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Dáil Éireann díospóireacht -
Wednesday, 14 Jan 2015

Vol. 863 No. 1

Hospital Services: Motion [Private Members]

I move:

That Dáil Éireann:

noting:

— the deplorable overcrowding being experienced in hospital emergency departments;

— the record number of patients waiting on trolleys;

— the further delays in scheduled hospital treatments that will result from such overcrowding; and

— the failure of the Government and the Health Service Executive (HSE) to adequately prepare for a situation they fully expected to happen;

agreeing that:

— the overcrowding crisis is causing an intolerable risk and danger to patients;

— patient dignity is being compromised;

— there are insufficient beds and front-line medical staff to treat the increased number of patients needing admission; and

— the crisis is being exacerbated by the number of patients clinically discharged who cannot leave hospital because the Government and the HSE is not providing sufficient nursing home beds or home care support; and

calls on the Government and the HSE to:

— immediately provide beds and increased frontline staff so that the overcrowding can be eased; and

— restore the number of beds funded under the Nursing Homes Support Scheme to at least the level supported in 2013.

The purpose of this motion is to highlight again the difficulties arising from the inevitable crisis we see every January with the number of people waiting on trolleys in accident and emergency departments. This year, by any stretch of the imagination, has seen an extraordinary increase in the number of people waiting on trolleys in our accident and emergency departments throughout the country. There were 601 such people last week. The difficulty is that we as a society have almost accepted this as a fait accompli, politically and, dare I say it, systematically. We owe it to people who present at accident and emergency departments who are genuinely sick and who are very often frail or elderly to have better services than they have received to date.

We tabled this motion to highlight the issue. I will read from an e-mail I received, although I will not mention names in the interests of privacy. It states:

My 76-year-old father was sent by our GP to an accident and emergency department in St. Vincent's Hospital on New Year's Eve. He spent over 50 hours there on a trolley and we had to supply him with pillows and blankets. He did not receive any hot food for the period endured. There was bread and yoghurt for breakfast, a sandwich for lunch and another sandwich for tea every day. Try to survive on that when you are well. I sat on the floor by his trolley. Barely able to breathe, he had to queue for the one available toilet and there were no washing facilities or privacy. There were insufficient numbers of doctors and nurses as we continue to export our expensively trained Irish doctors and nurses to Australia. Meanwhile, seriously ill people are scattered all over our inadequate emergency departments.

When he was admitted, service improved slightly. Sleep was an optional extra. My family spent over €100 on parking over the eight days he was there. As there are not any chairs available, visitors and others had to stand or sit by the patients on trolleys. I am appalled. Sick people must be treated better. Statistics mean little until it is you or your family being treated with such disrespect. This Government's time hand-wringing and blaming the situation on others is no longer acceptable. If a fraction of the money that has been wasted on Irish Water and other white elephants had been invested in primary care facilities and nursing homes, this well-flagged problem could have been eradicated.

The father of this person in Terenure was admitted to St. Vincent's Hospital on New Year's Eve and spent more than 50 hours on a trolley there. He is 76 years old. This motion is meant to highlight the crisis that evolves every January in our accident and emergency departments throughout the country.

The difficulty is we know this will happen so should we accept it as an inevitability or try to put measures in place that would address the underlying problems? The Minister has claimed that he has tried to secure an extra €25 million to deal with delayed discharges and to increase the number of fair deal nursing home beds by 300. By any credible stretch of the imagination, that is insufficient for many reasons. There will be 1,400 fewer fair deal beds this year than there were in 2013. The population is getting older year on year, with the number of people over 80 increasing by 3.5% to 4% every year. The pressure is consistently building because of the demographics of our society.

It is now time for us to park this nonsense on the trolley issue that happens year in, year out and that has gone on for years. We must deal with the issue in a meaningful way. The Minister has made a couple of interventions and although we would all wish a new Minister well, he cannot pretend he is a passive observer, a spectator or an analyst of the health services. He is the person ultimately in charge and he must roll up his sleeves to get involved in ensuring we have systems in place that will prevent an escalation in the number of people waiting on trolleys every January. This is not just about people waiting on trolleys as there is the issue of patient health being compromised, as has been highlighted time and again by front-line service providers such as the doctors and nurses working in our accident and emergency departments. They inevitably work in an environment that is compromising patient safety. Even today, the Taoiseach admitted this environment is not as safe as it should be.

There was a problem from last year that we saw evolving in the health service. When he took up his new post, the Minister was informed of the number of delayed discharges in acute hospital settings and was advised that this would create difficulty with regard to the capacity of accident and emergency departments in dealing with increased throughputs, particularly in the winter months. Nothing was done. Last November, we saw some spin in claims that the Minister had secured a major increase in funding to deal with delayed discharges. The bottom line is that when we work through the figures, we are still worse off than in 2013 with regard to the number of fair deal beds. Everybody accepts that we should not have cases of acute hospital beds being tied up by a patient who does not want to be there and should not be there. Such patients must be moved to a step-down facility or afforded a home care package or a fair deal nursing home bed.

We tabled a motion last November about the fair deal scheme, as people are now waiting 15 weeks to be approved for it. This time last year, the approval time was six weeks, which means that in 12 months, the wait has gone from six to 15 weeks. This is not about statistics as this affects real people who deserve and should expect respect from the health services and this Government. Resources must be provided to ensure an adequate amount of capacity in accident and emergency departments or acute care hospitals to deal with throughput. The motion is important for that and a number of other reasons. It will highlight the issue and put pressure on to ensure that appropriate resources can be put in place.

The Minister has said time and again it is not necessarily about resources and that there are other issues. Of course, there are other issues. There are issues in regard to how we manage elective surgeries and the changeover of staff, including non-consultant hospital doctors, etc., every January and July. There is a spike because of that, with new people coming into a new department and maybe unsure of the work practices and the rostering and all that flows from that. However, the bottom line is that we are aware of it. There is this idea that the Minister can sit passively by and establish an emergency department task force, which did very little as far as I can see. It met prior to Christmas and only for the fact it was dragged kicking and screaming to a table, it would not have met yet. There is this idea that we can accept 300 or 400 people on trolleys as the norm. It is not the norm. These are 300 or 400 people week in, week out whose lives and whose health is being compromised by the fact that the system cannot manage itself. The reason it cannot manage itself is obvious in the sense that delays in discharging patients is a critical issue. We just do not have enough front line staff in our emergency departments. They are two key issues. Management and the rostering of elective surgeries and the changeover of non-consultant hospital doctors at certain times are clearly creating huge difficulties also. Those issues must be addressed.

If it were about just changing the management structures and sending out a few memorandums from Hawkins House, I am quite sure the issues would have been resolved already. The Minister said he can issue an edict from the ministerial office but that it is not always implemented. However, the bottom line is that should be implemented. If the Minister sends out an edict or an instruction that something should be done, it should be done. If it is not done, there are a number of reasons for that. Either the Minister is sending out edicts that cannot be implemented because of a lack of resources or people simply do not believe the Minister has the solutions to the problems. For whatever reason, they are not always implemented and that will have to be looked at as a matter of urgency.

I looked back over statements made by the Taoiseach and the previous Minister for Health when in opposition and even when in government. They clearly show they are not dealing with the difficulties the health service is facing on a continuous basis with the urgency and importance they deserve because the funding provided to the health services in recent years has consistently undermined the system in terms of being able to deliver health care. We instanced the whole issue of the fair deal scheme.

The other key area, which everyone in this House agrees should be implemented to ensure we address the problems in our emergency departments and in our acute hospitals, is the whole issue of the primary carer strategy. It is a wonderful strategy which has been bought into by every stakeholder. The difficulty is that it has not been implemented. We are very slow to roll out the whole process of funding primary care. We have said previously in this Chamber that primary care is in crisis. There is a difficulty there and we cannot dismiss it. There are major problems in GP practices throughout the country. Many of them are financially below the waterline and are incapable of providing the services they want to provide and which their clients and patients need. That, in itself, is a key area that must be addressed.

If the Government was in office for only a matter of months or a year, we could accept that it takes time to find its feet and bed down but it is now going into its fifth year in office. It is no longer in its infancy; we are well into the latter years of the lifetime of this Government. It must accept it has some responsibility and it is time it shouldered that in a meaningful way.

