Dáil Éireann Debate, Wednesday - 5 December 2018
34. Deputy Louise O'Reilly asked the Minister for Health the status of negotiations between his Department and the representatives of healthcare workers for the rolling out of additional winter measures; and if he will make a statement on the matter. [51000/18]
Amharc ar fhreagraI note the publication of the winter plan. It was late but I suppose it is a case of better late than never. Other states and jurisdictions publish theirs in September. It is unfortunate that we wait until winter to do so. However, the plan is of no use and will be of no benefit unless there is commitment from the staff involved to engage with all of the changes and to make sure that it is rolled out. My question is a very simple one about the status of negotiations between the Minister and his office, the HSE and the people who will be delivering it on the ground.
I may have interpreted the question wrongly. I think there are two aspects to it: one is the winter plan but also how we are engaging with the staff, I presume in relation to the roll out of the winter plan, as opposed to more broadly. Ensuring that services are planned to meet critical periods of demand is a core operational function of the HSE. My Department has engaged extensively with the HSE throughout the year to ensure the most effective response to the challenges faced by the health service this winter. As part of this process, integrated winter preparedness plans have been developed by hospital groups and community healthcare organisations to meet the anticipated surge in demand for healthcare services during the winter months. The plans are designed to optimise existing resources and encompass operational management of patient flow and maintaining public health. The recent patient experience survey found that 81% of people surveyed said that they were always treated with respect and dignity in the emergency department and ensuring the values of patient dignity and respect are upheld at all times will remain a key priority.
The overall winter plan, which runs until 31 March 2019, was endorsed by the emergency department task force, which as Deputy O'Reilly knows is co-chaired by the Irish Nurses and Midwives Organisation, INMO. The plan includes a four-week period of focused action from 17 December to 13 January. During this period nine key hospital sites of concern will be targeted with a suite of enhanced actions including extended opening hours for local injury units, minor injury units and key primary centres; winter-ready clinics in the community targeting at-risk groups; increased diagnostic access for GPs and extending hours of service in hospitals so people do not find themselves delayed or stuck in a hospital while waiting for a diagnostic test; and enhanced senior decision-making across the hospitals.
A central component of the plan which is already under way is the provision of an additional 550 home care packages over the winter period to help patients return home from hospital with the supports they need. The winter plan will also seek to increase bed capacity in quarter 1 of next year. Over the past 12 months, we have added an additional 240 beds and work is nearing completion on a further 78 beds which are due to open in the coming weeks. In addition to winter funding, €10 million is being made available in 2019 to increase acute bed capacity. Further details will be included in the national service plan. Taken together, these initiatives will increase the number of available inpatient beds in the acute hospital system to more than 11,000, a threshold last seen in 2009, showing that the lost decade is perhaps now over.
The HSE advises that a briefing for the staff panel on the overall winter plan will take place this week and any clarifications required will be provided in this forum. The INMO has been very much co-chairing emergency department task force meetings. My understanding is that the plan will be published by the HSE tomorrow.
I was a member of the emergency task force. It is not an industrial relations forum and the HSE was always very clear with us about that so participation or otherwise does not indicate agreement by any trade union or representative group with regard to what is planned.
The Minister is talking about enhanced actions and clinics among other measures. It should be said that we do not just have a crisis in the winter: thanks to this Government we now have an all-year crisis, but let us just deal with the winter crisis for the moment.
I asked specifically whether there had been negotiations because what the Minister is citing here is significant changes in work practices, people moving out to winter ready clinics and enhanced actions. I asked the HSE some very pointed questions about this and it was not able to point to any level of engagement. It is not sufficient to say there will be a briefing two weeks after the plan has been published. I am asking about the status of negotiations. Can the Minister say now that the representative groups for all the people who will be involved in the plan are fully signed up to it and that he has the staff to deliver it?
