Jillian van Turnhout (Independent) | Oireachtas source

I thank the witnesses for their presentations. Perhaps everyone knows the answer to my first question, but I could not find it. Nine hours has been mentioned as the length of time over which someone in an emergency department should not remain on a trolley. From where does this figure come? In preparing for this meeting, I read the HSE's June 2012 report on the national emergency medicine programme. It continually referred to a figure of six hours. In the UK, the figure is four hours. We are in a crisis, but we should be aiming for the best care. On what basis have we determined that nine hours is okay and does the clock start when someone gets onto a bed or registers at the accident and emergency department? Maybe everyone knows the answer, but it is not apparent to me.

My colleagues have raised a number of issues around contributory factors and the interconnectedness of the health system, of which we are aware and which was highlighted in Mr. O'Brien's presentation, given the reduction in home help services and reliance on agency staff. Deputy Ó Caoláin referred to residential care beds and community infrastructure. The Minister raised the issue of delayed discharges. Has he a further update on the implementation of the report prepared by the ESRI and the Royal College of Surgeons in Ireland, RCSI, for the Irish Heart Foundation, entitled, "Towards Earlier Discharge, Better Outcomes, Lower Cost: Stroke Rehabilitation in Ireland", with a view to taking a proactive approach? The report showed how better outcomes could be achieved. In the Seanad, the Minister committed to considering whether it could be piloted. We should determine what can be done.

Our previous session on Huntington's disease was compelling and many issues arose, one of which was that, as an unintended consequence of the situation in emergency departments, respite beds were not available. Instead, they were being used to deal with this crisis. Anyone who was present for the presentation on Huntington's disease - Senator Crown described it rightly as a cruel disease - would be appalled that respite care beds were not available because of this.

I wish to address the issue of our ageing population, which Mr. O'Brien referred to, and nursing home care. In the early hours of 20 December 2014, I was faced with the decision of whether to have my father transferred to hospital from a nursing home on the opinion of an out-of-hours doctor. There is nothing a hospital can do for him. We are sending people into emergency departments, which are not the right and fit places for them. They go from one HSE service to another. I feel strongly about this personally because it happened in my own case, but I had to refuse the doctor's suggestion of a transfer repeatedly. It was as if I was doing something against my father's health. This is an issue for us. The committee produced an excellent report on end-of-life care and made a number of good recommendations, for example, nurse prescribers, that could be implemented in nursing homes instead of relying on transferring people into emergency departments. When we did that for my father in summer 2013, he spent 40 plus hours there. He is high dependency and does not have a medical situation with which the hospital can support him. He needs care, which is what he is getting now. Thankfully, he survived the crisis and is still with us.

Given the issue with end-of-life care, will the Minister revisit the recommendations of the committee's report? He replied to the committee, but they are not being taken up properly. We could save people from having to go through the trauma of presenting at emergency departments when doing so is not appropriate for their health care. I have spoken of my personal case, but I know from friends that many people must face this decision. Time and again they are told to send others to hospital. The only pathway available is through an emergency department. This is unacceptable. A person goes from one HSE facility to another. Why is the emergency department the only doorway into a hospital?