The Minister highlighted last year's budget as a major increase in funding but when one goes through the figures, no matter what way one tries to dress it up, our health service is starting from a very challenged position in 2015. The Minister is hoping, in terms of the figures, that there will be a major drop in the number of people who will qualify for medical cards on the income guidelines to make up the shortfall that will invariably come about. That is for what the Minister is hoping. That is the gamble but it has not paid off to date in terms of making up false savings that have been presented to this House by the previous Minister. We had almost fraudulent, bogus budgets which were signed off on by the Taoiseach and the Cabinet, of which the Minister was a member. It is time the Government not only rolled up its sleeves but actually showed commitment to our health service to give people dignity when they present at emergency departments so they do not have to lie on trolleys for more than 50 hours like the 76-year-old man in the emergency department of St. Vincent's Hospital on new year's eve. He was given a yogurt for breakfast, a sandwich for lunch and a sandwich in the evening and he had to queue for the one toilet. That is what is happening in our emergency departments. The Minister knows that well from his previous profession. He saw that at first-hand and now he has an opportunity to do something about it.

I urge the Minister to at least accept that the budget, which was presented to this House in November of last year, is simply not sufficient and that these once-off savings and these additional income streams will not provide a sound and sustainable funding model so that the health service can plan ahead and achieve its targets and outcomes but, more important, can treat patients with dignity and respect in a safe environment. That is what has to be done.

One of the issues put forward as a solution to the problem was the cancellation of elective surgery. That is just shifting one problem to another area. How many people have been geared up, ready to go into hospital for a procedure, for surgery or for some diagnostic procedure to be told at short notice that it has been cancelled? That is no way to run a health service. The difficulties in reassessing that person and re-entering him or her into the system continually grinds to a halt the waiting list system, which is already increasing exponentially. The idea that one of the great solutions is the cancellation of elective surgery as a means to address the crisis in our emergency departments is not good enough. It is something that has to be addressed quickly to ensure we do not consistently end up delaying elective surgeries and elective diagnostics to deal with the issue of trolleys in our emergency departments.

If the emergency department task force is the solution to the problems, I fear for the people working in our health service who must continually, under huge pressure and in unsafe work practice environments, deliver health care in this country. They are the people who are being let down and denied the opportunity to fulfil their professional mandates and to honour their commitments in terms of their professions, whether as a doctor, a nurse or another allied medical professional. They are the ones who want to help people but this Government has tied their hands behind their backs in terms of a lack of funding.

I commend this motion to the House. It highlights the difficulties but also asks Government to at least accept that the funding provided is not sufficient to deal with the crisis.

I welcome the opportunity to speak on this motion and I commend Deputy Billy Kelleher on tabling it. The most important point in the motion is the need to immediately provide beds and increase the number of front line staff to deal with overcrowding in our hospital emergency departments. The point has been made over and over that the Government and the HSE expected that this deplorable overcrowding would happen. We have to ask why there was not adequate preparation for this.

I would like to talk about Galway where the HSE itself talked about the unacceptable and growing concern about University Hospital Galway. The Irish Nurses and Midwives Organisation announced that its members are to be balloted on possible industrial action. We met the nurses outside the House today and they talked about the excessive workloads at the city's public hospitals. It made that statement after the INMO reported a record 563 people on trolleys in hospitals across the country. According to the INMO trolley watch survey, last week there was the record high figure of 601 people on trolleys. I know there has been some dispute as to how these figures are arrived at but I am sure we all agree the figures are far too high.

The INMO has stated very clearly that the conditions for staff and patients have reached an "intolerable and grossly unsafe" level. One of the spokespersons said "It is no longer possible to provide professional and high standards of care to vulnerable patients in such unsafe, under-staffed and immoral conditions". Nurses say they thought long about serving notice of industrial action in Beaumont Hospital and hospitals in Drogheda, Naas, Mullingar and Limerick. We should be very concerned about that.

Beds have been lost in Galway and Roscommon hospitals, principally through the closure of the accident and emergency department in Roscommon, which is putting further pressure on Portiuncula Hospital in Ballinasloe and University College Hospital, Galway. People still talk about the car parking situation in Galway because of the new building projects. There is talk of building a new unit with 50 psychiatric beds. It seems very wrong for all the development to take place in one hospital. A total of 22 psychiatric beds have been closed at St. Brigid’s Hospital in Ballinasloe. One of the first things to be done in Galway is to build a new car park because of the difficulties people have in accessing a parking place.

Last November we spoke about the shortage of nursing home beds and the fair deal scheme which was approving only a few people every week. That improved a little. The HSE is saying that an additional 7,600 beds will be required for long-term residential care between now and the end of 2021. There is a need for careful planning, for people to sit down and examine the situation. When nurses tell us, as they did today outside Leinster House, that patients are being examined in corridors in hospitals and dignity, as one said, has gone out the door we have to start asking serious questions. They say there is no privacy. There is not even a pillow, a basic comfort.

I hope the Minister is listening to what has been said. Local radio and newspapers indicate what is happening on the ground. There was a headline in last week’s Connacht Tribune asking how the emergency department crisis hit this new low. It reported that a patient was left parked in an ambulance for 90 minutes because there was no trolley and that a pensioner was discharged to get the bus home in her nightdress. The Tuam Herald gave more detail. It transpired that the woman, who had been in the hospital from 9.45 p.m. the previous evening, was not seen until the next morning and had to get a taxi to Eyre Square then a bus home. When one sees those situations one knows how serious and important it is that we get action in our emergency departments.

I thank my colleague, Deputy Kelleher, for giving us the opportunity to raise this issue this evening. We should not be debating this here because it should not have happened. There was notice, as there has been for many years, that January would be difficult. I am prepared to accept that the Minister took the necessary steps but that they were not implemented. That is a big problem, if the plans he put in place were not implemented. We are entitled to answers and the 600 people who last Monday week found themselves on trolleys are entitled to know why the Minister’s wishes were not implemented by either the HSE or by the Department.

The management of the HSE must answer why it is presiding over this situation, and seems relatively comfortable to do so, in the hope that we will move on to another debate and that if waiting lists or some other issue comes up it will deal with that. We will be here again in January 2016 and further Dáileanna will be here in 2017 and 2018 discussing this problem because of the time of year, unless there are fundamental changes in the attitude and ethos of HSE management on this issue. It has to stand up and take responsibility, as do senior officials within the Department. They must take responsibility and stop leaving the present Minister, or any future Minister, hanging out to dry for their failings and lack of willingness to implement policies.

We must have a proper system of primary care. General practitioners, GPs, are at the base of any proper system of primary care. They have never been under as much pressure as they are now. There is the lure of foreign climes, to which the Minister has referred, and the lure of more regimented health systems offering much more money. Young GPs are seriously tempted by that.

There is the difficulty of getting GPs to attend in rural areas. The notion that the rural practice allowance seems to be a bonus that the HSE will offer, depending on the candidate for the job, rather than being a standard offering for a rural practice is typical of the HSE’s attitude to GPs. If we are to have a proper primary care system which will allow us to avoid many of the incidents Deputy Kitt referred to and that have happened in hospitals over the past two weeks, GPs must be at the core of that system but the administration within the health system must give them the proper respect and resources. A properly resourced GP facility can do many things so that people do not need to go to emergency rooms. Proposals have been made for some time for them to deal with a range of conditions, such as haemochromatosis. Pharmacists are also an under-utilised resource on everybody’s main street that can work and get involved in primary care, with proper facilities, which would save people having to go to the emergency room at any time of the year but particularly now.

We must examine the administration practices of consultants and hospitals that allow hospitals to have the same work practices as other workplaces and shut down for two weeks. Everybody is entitled to their holidays and should be allowed to take holidays. Monday a week ago was the return to work day and many releases from hospitals that had not been signed off were suddenly signed off and the problems improved considerably throughout that week. That is ridiculous. People working in hotels would not be allowed to take leave over Christmas because it is one of the pressure points in the year. If administration and leave policies are playing a role in this problem they too need to be changed for next year and we cannot have those allowances in the system. We are not dealing with manufacturing an inanimate object but with people in a very distressed state. We have all seen cases like those referred to by Deputy Kitt. They are real people whose families are very distressed at what is happening.

