Thankfully, that is what we have again. We also have the Exchequer in a healthy position. For the first time in seven or eight years it is substantially in that position now.

I am pleased to have the opportunity to speak on this motion. When I was doing my research I discovered there has been a Private Members' business motion on this issue every year since 2004. We know who was in charge in 2004. It is a damning indictment of many different people and bodies that we are still in this situation today and that we continue to have a discussion on the matter in October, November or January of any given year.

We can consider this in three different ways. First, why are people ending up in accident and emergency units? Second, why are they staying there for so long? Third, why are people not leaving accident and emergency departments more quickly? We need to take practical steps.

The Minister of State and the Department will be well aware of the question of primary care centres and getting more people treated in them before they get to accident and emergency departments. There is major concern, particularly among rural general practitioners at the moment. I offer one example from Galway. A GP there contacted me and said he had treated a young man who required seven sutures in his leg. This took 12 minutes in the doctor's surgery. It was a bad laceration. The patient also required an anti-tetanus injection. For this, the doctor received €28 from the Government. The materials in this case cost €19, giving the doctor an after-tax income for this work of €3.90. I also understand from many GPs operating in rural areas that making house calls to elderly patients is no longer an option because of the time such calls take and the remuneration involved. Instead, those patients are being referred to accident and emergency departments. This involves ambulance calls, trips across the country and long waits on trolleys in overcrowded accident and emergency units.

We need to consider the type of patients who are coming into our accident and emergency departments. A particular point has come to my attention. I have been contacted by a number of people on the matter. This relates to cancer sufferers. We know these people are going through a serious time in their lives. They go to accident and emergency departments for routine treatment. The doctors know what they need to do to help to make these patients better, yet they are still waiting in the same queue as other people in accident and emergency departments, thus taking up time available to doctors. Let us consider the case of University Hospital Galway, for example. The doctors there know why those patients are there. Those who present could be put into another area where they could get the treatment they need. In that way they would not take up places in accident and emergency departments. Cancer sufferers should not be in accident and emergency departments during the course of their medication given the nature of their immune systems. Moreover, there is no point in their taking up space in this way.

I was contacted by a nursing home today. The person concerned said that in recent weeks he has contacted a number of hospitals to say the nursing home has between ten and 14 beds available all the time and that he would help in any way possible. I am not suggesting for a moment that everyone who is in a hospital could go to a nursing home, but I have no doubt some could. The person did not even get a call-back. Between ten and 14 beds were free in the system. The person from the nursing home wondered what needs to happen for hospitals to be able to move patients to nursing homes that can supply the beds for them. If there was more co-operation between the relevant hospitals, particularly those suffering from overcrowded accident and emergency departments, and those who have beds in the community, we could make progress. In that way, patients could be moved out of our hospitals much sooner than is the case at present.

I welcome what has happened regarding the fair deal scheme. There are many people willing to provide help, particularly those in the nursing home sector, and they need a lot more co-operation than they are currently getting.

Last week, I organised a public meeting on dementia which was attended by approximately 150 people. It was a real eye-opener for me and those in attendance. Almost everyone present at the meeting had a loved one living with dementia or was coming to terms with its effects. The simple but strong message that every single person made to me was the wish to remain independent and live at home. Almost 48,000 people are living with dementia in Ireland and the majority of them do not want to go to hospitals. Rather, they want to live in their own homes and do not want to have to line up in our emergency departments.

We have been very fortunate to have had in Dún Laoghaire a Living Well With Dementia project in Stillorgan and Blackrock. It was headed by Eilis Hession and her professional team and was half-funded by the HSE and Atlantic Philanthropies. The project lasted for a number of years and raised awareness of dementia. More important, it also provided support for the person with dementia and his or her carer. This model is advocated by the Alzheimer Society and it helps people with dementia to remain in their homes for as long as possible.

Many cases of people who arrive into our emergency departments can be avoided through long-term planning and investment. We need to focus investment on community long-term care and give a renewed emphasis to implementing the national positive ageing strategy which was launched in 2013. I urge the Minister of State to prioritise making staying at home the first option for people living with dementia and the elderly.

I must also mention briefly the ongoing difficulties we have experienced with nursing registration. I raised this matter with the Minister of State several times, including at a meeting of the Joint Committee on Health and Children, and I am pleased that steps have been taken, but more needs to be done. We cannot simply have a backlog of nurses caught in red tape when people are waiting on trolleys.

I wish to share time with Deputy Peter Fitzpatrick, three minutes and five minutes.

The health service is made up of different groups of vested interests. Many of the aspirations of these groups conflict with one another, which leads to major challenges for those who are trying to manage our health services. On top of that, the recent health Ireland survey, published by the Minister, Deputy Varadkar, shows the problems we continue to store up for our health services.

We still have significant problems with drug and alcohol abuse, obesity, high blood pressure and diabetes. We need to focus on decreasing the health and financial impact of these diseases. They are problems about which we can do something, and we need to redouble our efforts to sort them out because they are storing up major costs for individuals, families and our health service. It is something that will overwhelm our health service.

Many people come into the Chamber and talk about the NHS as if it was a panacea for all of our problems. In fact, it is not. It is in crisis for a number of different reasons. It is not able to look after patients. One will wait up to seven days in the NHS to see a GP, which is not a GP service compared to this country, where 96% of patients can see their GP within 24 hours of contacting a surgery.

Many things are working extremely well in our health services. We have an occasional crisis because that is the way of health services. They are not like a bus timetable or train schedule; there are peaks and troughs which frequently create problems.

There are issues within our population that we cannot control, such as growing old - we cannot stop that. We need to look after this cohort of patients, but they are not all the same. Many of my patients in their 80s or 90s are as healthy as can be. They live and drive independently and have active and very fulfilled lives. Another cohort within that population are fully dependent, and need full nursing home care and major resources in the community to help them. They are completely different from the other group.

