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

I welcome the witnesses and thank them for their presentations. The Committee on the Future of Healthcare is working in parallel with this committee and the witnesses have made presentations to that committee in that context.

The big challenge will be whether the State will have the ability to deal with the capacity issue in the health services. That is something we will have to assess both in the political sphere and in society, in terms of how we are willing to fund, and who is willing to pay for, expanding the capacity of the broader health system. When the witnesses talk about bed capacity they are referring to acute bed and intensive care unit bed capacity. Then one moves out to the community care setting and to the home, using that bed capacity in the context of home care, home care packages, home care supports and intensive home care packages. It is not just the acute hospital system - there is a lack of capacity across the system and in the nursing homes.

This meeting is primarily about emergency medicine and the overcrowding in our emergency departments in the last number of years. If memory serves, a previous Minister declared a national emergency in 2006. Then other emergencies were declared. It was seen as the horror of all horrors. There were 612 people on trolleys on the first Tuesday of 2017, so we have not addressed it. I am putting questions so I can get answers or at least opinions on what we must do, so these are not my stated views but questions to which I wish to get answers. I cannot get my head around the fact that, as an Opposition Deputy, I could have prepared a press release for the first Tuesday in 2017 last October, as a result of the trends over the past seven to ten years. On the first Tuesday of every year there is a spike in the numbers on trolleys. On every Tuesday of every week there is a spike in the number of people waiting on trolleys in emergency departments across the country. While there is a huge capacity issue there is also an inability in the system to anticipate what will come through the front door, even though we all know it will come through that door. In terms of rosters or preparedness to deal with the overcrowding in emergency departments, even on a short-term basis, why are we incapable of just anticipating what will come through the front door next Tuesday in the emergency departments? We all know today that there will be a spike next Tuesday. Why is it that management and stakeholders cannot collectively try to deal with that issue? Why is it that there is a spike in numbers on the first Tuesday of every year and on Tuesday every week and why can we not deal with that?

Regarding Mr. Doran's point about dedicated staff for admitted patients, I have visited emergency departments once or twice myself or to visit a person in an emergency department or as an Opposition Deputy trying to help, or perhaps hinder, but at least to observe. There appears to be no transitional place for patients who have been admitted to the inpatient system. They are warehoused in busy corridors or in nooks and crannies in our emergency departments. I always wonder why there is no capacity to build a proper annexe near the emergency department for people who are assessed, whose emergency treatment is over and who are now awaiting proper admission to the acute hospital system. Why are they still on trolleys in corridors? Could they not be on a trolley in a nice ward area before they go up to the hospital proper?

The reason I raise this is that Mr. Doran says we need dedicated staff. We do not have that capacity in the beds in the acute hospital system. In the meantime, patients on intravenous drips, people who are incontinent and people who are 90 to 100 years of age are waiting in corridors. Is there any transitional place where patients could be put while waiting for acute beds to free up in the hospital proper? I know it has been considered, but why has there not been action on it given that we have the emergency medicine task force? It is a flawed name because the word "emergency" should not be there at all. It has not been an emergency but has been very lethargic in assessing and anticipating potential problems or issues to ensure appropriate structures, processes and controls are in place. Many of the witnesses are familiar with this. There appears to be a neverending language about communication and the exchange of platforms between the HSE and relevant stakeholders, but for the last ten years we have had the most appalling incidents of people waiting inordinate lengths of time just to get to a place that is quiet and peaceful, before they are admitted to the hospital proper.

There was reference to the fact that we have 80 emergency medical consultants. We have 29 hospitals that provide some form of emergency care. Why are there only 80 consultants? Is it because there has been no recruitment effort or because nobody wishes to work in the environment? Is it because it is not remuneratively attractive? What are the reasons for only having 80 emergency medicine consultants?

I seek clarity on another issue. While there is bedlam and chaos in the emergency departments, the other end of the hospital is serene, tranquil and nicely managed. There is 9 a.m. to 5 p.m. discharging and 9 a.m. to 5 p.m. access to diagnostics, five days a week, although I am aware that it has gone to 8 a.m. to 8 p.m. in some places. Is there an onus on the stakeholders at the other end of the hospital, that is, the consultants and union representatives, to promote the concept of moving beyond 9 a.m. to 5 p.m.? Let us be honest, Ms O'Connor has colleagues who are operating from 9 a.m. to 5 p.m. while she is down in chaos. Why is there not more emphasis on the professional or representative bodies to promote that concept of expanding hospital hours? There was resistance by consultants to nurses being able to discharge, so it is not all just about the elephant in the room, which is the lack of capacity. Are there any opportunities for us to improve and do better with what we have, bearing in mind that everything the witnesses and I have said here today must be funded by taxation? Until recently the State simply did not have the capacity to fund even what we had, so that must be borne in mind.

On the issue of elderly people and nursing homes, Mr. Doran mentioned public health nurses. We know the demographics and the assessments that will confront this nation in the next number of years in terms of the aging profile, life expectancy and the demographics in age profiles. There will be huge demand in geriatric services and for geriatricians, nurse specialists, community care and so forth. At the same time, if there is a difficulty in a nursing home in the evenings or out of hours it is quite likely that a locum doctor will attend. They might not be familiar with the patient or even with the nursing home.

It is inevitable that the elderly person will be transferred by ambulance into an acute hospital, such as the one where Dr. O'Conor is working, in a state or crisis. Why is there not more emphasis on the need to enhance geriatric services to include geriatricians and consultant geriatricians in our public and private nursing homes to ensure there is confidence in the system and to allow older people to stay in the nursing home? Having spoken to representatives, I believe there is a reluctance to allow palliative care in nursing homes because it does not read well if people are passing away in nursing homes and there is the urgency then to move them on. Is this an issue that must be addressed to deal with the points about overcrowding as outlined by Dr. O'Conor?

On the issue of discharging, earlier in the discussion I referred to the lines of demarcation and prescribing. If one mentions to some GPs that nurses might prescribe, those GPs have apoplectic fits because they see it as a complete crossover into their area. It was mentioned that pharmacists should have more of a role in front-line care provision which is another no-no for some people. There is a need within the medical professions to embrace a bit of flexibility in the area of needing to accept that things must change for the betterment of people who avail of the services. This applies also to the stakeholders and workers' representatives,