I must now deal with a postponed division relating to amendment No. 1 to the motion regarding hospital overcrowding. On Wednesday, 20 November 2019, on the question that amendment No. 1 to the motion be agreed to, a division was claimed and in accordance with Standing Order 70(2), that division must be taken now.
Hospital Overcrowding: Motion (Resumed) [Private Members]
The following motion was moved by Deputy Stephen Donnelly on Wednesday, 20 November 2019:
That Dáil Éireann:
notes:
— that so far this year, more than 100,000 patients have gone without a hospital bed, waiting on trolleys in emergency departments;
— that to the end of October this year, 13,466 people over 75 years of age have endured emergency department waits of more than 24-hours, a third more than for the same period in 2018;
— that October was the second-worst month for hospital overcrowding since records began;
— the warning from the master of the Rotunda Hospital that it is ‘only a matter of time’ before newborn babies are injured or die as a result of overcrowding;
— the increase in the mortality rate from sepsis;
— the numbers presenting to emergency departments are rising;
— that emergency department overcrowding is linked to increased mortality and poorer outcomes for patients; and
— that delays in emergency departments result in poor patient experiences, with some patients enduring horrendous experiences, while others leave without being seen;
agrees that:
— the Health Service Executive (HSE) National Winter Plan 2019-2020 provides for no additional acute beds or frontline hospital staff;
— emergency medicine staffing levels are below international comparators, and below the agreed safe staffing levels;
— healthcare professionals in emergency medicine are under unprecedented, unsustainable and unacceptable pressure; and
— there is no funded workforce plan in place to reach agreed safe staffing levels;
acknowledges that:
— hospital bed occupancy rates average 97 per cent, and are 104 per cent in model 4 hospitals, compared to the recommended safe occupancy rate of 85 per cent;
— delayed discharge is significant and linked to a growing waiting list for home care support;
— there is a significant shortage of hospital beds relative to the capacity review; and
— there is no definite timeline for the provision of the additional acute beds needed; and
calls for:
— a clear funded timeline for the provision of additional acute beds to meet 85 per cent occupancy levels, and for step down beds, as set out on the capacity review;
— an immediate assessment of the number of acute inpatient psychiatric beds required;
— increased access to diagnostics for emergency medicine;
— implementation of the recommendations made by the Health Information and Quality Authority (HIQA) in their 2012 report;
— HIQA to investigate the impact of overcrowding on the health of people presenting to emergency departments;
— urgent progress on achieving safe staffing levels in emergency medicine, to include:
— ending of pay disparity for consultants;
— ending of the de-facto hiring embargo for nurses and midwives;
— a funded workforce plan; and
— an overhaul of human resources practices to improve working conditions for healthcare professionals; and
— investment in general practitioner (GP) services, including:
— funding chronic disease management;
— expansion of GP out-of-hours services; and
— appropriate access to diagnostics.
Debate resumed on amendment No. 1:
To delete all words after “Dáil Éireann” and substitute the following:
“notes that:
— the population aged 65 and over has increased by 35 per cent since 2009, with the result that there have been increasing levels of demand for health and social care services;
— there has been an increase of 29,000 attendances and 2,600 admissions to emergency departments in hospitals in 2019, as against the same period last year; and
— the Health Service Executive (HSE) has published its National Winter Plan 2019-20, which identifies mitigating actions to bring down the number of patients on trolleys, and reduce waiting times in emergency departments, notwithstanding the growing demand for its services;
acknowledges:
— the allocation of an additional €26 million to fund the implementation of the National Winter Plan 2019-20 to support egress from hospitals;
— the establishment of nine Winter Action Teams aligned to Community Healthcare Organisations and associated acute hospitals which have prepared integrated winter plans that will focus on demand management and reduction;
— that an additional investment of €52 million has been made to bring the total funding for home supports to €487 million in 2020;
— that over the last two years an additional €45 million has been provided to the Nursing Home Support Scheme (NHSS) budget, and in 2020 the NHSS will see a further investment into its budget of €45 million, bringing the total annual budget for the NHSS to €1.03 billion;