All of the conflicting interests within the patient population, and doctors, consultants, nurses and administration and physiotherapy staff, all have their ideas about how things can be done right. It is time we had a national conversation about what we will do about our health service. The solutions are not always what we can import from abroad. Many of the solutions are already in place and many parts of our health service are working very well. We need to analyse where the problems are and start sorting them out.

I welcome the opportunity to take part in the debate. I agree with much of what has been said by Members on both sides of the House. I agree that the safety and quality of patient care must be our primary focus. Patients should receive the very highest standard of treatment, irrespective of where they seek it. Elderly patients should not wait more than six hours for treatment.

In my constituency, Louth and East Meath, Our Lady of Lourdes Hospital is, unfortunately, regularly in the headlines because of the high number of patients on trolleys. I have worked very closely with the hospital in trying to reduce the number of patients on trolleys and I am confident that we are addressing the issue, although I would prefer if the numbers fell more quickly.

I have spoken on many occasions with my colleague, the Minister for Health, Deputy Varadkar, about the need to address overcrowding in emergency departments. We both agree that the situation is not satisfactory and improvements are needed. We also agree that simply throwing money at the situation will not resolve it, as has been proven in the past.

The emergency department task force was set up in December 2014 to provide a focus in dealing with the challenges posed by overcrowding in emergency departments. In April this year, the task force action plan was published and a range of actions were identified. They included optimising existing hospitals and community capacity; developing internal capacity and process improvements; and improved leadership, governance, planning and oversight.

I note that the task force implementation group met most recently on 2 November, that the implementation of the action I outlined is continuing and key priority actions have been identified. They include strong centralised operation processes within hospitals to drive bed management and discharge planning; consistent access to senior decision makers within the emergency department to ensure appropriate admission and enable effective discharge management on a seven-day basis; delegated discharge and enhanced roles for nurses to include the expansion of ENP roles with emergency departments; effective management of demand and capacity requirements regarding scheduled and unscheduled care; and an appropriate structures within the hospital and local community services to ensure an integrated and timely response to continuing care needs.

While we still have a long way to go, it is somewhat pleasing that progress has been made and this can be seen in the fact that delayed discharges are steadily reducing. There were 570 on 27 October 2015, down from 830 in December 2014. The waiting time for NHSS funding has reduced from 11 weeks at the beginning of the year to between two and four weeks. Transitional care funding supported almost 2,000 people who were approved for the fair deal scheme to move from acute to non-acute care while awaiting long-term care placements. Over 1,200 additional home care packages will have been provided by the end of 2015. Some 149 additional nursing home beds, including 24 additional private contract beds in Moorehall, County Louth, and 65 short-term beds in Mount Carmel have been opened in 2015.

We are on target to provide an additional 1,604 NHSS places. I note that the director general of the HSE is co-chairing the emergency department task force implementation group from now until March 2016. He has taken this decision in order to ensure that all relevant parts of the health services, including acute, social and primary care, are optimising resources in order to deal with the particular challenges associated with the winter months.

We are going in the right direction because, under the Minister, Deputy Varadkar, the health service is changing. We have learned that throwing money at a problem will not solve it. We need to make key changes to how we deliver health services. We need the full support of, and backing from, all key shareholders. These changes will not happen overnight as they will take time to implement.

I ask that all Members of the House, particularly members of the Opposition, work together on this issue. Health is not an issue for political football. We need joined-up thinking and a united approach to ensure we provide a world-class health system for the people of Ireland. I know from my work on the health committee that results can be achieved when we work together regardless of our party allegiance. We need to learn from the lessons of the past, when throwing money at a problem was seen as the only solution. The problem with our health service cannot be resolved by money alone. Changes are needed in how we manage and deliver health services. I firmly believe we are now on the right road to delivering a world-class health service and time will prove this.

Deputies Kitt, Ó Cuív, Calleary, Moynihan and Aylward will share time. Is that agreed? Agreed.

I thank the Minister of State for coming to the House. In particular, I commend Deputy Billy Kelleher on tabling the motion. He made a very important point yesterday when he spoke about the need for health professionals to highlight conditions which could jeopardise patient care. He referred to the fact that last month was the worst October on record, with 7,971 admitted patients cared for on trolleys. In the first ten months of this year almost 80,000 admitted patients were on trolleys. The fact we learned of a couple aged 90 who had to endure a very long time on trolleys has been well highlighted.

Having listened to very good discussions on radio on this matter, the overall feeling is that the fact we have lost so many beds is a serious issue. Recently, I listened to a discussion in which health professionals gave an overview of the health service. They spoke, in particular, about the fact that such a low percentage of the health budget is invested in primary care, which is leading to overcrowding in hospitals and many cutbacks in various programmes. I will mention one briefly - I referred to it yesterday during a Topical Issue debate - namely, the school dental service. This service lacks staffing and funding and yesterday the Minister assured me he would try to address it and that we should see improvements next year. It is quite instructive that it was highlighted in the media that 334 children in Galway were hospitalised for dental treatment last year. There is no doubt the lack of school dental checkups has led to these hospitalisations. Dental issues are not being identified because routine examinations are not being carried out. I hope the position is beginning to improve. There are also cutbacks in staffing. We must ensure that specific consideration is given to this matter. I refer to south Galway as a case in point in this regard.

The health professionals in the discussion to which I refer also spoke about other issues, such as the fact that they feel there is not enough support available in the area of mental health. I have seen evidence of this in east Galway, where 22 acute beds were lost in Ballinasloe. The professionals in question are of the view that there should be more support for public and private nursing homes. They also feel that if there is no investment in these areas, the result will be even more overcrowding in hospitals.

There has been a reduction in waiting times for fair deal applications. I welcome this development but these applications must be dealt with because if they are not, more people will end up in hospital. One commentator referred to Dr. Jimmy Sheehan's call for more use of scanning equipment and the need for more staff working at weekends. This is an issue which, I am sure, could be investigated. We also need to have people working midweek. There are these pressures on primary carers. We have some very good home care and home help packages. One gentleman informed me he has home help three times a day, which is very good. On the other hand, people have told me they only receive a half an hour at lunchtime, which is a very busy time of the day in terms of home help. This all leads to many people ending up in hospital.