I support Deputy Kitt’s remarks about the policy which has continued for some time of forcing services out of small hospitals into regional hospitals. Galway is an example. The nursing staff in Galway are phenomenal, as are all the nurses. They spoke today of the frustration at services being withdrawn from small hospitals from Letterkenny to Limerick and everything being put into the regional hospital in Galway whose campus is too small to deal with it all. That too results in the kind of problems that happened last week.

The problem in Mayo General Hospital was exacerbated by several issues but at one stage last week four ambulances were stalled outside the accident and emergency department with patients in them because there was no room in the accident and emergency department or the hospital for those four patients. The already poor ambulance service was hit by having the four ambulances parked up. Patients received some initial consultations in the ambulances. There needs to be a different approach to this problem. The notion that the emergency planning force for this did not meet, even though everyone knew the problem would arise, is like having a guard dog that cannot bark.

We need to have a properly resourced emergency planning force. I welcome the interesting decision to appoint Liam Doran as co-chairman of the task force. He has laid out that his solution to this problem involves extra staff and extra beds. I wonder whether his appointment by the Minister represents a somewhat tacit endorsement of that policy. I know there are many other issues in this area. The central involvement of Mr. Doran in this process must represent some sort of endorsement by the Government of the appointment of extra nurses and the opening of extra beds as part of the solution. Where will the budget for that come from during 2015?

Last year, the lack of funding for the fair deal scheme resulted in a reduction of more than 1,000 in the number of people receiving fair deal packages. We discussed the delays in getting approval for the fair deal scheme on Private Members' business well before Christmas. As a result of these delays, people who do not necessarily need to be in our main hospitals are unable to get into nursing homes. I understand extra money was allocated in the budget, but is that money being spent? What is the timescale for reducing the delays in processing fair deal applications in order to ensure there is space within the system at the beginning of February, when admissions tend to spike, or in the event of a flu outbreak? If there are 600 people on trolleys, it will be more difficult to deal with a major outbreak of some sort of winter disease.

I would like to make similar point about community care packages, which were the subject of a ministerial intervention before Christmas. Why do Deputies, Senators and other public representatives seem to have to go to war with local health officials to get community care packages and home help hours in place? After the need for such services has been signed off on by general practitioners and other professionals, the system seems to make people wait. It forces patients to stay in hospitals instead of giving them the supports they need. Very few people want to be in hospital. When they face a choice between being in hospital and being at home, they want to be at home. As I said at the outset, unless we are serious about primary care, such people will not have an opportunity to be at home.

I think the system has many questions to answer. Many plans that may or may not have been put in place were not acted on. This serious situation needs to be resolved. As a result of this ignorance and unwillingness to act, more than 600 people were treated in an undignified fashion last Monday week. It is totally unfair on our nursing staff, doctors and consultants, who are doing their level best in incredibly difficult situations, to have to face this problem every January. It seems that when we present this problem to them every January, it is debated in the news and it sucks up the attention of programmes like "Liveline" before the media coverage moves on. It comes again the following January. We should resolve to do something different this January so that we will not be discussing major waiting lists in emergency rooms throughout the country in January 2016.

I welcome the opportunity to speak on this Private Members' motion. I thank my colleague, Deputy Kelleher, for tabling this motion, which is very timely in view of the difficulties that are happening on a daily basis. The public at large is aware of the difficulties people experience when they have to interact with hospital services because it sees them on television screens and hears about them from family members, friends, neighbours and relations.

Our motion is very clearcut and direct. It is not long-winded. It is concise and to the point. It notes "the deplorable overcrowding being experienced in hospital emergency departments". We all know that the number of people waiting on trolleys exceeded 600 last week. The most depressing aspect of this matter is that these problems were foreseeable, as the Minister has admitted. He took some action in advance to make sure we would not have this crisis. His predecessor as Minister for Health, Deputy Reilly, said that any Minister who had more than 550 people waiting on trolleys would be facing a crisis. That is what we have today. We have had it for the last number of weeks. There might be some change from week to week, but the essence of the problem is still there. We need to talk about the underlying issues that are not being dealt with.

When I think about the number of people waiting on trolleys, the most depressing aspect of it is that many people cannot get from ambulances into accident and emergency departments because those departments are chock-a-block. Some Deputies have already spoken about this. Both sides of hospital corridors are full of trolleys that are being laid head-to-head or head-to-toe. Many people have had to wait in ambulances because of a lack of room. On some occasions, the ambulance trolleys on which people were brought in from ambulances by emergency technicians were left in hospitals because ambulance staff were not able to get those trolleys back when they were called out after their ambulances received subsequent emergency calls. Now they are holding on to the patient in the ambulance in the car park, rather than letting go of the actual trolley. That is a Third World way of doing business, if not a fourth or fifth world way of doing business. People must ask themselves if this is what we have actually come to.

The most important aspect of all of this relates to the many people who had scheduled hospital appointments. I can think of many elderly people who had appointments cancelled last October or November. In the wind-up towards the end of the year, hospitals that had reached their annual quotas for orthopaedic operations, for example, by September or October scaled down their levels of activity. Many surgeons were not fully occupied because sufficient resources were not available to provide additional nursing care in post-operative situations. The operations that were not being carried out were delayed until the new year. Many people are now finding in January, having got psyched up and ready for their operations, that their procedures are not going to proceed because elective surgery has been suspended in many cases. That is unnecessarily causing further distress and anxiety to older people. As a result, hospital treatments are increasing.

I was concerned to read at the weekend that some consultants are not willing to take on new patients because their waiting lists are full and those on the lists are having to wait for excessive periods of time. They believe it would be unsafe to add anyone else to the end of those lists because they would not be seen within a reasonable time. People who need to be taken onto consultants' waiting lists are not getting onto those lists. This is another element of what is not being counted in the health service. I suggest that the Minister and all his officials do not yet have a proper handle on the number of people who are waiting for outpatients' appointments and elective surgery. Some of those who are waiting are not being taken onto consultants' waiting lists even though they need to be seen. They are somewhere in limbo in the system.

The clinical risk to patients is a very serious issue. The Taoiseach said here in the Dáil today that "accident and emergency departments were not as safe as they ought to have been". Even though he did not say it in so many words, it is clear he was saying that accident and emergency units are not up to the acceptable standards that HIQA would want in such units. The Taoiseach acknowledged that here today. That is no recommendation to be giving the hospital service and the HSE in how they conduct their business. It is due to a lack of funding. Why is there a lack of funding for the HSE? The Government chose not to give adequate funding to the health services. It decided to use its resources in other ways. I will come to that in a few minutes.

I would like to speak briefly about the question of dignity on trolleys. I have seen elderly people - in their 70s and 80s and even older - being treated head to toe along the side of a corridor. I have seen young children in the corridor waiting to get into the same accident and emergency department. There is sometimes no dignity in the manner in which they are treated. There is no privacy when nurses come to them to check their blood pressure and see how they are doing, or when doctors come to do various tests at the side of a corridor. It is enormously upsetting for elderly people. They ask whether this is what they have come to at the end of their days. They ask whether this is really happening to them, having reared their families and worked for many years.

I mentioned in this House two months ago that I saw this happening in Naas General Hospital when I happened to be there on a few occasions in November of last year. On one particular day, the nurses took to the street at lunchtime to protest against the queues in the accident and emergency department. I stress that they did this on their own time. They wanted to highlight difficulties with patient safety. A further aspect of this issue was evident outside Leinster House today when we were met by nurses on our first day back in the Dáil. They were not speaking for themselves. They were not out looking for pay rises, roster changes or improvements in terms and conditions. They were speaking up for their patients. The families of patients are probably afraid to upset the doctors and nurses who are struggling to the best of their ability in accident and emergency departments.

Families can be slow to speak up in such situations.

