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

I will let Mr. O'Brien speak about the more operational areas, but I will make a few responses. Deputy Kelleher suggested a few times that I was well capable of delivering a lecture. He is quite good at it himself, so congratulations on that.

One of the difficulties is that health care in Ireland is too politicised. If there is a problem with a hospital in France, the people in the hospital are held accountable and if there is a problem with a trust in England, the trust is held accountable. In Ireland it gets political very quickly and often it allows the people who are responsible to get away with not taking responsibility. If we were to achieve anything in the next ten years - I do not expect it to happen in the next one or two years - it would be to de-politicise health a little and change the tone of the debate on health care. Both the Government and the Opposition would benefit from that and, more importantly, patients and the public would benefit from a little less political anger and politicisation of health care. Indeed, many of the things that should have been done in the past were not done for political reasons, because they were politically unpopular even though they were necessary changes.

I agree with Deputy Kelleher on one point, that emergency department, ED, overcrowding in a number of hospitals has become normalised and almost acceptable for the last ten or 15 years. However, it is not acceptable to me and I will continue to take a personal lead and give personal attention to it over the next few months. Long after the parliamentary questions stop arriving, long after this committee has moved on to the latest issue in the news and long after the news media have moved on to other pressing issues, I will continue to have a focus on this and double down on it. I am not promising I can fix it all, but I will give it the type of attention that no other Minister has given it in the past.

I cannot account for why hot food and pillows were not provided in St. Vincent's. Perhaps the local management can answer that. I visited the hospital last week and it is running an excellent emergency department. The use of technology by the consultants there is particularly impressive. The hospital opened three five-bed overflow wards and since then the numbers have been under control. I cannot tell why they were not opened earlier. Perhaps it was a decision taken on the ground or it could not find nurses for it, but I cannot give the Deputy the detail on exactly what happens on any given day in 26 to 28 hospitals and I doubt that he would expect me to.

The Deputy is correct that it is the emergency department task force, not an emergency task force. It is established to deal with this issue in the medium term. What happens every day is something different. Every day, twice a day and, on one occasion, three times a day there is a conference call involving some of the senior directors who are with me here, the hospital group CEO, social care and so forth. That is how the emergency response is co-ordinated. It is not a meeting around a table, with everybody travelling to Dublin. That is not how these things are done. The CEO of the group hospital in Limerick must be in Limerick and the CEO in the west has to be in Galway. It is done through conference call, not as a round-table meeting with coffee, sandwiches and so forth.

With regard to the request of the HSE, the Deputy knows how budgets work. Every Department and agency puts forward its request and if one were to add up what every agency and Department requested, we would probably have to double the budget and people's taxes every year, which is not realistic. The total request from the HSE was an additional €1.4 billion, and that was to do everything we would all wish to do in health. The committee members understand that every agency and Department cannot get everything they request. In fact, no agency or Department ever gets everything it asks for in the budgetary round. However, I was able to secure the first increase in the budget in seven years. Under the previous Government the health budget was cut back by 20%. Based on outturn, what was actually spent as opposed to what was estimated, the health spend has not been decreased at all under this Government and will increase slightly in 2015. However, we were nowhere near being in a position to reverse the cutbacks that were made by the previous Government.

In the meantime, demand has risen and I will not pretend otherwise. That is the truth. It is interesting that even though we spend €1.5 billion less than was spent in 2008 to 2009, there is more surgery carried out, more outpatient clinics and more work is done. In fact, the length of stay in hospital has decreased from nine days to 6.7, so there was a great deal of inefficiency there. The health service has become much more efficient in the last number of years.

With regard to the €100 million, it was not for delayed discharges but for the fair deal scheme. Most people who avail of the fair deal scheme are actually in the community, not in hospital. The number for those in hospital would have been lower. However, we certainly did not get everything we asked for and I will not pretend otherwise.