It is not an either-or situation when it comes to tackling the health budget because money must be spent. I refer, in particular, to the rheumatology situation, which was highlighted on "Morning Ireland" this morning. We do not have rheumatologists in the west of Ireland, and traditionally we have had waiting lists there. What was highlighted this morning was the fact that people must travel long distances to University Hospital Galway for treatment for rheumatoid arthritis. There is also a shortage of staff in Limerick, which was very much highlighted. The information we have received from the Irish Nurses and Midwives Organisation is something about which we should be very concerned. It has highlighted not only trolley watch but also the need for recruitment. It made a very strong point that unless resources are provided there will be ongoing issues about staffing and safe working environments. In addition, it is concerned about the people for whom it cares.

With regard to hospital beds, I refer to Portiuncula Hospital in Ballinasloe. This is a level 3 facility of significant size. There is a need for single en suite rooms and isolation areas. I hope planning permission will be obtained for the proposed new 50-bed unit - I look forward to it having 100 beds in years to come - there and that this will be built as soon as possible. The hospital's catchment area is large and there are many elderly patients living within it who require care. There are also staffing issues at the hospital. I hope we can make some progress to put in place more beds in the region for the people who badly need them.

I am sure the Minister of State is absolutely amazed that it is nearly five years since her party entered government and that so little has been achieved. I know from experience that time flies and one suddenly looks back and wonders what was going on. I have believed for a long time that we are great people for changing structures but that we are not great at making the structures that are already in place work. We now have the Saolta group and various other arrangements in place. Ultimately, however, the people who go into hospital, who require day care or who need access to another service do not really care what is the logo of the entity providing the care. What they are interested in is the service. I believe, and most of us have this experience, that when one starts changing the structures and moving people around, what happens is that the real change being sought is delayed. The question we must ask is whether the changes introduced in recent years have actually had an impact. Unfortunately, the figures suggest that the answer is "No". Certain high-level ideas that were attached to getting rid of the health board approach were good. The idea of uniform national services, irrespective of where one lives, within reason is good. However, the old concept whereby every health board had its own standards, etc., was not good, particularly in view of the fact that ours is a small country. I have always been a great proponent of taking a strategic national approach, whether for ambulance call-out times or waiting list times. I have not, however, been a great proponent of changing management and board structures because much of this tends to be very disruptive in terms of solving the problems that exist.

I have often wondered if we should take a more scientific approach, such as that taken by somebody running a manufacturing industry, when dealing with the flow of people in and out of hospitals. Rather than changing the management, perhaps we should examine whether all the logjams are necessary. I often described the accident and emergency department process in a hospital as equivalent to a hotel owner insisting that everybody who entered the premises, whether they wanted a meal, a pint or a bedroom, should register first at the front desk. If that happened, there would always be a queue at the front desk waiting to register. In my humble view and as any analysis would prove, many people end up in accident and emergency departments who need either a patch-up clinic, involving X-ray and appropriate outpatient treatment before going out the door, or who should be admitted directly to the hospital rather than through the accident and emergency department. We should ask ourselves if there should be a minor injury clinic that would operate separately from the accident and emergency department. There should be a separate process for incidents that would very likely require admittance, meaning people with a condition that inevitably requires a hospital stay in a known department would not have to go next or near the accident and emergency department.

When I was a Minister I was fascinated by the fact that one hospital in Kilkenny never seemed to have a queue in the accident and emergency department. We never got an answer on why that was so. I do not know if it is still the case. I had an interesting experience of that when I attended a football match in Kilkenny. Five minutes into the second half of the match, one of the London players came down very heavily and was carted off to hospital. The match continued for another 25 minutes of play and the lads togged off before coming out to get on the team bus. They found that their comrade had been to the hospital, had his foot X-rayed to find it was not broken and was bandaged and strapped. He was sitting on the bus waiting for the others. Does the Minister of State know of many hospitals, even in their quiet periods, that would deliver such a service? It is absolutely vital that we start looking at the systems we have rather than all the time playing around with the top structures.

To follow Deputy Ó Cuív's theme, the frustrating aspect of this debate is that we are here again. Debates on trolleys and accident and emergency departments are like Christmas in that they come around every year, although this year the debate is earlier. Anybody with a busy constituency clinic would have been able to pick up early in the summer that there were difficulties in the health service that would not normally be seen in June and July. There were delays, with operations being cancelled wholesale. If we could see it, it is beyond me why management in the HSE could not see it as well and start planning for it then, as opposed to adapting the normal winter plan, which apparently only comes into effect in mid-November. We have had the various incidents that have been highlighted in the past number of weeks in Tallaght and every other hospital, to be frank. The same management is comfortable putting out a tender for trolleys for Tallaght hospital without dealing with what is causing the use of trolleys in the first place.

When listening to Deputy Ó Cuív, I was reminded of a Dublin media personality visiting my home town, when his spouse got an ear infection. Their first question was to ask where was the nearest accident and emergency department and when I told them it was an hour away, they nearly got a bigger infection. If we have a properly resourced primary care system, it should be able to take much pressure from the accident and emergency departments. A properly resourced system would work seven days a week, with GPs rewarded for offering services rather than being penalised, so we would not drive GPs to Canada because of a lack of resources. We should not be going around begging to get doctors into rural areas because every rural vacancy is treated differently when it comes to the rural practice allowance. A proper system would work with district hospitals operating on an effective step-down basis.

On examining waiting lists, I noticed the waiting list numbers for Mayo General Hospital have fallen. That is not due to anybody in the constituency but rather an effective system of step-down working in Ballina, Belmullet and Swinford, using the older people's and community nursing homes as step-down facilities. People are being moved from Mayo General Hospital when they do not need to be there. We get them out at that end and stop them coming into the accident and emergency department when there is a properly resourced system of primary care around the county. In a county with such expansive geography, that is a necessity.

