I welcome the opportunity to raise the issue of the number of people waiting on trolleys in Beaumont hospital. This issue does not pertain solely to Beaumont, however, because we now have a major crisis on our hands in emergency departments throughout the country. Mr. Duffy, the CEO of Beaumont, rightly expressed concern about the more than 100 people on late discharges who are tying up bed availability in that hospital. Shall I wait until the Minister for Health has finished his conversation?
Topical Issue Debate
Accident and Emergency Services Provision
He is trying to sort his life out. He is a busy man.
More than 45 people were waiting on trolleys in the emergency department in Beaumont recently. There is a lack of urgency in dealing with this issue. At any one time, 100 people are in Beaumont hospital when they should be in nursing homes, in receipt of home care packages or in other step down facilities. The funding provided as recently as the budget shows that the Minister is not taking this issue seriously enough to provide adequate funds to shift people from acute hospital settings to more suitable facilities. Forever and a day we have been debating the numbers waiting in emergency departments and on trolleys. The HIQA report on the ambulance service found inordinate delays in transferring people from ambulances to emergency departments because of overcrowding. The Minister has to take a hands-on approach with this issue. He cannot say it needs a long-term solution. Four years ago the Government committed to resolving the problems affecting emergency departments. This is a national crisis which persists without any effort on the part of the Minister or the Government to address it in a meaningful way.
Beaumont hospital, which is located in my constituency of Dublin North Central, faces a serious crisis. The Minister needs to wake up and face the reality because many families of patients have the impression that he does not understand what is happening on the ground. One nurse who worked in one of the wards expressed disgust that people were being left on trolleys for 70 hours and that 20 patients were waiting on chairs. Beaumont can only accommodate 26 extra patients on trolleys and the rest have to go on chairs. In recent weeks, there were 49 more patients than beds. Nationally, in the region of 300 patients are on trolleys. This is a national emergency. Beaumont Hospital had to go off call during the week because it could not deal with the crisis. In 2007, the former Minister for Health, Deputy Reilly, was prancing around the Dáil on this issue as Opposition spokesperson on health. The silence on that side of the House has since become deafening, however. Approximately 100 beds in the hospital are occupied by patients who should be accommodated in nursing homes or other long-term care. This is part of the solution. We need to fund these packages and nursing home places if we do not want to leave more senior citizens and ill people on chairs and trolleys. That is not acceptable in 2014.
I thank Deputies Billy Kelleher and Finian McGrath for raising this issue. Many emergency departments are currently experiencing overcrowding, although Beaumont is one of the worst. It is a busy time of the year, with increased numbers presenting for treatment and requiring extended observation or admission. This is compounded by a rise in winter-related illnesses.
As well as larger numbers attending emergency departments, including those attending Beaumont, the older age profile and nature of their medical needs result in longer than average stays in hospital and delays in discharges. This is a further difficulty in the management of patient flow. Additional funding of €25 million has been provided in 2015 to address delayed discharges. These funds are targeted at hospital and community services which can assist in discharging patients by addressing their care needs outside of an acute hospital setting and will free up bed capacity and, therefore, reduce emergency department overcrowding. An extra €3 million was allocated in this year's recent Supplementary Estimate for health to allow the delayed discharge initiative to start this year, rather than next year as originally intended. This has facilitated the allocation of 1,000 additional fair deal and nursing home places in the past week, compared to the usual 700, an additional 400 home care packages and the provision of step-down and community beds, including 19 for Beaumont, for patients who do not yet have a long-term care place or an appropriate support package to facilitate their return home. A number of patients who had been awaiting discharge from Beaumont have been able to leave hospital as a result. Many others have been approved for funding but there have been delays in getting them to the nursing home or back home.
As well as allocating additional physicians to the emergency department to assess patients, Beaumont Hospital has cancelled elective surgery and is currently accommodating patients who have been waiting the longest in its day ward. The media have highlighted the pressures on the hospital, and this has helped reduce presentations. Patients have been advised, where possible, to attend GPs or other health care clinics. GPs are also being asked to consider referring frail elderly patients who require rapid geriatric assessment to the Mater-led clinic in Smithfield so they do not have to wait in busy emergency departments.
