Ms Patricia King:

The Irish Congress of Trade Unions, ICTU, is pleased to address the Oireachtas Joint Committee on Health on the critical and topical issue of overcrowding in all our hospital emergency departments. This engagement is all the more important days after 612 patients, admitted for inpatient treatment, were left on trolleys in our overcrowded hospitals.

ICTU has monitored with increasing concern the marked increase in hospital overcrowding in recent years. We note that it is the elderly and ordinary workers, as well as their families, who suffer most through that overcrowding and the compromising of care that follows. Congress has also been informed on an ongoing basis of this situation through the work of our health union affiliates and, on a daily basis, by the trolley-ward watch figures released by the Irish Nurses and Midwives Organisation, INMO. In that regard, and to graphically measure the extent of the growing crisis, I draw the committee’s attention to appendix 1 in our written submission. This records the unacceptable increase in the number of admitted patients on trolleys in emergency departments or throughout hospitals over the ten-year period from 2006 to 2016. These figures confirm that, notwithstanding the measures taken, the reality is that overcrowding continues, unabated, with a record number of admitted patients on trolleys in 2016 of 93,621.

In terms of a political response, we remind the committee that, in 2006, the then Minister for Health and Children declared that 486 people on trolleys was a national emergency, which required a significant and sustained response. Regrettably, history shows the required response was not forthcoming. After 2008, the economic recession saw our public health service subject to significant contraction in overall financial allocation, staffing numbers through a recruitment embargo and the resultant closure and curtailment of services including the closure of public acute/long-term care beds and the restrictions on community nursing and support services.

This contraction, which was unmanaged and undertaken without any risk assessment or reference to the growing concern of health service staff who saw the implications, has, without doubt, been a major contributory factor to the record levels of emergency department overcrowding now taking place. In addition, and as a direct result of flawed decision-making and policy analysis, emergency department overcrowding was exacerbated under the guise of the reconfiguration of services particularly in such areas as the mid-west and the north east. I refer the committee again to appendix 1 to see the damage done when budget considerations determine health decisions, regardless of their impact upon services, patients or staff, for example, Limerick and Drogheda.

In the context of the current, record, level of overcrowding ICTU believes the problem must be addressed, with both short and medium-term measures, recognising overcrowding in emergency departments is not the fault of emergency departments. It is simply the outward manifestation of a public health service too small to cater for the demands being placed upon it, year on year, through changing demographics, health expectations and scientific developments. Hospital overcrowding cannot be laid at the door of senior managers who are not given the resources, both in terms of acute and community-based services, to adequately respond to the demands being placed upon any given hospital. It is also worth noting that any individual hospitals ability to respond to this ever increasing demand is influenced by its own bed capacity, access to transitional or long-term care beds, access to primary and social care services, including public health nursing or home help and other supports. In other words, capacity, both in terms of capital and human resource, are central to resolving this problem.

Short-term actions must include an immediate requirement that all hospitals roster senior clinical decision makers over the extended day on a seven-day week basis, at least until the end of this winter period. This will aid the speed of decision making in the hospital environment, thereby assisting patient flow as decisions to admit or discharge or refer are made quicker. Special measures must be taken to alleviate the staffing crisis which exists right across our hospital services at this time. This will have to include, at least for a defined period, incentivised measures so that we minimise the impact upon patient care arising from overcrowding. Special measures must also be taken to allow for the re-opening of public acute and long-term care beds, again including incentivised measures where required, so that we make maximum use of all available bed stock.

The committee must note that, as of today, approximately 150 acute beds are closed with hundreds of long-term public beds closed all due to staff shortages. Senior management, who can make resource decisions, must also be present on a seven-over-seven basis until the end of the winter period.

In terms of medium-term solutions, by which we mean a three to five-year period, congress believes the capital and current funding necessary to increase acute bed capacity by at least 1,500 must be provided, with the additional beds being allocated in areas where the need is greatest. We remind the committee that, if one refers to OECD figures, Ireland has 2.8 beds per 1,000 population. The OECD average is 4.8 beds. Congress believes there is also a need for a significant and sustained investment to increase public long-term bed capacity which would have both a capital and ongoing cost. This is in recognition of the massive change in demographics that will occur in the coming years, given the reality that this will see us with an ageing population with co-morbidities requiring high levels of intervention and support to maintain people's quality of life and, where possible, their independence.

There is also a need for investment in primary care-community services, which would see them operate on an extended day basis in a seven day cycle. This should help to provide access to services and individual care supports, as required, as an active and more effective alternative to attendance at an emergency department. This would also require significant and sustained investment as currently most primary care-community services are available on a Monday to Friday basis, with only urgent and priority cases being serviced at the weekend and on public holidays. This is not a model of delivery which keeps people out of hospital.

ICTU holds the view that the ever increasing levels of overcrowding in hospitals must be viewed as being totally unacceptable and a reality which, notwithstanding the economic constraints, cannot be allowed to continue. No public acute hospital can function safely with bed occupancy rates of up to 100% when anything over 85% is viewed internationally as overcrowding. It can only be addressed, however, by a complete realignment of our current approach to health care which views emergency departments as separate from all other parts of the public health system. The only way in which we can address the overcrowding is by integrating care services through a series of initiatives which include increasing acute bed capacity, transitional-long-term care bed capacity and expanding community nursing and other support services, as well as home care services. ICTU and, in particular, its health union affiliates will fully support all investments and new ways of working designed to increase public health services capacity, ensure full integration of care services, from the home to supported living, long-term care and acute intervention. We reference congress's submission to the special Committee on the Future of Healthcare to demonstrate our commitment to such radical change.

We thank the committee for its time and look forward to engaging with it in order that we can elaborate on this submission or answer other questions it may have. My colleagues, Mr. Doran, will field many of those questions.