Our district hospitals should be able to do X-rays seven days a week rather than five days a week between 9 a.m. and 5 p.m. That way of thinking and doing business must change, and surely with any kind of reform that must be considered. I am not convinced about these hospital groups. They have nice flashy logos - it is Saolta in our case - but do those groups involve the district hospitals, or is it a case, for example, that Mayo General Hospital needs to work with them? What have the hospital groups brought to the equation in dealing with this problem? If we look at the size of the problem in mid-November, it is far more serious than it has been for some years. Much work must be done around those hospital groups.

We are supposed to have had much public service reform in the past few years. I know it took much work to get to an 8 a.m. to 8 p.m. working day but we must examine the possibility of a seven-day service, putting extra positions in place to do that. It is ridiculous that operating theatres are empty through the night and X-ray machines are switched off at weekends unless there is an emergency appointment. It is ridiculous that services that can be done and which do not take long must be done between 9 a.m. and 5 p.m. It is absolutely ridiculous, particularly when people must travel long distances, that everybody gets the same appointment at 9 a.m., meaning that in many cases hundreds of people will turn up for that appointment, leaving some people to be seen only at 3 p.m., 4 p.m. or 5 p.m. Such practice still goes on. Until patients are treated with dignity and respect, with resources provided to back this up, there will be more cases like we saw in Tallaght, with accident and emergency services backed up.

I am not convinced that the current management of the HSE understands this but if it does, it is not interested in change or putting patients at the front and centre of the system. With the kind of money being spent on health, we should be able to resolve these problems. We do not necessarily have to think outside the box; with a bit of cop-on we could resolve these problems. If somebody experienced the journey of a patient from Erris or Ballina into Galway, he or she would know it involves driving through the city of Galway in peak traffic to try to get to the regional hospital, when there are hundreds of acres in Merlin Park that could offer many services without forcing people through the city. That would require somebody to think about the patient in his or her home and what it takes to get to the hospital. We are pushing people into these super-hospitals but it seems nobody in the HSE management is thinking of the patient's journey. As long as this continues, we will have accident and emergency department problems every year. We will see tenders for trolleys each year and we will hear of cases where people were on those trolleys for 97 hours every week from November to March. That is simply not good enough.

We can wring our hands in the Chamber, give out and vote but we will go home again at 9.30 p.m. The problems will continue at 9.30 p.m. this evening, at 9.30 a.m. tomorrow and 9.30 p.m. tomorrow evening. The people who should be accountable are not here in the Chamber and the people running the health service are not here. It is time they walked in the shoes of the people they are supposed to serve; if they did, we would have a different kind of health service.

I welcome the opportunity to contribute to this serious debate. I compliment Deputy Kelleher on bringing it before Dáil Éireann so we can discuss the crisis in accident and emergency departments.

We need to realise there is a very serious issue. We are well served with many fine people working in the health service, but in the part of the country I live in, a decision is made by families before they send elderly people into the emergency department at Cork University Hospital because of the lack of dignity they would face and because they would be waiting for hours. We saw the closure of the emergency department in Mallow hospital, which was a fantastic service for Duhallow, western Duhallow in particular, and places that are more than an hour and ten or 15 minutes from Cork city. I have first-hand experience from my family of the likes of the emergency department in Mallow hospital. Going back a few years ago, I was in an ambulance after a road traffic accident where they diverted the ambulance at the racecourse in Mallow to Mallow hospital instead of Cork. We left the scene of the accident for Cork and had to be diverted because the patient deteriorated. Thankfully they were resuscitated in Mallow and then sent on to Cork. The decisions being made do not reflect the reality on the ground.

There is one issue I want to raise, namely, the ambulance service in the Duhallow region. Every week, somebody rings me about the ambulance service. Last Monday afternoon, I got a phone call from a relative whose family member had gone into an epileptic fit. They had rung for an ambulance and waited 40 or 45 minutes for it, then they rang me out of desperation, not thinking we could wave a magic wand or whatever. The issue was that the ambulance was coming from Tralee because there was no ambulance in Duhallow at that stage, and then through the emergency call centre there was another change and the ambulance came from a different direction. The region of Duhallow is not being well served. There was an ambulance taken out of the Millstreet area with this new configuration of the ambulance service. There was always an ambulance in Macroom, Kanturk, Mallow and Millstreet. That ambulance was covering the Cork-Kerry border and the greater part of Duhallow. It covered 27,000 or 28,000 people. The region itself would be larger than some rural Dáil constituencies. We have no ambulance service there. If an ambulance leaves Kanturk and takes a patient to the CUH or to any other hospital in the city and then there is a call-out to Littleisland or to Cobh or anywhere else, the ambulance is immediately dispatched because this is the nearest ambulance and if there is a call in Kiskeam or Rockchapel or any of those places, there is no ambulance. It will be the Limerick or the Kerry ambulance, which might be an hour or an hour and a half from those places. It is simply not acceptable in this day and age.

We have seen the issues with the new call-out services. That is a concern as well. When people are ringing an ambulance for a family member, they are very distressed. They are very worried and they are asked all these questions. It is fine for somebody to be taking down the details but there needs to be a small bit of human kindness and compassion. Operators must understand that people are very distressed, whether there has been an accident or whatever has happened to cause someone to ring an ambulance.

The basic point is that the removal of the ambulance service from Millstreet has been catastrophic in terms of ensuring an ambulance is available to reach within a reasonable timescale the people in western Duhallow whom I represent. It is a crying shame and I ask the Minister to go back and look at it because it is not acceptable.