— the sustained focus in recent years on reducing delayed transfers of care and enabling patients to be discharged from hospital in a timely manner;
— the increased investment of €210 million per annum to be made by 2023 in general practitioner (GP) services set out in the Agreement on Contractual Reform and Service Development of May 2019;
— the establishment of a fully-funded chronic disease management programme to be delivered by GPs from January 2020;
— the commitment to comprehensive patient care on the part of GPs including the improvement of out-of-hours services;
— the steps being taken to introduce diagnostic facilities at community level;
— that the Minister for Health is engaging with the Rotunda Hospital, RCSI Hospital Group and the HSE in relation to the scope of interim works necessary to address the infrastructural challenges in the Rotunda Hospital, pending its relocation to Connolly Hospital Blanchardstown;
— the increased investment in the health services, including the increase of over 250 whole-time equivalents of medical and dental staff and over 370 in-patient and client personnel since the beginning of 2019, and 800 nurses and midwives since September 2018;
— the HSE has established a Medical Workforce and Patient Safety Oversight Group to agree and oversee implementation of actions in relation to recruitment of consultants and non-consultant hospital doctors;
— that engagement with the consultants’ representative bodies has commenced and further engagement is planned;
— that Project Ireland 2040 provides €10.9 billion for health capital projects including 2,600 acute hospital beds and 4,500 social care beds
— that the Government will provide record levels of funding of €18.3 billion in revenue and capital funding for the health services in 2020; and
— the publication of the Sláintecare Action Plan 2019 progress report this week which will show that the Government is on track with its implementation; and agrees:
— with the Sláintecare vision of a universal single-tier health and social care system where everyone has equal access to services based on need and not ability to pay;
— that as part of the Sláintecare Action Plan 2019 reducing waiting times for patients in hospitals and for community services is a key priority for the Government;
— that the Government, through its policies and funding for the health services, is addressing the issue of capacity in the healthcare system by enhancing community services, improving patient flows and providing additional capacity in line with the recommendations of the Health Service Capacity Review; and
— that the most effective way of achieving the Sláintecare vision is by backing the Government’s continued implementation of the Sláintecare Action Plan 2019, which has the support of all parties.”
-(Minister for Health)
Amendment put:
The Dáil divided: Tá, 39; Níl, 66; Staon, 0.
Tá
- Bailey, Maria.
- Barrett, Seán.
- Brophy, Colm.
- Bruton, Richard.
- Burke, Peter.
- Byrne, Catherine.
- Canney, Seán.
- Cannon, Ciarán.
- Carey, Joe.
- Corcoran Kennedy, Marcella.
- Coveney, Simon.
- Creed, Michael.
- D'Arcy, Michael.
- Deering, Pat.
- Doherty, Regina.
- Donohoe, Paschal.
- Doyle, Andrew.
- Durkan, Bernard J.
- Farrell, Alan.
- Flanagan, Charles.
- Griffin, Brendan.
- Harris, Simon.
- Humphreys, Heather.
- Kehoe, Paul.
- Kyne, Seán.
- McGrath, Finian.
- McHugh, Joe.
- McLoughlin, Tony.
- Mitchell O'Connor, Mary.
- Naughton, Hildegarde.
- Neville, Tom.
- O'Connell, Kate.
- O'Dowd, Fergus.
- Phelan, John Paul.
- Ring, Michael.
- Rock, Noel.
- Ross, Shane.
- Stanton, David.
- Zappone, Katherine.
Níl
- Aylward, Bobby.
- Barry, Mick.
- Boyd Barrett, Richard.
- Breathnach, Declan.
- Broughan, Thomas P.
- Burton, Joan.
- Butler, Mary.
- Byrne, Thomas.
- Cahill, Jackie.
- Calleary, Dara.
- Cassells, Shane.
- Collins, Michael.
- Collins, Niall.
- Connolly, Catherine.
- Coppinger, Ruth.
- Cowen, Barry.
- Curran, John.
- Doherty, Pearse.
- Donnelly, Stephen.
- Dooley, Timmy.
- Ellis, Dessie.
- Fitzmaurice, Michael.
- Fitzpatrick, Peter.
- Gallagher, Pat The Cope.
- Grealish, Noel.
- Harty, Michael.
- Haughey, Seán.
- Healy, Seamus.
- Kelly, Alan.
- Kenny, Gino.
- Kenny, Martin.
- Lahart, John.
- Lowry, Michael.
- MacSharry, Marc.
- Martin, Catherine.
- Martin, Micheál.
- McConalogue, Charlie.
- McGrath, Mattie.
- McGrath, Michael.
- Mitchell, Denise.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Munster, Imelda.
- Murphy O'Mahony, Margaret.
- Murphy, Catherine.
- Murphy, Eugene.
- Murphy, Paul.
- Nolan, Carol.
- O'Brien, Darragh.
- O'Callaghan, Jim.
- O'Dea, Willie.
- O'Keeffe, Kevin.
- O'Loughlin, Fiona.
- O'Rourke, Frank.
- O'Sullivan, Jan.
- Ó Caoláin, Caoimhghín.
- Ó Cuív, Éamon.
- Ó Snodaigh, Aengus.
- Penrose, Willie.
- Pringle, Thomas.
- Rabbitte, Anne.
- Ryan, Brendan.
- Smith, Brendan.
- Smith, Bríd.
- Smyth, Niamh.
- Troy, Robert.