Accident and emergency staff have a tremendous responsibility, but many are overstretched and are being put in an impossible situation. We must ask ourselves why. The reason is simple: we have 2,000 fewer beds in the system. One cannot remove 2,000 beds over a number of years and expect the system to function as normal. This has led to the inevitable consequence of there being a backlog in accident and emergency departments. As has been stated, there are also delays in the fair deal scheme. It is extraordinary that the Minister keeps referring to the cap on its budget as if someone somewhere capped it. He is the Minister. He capped the budget. He cannot blame the Minister for Public Expenditure and Reform, Deputy Howlin, or the rest of the Government.

Actually, the Oireachtas capped the budget.

Yes, but the Oireachtas-----

The Minister should not absolve himself, please.

The Government could raise the cap. The Estimates have been published and will appear before the health committee in the coming weeks. I hope that the Minister will make a case to the Minister for Public Expenditure and Reform for lifting the cap.

Fewer public beds are available in what are called community hospitals. It would be remiss of me to speak on this issue without mentioning the farcical situation of Abbeyleix hospital and St. Brigid's Hospital in Shaen, Portlaoise, both of which are community hospitals. Abbeyleix hospital could have up to 50 patients, yet the Government, including the Minister's predecessor, Deputy Reilly, announced its closure. It is still not closed, but no one is being admitted to it other than on a respite basis. An attempt has been made to close the hospital but, for a modest amount of money, it could be brought up to the Health Information and Quality Authority, HIQA's standards. The choice has been made to outsource care of the elderly. The same is the case in St. Brigid's Hospital. For the umpteenth time in the Chamber, I ask the Minister to make a decision and announce once and for all that he will upgrade both hospitals. It would be a scandalous waste of resources not to utilise their facilities.

Let us not move away from my question on why we are in this situation. It is because of Government budgetary choices. It is ironic that this debate is occurring at the beginning of January when the Government made its choices in the middle of October. The Government could have provided more money for hospital beds or crowded accident and emergency departments, but instead chose to give tax cuts to the wealthy, those on the top tax rate. The Government could have decided to provide more money for outpatient appointments, putting people on consultants' waiting lists, reducing elective surgery waiting times or lifting the cap on the fair deal scheme, but instead chose to look after the most well-off in society by giving a tax cut of 1% to those earning more than €70,000. People earning that much benefitted more from the recent budget than anyone else. They are receiving their tax cuts in their pay packets today. Meanwhile, hundreds of people are lying on accident and emergency trolleys.

I move amendment No. 1:

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

"acknowledges:

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

— that the Government regards trolley waits of over nine hours as unacceptable and that optimum patient care and patient safety at all times remain a Government priority;

— 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 emergency care; and

— the targeted, integrated approach being adopted by the HSE in relation to the needs of elderly patients who no longer require acute care;

notes, in particular:

— that all hospitals have escalation plans to manage not only patient flow but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care;

— actions being taken to address ED overcrowding, including the opening of additional overflow areas, the reopening of closed beds, the provision of additional diagnostic scans and consultants doing additional ward rounds to improve the appropriate flow of patients through the hospital system;

— other actions being taken, including the provision of additional home care packages, additional transition beds in nursing homes, 300 additional Nursing Homes Support Scheme places and an extension in Community Intervention Teams;

— that the Minister for Health convened the Emergency Department Taskforce to find long-term solutions to overcrowding by providing additional focus and momentum in dealing with the challenges presented by the current trolley waits; following an initial meeting last December, the HSE is working on an action plan to be finalised by the end of January to specifically address ED issues with a view to a significant reduction in trolley waits over the course of 2015;

— that the Government has made provision for a welcome increase in the total financial resources available to the HSE in 2015; this increase in funding, which is comprised of additional Exchequer funding of €305 million, increased projected once off revenues of €330 million, and minimum savings of €130 million in areas such as procurement, and drug and agency costs, is part of a two year programme to stabilise and improve health funding after seven years of significant retrenchment as a direct consequence of the emergency financial situation the Irish State has had to address;

— that in 2015 the budget for the Nursing Homes Support Scheme is €949 million and this is supporting over 22,300 people in residential care; the budget for community services is €315 million and this is providing home help and home care package services to some 56,000 people at any one time;

— that the Government provided additional funding of €3 million last December and €25 million in 2015 to address delayed discharges; this funding is being targeted at hospital and community services which can demonstrate initiatives to address specific needs of delayed discharge patients most positively and therefore improve timelines for admission from EDs and waiting lists; this has reduced the waiting time for approved applicants from over 14 weeks to 11 weeks currently;

— that the Review of the Nursing Homes Support Scheme which is currently underway will consider the future funding and sustainability of the Scheme as well as how

community and residential services are balanced; this Review will be completed shortly, following which the Government will be considering how best to meet the needs of older people in the future; and

— that the long-term solution to the problem involves a shift from worsening ill-health in our population to greater well-being through societal change supported by Healthy Ireland initiatives on obesity, smoking, alcohol misuse and greater physical activity; and

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

I thank the Fianna Fáil Party for giving me another opportunity to report on emergency department overcrowding and to outline the actions that are being taken by hospitals, social care, the HSE and the Government to alleviate the current situation in the short term and resolve it in the medium term.

The Government acknowledges that the problem of overcrowding is serious, real and cannot continue. We discussed it at Cabinet this week and last. It was on the Cabinet sub-committee agenda in December and will be again this month. I attended the second meeting of the emergency department task force today, but I assure the House that much more than task force meetings is happening. There have been daily, twice daily or, on one occasion, thrice daily conference calls among senior national and regional-level staff since the new year. I took part in one of these over the weekend.

This issue is a priority for me and the Government. Emergency department overcrowding is a blight on our health service, which is otherwise good in so many ways. I cannot accept the suggestion from some Members opposite that we have a Third World health service. That does a disservice, not just to our country, but also to the people who work in and use our service.

The Minister should take responsibility for it himself, so.

In fact, our health service is rated 14th out of 31 by the European Health Consumer Index, ECHI, and mortality and survival rates are above the OECD average and going in the right direction. Life expectancy is increasing, too. This would not be the case if we had the Third World health service the Members opposite seem to believe we have.

Emergency department overcrowding is a chronic problem that has beset us for at least 15 years and turns into a crisis whenever there is a surge of patients or a significant delay in discharges. It is not an emergency department problem per se, but a systemic one that manifests itself in the emergency department. As Deputies will know, I have worked in three emergency departments as a doctor, was on-call senior house officer to three more and have visited three since my appointment as Minister for Health, including two in the past week. I know the territory.

The Leader of the Opposition, Deputy Martin, also knows the territory. He was Minister for Health for four years between 2000 and 2004. During that time, the Fianna Fáil-led Government, supported by Independents, promised to end waiting lists permanently within two years and ensure full bed capacity in hospitals. That was in 2002 and was another case of "A lot promised, little done". That Government remained in power for a further nine years. This Government has been in power for four years. During that time, matters have consistently improved year on year until they started to deteriorate again in the summer, culminating in a spike last week. Comparing like with like, either using the special delivery unit, SDU, or nurses' union trolley watch numbers, the situation has still not reached the levels experienced under Fianna Fáil. It was bad this new year, but was nowhere near as bad as in the 2003-04 period when Deputy Colm Keaveney, who helped propose this motion, attacked Fianna Fáil and Deputy Martin for creating a so-called nightmare in our health service.

All the time there were horror stories in the newspapers, not just in January, but almost every single day. There was the story of the 85 year old woman in May 2003 who was sent home after spending 75 hours on a trolley. Later that same month, a 79 year old grandmother died in Tallaght hospital after spending five days on a trolley. There were stories of patients having to be treated in the car park because there was no room for them inside and other stories of patients sharing trolleys, taking shifts to sleep. I would be happy to share some of the press cuttings from that period with the Deputy opposite.