Delayed discharges absolutely are a factor, but they are not the sole cause. It is estimated that perhaps a quarter or a third of the number of people admitted into hospital do not need to be admitted. Often that is due to the fact that the decision to admit can be made by more junior staff who are less risk averse than more senior staff. I was in that position myself and I did it. It is a problem in some hospitals where there is a difficulty recruiting senior staff. Therefore, the threshold for admission is lower than it would be in a hospital that has more senior staff or in a hospital that has better access to diagnostics or to outpatients quite quickly. There are many issues to be dealt with. Emergency department overcrowding happens because ten things went wrong somewhere else and generally not because of what is happening in the emergency departments. They simply get left with the mess, unfortunately.

I do not wish to get bogged down in the figures as it does not really matter, but the SDU figures are calculated three times per day so they give us a different read from the nurses' union figures, which are only calculated once in the day. The Trolley Watch figures are quite similar. Ward Watch is different. That includes people who are on trolleys or extra beds in wards, often in other buildings and up to 1 km away. I do not mind how one counts it. With statistics there are many ways to count things, but I believe people should be accurate in describing what the figures mean. When one uses the ward watch figures and talks about ED overcrowding, that is just incorrect because people counted in ward watch are not anywhere near the emergency department. Also, when one makes comparisons one must compare like with like. One cannot compare the 2 p.m. figure from the HSE numbers with the nurses' figure from 8 a.m. I ask the Deputy to be accurate in what he describes and to compare like with like. I do not care whose figures he uses as long as he uses that basic mathematical, scientific and statistical fact. That is all I will say about statistics. However, I agree with everyone that nobody should be on a trolley for a long period of time. It does not really matter what the number is, it just helps us to control it in some way.

I mentioned funding already. There are competing priorities, such as housing, homelessness and children. People should always use the resources they have efficiently first before they ask for more. Frankly, it is not always the case that people do that in the public service. It is very important that people use the resources they have efficiently and then demonstrate that they need more. I have that responsibility as well and I am in a much stronger position when I go to the Economic Management Council, EMC, and the Minister for Public Expenditure and Reform to seek additional funding when I can demonstrate that money we have is used as efficiently as possible. The health service has become a great deal more efficient in recent years.

Senator van Turnhout mentioned the early support of discharge for stroke. That is being done for chronic obstructive pulmonary disease, COPD, and has worked really well. We wish to do it for stroke too. There are plans for a pilot scheme, but there is an initial investment and cost involved. In addition, it might not be appropriate for every region and might work better in urban regions where outreach is easier than in rural areas. All of that must be figured out.

The Senator is 100% correct about controlling demand. Demand for hospital services is increasing with our ageing population and we will always be running up the escalator, which is coming down fast towards us, unless we control demand. That involves a number of matters. It involves the Healthy Ireland philosophy, making our population's health better, dealing with smoking, obesity, inactivity and so forth, screening, prevention and expanding primary care services, which is very important. With regard to nursing homes, there are approximately 1,000 nurse prescribers in Ireland at present. There was none a couple of years ago. That was achieved by the former Minister, Deputy Reilly. We need more of them. There are also community intervention teams, comprising nurses who go into homes and nursing homes to change the drips, give IVs and the like. As Tony O'Brien mentioned, that is being expanded and there is a specific allocation in the service plan for 2015 to expand it further. However, we are only getting started on this. Perhaps it should have been done years ago, but I can only do my best with our current position.

Another issue is advance health care directives. That legislation will be brought to the Dáil this year. It will empower people to make decisions as to whether they want to end their life in more comfort at home or in the nursing home rather than having to go through an ED and die in the hospital, which is not necessarily right for everybody. We wish to give people the power to make those decisions for themselves.

We are in discussions with the Department of Public Expenditure and Reform on the new capital programme. There will be a new national development plan, NDP, which will run from 2016 to 2021 and we are involved in discussions on that. Obviously, long-term care and community nursing home facilities are high on our request list for that.

I believe I have covered most of the matters that I can cover in that regard.

In regard to the immediate steps being taken arising out of the emergency department task force, what is important is that we keep doing what we are doing. I will ask Mr. O'Brien to update the committee further on the campaign in regard to recruitment of nurses. In regard to the doctors, the key issue appears to be salaries for consultants. It has been difficult to fill a number of senior posts. A second ballot on revised proposals will be held soon. I hope that all things going to plan, we will in a matter of weeks have agreement with the IMO on a new consultant payscale, which will then allow us to commence recruitment of the 250 vacant consultant posts.