“That Dáil Éireann:
— that so far this year, more than 100,000 patients have gone without a hospital bed, waiting on trolleys in emergency departments;
— that to the end of October this year, 13,466 people over 75 years of age have endured emergency department waits of more than 24-hours, a third more than for the same period in 2018;
— that October was the second-worst month for hospital overcrowding since records began;
— the warning from the master of the Rotunda Hospital that it is ‘only a matter of time’ before newborn babies are injured or die as a result of overcrowding;
— the increase in the mortality rate from sepsis;
— the numbers presenting to emergency departments are rising;
— that emergency department overcrowding is linked to increased mortality and poorer outcomes for patients; and
— that delays in emergency departments result in poor patient experiences, with some patients enduring horrendous experiences, while others leave without being seen;
— the Health Service Executive (HSE) National Winter Plan 2019-2020 provides for no additional acute beds or frontline hospital staff;
— emergency medicine staffing levels are below international comparators, and below the agreed safe staffing levels;
— healthcare professionals in emergency medicine are under unprecedented, unsustainable and unacceptable pressure; and
— there is no funded workforce plan in place to reach agreed safe staffing levels;
— hospital bed occupancy rates average 97 per cent, and are 104 per cent in model 4 hospitals, compared to the recommended safe occupancy rate of 85 per cent;
— delayed discharge is significant and linked to a growing waiting list for home care support;
— there is a significant shortage of hospital beds relative to the capacity review; and
— there is no definite timeline for the provision of the additional acute beds needed; and
— a clear funded timeline for the provision of additional acute beds to meet 85 per cent occupancy levels, and for step down beds, as set out on the capacity review;
— an immediate assessment of the number of acute inpatient psychiatric beds required;
— increased access to diagnostics for emergency medicine;
— implementation of the recommendations made by the Health Information and Quality Authority (HIQA) in their 2012 report;
— HIQA to investigate the impact of overcrowding on the health of people presenting to emergency departments;
— urgent progress on achieving safe staffing levels in emergency medicine, to include:
— ending of pay disparity for consultants;
— ending of the de-facto hiring embargo for nurses and midwives;
— a funded workforce plan; and
— an overhaul of human resources practices to improve working conditions for healthcare professionals; and
— investment in general practitioner (GP) services, including:
— funding chronic disease management;
— expansion of GP out-of-hours services; and
— appropriate access to diagnostics.”
The following are testimonies received about the health service.
We have been in St. Vincent's for 3 days. 3 days with tea and good nurses but zero doctors.
The 'lucky' people here get a trolley to lie on, lots of very ill and elderly people are actually sitting on chairs.
My 86 year old mum ends up in A&E regularly and has spent days stuck in limbo.
My mam is one of those statistics - 83 years old, 4 weeks after surviving a heart attack, was brought in coughing up blood from lungs ... it was 13 hours before she even saw a doctor.
My mum is a 70-year-old woman. She spent 105 hours on a trolley in Limerick and expressed fears she would die if a fire started.
A woman was found on the floor 'screaming in pain' with a broken hip, having been assaulted by a drunk.
I mopped the blood off the table in the canteen with napkins, blood from my 4-year-old's open head wound.
They go on and on.
Yesterday, 534 men, women and children were waiting on a trolley in an emergency department in one of our hospitals. Today, the number is 577. The figures in August, September and October were the worst on record for each of those months. October, the month just passed, was the second worst month on record. On 2 October, the highest ever daily figure was recorded for men, women and children waiting on a trolley in an emergency department. Last year, by the end of October, more than 10,000 elderly men and women over the age of 75 had waited on a trolley for more than a day. The Government described that as totally unacceptable and said it would not happen again. This year, the figure is not 10,000 but 13,000, having increased by one third in one year. The Master of the Rotunda Hospital warned just a few days ago that it is "only a matter of time" before newborn babies are injured or die as a result of overcrowding. As of the end of October this year, more than 100,000 men, women and children had waited on a trolley. Nothing like this has ever happened before.
What has been the Government's response this year? It is a winter plan that includes no extra beds or clinicians and a hiring embargo that the HSE tells us does not really exist. The Government has arrived at a burning building with a smoke alarm. What of our healthcare professionals? Just today, healthcare professionals have told me they are "overwhelmed", "burned out", "exhausted" and "under massive pressure all the time". Every Deputy in this House who engages with healthcare professionals will have heard the same. They are under unprecedented, unsustainable and completely unacceptable pressure. It is unacceptable for them and for patients and their families.
Why is something so bad happening in our society and healthcare system? There are three big reasons. First, too many people are having to go to emergency departments. Second, when they arrive in emergency departments, they do not always get the help and treatment they need. Third, there are not enough beds. That is pretty much it. I will deal with each of those reasons. Too many people are having to go emergency departments in the first place. General practitioners could treat many of these people in the community but they do not have the resources to do so. They do not have the time they need to spend with each patient, nor do they have access to the diagnostics they need for their patients. They do not have the practice nurses that general practitioners have in other countries where they actively manage the welfare of their patients, keep them healthy and treat them at home, in primary care centres or in GP surgeries. However, we do not have that and, therefore, people get sicker and end up having to go into our emergency departments.
What happens when people arrive in emergency departments? Much of the time they arrive into complete chaos in emergency departments being run by skeleton crews who are heroes trying to keep the system going. The staff who see the patients after 5 o'clock in the evening know they cannot get access to diagnostics. They do not have a suitable treatment room or assessment room. They do not even have a triage room or a suitable resuscitation area. They will do what they can but they will often ask patients to wait on a corridor. If they admit them, they will ask them to lie on a trolley on a corridor where they may be assessed and treated. That is the reality people are dealing with today.
Why are there are not enough beds? First, there are simply too few beds but also the beds we have are not being used properly. What is going on? Patients are being discharged but they cannot leave the hospital because they do not have a home care package to allow them to return home. Interestingly, Deputy Butler and I spoke about this yesterday. She made the point that in Waterford hospital the number of people waiting on trolleys pretty much matches the number of people who have delayed discharges. Let us reflect on that. If there are 25 people on trolleys waiting for beds and 25 people in beds waiting to get out of them, it does not take a genius to work out the solution. Give patients the home care packages they need, free up the 25 beds and get those who are on trolleys into those beds.
Other patients are told that they can go home but that they need a scan and if they do go home, it will be two years before they get it. They are then put in a bed to wait for three days so that they can be put on the hospital's priority list for the scan. A safe occupancy level is approximately 85% but occupancy levels in Ireland stand at approximately 100%. All sorts of stuff goes wrong when the hospital is under that much pressure. If an urgent emergency, such as a big trauma case, arrives, everything else gets knocked out.
We know why this happening, which means we know how to fix it. In this motion, Fianna Fáil has put together a very straightforward plan, which would work. We need to reduce the number of people going into emergency departments by funding GPs to treat people in their communities. This means more GP out-of-hours services, access to diagnostics and funding for care pathways, particularly for the elderly and those with chronic diseases. We need to increase emergency department capacity, ensure safe staffing levels, end the hiring embargo, eliminate pay inequality for consultants and provide better access to diagnostics. We need to free up hospital beds and provide the new beds that are required more quickly. We also need to fund home care so that we can get people out of hospitals when they are discharged.
The crisis we are experiencing in emergency departments has never been seen before in Ireland. It does not exist in any other European country. If we implement this plan, it will not need to exist here.