Hospitals have been working with the special delivery unit on winter planning initiatives to address the anticipated seasonal surge arising principally from changing weather conditions. However, the successful management of access to emergency and acute care cannot be solely dependent on intensive, short-term solutions. The emergency department task force is being re-established to develop such solutions. It will meet for the first time on Monday, 22 December - I intend to be present - and monthly thereafter in order to address solutions to problems being experienced by emergency departments.
Overcrowding in emergency departments has been a feature and failure of our health service for as long as I can remember. It was a problem this time ten years ago when I was a senior house officer in Beaumont's emergency department, and it was a problem when I visited the emergency department last week to speak with patients on trolleys and chairs. Overcrowding waxes and wanes and its severity varies from place to place but I want to get a handle on the issue in the coming year. The report due to be published later this week will show a significant improvement in ambulance hand over times, which is evidence that the actions we put in place are producing results. Short-term actions are under way but they are not enough. We also need long-term solutions. On the northside of Dublin and in other parts of the country there are simply not enough nursing homes, even if fair deal packages were available.
Generally, people in Dublin are not willing to send their relatives to nursing homes hundreds of miles away and, frankly, they are right.
It was not, in fact, the last Minister who described this as a national emergency, but a Minister ten years ago. He was an Independent Minister in a Fianna Fáil-led Government. Declaring it a national emergency ten years after it was declared a national emergency seems a little silly. What is important is to get things done.
The Minister's difficulty is that it is a national emergency, because 45 people were waiting on trolleys in Beaumont Hospital a few days ago. Despite all the excuses and the pretence, this did not sneak up on the Minister. The problem has been evident for some time. It has also been evident in the context of nursing homes. As everybody knows, the demographic trends clearly show that our population is getting older annually. There is a 4% increase in the number of people over the age of 80 every year. The idea that this just happened all of a sudden and everything had been fine all along is not the case. The Minister was forewarned about this, as was the previous Minister.
We simply cannot have a situation where over 700 people who are defined as late dischargers are in beds in hospitals throughout the country every night. Mr. Duffy said there are 100 in his hospital who should be elsewhere. However, there is a paltry sum for nursing homes in the Supplementary Estimates and in next year's funding as well. The bottom line is that there is a huge scarcity of nursing home beds and that issue has not been addressed either in the context of extra funding for the fair deal scheme or in the incentivisation of the provision of extra nursing home beds. Until such time as the Minister resolves that, there will be people on trolleys for a very long time.
The Minister's response shows that it is a national emergency and crisis. It also shows the priorities of this Government. Intelligent people can plan for the seasonal problem issue and the cold winters. There will be times when there are build-ups, but there can be a long-term plan and a crisis or emergency plan put in place. As Deputy Kelleher said, there is the wrong patient in the wrong bed syndrome. Liam Duffy said that during the week with regard to the 100 beds in his hospital. The patients should be placed in proper nursing home care environments or be given home care packages.
The catchment area of Beaumont Hospital on the north side has an older population with many senior citizens. Also, last August the Minister was warned by people who work in the front-line services that a crisis was coming down the line. I urge the Minister to focus on this issue and to get his priorities right.
There is no pretence. I am very aware that there is a serious problem with overcrowding, trolleys and delayed discharges in our hospitals. In many ways, they are symptoms of a more systemic problem within our hospitals. Warnings are not solutions. Solutions require plans, money, action and co-operation. It was mentioned that there are approximately 800 delayed discharges. The additional €25 million is not paltry. It is 300 additional long-term care places and 400 additional home care packages. That is a total of 700. It is not as simple as 800 minus 700 because, of course, new delayed discharges arise every week. However, it will allow us to get a handle on this for a period in the short term. It will not solve the problem.