Staon
Tellers: Tá, Deputies Seán Kyne and Tony McLoughlin; Níl, Deputies Michael Moynihan and John Lahart.
Amendment declared lost.
I move amendment No. 2:
To delete all words after “Dáil Éireann” and substitute the following:
“notes:
- that so far this year, more than 100,000 patients have gone without a hospital bed, waiting on trolleys in emergency departments;
- that to the end of October this year, 13,466 people over 75 years of age have endured emergency department waits of more than 24-hours, a third more than for the same period in 2018;
- that October was the second-worst month for hospital overcrowding since records began;
- that Fine Gael have had eight years to address the overcrowding crisis, but the number of patients on trolleys have gotten worse year on year, as follows:
- 2012 - 66,308;
- 2013 - 67,863;
- 2014 - 77,091;
- 2015 - 92,998;
- 2016 - 93,621;
- 2017 - 98,981;
- 2018 - 108,227; and
- 2019 (to date) – 100,000 plus;
- that in four of these years, 2016, 2017, 2018 and 2019, Fianna Fáil have been in a confidence and supply arrangement with the Fine Gael Government, and have agreed and facilitated Fine Gael Budgets which have had a catastrophic impact on the health service;
- the warning from the master of the Rotunda Hospital that it is ‘only a matter of time’ before newborn babies are injured or die as a result of overcrowding;
- the Irish Association of Emergency Medicine has calculated that there could be between 300 and 350 excess patient deaths each year due to the trolley crisis and emergency unit overcrowding;
- the increase in the mortality rate from sepsis;
- the numbers presenting to emergency departments are rising;
- that emergency department overcrowding is linked to increased mortality and poorer outcomes for patients; and
- that delays in emergency departments result in poor patient experiences, with some patients enduring horrendous experiences, while others leave without being seen;
agrees that:
- the Health Service Executive (HSE) National Winter Plan 2019-20 provides for no additional acute beds or frontline hospital staff;
- a recruitment moratorium in the health service was brought in by the then Fianna Fáil Government in 2007, two years before any other sector in the public service and the damage done by that policy is at the root of many of the problems in the health service to this day;
- emergency medicine staffing levels are below international comparators, and below the agreed safe staffing levels;
- healthcare professionals in emergency medicine are under unprecedented, unsustainable and unacceptable pressure;
- pay inequality for new entrant consultants and the failure to fully unwind the Financial Emergency Measures in Public Interests (FEMPI) for consultants has crippled the public health system and caused gross staff loss, demoralised current staff, and has left the health service with around 500 consultant vacancies across different specialties, many in emergency medicine;
- there are over 1,300 nursing and midwifery vacancies in the public health sector as a direct result of the HSE’s recruitment freeze;
- in order to deal with the shortage of staff, the health service has an over-reliance on costly agency staff, with nearly €2 billion being spent on agency staff since Fine Gael entered Government eight years ago;
- there is no funded workforce plan in place to reach agreed safe staffing levels; and
- the staffing crisis has created a severely challenging working environment, where nurses and doctors routinely work beyond their contracted hours in order to ensure patients are cared for in hospitals, at a significant physical, mental and financial cost to themselves and their families and friends;
acknowledges that:
- hospital bed occupancy rates average 97 per cent, and are 104 per cent in model 4 hospitals, compared to the recommended safe occupancy rate of 85 per cent;
- Ireland had the second lowest number of hospital beds in the Organization for Economic Cooperation and Development (OECD) leading to a lower than average hospital stay, 6.2 days, compared to the OECD average of 8.2 days;
- in the past decade acute hospital in-patient bed numbers were cut when they should have been increased in line with the country’s growing and aging population;
- unions representing workers in the health service have been highlighting the issue of a chronic lack of capacity in the health service and how it contributes to hospital overcrowding for almost a decade;
- delayed discharge is significant and linked to a growing waiting list for home care support;
- delayed discharges constitute one of the biggest financial wastes of money and resources in the health service and cost the health service nearly €600 million since 2016;
- the freezing of home help hours has contributed to delayed discharges as patients who are fit to return home are left stuck in hospital with the result being that many of the 7,225 elderly people on a waiting list for home help hours are stuck in hospitals;
