Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I have not provided the committee with a formal opening statement for a number of reasons. This matter was discussed in a Topical Issue debate in the Dáil yesterday and is also the subject of the Private Members' motion in the Dáil this week. At present, the Minister of State, Deputy Lynch, is covering for me for the second part of the Private Members' motion debate in the Dáil. Rather than repeating everything I said yesterday I thought I would keep it quite short to allow Mr. O'Brien to give a more detailed statement and also allow time for questions and perhaps a free-flowing discussion on some of the solutions to this very long-standing problem.

At eight o'clock this morning 256 people were on trolleys, of which 141 had been on trolleys for more than nine hours; it is after nine hours that it becomes a patient safety issue. Most of these people will be in beds by tonight and the number is continuing to fall. Within this is huge variation. In the midland regional hospitals in Mullingar, Portlaoise and Tullamore, in Kerry General Hospital and in Connolly Hospital Blanchardstown nobody was on trolleys for more than nine hours this morning. In St Vincent's University Hospital, Tallaght hospital , St. James's Hospital, University Hospital Waterford, Letterkenny General Hospital and South Tipperary General Hospital in Clonmel only one person was on a trolley, whereas in Beaumont Hospital the number was 22 and in Our Lady of Lourdes Hospital it was 25. There is long-standing chronic overcrowding in Beaumont Hospital and Our Lady of Lourdes Hospital, which has been going on for as long as I can remember, certainly since I was working in Beaumont Hospital which is a long time ago. There are also hospitals which are not always in difficulty but are at present, such as University Hospital Galway and Portiuncula Hospital.

When comparing year on year we tend to compare the day of the week, with regard to seasonal factors and the time of the year. To use the special delivery unit's numbers, on this day of the week last year 280 people were on trolleys, so the number is lower than it was this time last year. If we use the trolley watch figures of the Irish Nurses and Midwives Organisation, INMO, to compare the third Thursday in January going back historically, 244 people on trolleys were on this morning and the last time it was that low was in 2005. Based on these figures, comparing like with like, it is at its lowest level in ten years. Ward watch includes patients on trolleys in wards, which is done in some hospitals to relieve pressure on emergency departments. These figures have been collected for the past two years so they do not compare like with like, but if I were to use statistics against me and make us look as bad as possible the figure is still lower than it was in 2008, 2009, 2010 and 2011.

It is fair to say the actions which have been put in place by hospitals, the HSE, social care and departments have worked, and I want to express my appreciation to HSE management, hospital staff, social care in particular, and nursing homes for pulling out all the stops over the past while to deal with this surge. I have been looking back over numbers, and surges are not as predictable as one might think. Some people refer to "black Wednesday", which is the worst Wednesday in January, which does happen, but it happened a week earlier this year for a number of reasons, particularly the fact there was a very long Christmas period this year compared to previous years. Surges can happen at other times and we have had peaks in previous years in February, March, April and May which were often linked to respiratory illness and an increase in presentation as a result of this. We are not taking anything for granted and I guarantee the committee there is no level of complacency.

At present approximately 140 people are on trolleys for more than nine hours, and this figure generally reduces to 100 at the end of the day. We are back to what has been normal in Ireland for the best part of ten years, but I do not accept it should be normal. Almost every country in the world has surges of patients, which mean that from time to time patients are on trolleys. Various countries have various ways of dealing with this. In a number of hospitals in Ireland we have a chronic overcrowding problem, which has been going on for the best part of 15 years. When a surge occurs it becomes a total disaster, which is what we need to focus on resolving once and for all over the coming months. This is what the emergency department task force, co-chaired by Dr. Tony O'Connell of the HSE and Mr. Liam Doran of the INMO, will do. It will dust down old plans which were not implemented and come up with new plans. We will focus on this over the coming months and try to get into a position where trolleys are unusual by the summer, which will give us some headroom going into next winter.

This is not straightforward as there is no single solution to this. Delayed discharges are a big part of the picture; hundreds of people in our hospitals could go home if circumstances were right, but this is not what it is all about. Beaumont Hospital has as many delayed discharges as St. James's Hospital, but while St. James's Hospital rarely has people on trolleys for more than a few hours Beaumont Hospital always does. Letterkenny General Hospital has no delayed discharges and has had people on trolleys for a period of time. Cavan General Hospital has 15 or 17 delayed discharges but rarely has people on trolleys. Many factors are at play and delayed discharges are just part of it. Some of it is down to patient flow, management or any number of issues, and it is not simple. One can solve a problem in one place in health but create another one in another area. An element of this is happening at present because elective surgeries have been postponed, which adds to surgical waiting lists. Elective surgery is always pulled back a bit in January, so it is not as bad as it may seem, but it certainly will create another problem down the line. In health one is always fighting on all fronts, but I guarantee the committee we are all up for it.

Through the task force we want to redevelop a partnership approach to addressing this problem involving the Department, the HSE, clinical programmes, key physicians and the unions representing management and nursing. We also have a patient representative on the task force, Mr. Stephen McMahon, which is an important addition.

I had two concerns going into this week. One was the junior doctor changeover, which went well, and the other was influenza. It is the case that influenza-like illness rates have risen from 15.5 per 100,000 to 29 per 100,000 this week.

We are seeing an influenza outbreak and, obviously, the advice is what it always is, namely, that people who are high risk should get vaccinated. GPs are being asked to prescribe Tamiflu, the antiviral medicine, to those presenting with influenza-like illnesses in high risk groups, and we are asking everyone to do what needs to be done to prevent the spread of influenza. That includes covering one's mouth with a tissue when one coughs or sneezes, disposing of the dirty tissue at the earliest opportunity and cleaning one's hands because the illness is, of course, transmitted through contact and droplets. At risk groups include people aged 65 years and older; people, including children, with chronic illness such as lung and heart disease, neurological disorders, diabetes and neurodevelopmental disorders; those with lowered immunity levels due to disease or treatment; all pregnant women, in respect of whom the vaccine can be given at any stage in pregnancy; those with morbid obesity, that is, a body mass index of greater than 40; residents of nursing homes, old people's homes and other long-stay facilities; and health care workers and others who care for those in at risk groups. We are encouraging people in those groups to get the vaccine if they have not done so already, advising GPs to prescribe antivirals to this group and asking the public to help us prevent the spread of influenza through regular hand washing and covering their noses and mouths with a tissue.