Going back to the motion Deputy Kelleher has placed before the House, we saw last week various reports about elderly people waiting on trolleys. There was almost a wringing of hands and an attitude that it was somebody else's fault. There were all kinds of commitments made, going back seven, eight or nearly ten years at this stage, that if certain people were elected, they would get rid of the trolleys and so on. Last week, there was an attitude of, "How dare you bring up the issue of trolleys in the Dáil and how dare you bring the privacy of patients into it?" The dignity of patients is destroyed while they are waiting on trolleys. It is not acceptable to have an elderly person on a trolley having come from their home or sometimes a nursing home because they are ill. It is not acceptable to have them on a trolley for 24 hours or longer. It is very challenging for the patients, their families and any ounce of human dignity to have them in that place.

We all have to ensure that when this debate is over we continue to keep the pressure on, that there is a proper attempt at solving this issue, that we do not just have a vote tonight on the counter-motion and walk our way through it, and that we make a proper attempt to sort it once and for all. I impress upon Dáil Éireann that it is not acceptable what the configuration of the ambulance services has done to my region of Duhallow in taking an ambulance out of Millstreet and leaving the Duhallow region without a service, a region which is an hour, and in some instances over an hour, from any one of the hospitals in Limerick, Cork or Tralee. That is not acceptable and the issue needs to be revisited by the HSE immediately if not sooner.

I commend my colleague, Deputy Billy Kelleher, on bringing forward this motion to ensure the crisis of overcrowding in emergency departments is at the forefront of Dáil business. The only consistency that has resulted from this Government’s chaotic handling of the health system is the incremental pressure placed on front-line emergency staff. Emergency medical consultants, nursing staff and all other support staff are forced to go above and beyond the call of duty every day just to ensure hospitals can function on the most basic of levels. Their job is a difficult one, and as the crisis deepens over the winter months, it will be next to impossible as even more pressure is placed on emergency services.

The latest figures made available by the Irish Nurses and Midwives Organisation show that the number of people on trolleys at St Luke’s General Hospital in Kilkenny has soared by 144% in the space of a single year. These figures are inexcusable and are the clearest sign yet that the Minister, Deputy Varadkar, is completely out of his depth. Kilkenny has recorded one of the largest increases in the entire country when it comes to the number of people stuck on trolleys. There were 143 people stuck on trolleys in Kilkenny in October 2014, but the latest figures show there were 349 patients on trolleys in October 2015. How does the Minister stand over a situation where a growing number of patients are languishing for hours on end on trolleys in corridors and other public spaces?

I spoke to a man only a matter of hours ago who had attended the emergency assessment unit of St. Luke’s in Kilkenny before being sent home with no diagnosis following an eight-hour wait. The staff had to resort to asking him to come back tomorrow. The man informed me that there was little or no room for staff even to turn, let alone operate at the level required to administer appropriate care and attention to those who were waiting. Patients were reduced to tears and staff members were visibly upset at working in such intense conditions. I am not talking about a year ago; this was yesterday. While in power, Fianna Fáil channelled significant investment, which oversaw the opening of a state-of-the-art 26-bed unit at Kilcreene hospital for the purpose of respite and step-down care. These beds would be prime real estate now, given the current crisis facing us. I urge the Minister to investigate the possibility of reopening this facility. Kilcreene hospital is a facility which can assist in mitigating this emergency in the south east. It is an essential component of the health service in the region and with minor investment this hospital can meet HIQA requirements and relieve the pressure on surrounding emergency departments.

During a previous Fianna Fáil motion on hospital waiting lists in September of this year, I asked the Minister to give a strong commitment that orthopaedic services and elective services would be maintained at this first-class facility indefinitely as a support to Waterford Regional Hospital. This request was not directly addressed in the Minister’s response so I am raising the matter for a second time.

Another neighbouring hospital of mine, Waterford Regional Hospital - or, as it is now known, University Hospital Waterford - is the closest hospital for many in south Kilkenny. This is another crucial emergency department which caters for many rural areas of south Kilkenny and is bursting at the seams. I have outlined to the Minister the waiting list crisis at the hospital on previous occasions during the Topical Issue debate, but my call for action continues to fall on deaf ears. It is getting to a point at which the sick are nervous and anxious when they learn that they may have to attend an emergency department. They are pleading with their GPs and trying to avoid emergency departments at all costs. This is not how a modern health service should operate.

I again ask the Minister of State about the St. Luke's accident and emergency department. I cannot stress strongly enough that it was chaotic down there yesterday. I was asked to go on local radio this morning to speak about it. A patient who was on a trolley there yesterday spoke of the serious situation. This cannot continue. It is November, five weeks before Christmas. We are going into the bad season - what we call the serious season - of January, February and March, when there will be much more sickness around. What will happen at St. Luke's in those months? I ask the Minister of State to take note of this and bring our comments back to the Minister.

The Minister of State has five minutes.

I will go straight into the reply, but having only five minutes for a response is not enough. Maybe we should take a look at that. I know the Ceann Comhairle and I cannot do anything about that.

It is the same during every Private Members' debate.

I would entirely agree with the sentiment expressed about the distress that is caused to those who must wait for a long period of time either on a trolley or on a chair. It is uncomfortable, it is distressing and it does not lend dignity, let alone service. However, quoting statistics will never have the same impact as personalised stories, and we saw that this week and last week with consultants and, indeed, the relatives of elderly patients who were waiting for admission in emergency departments. Was there an elderly man on a trolley in an Irish hospital for more than 24 hours last week? Yes. Should it have happened? No. We all are agreed on that. Was there an elderly person on a trolley the week before for more than 24 hours? I think the answer would be "Yes". Should it have happened? No.

Every month, the HSE publishes the number of patients who have been waiting for admission to hospital. It publishes the number discharged within six hours, the number waiting longer than six hours, the number waiting longer than nine hours and the number waiting longer than 24 hours.

This year, we asked the HSE to start publishing the data on patients attending emergency departments who are over 75 years of age. Between January and September, there were 88,772 visits to emergency departments by patients over the age of 75. This accounts for 12% of the total number of visits by patients to emergency departments. A total of 46.2% of those over the age of 77 are admitted or discharged within six hours of registration. The point is that these figures exist. They are there for anyone to look up on the website.