According to the Irish Independent in 2003, ambulances had to wait for up to three hours at Beaumont hospital's chronically overcrowded accident and emergency department one weekend and their trolleys were used to treat patients. One would swear from the comments of the Members' opposite that this was something new. A headline in The Irish Times read: "Patient dies after five-day trolley wait". The article continued, "Tallaght Hospital has said it is treating seriously a complaint from a Dublin family, whose 79-year-old mother died yesterday after spending five days on a trolley in the hospital's accident and emergency (A&E) unit." In 2000, a 90 year old woman fell off a hospital trolley after she had been left unattended, broke her leg and subsequently died, an inquest was told. Dr. Ciaran McLoughlin, the west Galway coroner, stated that he had no doubt the fall contributed to the death. There was another story of a woman who spent 75 hours on a trolley before being sent home and yet another of a County Galway boy who waited six years for necessary surgery. The latter was particularly condemned at the time by a Galway county councillor, Deputy Keaveney, who went on to say that, if all of the studies commissioned by Deputy Martin were stacked together, one could probably have built an extension to the hospital. The response of Deputy Martin, the then Minister, was a very simple one: it was not a "crisis", the term was being used with "gay abandon" - he did not like the term at all - and, of course, the situation was not his "fault".

How did he address the crisis? Did he stand up and take responsibility? Did he take steps to address it? No, he did not. In May, he insisted in the House that he did not like the word "crisis", complained that it was being used with "gay abandon" and that none of it was his "fault". No wonder Dr. Maurice Neligan, writing in The Irish Times, wondered if "you were right there, Micheál" and criticised the Minister's "capacity for self-delusion". Later, it was revealed that €400 million in new health facilities and hospital wards had remained unopened. Some 147 reports were commissioned, costing €1 million, and €2 million was spent on public relations. Thirty thousand people marched on the streets to protest.

Deputy Martin had four years as Minister, with a budget and staffing levels that increased exponentially each year. Despite having every opportunity, all of the tools and plenty of time, he achieved little. Now he wants to be Taoiseach.

It seems to me, however, that he was the greatest innocent bystander in history, as the health service lurched from crisis to crisis and wild promises were made and then ignored. With such a legacy behind him, I am grateful for his advice. Any Minister for Health could learn a lot from his mistakes and poor leadership. His is a poor example to follow and I do not intend to do so. He suggested recently that I should stop acting like a "commentator and some sort of analyst". Perhaps he is concerned that I actually can analyse the problems, that I am not afraid to comment on them and face up to them. He seems worried that I am actually prepared to take responsibility for solving them, when he would not. He fears being shown up and people being reminded of what he failed to do as Minister for Health and the appalling damage he did to the economy as a member of the previous Government.

I have also listened to the views put forward by Sinn Féin commentators over the past week. For the benefit of the House, I will refer briefly to some of the news from Northern Ireland, as reported in the Belfast Telegraph. We are told that the Belfast Health Trust stopped all non-urgent elective surgery up to and including 11 January, leaving many people back on waiting lists. Joanne Gibson from Fintona in County Tyrone spoke to a reporter about how she was admitted to the emergency department at Enniskillen hospital at 11.30 a.m. and was still there at 8.30 p.m. She was finally moved to the surgical ward more than a day later, at 1.30 a.m. The Belfast Telegraph article includes the following statement by Dr. George O'Neill:

I have people who wait up to a year to be seen, to be diagnosed, and then they are put on a waiting list to have a procedure carried out. We are now getting back to where it was four, five, six, seven years ago.

I could go on but I will not. The point is that emergency department overcrowding is not a new problem and it is not unique to Ireland. There is, for example, a major issue in this regard in England at the moment. It is a sad reflection on our health service and our politics - on all of us - that we have been debating and discussing this for 15 years or more. It really is a case of Groundhog Day at this time of year every year. Why not use this opportunity to do something different? Let us all acknowledge the realities and spend a few hours in this Chamber today and tomorrow and in committee doing what the public actually wants us to do, namely, coming up with ideas and solutions. Let us make this a debate worth having. That is what I would like to do.

Getting on top of this matter once and for all will require sustained attention over the coming months. I am committed to giving it the attention and political priority it deserves but I am loath to make promises. It is clear that this is not going to be an easy issue to resolve. It is not just a matter either of delayed discharges, staffing levels, skill levels, whether staff have a temporary or permanent contract, hospital avoidance, patient flow, management or advance planning. In fact, it is about all these things and more. The health service is like a delicate musical instrument which must constantly be retuned and fine-tuned if it is to work well.

The number of patients on trolleys in our emergency departments reached 525 last Tuesday morning. When one compares like with like, either using the special delivery unit's Trolley GAR measure or the Irish Nurses and Midwives Organisation's trolley watch, this was the highest figure in four years. Today, comparing like with like and time of year with time of year, the number is the lowest in seven years. However, I am not here to talk about statistics but about people. An individual on a trolley does not really care whether he or she is number 300 or 400. He or she just wants a bed and to receive the necessary treatment. While surges will occur from time to time, patients on trolleys should not be a year-round phenomenon in the way they are in some hospitals, and no patient should ever have to spend more than nine hours on a trolley waiting for a bed. Aside from the discomfort, loss of privacy and dignity, it is a patient safety risk, particularly for the frail elderly.

As of 2 p.m. today, there were 217 patients on trolleys in our emergency departments, with 131 in that position for more than nine hours. Most of these patients will be in beds before tonight but, of course, more patients will come in behind them. The situation varies from hospital to hospital and the reasons for this discrepancy also vary. Some hospitals have a problem with delayed discharges and put the on-trolley numbers down to that. Others have very few delayed discharges but still have patients on trolleys, which they put down to other reasons such as difficulty recruiting and retaining senior medical staff. Even though the situation is much improved, we are not out of the woods yet. Looking back to previous years, we have seen peaks in trolleys and overcrowding at various points in a given year, including in February 2011, March 2012 and May 2013. It is clear that a sustained focus will be required throughout the winter and into the summer. There is, moreover, always the risk of a winter vomiting virus, severe respiratory illness or influenza.

A range of measures is being taken to ease the situation. Non-urgent elective surgery has been cancelled, with the extent of and criteria for such cancellations varying from hospital to hospital, depending on the extent of overcrowding. Some less congested hospitals, for instance, have managed to do some elective surgery this week. Elective surgeries for life-threatening conditions like cancer cannot, however, be postponed for more than a few days. That is why I do not agree with calls for a blanket ban on all elective surgery, as put forward by some union groups. Closed wards have been reopened. Additional home care packages are being provided and, as of last weekend, no patient ready to be discharged is awaiting a home care package.

Transition beds in nursing homes are being funded while the paperwork required under the fair deal scheme is being worked out. In addition, 300 extra nursing home places are being funded under the scheme. There has been a delay in getting some patients into nursing homes, but this issue is progressing. It has been claimed that there are 1,200 nursing home spaces out there and there may well be, but they are not necessarily where they are needed. It is not possible to send people from Beaumont or Drogheda, for example, to a nursing home in Kerry and expect their relatives to visit them there. It might be the type of thing the NHS can do, but it would never be acceptable in this country.

To speed up patient flow, additional diagnostic scans are being made available and consultants are being asked to do ward rounds twice a day to speed up discharge. Community intervention teams are being extended, thereby allowing more patients to go home or stay at home or in their nursing home, where they will be visited by a nurse to give them their IV medicines or change their drip. Planning is under way to extend this measure to Drogheda, Naas and Waterford. It will also need to be available at weekends.

Extra beds or trolleys on wards reduce overcrowding in emergency departments, relieve pressure on department staff and offer a much safer solution for patients. This is done in other countries and is known as the "full capacity protocol" in the United States. Crucially, it breaks down silos and ensures overcrowding becomes a problem for the whole hospital rather than solely a problem for the emergency department, thus encouraging medical and other staff to expedite interventions and investigations and secure earlier discharge. However, extra beds on wards should never be seen as normal and it is appropriate that they should be counted. Whatever the methodology used, we should always be accurate in describing and interpreting our statistics and only ever compare like with like.

It is clear that an unprecedented number of delayed discharges is contributing to the problem of emergency department overcrowding, but there is more to it than that. The delayed discharges numbers peaked at 850 in early December and are now falling because of the measures that have been put in place. They now stand at 751. In Beaumont, for example, there are 81 delayed discharges, down from 100, and 23 patients on trolleys. In St. James's Hospital, there are 100 delayed discharges but very few patients on trolleys. In Letterkenny, there are no delayed discharges but there are four people on trolleys. In Cavan, there are 17 delayed discharges and no patient on a trolley. I am offering these examples to show there is no direct correlation between delayed discharges and emergency department overcrowding.