Part of what is being put in place for the longer term is the opening of Mount Carmel as a community hospital in Dublin. Dublin, uniquely, does not have a community hospital for step-down care. It will now have one for the first time, with the first beds opening next March. We are putting in place additional community intervention teams. These are nurses who can see patients at home. Patients can be discharged more quickly and get their IV, intravenous therapy, at home. Nurses can also go to nursing homes. For example, if an elderly person in a nursing home has a urinary tract infection, UTI, or an infection, they can be treated in the nursing home and not be required to go through the emergency department.
We have a suite of short-term solutions and a suite of long-term solutions. There are also big issues around patient flow, and that will require a lot to happen. It is disappointing, but true, that in many of our hospitals ward rounds are not happening at weekends and during the day. Patients are not being discharged by consultants as they might be. It is also unfortunately true in our hospitals that when beds become available they go to elective admissions, even when there is overcrowding in the emergency department. It is a very difficult issue to tackle.
It is interesting to see the huge variations from hospital to hospital. Two miles away from Beaumont Hospital is the Mater Hospital, which has a very similar catchment area and a not dissimilar budget, and not far away from there is St. James's Hospital. They have their problems, but certainly not on the scale of Beaumont Hospital. Beaumont Hospital has had problems since the day it was opened.
These are not straightforward issues. It is not a case of Action Man Minister going there with a bag of money or a ministerial order-----
The Minister was an Action Man in opposition.
-----but it will be a very high priority for me next year. I will not promise that I can magic it away through action and money. It will require a persistent focus over a long period of months.
Homelessness Strategy
I thank the Ceann Comhairle for selecting this matter. It focuses on the issue of homelessness and I phrased it so that it relates to families.
Our traditional view of homelessness tends be that it affects an individual whose particular circumstances have led to the person, be they male or female, ending up on the street. However, something different is happening now. It is largely the fall-out from the collapse of the economy and the banking system. People sometimes boast about the great things that came from the Celtic tiger economy. I am sure there were some, but there were many things that were not so pleasant, such as emigration and so forth. The housing crisis was one of them and the present Government is left in the situation of trying to resolve it, given the history of not only social housing but also private housing over the past ten years. Social housing was practically abandoned by the previous Government and the current Government had no money. Just as in the case of hospitals, which was the subject of the previous Topical Issue, if one does not have money, one cannot do things. That is the reality.
Currently, we have the highest percentage of people in the private rented sector in the history of the State. That includes families and students. It is a mixture of families. Some are comfortably off while some are on very low incomes. There are also families who are in receipt of the rent supplement, which quite rightly gets much attention. However, a new problem that has got out of control is the increase in private rents. It is spiralling. It is said to be a phenomenon confined to Dublin, but it is not. Private rents are out of control. I can offer the example of my area, Dublin 24, which has seen the highest increases. In some of the cases I am dealing with, private rents have increased by 31% in a period of 24 months. No rent supplement can compensate for that. We must get a handle on whether the hard-pressed taxpayer should continuously chase after the increases that private landlords add to the rental for their premises. I do not believe they should, and it is something to which many taxpayers would object.
Essentially, given the increase in rents in the private rental sector, I believe families who are in private rented accommodation will end up as part of the homeless population - the individual people we tend to talk about - unless we introduce a rent freeze for a period of two years.
While some in the House think we can introduce a programme and build houses in three months, the reality is different. It takes 18 months to two years to build a house and I would expect legislators to know this. In the intervening period it is getting out of control and homelessness will affect not just individuals but also families. The argument has been made that controlling rents is a constitutional matter. If so, it is up to the Minister and me to do something about it. What use is a Constitution that leads to families finding themselves homeless?
On behalf of my colleague, the Minister for the Environment, Community and Local Government, Deputy Alan Kelly, I thank the House for providing me with an opportunity to update Deputies on actions being taken to address homelessness in the immediate, short and longer term.