Really, the point I make is that the previous Government - I do not do the "previous Government" bit often-----

-----under the then Minister who is now Fianna Fáil's leader, denied that there were patients on trolleys. Deputy Martin said he did not believe the counts by the Irish Nurses and Midwives Organisation. He simply did not believe it, but not believing it did not make the figures go away, just as not believing that the troika was on the way in made it go away. It did not happen. We had an economic collapse in this country and it has left us in a position in which we are now rebuilding this country-----

They made Deputy Gilmore a writer.

Deputy Kelleher will get his chance in a minute.

-----and we are not doing a bad job on it.

I was amused to listen to Deputy Ó Cuív, whom I have great time for, when he stated that it is amazing how time flies in government and how little is done. I would like to start by talking about primary care, because I agree that it seems to be the focus of what we need to do.

Where is Deputy Shortall?

There is universal agreement that having more services in primary care is better for patients and also results in fewer hospital visits. Let us take a look at exactly what we have been doing in primary care since 2011, rather than at the previous Administration. Forty-six primary care centres have been delivered since March 2011. There are an additional 50 locations where primary care infrastructure is under construction or at an advanced planning stage. Primary care teams and personnel are being put in place. Clinical programmes are being developed. A new contract with the GPs is being negotiated. We have moved ahead with the diabetes cycle of care for type 2 diabetes, also delivered in the community. We have introduced an asthma programme for those under six. We have introduced free GP care for both those over 70 and those under six. We are negotiating a new contract with GPs and, subject to this, will further extend GP care to children under 12. We have increased the number of discretionary medical cards from 52,200 in June 2014 to over 90,000 now.

We have introduced a project to standardise the accreditation process for minor surgery in GP practices. This is far more meaningful than it sounds. This project will involve a network of 24 GPs across 20 locations in 11 counties. In the past, GPs were responsible for carrying out many minor surgeries in the community but this was not recognised as such. We are now determined, rather than being dazzled by the high-tech and the high-spec, to move back into primary care, and that is what we are doing.

What we have done in mental health, I think everyone agrees, has been quite spectacular. This was at a time when this country, when we came to power, had four months' funding left.

At the very least-----

Deputy Calleary will get a chance.

-----we should be given some credit-----

-----for keeping the health service standing up and developing it to the extent that it should have been when the previous Fianna-Fáil-led Government had more money that it knew what to do with.

They had nothing to do only follow the plan.

Deputy Dooley is sharing time with Deputies McGuinness and Kelleher.

If the Minister of State's speech had been delivered by a member of the Administration of North Korea, it would be laughable in the outside world.

If it was true, it would be okay.

You are nearly suggesting that there is no problem and asking why we are complaining.

Deputy Dooley should address his remarks through the Chair. It only leads to aggravation.

Today, at a quarter to two, I received an e-mail, which I will refer to. To protect the individuals concerned, I will not mention specific villages or names. The e-mail states that the writer's sister-in-law, who lives in a village in County Clare, has recently been diagnosed with breast cancer and subsequently had an MRI scan to determine the stage it was at. Unbelievably, she was informed by the regional hospital in Limerick this morning that there is no professional radiologist available to read the scan, nor will there be for the foreseeable future. It states that she needs treatment sooner rather than later, but this is not possible without the results of the scan. She is a mother of three children, the oldest of whom is 14, and she is already undergoing treatment for a rare sarcoma. The e-mail states that this latest news came as a major shock, compounded by the fear of not knowing what the future holds for her due to the inadequate and inept health system. The e-mail is signed, and I verified its contents.

The Minister of State can do her piece about the previous Government and I can do my piece about the previous Opposition.

I do not normally. Deputy Dooley knows that.

I can come in here and remind the Minister of State that her party and Fine Gael in opposition criticised the decision of the previous Administration to begin a process of reconfiguration of the health services, all of which was based around international best practice and which was introduced to ensure the best possible outcomes for patients. They objected to it from an Opposition standpoint. They used emotive language, suggesting that people would die and that they would not get critical care within the golden hour, a scenario that has been so richly abused by Fine Gael and the Labour Party. When they came to government, they accepted the facts of international best practice and went on to say that reconfiguration would continue apace, but they have failed abysmally to invest in, support and fund it.

A critical component of the reconfiguration process is an adequate and appropriate ambulance service. The ambulance system is creaking. I had the opportunity to visit its headquarters recently. They are fine people and they have great technology, but they have ambulances on the road that are out of date and, in some cases, falling apart and breaking down, which means patients are not getting the care they need on time.

In my county of Clare, there is a shortage of 20 personnel. There is not adequate staffing in the county to deliver on reconfiguration. I see none of my colleagues here who frightened the people of Clare against the notion of reconfiguration, using emotive language and saying 20 people per year would die. I have challenged them on many occasions to come in here and say whether 20 people per year died because of the principle of reconfiguration. If that is the case, why has the Government not reversed it? It has refused to enter the debate.

Having accepted that reconfiguration was the right policy in the first instance, the Government has declined to challenge the Minister for Finance, the Minister for Health and the Minister for Public Expenditure and Reform to put an adequate amount of money in place to properly fund the reconfiguration process. Until that happens, the Government will not have a system in the health service that meets the needs of people who have been transferred, in the case of Limerick, from Nenagh, St John’s Hospital and Ennis. People took hard decisions and, eventually, bought into the notion that it was the right thing to do. However, the Government has failed abysmally to fund the policy.

There is not an appropriate person in University Hospital Limerick to read cancer scans. Limerick is a centre of excellence for the delivery of cancer care and, heretofore, the assumption was that the policy would be adequately funded. However, it does not appear to be. It gives me no pleasure to challenge the Minister of State or the Government on the issue, given that the lives of people are affected by it. However, we owe it to the people we represent to challenge the Government every day of the week until we receive adequate funding.