The actions we are taking to address overcrowding will help to deal with the surge we are experiencing at present and, we hope, get us through the winter. However, this does not represent a long-term solution. The long-term solution involves a shift from worsening ill health in our population to greater well-being through societal change supported by the Healthy Ireland programme and initiatives on obesity, smoking, alcohol misuse and greater physical activity. Without an improvement in population health, we will always be running up an escalator, working harder and employing more resources merely to match increasing demand. To make progress on the health and well-being agenda in 2015, we will carry out and publish the first survey of the health of the nation since the SLÁN report in 2007. We will then repeat it annually to see what progress we are making. Other measures will include new policies on obesity, the physical activity plan and the public health (alcohol) Bill, the heads of which I hope to publish within the next few weeks.

We also need to invest more in better primary care and social care. Better primary care will ensure people do not end up in hospital in the first place or at least not as frequently. This will require better management in the community of chronic diseases like asthma, chronic obstructive pulmonary disease and diabetes and better management and care of the frail elderly. I expect this approach to be at the centre of the new GP contract. I anticipate negotiations on that contract will begin later in the year once the talks on the provision of free GP care to under sixes are concluded. Deputy Calleary may be interested to know that the primary care service plan for this year includes provision for a minor surgery pilot programme under which 30 GPs will perform minor surgeries on GMS patients. There is also provision for access to ultrasound facilities, particularly for GPs in the southern part of the country, as well as a pilot programme to allow GPs to provide venesection for haemochromatosis. We also need much better social care in order that patients fit for discharge can get home or into a nursing home much sooner.

None of these things can be done quickly or without additional costs, at least initially. However, I will do my best to drive them forward. Ireland should be a country in which one can grow old with dignity. Today, unfortunately, that is not always the case.

Deputy Calleary asked if I accept that additional nurses and beds might form part of the solution. I do accept this, and that is why additional beds have been opened. I expect that these will remain open for months. We need to recruit additional nurses, and discussions are under way regarding a campaign in this regard. I am absolutely sure, however, that extra beds and nurses do not constitute the entire solution. One of the great successes in recent years has been the reduction in average lengths of stay. The average patient used to spend nine days in hospital, but this has been reduced to 6.7, which means that a great deal more work can be done. Even though budgets have remained flat, the number of surgeries carried out last year was 13% higher than the number carried out in 2010. The latter is due to greater efficiencies and increased use of day surgery in particular.

I look forward to listening to Members' contributions to this debate. I will provide the Joint Committee on Health and Children with a further update on this matter tomorrow. I will attend that meeting in the company of my senior officials and the director general of the Health Service Executive, Mr. Tony O'Brien. I take this opportunity to reject the Fianna Fáil motion before the House.

I take this opportunity to thank and acknowledge the contribution of front-line medical staff both in and outside our hospitals for the work they have done in the past two weeks and also that which they do on a daily basis. It has been an extremely difficult and challenging time for everybody working in our health service and also for those seeking to access that service, namely, patients.

It is never acceptable to have people waiting on trolleys in corridors or wherever, or sitting in waiting rooms for three or four - not to mention nine - hours. It is especially not acceptable for elderly or very young people to be obliged to wait. Last week, parents with very young infants were obliged to wait to be seen at Our Lady of Lourdes Hospital in Drogheda. My constituents in Meath East, along with the Minister and I, know this is not acceptable. However, it is not something that just happened in the past few weeks or in recent years. This problem has obtained for some time and it was caused by mismanagement of both the health system and the funding relating thereto over a period of many years by a previous Fianna Fáil Government. Between 2000 and 2004, one of the Ministers in that Government who had responsibility for health spent €14.7 million on reports both identifying the problems that existed and suggesting methods of solving them. However, as the current Minister indicated, we know that none of the reports in question were ever implemented because they were unworkable. Fianna Fáil is now presenting that former Minister as the alternative Taoiseach.

We know that throwing money at the problem is not the only solution. After all, we still had a substandard health system at the height of the boom. The providers of health services need to work together as a team. Change will not happen unless all interested parties, in both the health system and communities, work together. I visited the accident and emergency department of Our Lady's Hospital, Navan, last week, and the staff explained to me how they are managing at present. One of them informed me that they had received a great deal of help from the community. I refer here to simple things such as family members driving loved ones to or picking them up from hospital, thereby negating the need for ambulances to be used, and people attending their local GPs instead of visiting the accident and emergency department. This has helped to ameliorate matters. It is extremely important that those to whom I refer should work together. When the necessary plans were put in place last week, the numbers waiting in accident and emergency departments dropped. This week, the numbers are well below those that obtained at the same time last year.

Unfortunately, there is only so much that members of the community can do to help doctors and nurses. In addition, front-line staff can only be stretched so far. There is a need for further step-down care places to be provided, and I acknowledge what the Minister said in this regard. A number of such places were recently made available at Kilmainhamwood nursing home in north Meath. However, more of these places are required in the area. In addition, we must ensure that the Fair Deal scheme is funded in a comprehensive manner. While numbers have been kept quite low at Our Lady's Hospital, Navan - the Minister acknowledged this during a conversation I had with him earlier in the week - Our Lady of Lourdes Hospital in Drogheda is at breaking point. The latter facility has always been at the top of the list in terms of the number of people obliged to wait to be seen. There is a need for further staff to be recruited. When I spoke to staff and management at the hospital last week, I was informed that staffing levels are a problem. While recruitment has taken place, the numbers taken on have been limited. There is a shortage of doctors and nurses at the hospital, and this has led to staff feeling quite pressured.

Drogheda is not situated in my constituency but it is quite close by. I have been sent to Our Lady of Lourdes Hospital on a number of occasions and many of my constituents have also presented there. When the Minister is working with the task force he established in December - a move I very much welcome - will he consider Our Lady of Lourdes Hospital in Drogheda in conjunction with Our Lady's Hospital, Navan? I ask that the position of both facilities be further analysed and that a plan in respect of them be put in place. While the population of the north east has grown, the services available have not grown with it. That is not just the case with regard to health, although I accept that the latter is the issue on which we are focused this evening.

Most people would agree that there is no quick solution to this problem. Ireland has a growing and an aging population and this is going to give rise to difficulties as time progresses. I welcome the wide range of actions being put in place by the HSE and the Minister to improve matters both in general and in the context of emergency care. I also welcome the €25 million that has been allocated in respect of delayed discharges, as well as €3 million in additional funding that was provided at Christmas. We know that the position with regard to accident and emergency departments is unpredictable. There could be two people waiting to be seen at a given time and five minutes later there could be 15 people there. It is impossible to predict what is going to happen in an accident and emergency department. However, both the Government and the Minister are focused on finding a solution. I thank the Minister for his statement tonight on the many factors we are dealing with and the many measures that have been taken. I also thank him for the work he has done in the past two weeks. The figures do not lie. The numbers of people waiting in accident and emergency departments were reduced within the space of a week as a result of everyone working together.

On a slightly separate note, I take this opportunity to urge the Irish Nursing and Midwifery Board to find a solution to the current problem with regard to retention fees. The board is meeting tomorrow and I plead with its members to identify a solution as soon as possible, because we do not want to find ourselves in a situation whereby thousands of nurses might be struck off the register.

I welcome the opportunity to contribute to the debate on this extremely serious issue, which has been topical both in the past two weeks and for the past 15 years or so. I have no wish to present myself as an expert in identifying solutions to all the problems that exist. From what has been said during the past fortnight, it appears that no two experts have the same answer to this problem. People seem to list four or five different priorities in the context of how they feel it should be solved. One of the reasons this problem has continued for so many years is that although many people have identified certain parts of the health system as being the cause of difficulties, we have never actually brought everyone together in the interests of finding an overall resolution.