It is a very positive reflection on our society and political culture that this ongoing debate on homelessness is taking place. There are very few nations across the world that place such an emphasis on the plight of the homeless and fewer, even among our EU colleagues, that are so effective in implementing responses and bringing about solutions. The issue of homelessness is complex and about much more than just funding and money, as the Deputy pointed out. Statutory responsibility for the provision of accommodation for homeless persons rests with individual housing authorities. The HSE also has a role to play in providing the health care and social supports required by homeless individuals.
I assure the Deputy of the commitment of my Government colleagues on the issue. There has been a focused and co-ordinated approach to tackling homelessness. In February 2013 the Government published its homelessness policy statement which outlined its aim to end long-term homelessness by the end of 2016. The statement emphasised a housing-led approach, which is about accessing permanent housing as the primary response to all forms of homelessness. Last May the Government considered and approved the implementation plan for the State's response to homelessness. This is a practically focused delivery plan which contains 80 actions which will contribute to the delivery of a ring-fenced supply of 2,700 units of accommodation by the end of 2016.
The long-term solution to homelessness is to increase the supply of homes. Last month the Minister launched the Government's social housing strategy 2020. This six year strategy sets out to provide 35,000 new social housing units at a cost of €3.8 billion and restores the State to a central role in the provision of social housing through a resumption of direct building on a significant scale by local authorities and approved housing bodies. The strategy is about providing housing for all social housing households, including homeless households, during the course of the six year period. Significant funding has also been made available to housing authorities to refurbish vacant units and this work will continue. This is a priority because it can provide much needed homes for homeless households. For example, there are 655 units in Dublin city that, with refurbishment, could be returned to productive use. Work has started on 245 of these and a further 410 will be completed in the next four to six months.
It is also essential to increase the volume of housing supply being made available to homeless households so as to meet the current urgent situation. Therefore, the Minister will be issuing a direction to the four Dublin housing authorities to allocate 50% of all housing allocations to homeless households and other vulnerable groups for the next six months, having regard to the time spent by these households on the homeless and other housing lists as at 1 December 2014. He will be considering a similar approach for other housing authorities across the country. He is also approving regulations to provide for the new housing assistance payment to be rolled out in the Dublin region on a pilot basis and which is specifically focused on homeless households. The pilot scheme will ensure homeless households in the Dublin region can access accommodation in the private housing market.
Earlier this month the Minister convened a special summit on homelessness to reaffirm the Government's commitment to end involuntary long-term homelessness by the end of 2016. The summit was attended by the Catholic and Church of Ireland Archbishops of Dublin, Deputies, elected members, officials and politicians from the Dublin local authorities, representatives of the NGO sector involved in the delivery of homeless services and officials from a range of Departments and State agencies. A number of actions arising from the summit were considered by the Cabinet sub-committee on social policy and public service reform at its meeting on 8 December and were then formalised in an action plan to address homelessness which was noted by the Government at its meeting on 9 December. The action plan which is available on the website of the Department of the Environment, Community and Local Government contains a number of actions which constitute an immediate response to the issue of rough sleeping in Dublin, as well as actions identified which tackle the more systemic issues, classified under the three categories of the housing-led approach.
I thank the Minister of State for his comprehensive reply. I commend both the Minister, Deputy Alan Kelly, and the Minister of State, Deputy Paudie Coffey, for the substantial, historic investment in social housing. It is the first time in the history of the State that such a substantial amount of money has been provided for the provision of social housing. I commend the speedy action taken in recent weeks, in bringing homelessness to the top of the agenda, not just in Dublin but also nationally. I know that the Minister of State, Deputy Joe McHugh, will convey to the Minister my point about a rent freeze. In the next two years we will walk into a situation where houses will be on stream. I do not believe in the broad brush characterisation of landlords, as there are good landlords. However, there is evidence that our difficulty with supply of and demand for homes is being exploited. It is for us, as legislators, to protect tenants. There should be emergency legislation. I am advised that while a constitutional change might be required to introduce rent control, it would not be required to introduce a rent freeze. We should be at the front in doing this before the crisis worsens.