At the emergency department taskforce meeting last week we heard from HSE management, as the Irish Nurses and Midwives Organisation, INMO, would have heard at the meeting that it co-chairs, that there was significant buy-in for this plan from health service staff, including its own members around the country. It is important to point that out. Much of what we are asking people to do is a core part of the responsibility to make sure we can deal with increased demand. I do not think it involves protracted negotiations with the unions. I do not think planning for the winter period should involve that. There will be a briefing for the staff panel by the HSE on the overall winter plan this week. Clarifications required will be provided.
I thank the staff who have been involved in formulating these plans in individual hospitals and community healthcare organisations, CHO, and are very much signed up, bought in and invested in these plans. People in our health service work extraordinarily hard. I am very proud of the work they do and it is important that staffing levels in the hospitals, the emergency departments, diagnostics, community and primary care services are sufficient. That is part of proper rostering, which management is paid to do. I have no doubt that is happening at individual sites around the country. The emergency department task force is not an industrial relations forum and I am glad to hear the Deputy make that point. I very much agree with it but there will be a briefing for the staff panel this week. I do not, however, envisage a difficulty in this regard. I do envisage many health care staff working extraordinarily hard over the winter period as they do all year round and I am very grateful to them for that.
"Signed up, bought in and invested", that is certainly not what individual health care workers are saying. With regard to the plan my question was specifically about the status of negotiations. The Minister is saying that he does not think negotiations will be required, that there will be no changes in work practices and if there are no changes in work practices and everything will be as it was we can expect there to be 500 odd people still on trolleys plus whatever number for the winter surge. Is that what the Minister is saying because if there is to be a change in work practice that should be negotiated? If there is not to be a change in work practice it will be the same as before and nothing changes and everything gets steadily worse in the way it has continued to do.
I asked about negotiations, not about whether there is some good feeling towards having a plan, late as it was. There probably is good feeling towards having a plan. Have the changes in work practices that the Minister outlined when he spoke about the new clinics and the potential changes in rosters been agreed with the staff? The emergency department task force is not an industrial relations forum. We were told repeatedly that it is not but every time the representatives of nurses and other healthcare workers tried to raise industrial relations issues at it we were told there is an industrial relations forum. That is not a briefing, that is engagement, which fuels industrial relations. I am curious to know, if there have been any negotiations, what is their status and if not, I can only expect that there will be no change in work practices.
I do not want to speak for the INMO but my recollection of its request at the emergency department taskforce last week, which it co-chaired - that is an important point - was that there would be a meeting of the staff panel. That is happening this week as a result of its request. We were also told at the emergency department taskforce that staff around the country had volunteered for alternative rostering, put their names forward and put their hands up to play their part this winter in dealing with what is a significantly busy time. I accept that there are challenges all year round but this is a particularly busy time.
We are delivering a winter plan this year that will see in 2019, for the first time since 2009, more than 11,000 hospital beds operating throughout the health service. We are trying to take a different approach this year, considering all of the winter but particularly the period from 17 December to the middle of January when there tends to be a particular surge. The HSE is considering a clinical lead, as we had for the papal visit, so that we can co-ordinate this. I do not believe there is a particular animosity or disagreement between the health service and the unions. I certainly have not been made aware of any.
I assume the staff are meeting at the national joint council. That is an industrial relations forum. The Minister said that staff have volunteered for change of roster and work practices and have added their names to lists. Could he please advise who is co-ordinating those lists? Is it being done centrally or on a site by site basis? Who advised the Minister of all these volunteers, the HSE or the representative bodies?
This matter came up at the emergency department taskforce meeting co-chaired by the HSE and the INMO which I attended last week in Dr. Steevens' Hospital. The response from the HSE was that at individual site level rostering was being addressed. It was satisfied rostering was being addressed but, as appropriate, it was seen as beneficial to brief the staff panel this week, which is exactly what is going to happen. I do not think there is an issue here. I thank the staff for developing their own plans. These are not centrally handed down plans but individual sites, hospitals and CHOs have developed their own plans. That is right and proper. It gives people ownership of the plans and I am very pleased that we are in a position as a Government to enforce them.