I would certainly not be doing my job as a public representative if I did not highlight some of the issues that arose for my constituents in the past couple of weeks. I refer, for example, to a very frail 84-year-old gentleman who underwent heart surgery last April and who was brought by ambulance to the accident and emergency department of Portiuncula Hospital in Ballinasloe at 5.30 p.m. on Friday, 2 January last. He was not seen until 4 a.m. on 3 January, at which point he was X-rayed twice. He had become quite weak by that point and was placed in a wheelchair. One Monday 5 January last, he was discharged from the hospital with pneumonia. I was contacted by his son on the Friday night and I rang the hospital immediately after to discover the position. I immediately recognised the level of stress and concern in the voice of the nurse with whom I was dealing, who clearly outlined the pressure under which the staff were operating. She informed me that they were being obliged to categorise those presenting at the accident and emergency department on the basis of the seriousness of their medical conditions. Anyone whose loved one is obliged to visit an accident and emergency department will be of the view that his or her condition is serious. Hospital staff operate under a great deal of pressure and it is simply not acceptable that only one doctor was on duty on the night of Friday, 2 January at the accident and emergency department of Portiuncula Hospital. This is, perhaps, a resource issue to which we must give proper consideration.

I was obliged to attend the accident and emergency department in Portiuncula Hospital on two occasions in the past year, once on my own behalf and once with my daughter during the summer. It was only by pure chance that we were seen immediately on both occasions. It is almost a question of good luck and timing as to how long it will take to be seen. On occasion, one can walk into an accident and emergency department and there will be very few people present. My daughter and I attended Portiuncula Hospital during the summer months, which is probably the time when fewest people present in accident and emergency departments. Overcrowding in such departments always occurs in December and January, not just here but also in Northern Ireland and across the UK.

What are the solutions in this regard? It is very easy to identify what is wrong and to recount anecdotal evidence. However, we must try to identify long-term solutions to the problem that exists. I welcome the changes the Minister has made and also the additional funding that has been allocated in respect of delayed discharges. The latter will certainly be of assistance in some, but not all, hospitals. It is important that the task force he has established should put forward some really sustainable solutions that can be implemented. In the past, reports were compiled, problems were identified and solutions were recommended, but absolutely no action was taken. We cannot allow that to be the case on this occasion. I am of the view that the Minister will, within the budgetary constraints that exist, implement the recommendations the task force puts forward in order that 12 months from now there will not be a recurrence of what happened in recent weeks.

I acknowledge we are not even out of the woods in respect of the current problem and that it may spike in a couple of weeks.

A possible solution, mentioned by the Minister, involves the role of general practitioners and primary care. We realise we need to have more primary care units rolled out and built and give more resources to general practitioners. I am convinced that a percentage of people arriving in accident and emergency units do not need to be there and are simply taking up space. While the percentage may be small, reducing it, by any amount, can only do good. That is a long-term solution but we also need short-term ones. I acknowledge the trends are in the right direction but, as the Minister of State, Deputy Kathleen Lynch, said yesterday on the radio, one person waiting more than nine hours is one too many. We must get this under control. The one phenomenon we do not want is fear on the part of people who legitimately need to attend an accident and emergency department.

We have an issue with our ambulances. This has been highlighted, particularly from a rural perspective. Ambulances arriving at accident and emergency departments simply cannot get patients in quickly enough, thereby causing concern and upset.

When researching this matter this evening, I came across a media article that very clearly spells out the current problems. It states:

It hasn’t gone away you know. Turn on any radio or TV news programme, or open up any newspaper last week and ‘accident and emergency trolley crisis’ headlines were in your face...

Whatever the Government might say about the huge amount of funding invested in the health service in recent years, the fact remains that there is underinvestment in key areas, such as in adequate community facilities for the elderly once they have completed their acute care, and in adequate numbers of acute beds to carry out non-emergency work. There is also a need for investment in the expansion of primary care to allow it to take on more work that is currently carried out in hospital...

So the 'accident and emergency crisis' is not simply a matter of how many patients are crowded into accident departments at any given time; it is largely a crisis relating to the capacity our healthcare system has to meet patient demands. It remains to be seen whether Mary Harney’s new action plan will address the capacity problem, particularly as she has said there will be little additional funding provided for the health service next year. A short-term action plan can only achieve so much; there is also a need for structural and attitudinal change.

This was written in October 2004 and it is now 2015. At times when we had a lot of money to spend, this was not addressed, or addressed correctly. It is time for people to put their heads together and finally find a solution to this problem.

A chairde, cuireann sé an-díomá orm mar urlabhraí Shinn Féin maidir le cursaí sláinte go bhfuil an cheist seo á plé againn arís. Theip ar gach aon dream a bhí sa Rialtas le deich mbliana anuas aghaidh a thabhairt uirthi nó aon réiteach a fháil. Tá ag teip ar an Aire, Teachta Varadkar, chomh maith.

Last week saw the highest number on trolleys ever recorded, with the number reaching as high as 601 at the start of the week. Beaumont Hospital and Our Lady of Lourdes Hospital in Drogheda were among the worst affected. While the figures have decreased somewhat this week, the system still has to deal with the 359 persons who are on trolleys today. Hospitals could be put under further significant pressure by weather conditions or an increase in seasonal illness. Were we to see icy conditions across the country, I fear accidents might swamp our already understaffed and under-resourced accident and emergency network.

The Minister, Deputy Varadkar, was nowhere to be seen, let alone heard, while the crisis developed. We eventually learned – some of his colleagues did not offer the explanation – that he had been on holiday. This is his due but, following his return, he attempted to wash his hands of the situation, saying he could not magically press a button in the Department to fix the crisis. As Minister, he must take responsibility. If there is resistance to change, the onus is on him to tackle it. We need to know that solutions are being applied and what they are. We do not want to hear why the Minister believes certain things cannot be done. It was not very long ago that the Taoiseach admonished the Minister for this.

The rate of presentation at accident and emergency departments has increased. We know that health systems experience high demand during the winter, and also that some people choose to attend their local emergency department instead of their general practitioner for the treatment of minor illnesses, but we have an increasing population and our health staff are seeing many more older and sicker patients. This was foreseeable. In fact, the Minister told us that he foresaw it but, despite this prescience, he was unable or unwilling to do anything to deal with the problem before it developed.

The numbers on trolleys increased this year for several reasons. Reduced numbers of step-down beds and poor provision for elderly patients fit to be discharged to alternative settings were chief among them. There are upwards of 800 patients whose acute care is finished but who have not been discharged into more appropriate step-down care settings. There are a shocking 2,135 people on the national placement list awaiting funding, with an average waiting time of 15 weeks.

There is a lack of capacity both in acute hospitals and step-down facilities and also across the long-term residential care sector. There is a crisis in staffing. There are currently 265 nursing post vacancies. The HSE is finding it difficult to recruit staff due to a lack of permanent contracts, the lack of certainty and the strain on nursing and medical staff in accident and emergency settings. Since the Minister refuses to ensure adequate staff, we will see a further exodus of staff from this section of the health service. This is a vicious circle.

A further problem is that many medical staff are non-senior, leaving accident and emergency departments lacking in senior decision-makers. The €25 million the HSE secured in the budget to address delayed discharges was a quarter of what it had requested. The Minister has convened emergency department task force meetings. When he was asked why the emergency department task force had not worked, he said, "I don't know". This is not good enough. As Minister, he cannot simply say he does not know and hope the problem will go away.

Other jurisdictions have also been under pressure in accident and emergency departments. The problem is not unique to us and many have experienced increased waiting times. We must remember, however, that in the neighbouring part of our island, the Six Counties, the target is four hours – a target that would be fanciful thinking regarding many accident and emergency departments in this State.

Earlier today, I commended nurses for their brave stand against the Minister's lack of action on the hospital overcrowding crisis. The Irish Nurses and Midwives Organisation organised a protest outside the Dáil today in a further effort to force the Minister to act.

It is an indictment of the current Minister's failure to deal with the crisis that nurses felt compelled to take to the streets. Through his cavalier attitude he has been grossly insensitive to all patients who have suffered the indignity and danger of long waits on trolleys. However, it is not only to him that I level such an accusation. We also saw Deputy Martin attend the protest today, so bold as to have forgotten his own role as Minister for Health and Children when he failed to address this problem, and the role of his party in the economic ruin of this country, with the cutbacks that followed leading, in part, to the current crisis.

I support all the hardworking and conscientious nurses who protested in the cold today and also their hardworking colleagues in hospitals across the country. They are demanding action and we in Sinn Féin support this demand.