- there is a significant shortage of hospital beds relative to the capacity review;
- there is no definite timeline for the provision of the additional acute beds needed; and
- Fianna Fáil facilitate this Government and that the Minister for Health only holds that office because Fianna Fáil abstained in a no confidence vote in him in February of this year; and
calls for:
- a clear funded timeline for the provision of additional acute beds to meet 85 per cent occupancy levels, and for step down beds, as set out in the capacity review;
- an immediate assessment of the number of acute inpatient psychiatric beds required;
- all hospital beds closed during the austerity years to be reopened;
- increased access to diagnostics for emergency medicine;
- the implementation of the recommendations made by the Health Information and Quality Authority (HIQA) in their 2012 report;
- HIQA to investigate the impact of overcrowding on the health of people presenting to emergency departments;
- investment in co-locating general practices and acute mental health services next to emergency departments so those patients who do not need emergency department care can be treated in a more appropriate setting;
- increased investment for transitional care beds, adequate step-down facilities, home care packages, and home help hours to ensure that all patients who can be moved home, or to a more appropriate care setting, are given that opportunity;
- the speeding up of the move towards primary and community care ensuring that all primary care centres are adequately resourced with new staff and funding;
- urgent progress on achieving safe staffing levels in emergency medicine, to include:
- the ending of pay disparity for consultants and the full unwinding of FEMPI for consultants;
- the ending of the de facto hiring embargo for nurses, midwives, doctors and other staff across the health service;
- genuine investment in recruiting more staff to the health service, while simultaneously addressing the key issues for existing and prospective staff of working conditions, facilities, supports, training opportunities and pay;
- a funded workforce plan; and
- an overhaul of human resources practices to improve working conditions for healthcare professionals;
- investment in general practitioner (GP) services, including:
- funding chronic disease management;
- expansion of GP out-of-hours services; and
- appropriate access to diagnostics;
- a commitment to put in place a plan for piloting salaried HSE employed GPs in both rural and urban areas; and
- the full implementation of all the recommendations in the Sláintecare Report.”
Amendment put:
The Dáil divided: Tá, 20; Níl, 88; Staon, 0.
Tá
- Barry, Mick.
- Boyd Barrett, Richard.
- Broughan, Thomas P.
- Connolly, Catherine.
- Coppinger, Ruth.
- Doherty, Pearse.
- Ellis, Dessie.
- Fitzmaurice, Michael.
- Healy, Seamus.
- Kenny, Gino.
- Kenny, Martin.
- Martin, Catherine.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Murphy, Paul.
- Ó Caoláin, Caoimhghín.
- Ó Snodaigh, Aengus.
- Pringle, Thomas.
- Smith, Bríd.
Níl
- Aylward, Bobby.
- Bailey, Maria.
- Barrett, Seán.
- Breathnach, Declan.
- Brophy, Colm.
- Bruton, Richard.
- Burke, Peter.
- Burton, Joan.
- Butler, Mary.
- Byrne, Catherine.
- Byrne, Thomas.
- Cahill, Jackie.
- Calleary, Dara.
- Canney, Seán.
- Cannon, Ciarán.
- Carey, Joe.
- Cassells, Shane.
- Collins, Michael.
- Collins, Niall.
- Corcoran Kennedy, Marcella.
- Coveney, Simon.
- Cowen, Barry.
- Creed, Michael.
- Curran, John.
- D'Arcy, Michael.
- Deering, Pat.
- Doherty, Regina.
- Donnelly, Stephen.
- Donohoe, Paschal.
- Dooley, Timmy.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Flanagan, Charles.
- Fleming, Sean.
- Gallagher, Pat The Cope.
- Grealish, Noel.
- Griffin, Brendan.
- Harris, Simon.
- Harty, Michael.
- Haughey, Seán.
- Howlin, Brendan.
- Humphreys, Heather.
- Kehoe, Paul.
- Kelly, Alan.
- Kyne, Seán.
- Lahart, John.
- Lowry, Michael.
- MacSharry, Marc.
- Martin, Micheál.
- McConalogue, Charlie.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McHugh, Joe.
- McLoughlin, Tony.
- Mitchell O'Connor, Mary.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murphy O'Mahony, Margaret.
- Murphy, Eugene.
- Naughten, Denis.
- Naughton, Hildegarde.
- Neville, Tom.
- Nolan, Carol.
- O'Brien, Darragh.
- O'Callaghan, Jim.
- O'Connell, Kate.
- O'Dea, Willie.
- O'Dowd, Fergus.
- O'Keeffe, Kevin.
- O'Loughlin, Fiona.
- O'Rourke, Frank.
- O'Sullivan, Jan.
- Ó Cuív, Éamon.
- Penrose, Willie.
- Phelan, John Paul.
- Rabbitte, Anne.
- Ring, Michael.
- Rock, Noel.
- Ross, Shane.
- Ryan, Brendan.
- Smith, Brendan.
- Smyth, Niamh.
- Stanton, David.
- Troy, Robert.
- Zappone, Katherine.
Staon
Tellers: Tá, Deputies Aengus Ó Snodaigh and Denise Mitchell; Níl, Deputies Michael Moynihan and John Lahart.
Amendment declared lost.
Motion put and declared carried.
Sitting suspended at 1.30 p.m. and resumed at 2.10 p.m.