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Emergency Departments

Dáil Éireann Debate, Tuesday - 18 October 2016

Tuesday, 18 October 2016

Ceisteanna (18)

Alan Kelly

Ceist:

18. Deputy Alan Kelly asked the Minister for Health if his attention has been drawn to the fact that private investor-owned, profit-oriented hospitals, details supplied, are advertising for patients on the radio while poorer, less well-off patients are spending days on trolleys in overcrowded emergency departments; his views on whether the capacity of these private hospital emergency departments should be used by the State temporarily; and if he will make a statement on the matter. [30922/16]

Amharc ar fhreagra

Freagraí ó Béal (14 píosaí cainte)

If we have a bad flu epidemic this winter, we will face hell in our emergency departments. Listening to the radio most mornings, it galls me to hear private hospitals advertising - almost rolling out the red carpet - that they are available for anyone who has an emergency while down the road patients are waiting for hours or days on trolleys. Will the Minister consider renting, or in some way finding access for public patients to, these hospitals because in this day and age it is completely unacceptable to have this disparity?

The short answer is "Yes". The Deputy raises an important issue in terms of trying to ensure we have parity of access to our health services for all patients. We have seen in other waiting list areas where we have, through State expenditure, supported our patients accessing health services. My commitment is to beef up the public health service, but we must also acknowledge where there is capacity in other parts.

As the Deputy will be aware, I have no role at present in regulating the activities of private hospitals, although there are a number of issues in the suggestion that I would like to tease out with him. Emergency departments in public hospitals provide comprehensive 24-7 emergency care to all patients regardless of health insurance status. Currently, no emergency department in a private hospital offers a 24-hour service and only a minority provide services at weekends.

My Department is engaging with private hospitals on their potential to contribute to meeting the demand for acute services right across a range of services. There is already significant experience in using the services of such hospitals to assist in addressing lengthy waiting times for scheduled care. An example of such collaboration is that this year €20 million is being allocated to the National Treatment Purchase Fund, NTPF, rising to €55 million in 2018. I envisage the NTPF utilising both the public and the private hospitals to reduce waiting lists. I recently met the Private Hospitals Association to review both this experience and the further scope for private hospitals to contribute to urgent health priorities. Our patients waiting for care do not want a big ideological debate. They want to know that we are expending taxpayers' money to get the access to our health service.

To date this year, the HSE has reported an increase of approximately 5% in emergency department attendances. Despite increased demand, there has been a decrease of almost 5% in numbers of patients waiting on trolleys. That is no comfort to someone waiting on a trolley but we have seen increased demand yet fewer patients on trolleys. In addition, patient experience times have been improving, with 82% of all patients completing their emergency department episode of care within nine hours.

My Department, working with the HSE, has been driving a range of measures to alleviate overcrowding and reduce patient experience times in emergency departments. In September, the HSE published the Winter Initiative Plan 2016–2017, which provides €40 million of additional funding to manage increased demand for health care during the winter. Indeed, I will be visiting Deputy Kelly's county with him shortly on this matter.

I thank the Minister. He started off the answer fairly well but he went downhill after that. There was no meat in the detail except to agree with my hypothesis that it is wrong that a 90 year old woman who goes into an emergency department such as the Mater hospital could be on a trolley for two to three days while 100 yards down the road an executive can go into another emergency department and be treated immediately. In the Beacon Hospital, as Mr. Brian Fitzgerald has said, 95% of the time patients will be seen almost immediately by a consultant. The Blackrock Clinic states its highly valuable facility is there for those who "prefer to receive this treatment without delay".

This is not acceptable. We will have an epidemic this winter if a crisis develops because of influenza. We need quick answers, quick decisions and quick engagement with private hospitals to use their capacity immediately. I am aware they do not provide all the services, as the Minister rightly outlined, but they do provide services and they have capacity because they continue to tell us that through advertisements on the radio.

That is the closest I will ever get to a compliment from Deputy Kelly. It started off well but I wanted to start off well because I did not want to dismiss the Deputy's idea. There is merit in scoping out this issue. Discussions would be needed on the type of procedures, how it would work, how we would make sure we do not divert resources from public hospitals, and how we make sure that we get on with solving the pressures in our accident and emergency departments. It is not that we are sitting on our hands doing nothing for this winter, as the Deputy knows. While my Department will have further meetings with the Private Hospitals Association and while we have already begun a dialogue as to how it can contribute more services, taxpayers provide funding and we are already putting in place €40 million for the winter initiative. That involves some of the things the Deputy is talking about regarding an influenza epidemic. It involves more people getting the influenza vaccine, and we should all take this opportunity to remind people to get it. It involves 13 community intervention teams, which can reduce our hospital bed requirements by approximately 73. It involves opening our primary care centres and expanding out-of-hour GP services. It involves, as we have done in Cork, opening acute medical assessment units, AMAUs, at the weekends. The unit in Cork is the first one in the country that is open seven days a week. It involves more home care packages, so it is multifaceted. The private hospitals have a role to play and I am happy to examine that aspect.

The Minister should make them play their role. He said it is not an ideological debate but I beg to differ. It is an ideological debate. When we had to provide emergency measures to socialise the debts of banks a number of years ago, we did so. I disagreed with it and voted against it, unlike others in this Chamber.

It is a good job the Deputy lost that one.

We have an issue here because we have to socialise the dearth of infrastructure when it comes to emergency departments and we need to do it immediately because people are going to die on trolleys if this is not done. Despite all the Minister's measures, we will not have the immediate capacity that we need in emergency departments if he does not take this proposed measure. There is an issue over what is more appropriate and what is a priority - the common good versus private property interests. The Minister should make a name for himself and gain access to the private hospitals immediately in order to alleviate the terrible situation we could be facing into this winter.

Of course the Deputy knows it is more complicated than just making that decision. We have to look at what we would like to do in the private hospitals rather than what would be done.

We could do it in 48 hours a few years ago.

I do not think he is suggesting that we would replicate the way decisions were made about banking debt in regard to health policy.

I agree with the Minister on that.

We can all learn collective lessons in that regard. When we are talking about this winter and any winter, we should not only talk about the hospital solution. I will examine the Deputy's idea. There is merit in what he said. We also need to examine why people are turning up in our hospitals given that such patients would not turn up in hospitals in other countries. That is down to a considerable lack of an out-of-hours general practitioner, GP, service. It is also down to AMAUs and having more home care packages.

It will not be solved this winter.

We have put €40 million behind it. It is my job to make sure that taxpayers and patients see benefits from that. We cannot just say to the HSE, "here is €40 million", and not expect to see an improvement. I want to drive that improvement but I will engage with the Deputy further on this because he raised an important point.

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