It has been suggested by some commentators that Sinn Féin have said that this crisis was caused by austerity alone. I wish to dismiss that outright; it is not the case. We understand this has been a perennial problem, one that occurred even when the health system was relatively awash with money. It has, however, been magnified by staff redundancies and ward closures that have been visited on our hospital sites. What can be done? There are a number of measures that need to be taken and solutions that need to be applied but, sadly, the Minister appears to refuse to examine most of them. The HSE had sought €106.5 million to free up hospital beds and reduce overcrowding, of which only €25 million was granted. Despite record numbers awaiting appropriate placements, the Minister has not requested additional funds to deal with the problem. Additional funds are needed to support an adequate number of home care packages and for the re-commissioning of wards and the provision of the required additional step-down beds to assist in discharging the some 800 elderly patients in pre-discharge beds.

We need an attractive recruitment campaign to bring nurses back to Ireland to alleviate under-staffing. We also need to plan for the significant challenges of an ageing population, including long-term residential care requirements.

The emergency department task force should meet regularly until this crisis is successfully addressed, and it must also ensure that a system is in place to meet the problem head-on before it reoccurs.

Consultants, the senior decision makers, must ensure that they are present to help ease admission, fast-track treatment and discharge when appropriate. I welcome the fact that Mr. Liam Doran has been appointed co-chair of the emergency department task force. The task force's scope must be wide enough to examine structural reform to avoid the problem in the future.

Delays in funding house adaptations, lack of sufficient home-help packages and home-help cuts of 2.3 million hours since 2008 all have added further pressure on the entry points to the acute hospitals. Irish Nurses and Midwives Organisation, INMO, members at Naas General Hospital, Limerick University Hospital, Ennis, Nenagh and Croom all have voted for action. We must remember that they will continue to provide clinical care and all possible supports for patients. Their decisions are in the vein of trying to make the Minister pay heed to their concerns as front-line professionals.

The Joint Committee on Health and Children is to receive the Minister, Deputy Varadkar, tomorrow and I hope he will be able to tell us that the number on trolleys is again decreasing. If this turns out to be the case-----

It is 167 now.

We will see. If, as I hope, this turns out to be the case, it will have little to do with the sluggish response of the Government. Fine Gael and Labour have failed to address the root of the problem. I have heard nothing that convinces me that this will not reoccur next year, and sooner, if circumstances present.

Solutions are now needed. The Minister must address this crisis with the measures I outlined, but also commence reform of the organisation of the health services, including primary care, to ensure there is a refocusing of reliance in the first instance on general practice and prevention, rather than flooding the bottlenecks of the accident and emergency departments.

It is undisputable that the cuts implemented by the Government as part of its austerity programme are compounding the current overcrowding levels greatly. However, it is also important to take note of other issues at play here.

There has been a 9.4% decrease in nursing staff since March 2011 under the current Fine Gael-Labour Government. This does not take into account the cuts made under Fianna Fáil previously.

As a result of the current crisis, some of those who have been waiting for many months, or indeed years, for surgery have now had their hopes dashed and their procedures cancelled. These patients must also be remembered and everything must be done to ensure they are catered for as soon as possible.

There are massive waiting lists, which will only be extended due to the current situation. The reality is that one in every eight patients on a hospital waiting list is in a queue for over a year and some people are waiting up to four years to see a consultant. Nearly 50,000 patients, including 2,891 children, are waiting more than a year on lists, despite the Government's previous commitments that nobody would be on a waiting list for more than 12 months. There is a 400% increase in the numbers on outpatient lists since January, according to HSE performance indicators that were published last November.

Dr. Stephen Thomas of Trinity College's centre for health policy and management recently stated in response to the November HSE performance indicators that this country has seen "the biggest proportionate drop in healthcare across Europe" and that "We've lost almost 20% of our health funding, and certainly about 11-12% of our staff".

Sinn Féin has long proposed a lifting of the recruitment embargo. We would initially prioritise the recruitment of front-line workers and allocate an additional €6.67 million to increase emergency ambulance cover. Providing two additional ambulances, including personnel for each of the four regions, would ease some of the pressure on the ambulance service and, in turn, on the accident and emergency departments.

I call Deputies Seamus Healy and Thomas Pringle. They have five minutes to share.

Accident and emergency and hospital overcrowding is unacceptable in any circumstances and the health services, as the Minister will be well aware, have been devastated by cuts. Hospital and health staff are overwhelmed by the situation. They are under severe pressure and they are working above and beyond the call of duty every hour of every day. Despite their best efforts, they are struggling to provide a safe service.

The austerity budgets of the past number of years and the cuts by the Government and the previous Fianna Fáil-Green Government have devastated the service. Those cuts include €3.5 billion taken out of the budget, 11,000 staff taken out, 2,000 beds closed and 2.3 million home-help hours lost. The fair deal scheme has been devastated. There are now 2,000 people waiting 15 weeks for that service. This time 12 months ago there were 523 at six weeks. Inpatient and outpatient waiting lists have ballooned and the elderly are waiting months on end for simple appliances, such as walkers and geriatric chairs.

The effect of these cuts in hospitals is reflected in my local hospital, South Tipperary General Hospital, where the budget has been cut by 25%, or over €13 million, and it has lost over 100 staff. Despite that, the hospital has put in a huge effort and activity levels have increased every year. The hospital is now operating at 120% capacity every day.

This overcrowding in accident and emergency has gone on for ten to 15 years and we know the solutions. It is time to stop the short-term temporary solutions that we have heard again here from the Minister tonight. We need permanent solutions to ensure this does not happen in future.

Measures such as the provision of medical assessment units, the use of discharge lounges, rapid access to outpatient departments, direct admission by GPs in some cases and community intervention teams all are ones that need to be put in place in all hospitals. These are helpful and worthwhile but of themselves will not solve the overcrowding crisis in the accident and emergency departments.

The Minister must now take permanent decisions on long-term solutions. He must open the closed beds. He must put in place additional step-down facilities. He must employ additional nursing and support staff. The fair deal scheme must be put back on an even keel, at least to the same level as it was last year. Community services, primary care and particularly home help and home care assistance must be brought back to at least what they were when the Government took office, and appliances must be made available for the elderly. If these measures are not put in place then we will be dealing with this issue next year and the year after, and the year after that. It is time for the Minister to bite the bullet and put these in place to ensure this is solved once and for all.

I welcome the opportunity to contribute to this Private Members' debate on the crisis in the emergency departments in hospitals.

Today, in Letterkenny General Hospital there are 11 patients on trolleys. Yesterday, there were 31. This is not a new situation for Letterkenny General Hospital. Indeed, the citizens of Donegal and the staff of the hospital are all too familiar with it.

Looking back, taking one random day in a number of months last year, in March 2014, 19 patients were on trolleys in Letterkenny General Hospital, in May 2014, 22 patients were on trolleys and in September 2014, 12 patients were on trolleys within the hospital.

That is the ongoing situation. While there might be a spike right now because of the winter conditions and the increase in respiratory complaints among the elderly and other patients, this situation has been ongoing for years at Letterkenny General Hospital. The cause of the problem is that over the past six years, this Government and its predecessor took more than €3 billion out of the public health system. It is not possible to run a health service with that level of cuts. The only way to work within those budgets is by maintaining queues, whether they comprise people on waiting lists to see consultants and access treatment or queues of patients on trolleys in emergency departments. That is the only way the budgets can be controlled and it is the system over which the Minister is presiding.

The only way to solve this problem is by way of long-term investment. The only way to make savings is by taking a long-term view. The Minister needs to invest in the health service now. He must invest in the provision of additional beds in hospitals to ensure patients can be accommodated. He must invest in long-term care in the community facilities in order that patients can be moved out of hospitals. However, the nub of the matter is that if the Minister does provide extra beds in community hospitals and nursing homes, he will not save any money. By freeing up beds in hospitals, new patients will be moved in straight away, which will cost money. That is the reality within the health services. It is the reason we have these delays and people sitting on trolleys. To control budgets, the Department of Health and the HSE are controlling access to hospitals.

Debate adjourned.
The Dáil adjourned at 9.05 p.m. until 9.30 a.m. on Thursday, 15 January 2015.
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