Oireachtas Joint and Select Committees

Thursday, 17 December 2015

Joint Oireachtas Committee on Health and Children

Task Force on Overcrowding in Accident and Emergency Departments: Discussion

11:15 am

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I wish the witnesses a happy Christmas and a successful new year, personally and in their endeavours in the context of addressing emergency department overcrowding. While it is known as the emergency department task force, we could rename it "the department of emergencies task force" given the amount of firefighting that has been required from time to time in our health services. I note with interest in the context of the previous discussion on hospital groups and primary care that new registrations at emergency departments were at their highest rate since May in November 2015 at 99,418. Given that 83% were discharged or admitted within the nine hour timeframe as laid down, one must ask why we continue to consistently send people to hospital who should not be going there. With the roll-out of primary care and primary care teams, that sector should be taking up more of those numbers if it were functioning at the level we anticipated or hoped. Nevertheless, we appear to be continuing to herd people to our acute hospitals system and primarily to emergency departments.

A cursory glance at the number of people attending our emergency departments shows that the vast majority goes home. As such, what is wrong with our primary care strategy that it is not dealing with the issue of overcrowding in our emergency departments? We all say that it is the presentation of people at our emergency departments and the number of delayed discharges in our acute hospitals setting that is the difficulty people face on a daily basis in having to wait an inordinate time on trolleys. Of course, there have been some improvements, but there have also been disimprovements in the sense that an inordinate number of elderly people are having to wait a very long time on trolleys in our emergency departments. In that context, we have had cases that were investigated and in respect of which reports were published on the treatment of those persons. Apologies were made by hospitals and the HSE. It seems to be something, nevertheless, that continues to happen. Notwithstanding geriatric supports within the community and at step-down facilities and home care packages, it appears to be an issue that is still causing major difficulties for the HSE and, more importantly, patients themselves. I ask the witnesses to elaborate on why more and more people are presenting at our emergency departments given that the stated policy of the HSE, the Department and the Government in the primary care strategy is to have fewer people presenting. Why is that the case?

We have seen that in January every year, numbers escalate before dropping accordingly throughout the year until the following winter in November. Elective surgery was almost always blamed for the overcrowding in our emergency departments because there was insufficient throughput in the acute hospitals system. In terms of planning, the task force takes into account in winter proofing and assessment of patient flows, delayed discharges and, equally, elective surgery. Is there a policy to delay elective surgeries in January and February 2016 to allow for a reduction in trolley numbers in our emergency departments or is the same capacity and throughput for elective surgery still envisaged? Has the decision been taken to delay elective surgeries? While some elective surgeries can wait, not all are non-urgent. Very often, we seem to forget that.

In terms of the recently postponed industrial action by the INMO, what was resolved in terms of the late-night negotiations with the Workplace Relations Commission to address the issues of overcrowding, patient safety, patient wellbeing and patient dignity in our emergency departments? That was the primary purpose of the industrial action from what I could gather. It was centred primarily on the need to address patient safety. Could somebody explain to me what the outcome of the negotiations was that will impact directly on patient safety? In terms of recruitment and retention of emergency medicine consultants and nurse specialists in emergency medicine, approximately 144 vacancies exist in the emergency departments.

There is also a difficulty with recruitment related to the retention and attraction of emergency medicine consultants.

An investigation was to be carried out into the leaking of an email concerning a consultant from Tallaght. A certain Dr. Gray was highlighting deficiencies in the Tallaght hospital emergency department, particularly in respect of overcrowding and care of the elderly. He referred to the pressure under which staff were working. What is the status of the investigation? It seems that when Dr. Gray came forward to advocate for patients, he was treated unfairly, at the very least, owing to the leaking of an email that had been circulated among a select few. Has the investigation been fully completed and will the outcome be made public?

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