In light of the statistics the Minister of State put before us, which are designed to baffle and mislead, I will read a message from Margaret, who attended St. Luke’s General Hospital. She stated:

I had a reason to spend a good part of yesterday [Monday, 9 November] in St Luke’s hospital in Kilkenny. There were lines and lines of people, all in need of care and attention queueing at the medical assessment unit. People were waiting to be seen. Some were awaiting tests, others results. Some were waiting for beds and a decision to be made in that regard. Patients were waiting on chairs and trolleys and in wheelchairs. People accompanying them stood for hours and, eventually, sat on the floor. There were so many people that the staff literally did not have room to turn. They continually had to excuse themselves just to work. Under these appalling conditions, staff heroically and unselfishly ploughed on and helped and cared for people professionally with empathy and kindness. Thanks to all the staff.

She thanked the staff and criticised successive Governments for not investing fully. This is in a hospital which Deputy Eamon Ó Cuív said earlier was the lead hospital in terms of development and the delivery of services in the country. This is happening in our hospital while yards away from where people are being admitted, there is a brand new unit that was opened and closed and that could ease the pressure. However, staff are not being provided. The nurses and front-line staff are a BAND-AID in the system, holding it together.

Meanwhile, while the unit lies empty and is not being used for the purpose for which it was built, the HSE has decided to run down the services at Kilcreene Orthopaedic Hospital and look to an overcrowded campus in University Hospital Waterford. The treatment of patients is chaotic and no respect is being shown for the dignity of the patients by the system which the Minister of State represents, the HSE and the Department of Health. Shame on them for putting patients and front-line staff in this predicament. It is about management and using the resources the Government has. In St. Luke’s, the Government is doing neither. It is ignoring the issue regarding Kilcreene hospital.

Another lady contacted me today and said her elderly parent was in bed and asked for an extra sheet and blanket. The nurse leaned in and quietly and politely told her that her best bet was Dunnes Stores. What kind of system is the Government running? There is a shortage of bed clothes. There is a new arrangement for hospital stores and these essential items cannot be accessed easily. There is a shortage of staff. Stroke victims, the elderly and those who are in deep shock who attend accident and emergency services are being left without the care and attention they deserve and require. Staff members complained to management long before this happened, but were ignored and now there is chaos. How can any management team in any hospital in the country stand over it?

The Minister of State remarked on funding to the hospitals. She stands over the HSE that must now pay compensation of €9 million to suppliers because it broke the rules and did not meet the criteria. She stands over a HSE that cannot collect its debt from the private health insurers, not because the private health insurers will not pay, but because the HSE consultants will not sign off on it. How many hospital beds would be off the corridors and in the wards, how many sheets, blankets and pillows could the Minister of State provide for a hard-pressed service, if the management, who are well paid, would collect the money and reinvest it in front-line services? We should examine what is happening in the UK health service, which is returning to the cottage hospitals which are easily managed, where there is no MRSA or infections, and where those who are elderly and in dire need of the service get it when they want it. Shame on the Government and the House that the elderly and sick are left as they are in our hospitals throughout the country.

I welcome the contributions of all Deputies. While the views expressed on the Government side of the House were much more couched and nuanced in their criticism, the overriding fact cannot be denied. Our health service is in crisis. Many Deputies on the Minister's side of the House alluded to this fact. Some Deputies will come in and read scripts from the various press offices of Fine Gael and the Labour Party, to condemn us for highlighting what is a topic of discussion on every airwave and in every newspaper and in the emergency departments, hospital canteens and homes throughout the country. The health services are in crisis. The first issue in dealing with any problem is to acknowledge that there is a problem, and the Government must do so. We were accused of tabling a motion that was long on aspiration. The Minister's amendment is much longer on aspiration. It is also much longer on deceit. It is like something from Alice in Wonderland. It does not tally with reality. The Minister should have tabled the following amendment:

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

“acknowledges:

— that we have broken most of our promises, and notes in particular that we broke promises in the area of the fair deal, discretionary medical cards and the drug reimbursement scheme

— that we have driven nurses from the country because of the graduate scheme which was recently introduced

— that we have driven our consultants and GPs from the country and consistently undermined the basic infrastructure of delivering health services, namely, the human resource element, the staff who are working day and night to try to provide a service that is not being resourced by the commitments the Government said it would make in its general election mandate.

Either the Government sought a dishonest mandate, or it has been incapable of delivering on the promises it made. Either way, it does not augur well for the health services.

While the motion refers primarily to the emergency departments in our hospitals, there have been continual U-turns on universal health insurance and the privatisation of hospital management, a move that was roundly condemned in the context of the establishment of hospital groups through the wording of reconfiguration. Our motion aims to highlight the deficiencies in our health services but also to highlight the inadequacies of the Government’s response and its handling of the core issues on a daily basis.

We have appalling stories from families whose loved ones have been visiting emergency departments throughout the country. People who are charged by the HSE and the Government with overseeing patient safety are speaking out by telling the Minister that our emergency departments need help because patients' lives are being put at risk. Those who are charged directly by the Minister and the HSE with caring for patients in our emergency departments have brought it to our attention that in recent times, patients aged 91, 93 and 100 years of age have had to wait inordinate lengths of time on trolleys in emergency departments. When they speak up and ask the Minister for help, the Minister vilifies them, undermines them and says they have agendas. The only agenda I have found when speaking to people who work in emergency departments is a desire to provide safe and adequate care in a timely fashion to those who present at their departments.

The Minister and the Minister of State have to get their act together. They need to acknowledge that they have singularly failed. There has been a consistent failing in the delivery of the budget. We recently had another bogus budget, just as we have had every year since this Government came into office. The backdrop against which the budgets in question have been delivered is almost laughable. Every year, we need a supplementary budget towards the end of the year to keep the lights on and ensure the staff are paid. That is how our health service is being managed.