I will convey the Deputy's specific point to the Minister. This is about supply and demand and the increase in rents. The issue is not confined to the capital but also manifests itself in places such as Limerick, Galway, Waterford and Cork. The Deputy acknowledged the short timeframe in which the Government has taken a series of actions. Within a period of six years the Government plans to invest €3.8 billion in the building of 35,000 houses, comprising public private partnership and State provision. This is an attempt to address the supply and demand issues. As an economics student, my first lesson was on supply and demand. There are supply issues in Dublin. There was a high profile issue in recent weeks. I acknowledge the proactive approach taken by the Cabinet and the Minister and the Minister of State in introducing the 50% quota to ensure 50% of local authority stock within four local authorities go to homeless persons to ensure that over the Christmas period we will not have people on the streets, aside from those who decide to do so voluntarily.
I appreciate the supply and demand points raised by the Deputy. He raised the issue of interfering with the market through a rent freeze. The market is the market, but the Government can lead from centre stage by addressing the issue of supply. We can work towards resolving it in partnership with the private sector.
Alcohol Sales Legislation
The Minister for Health, Deputy Varadkar, will be aware the ready availability of cheap alcohol is a serious problem in Ireland that requires urgent attention. There are 2.48 million people in Ireland who drink alcohol, 54% of whom drink harmfully and excessively according to the Health Research Board survey in 2014. In other words, 1.24 million people drink harmfully and excessively. Three people die every day due to alcohol and 2,000 hospital beds are occupied every night by people with alcohol-related illnesses. In 2010, the average Irish consumer drank 11.9 litres of pure alcohol, which is equivalent to 428 pints of lager, 125 bottles of wine or 45 bottles of vodka. I could continue with the worrying statistics but I believe the Minister gets the picture.
Moreover, due to low supermarket prices and aggressive price promotions, consumers can purchase large amounts of alcohol at ridiculously low prices. However, hundreds of deaths could be avoided each year with a minimum price for alcohol units. I urge the Minister to implement swiftly the public health (alcohol) Bill and to ensure it firmly includes a fair and feasible solution through minimum unit pricing. Unless minimum unit pricing is introduced, we will allow the serious link between cheap alcohol and anti-social behaviour to only grow worse. Our streets often are dangerous late on weekend nights because of marauding and demented youths fuelled up on cheap alcohol, which more than likely has been consumed in their own homes or the homes of their friends. As matters stand, Irish teenagers are more likely to be heavy drinkers than teenagers in any other European Union country. We are failing young people by not responding to the normalisation of alcohol misuse through the cheap and widespread availability of alcohol. Moreover, parents must wise up and take on their responsibilities as primary carers for their children and teenagers. Today, the Irish Heart Foundation launched a campaign called "Can you stay On The Dry in January?". To put it bluntly, this campaign is fighting to keep more hearts beating by asking the Irish public not to drink for one month and to avoid the temptation of cheap and readily available alcohol. When I cite the statistics in respect of binge drinkers, I do not refer to the stereotypical alcoholic but to the everyday person who does not even realise the volume of alcohol he or she drinks or the frequency at which he or she drinks. We almost boast about our identity as a nation of heavy drinkers and this is extremely worrying. Research has shown that Irish women drink significantly more than their European counterparts. Most women do not even realise that drinking three to six glasses of wine a day can increase their risk of breast cancer by 41%. There is an urgent need for a major sea-change in how we view our national relationship with alcohol. I believe that minimum unit pricing will help discourage and deter people from buying cheap alcohol.
I thank Deputy Mitchell O'Connor for raising this important matter and acknowledge her long-standing interest in this important social problem. Ireland has a serious problem in that we drink too much alcohol, even if consumption now is falling. Furthermore, when we drink, we tend to binge-drink. Ireland has the second-highest rate of binge-drinking in the world and this pattern of drinking causes significant harm to individuals, their families and society. I will take a moment to mention some other harms that alcohol can cause. It is linked to more than 60 different types of diseases and conditions, including cancer, as Deputy Mitchell O'Connor mentioned, physical injuries and cardiovascular disease. It is a factor in half of all suicides and deliberate self-harm and can be associated with public order offences, road traffic collisions, sexual violence and abuse.