I make no apologies for tabling this motion. I did not do so just to have a cheap shot at the Government. I tabled it because of the hundreds of e-mails that are sent continually to our offices by general practitioners, nurses, consultants, non-consultant hospital doctors and public representatives of all parties. We frequently table Dáil questions with those representations in mind and we have tabled this motion in the same spirit. There is a despair among those attending emergency departments and those working to deliver health care in those departments. I condemn the Government's actions and I commend the motion to the House.

Amendment put:
The Dáil divided: Tá, 69; Níl, 42.

  • Bannon, James.
  • Barry, Tom.
  • Bruton, Richard.
  • Butler, Ray.
  • Buttimer, Jerry.
  • Byrne, Catherine.
  • Byrne, Eric.
  • Cannon, Ciarán.
  • Carey, Joe.
  • Coffey, Paudie.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Conway, Ciara.
  • Coonan, Noel.
  • Corcoran Kennedy, Marcella.
  • Costello, Joe.
  • Creed, Michael.
  • Daly, Jim.
  • Deering, Pat.
  • Dowds, Robert.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Fitzpatrick, Peter.
  • Griffin, Brendan.
  • Hannigan, Dominic.
  • Harrington, Noel.
  • Harris, Simon.
  • Hayes, Tom.
  • Howlin, Brendan.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Keating, Derek.
  • Kehoe, Paul.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • Lyons, John.
  • McEntee, Helen.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • Mitchell O'Connor, Mary.
  • Mulherin, Michelle.
  • Murphy, Dara.
  • Murphy, Eoghan.
  • Neville, Dan.
  • Noonan, Michael.
  • O'Donnell, Kieran.
  • O'Donovan, Patrick.
  • O'Dowd, Fergus.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • O'Sullivan, Jan.
  • Perry, John.
  • Phelan, John Paul.
  • Reilly, James.
  • Ring, Michael.
  • Ryan, Brendan.
  • Shatter, Alan.
  • Spring, Arthur.
  • Stanton, David.
  • Tuffy, Joanna.
  • Twomey, Liam.
  • Varadkar, Leo.
  • Wall, Jack.
  • White, Alex.

Níl

  • Adams, Gerry.
  • Aylward, Bobby.
  • Broughan, Thomas P.
  • Browne, John.
  • Calleary, Dara.
  • Collins, Joan.
  • Colreavy, Michael.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Dooley, Timmy.
  • Ellis, Dessie.
  • Ferris, Martin.
  • Fitzmaurice, Michael.
  • Fleming, Tom.
  • Grealish, Noel.
  • Halligan, John.
  • Healy, Seamus.
  • Kelleher, Billy.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Mac Lochlainn, Pádraig.
  • McConalogue, Charlie.
  • McDonald, Mary Lou.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGuinness, John.
  • McLellan, Sandra.
  • Martin, Micheál.
  • Moynihan, Michael.
  • Murphy, Catherine.
  • Ó Caoláin, Caoimhghín.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • O'Sullivan, Maureen.
  • Pringle, Thomas.
  • Smith, Brendan.
  • Stanley, Brian.
  • Tóibín, Peadar.
  • Wallace, Mick.
Tellers: Tá, Deputies Joe Carey and John Lyons; Níl, Deputies Billy Kelleher and John McGuinness.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 69; Níl, 42.

  • Bannon, James.
  • Barry, Tom.
  • Bruton, Richard.
  • Butler, Ray.
  • Buttimer, Jerry.
  • Byrne, Catherine.
  • Byrne, Eric.
  • Cannon, Ciarán.
  • Carey, Joe.
  • Coffey, Paudie.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Conway, Ciara.
  • Coonan, Noel.
  • Corcoran Kennedy, Marcella.
  • Costello, Joe.
  • Creed, Michael.
  • Daly, Jim.
  • Deering, Pat.
  • Dowds, Robert.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Fitzpatrick, Peter.
  • Griffin, Brendan.
  • Hannigan, Dominic.
  • Harrington, Noel.
  • Harris, Simon.
  • Hayes, Tom.
  • Howlin, Brendan.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Keating, Derek.
  • Kehoe, Paul.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • Lyons, John.
  • McEntee, Helen.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • Mitchell O'Connor, Mary.
  • Mulherin, Michelle.
  • Murphy, Dara.
  • Murphy, Eoghan.
  • Neville, Dan.
  • Noonan, Michael.
  • O'Donnell, Kieran.
  • O'Donovan, Patrick.
  • O'Dowd, Fergus.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • O'Sullivan, Jan.
  • Perry, John.
  • Phelan, John Paul.
  • Reilly, James.
  • Ring, Michael.
  • Ryan, Brendan.
  • Shatter, Alan.
  • Spring, Arthur.
  • Stanton, David.
  • Tuffy, Joanna.
  • Twomey, Liam.
  • Varadkar, Leo.
  • Wall, Jack.
  • White, Alex.

Níl

  • Adams, Gerry.
  • Aylward, Bobby.
  • Broughan, Thomas P.
  • Browne, John.
  • Calleary, Dara.
  • Collins, Joan.
  • Colreavy, Michael.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Dooley, Timmy.
  • Ellis, Dessie.
  • Ferris, Martin.
  • Fitzmaurice, Michael.
  • Fleming, Tom.
  • Grealish, Noel.
  • Halligan, John.
  • Healy, Seamus.
  • Kelleher, Billy.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Mac Lochlainn, Pádraig.
  • McConalogue, Charlie.
  • McDonald, Mary Lou.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGuinness, John.
  • McLellan, Sandra.
  • Martin, Micheál.
  • Moynihan, Michael.
  • Murphy, Catherine.
  • Ó Caoláin, Caoimhghín.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • O'Sullivan, Maureen.
  • Pringle, Thomas.
  • Smith, Brendan.
  • Stanley, Brian.
  • Tóibín, Peadar.
  • Wallace, Mick.
Tellers: Tá, Deputies Joe Carey and John Lyons; Níl, Deputies Billy Kelleher and John McGuinness.
Question declared carried.
The Dáil adjourned at 9.25 p.m. until 9.30 a.m. on Thursday, 12 November 2015.