The Health Research Board reported yesterday that alcohol was involved in one of every three poisoning deaths in Ireland in 2012 and remains a substance implicated in most poisonings. Our alcohol problem is significant and decisive and innovative action is needed to address it. In October 2013, a comprehensive and detailed package of measures was approved. The overall objective is to reduce Irish consumption of alcohol from 12 litres of pure alcohol per person per year to 9.1 litres, which is the OECD average, by 2020 and thereby to reduce harms caused by the misuse of alcohol. The key measures in the drafting of the public health (alcohol) Bill will include provisions for minimum unit pricing, restrictions on marketing and advertising, structural separation of alcohol from other products in mixed trading outlets and labelling of alcohol products among other measures.
Minimum unit pricing is a key part of the Government's strategy to deal with alcohol misuse. I believe it is the one measure that will make the most difference most quickly. Minimum unit pricing, MUP, sets a minimum unit price for alcoholic drinks below which alcohol cannot be sold. Under MUP, alcohol which is cheap relative to its strength is increased in price. MUP is able to target cheaper alcohol relative to a strength because the minimum price is determined by and is directly proportional to the amount of pure alcohol contained in the drink. It mainly is aimed at those who are higher risk, such as adolescents and people who have a harmful and hazardous alcohol consumption pattern. It therefore should have only a very marginal effect on moderate drinkers. There is strong and clear scientific evidence that an increase in alcohol prices reduces hazardous drinking and serious alcohol-related problems. My Department, in conjunction with our colleagues in the North, commissioned a health impact assessment from Sheffield University as part of the process of developing a legislative basis for minimum unit pricing. The research studied the impact of different minimum prices on a range of areas, such as health, crime and the economy. Work on developing a framework for the necessary Department of Health legislation is continuing and the heads of the Bill have just been sent to other Departments for observation. All things going to plan, I intend to publish the heads of this Bill in January 2015, allowing some time for the Oireachtas committee to consider them.
I thank the Minister and am delighted to hear he intends to publish the heads of the Bill in early January 2015. I note he spoke about the dangers of drink but if I may, I wish to bring another aspect to this issue. I ask that Members not forget the sale of cheap alcohol is contributing greatly to the decline in people shopping locally. Local retailers and publicans are struggling to compete with supermarkets, below-cost selling and massive advertising expenditure. Instead, customers are loading up on cheap alcohol in large supermarkets. As the Christmas season is under way - the Minister mentioned this - I also must highlight that almost one in three road deaths in Ireland are alcohol-related and such deaths are avoidable. In addition, it is known that excessive alcohol consumption can contribute to domestic violence and according to Women's Aid, alcohol often is a trigger or de-inhibitor and can be used as an excuse by the abuser for domestic violence. If this culture of harmful binge-drinking is to be tackled effectively, the key areas of alcohol pricing, marketing and availability must be tackled, beginning, as the Minister has just announced, with the swift implementation of the public health (alcohol) Bill.
While one spends a lot of time in this Chamber disagreeing with people, I could not agree more with Deputy Mitchell O'Connor. There is absolutely no doubt but that alcohol is a contributory factor in domestic violence, as well as an excuse for it on some occasions, which is unacceptable. In my previous position as Minister for Transport, Tourism and Sport, much work was put into road safety and even though there has been an increase in the number of deaths on the roads over the past year or two, it has come down from a very high level of more than 600 per annum to approximately 200 per annum at present. This really demonstrates that interventions do work and among those interventions was mandatory alcohol testing, which made a big difference.
On the issue of the shops, I take the Deputy's point. I have no doubt but that large supermarkets and multiples use cheap alcohol as a footfall generator to get more business into their shops and that this probably does have a detrimental impact on smaller stores on main streets. Obviously, however, my responsibility in bringing forward this Bill as Minister for Health is on public health grounds and on those grounds alone.
The Dáil adjourned at 11 p.m. until 9.30 a.m. on Wednesday, 17 December 2014.