Alan Kelly (Tipperary, Labour) | Oireachtas source

I apologise for my absence earlier on but multiple things were going on.

Several of members present also serve on the Committee on the Future of Healthcare, which is a separate committee setting up a strategy for ten years. We had a submission from the chief executive officer of the Mid-west hospitals group, Ms Colette Cowan, who is dealing with one of the biggest emergency problems in the country, in Limerick. I represent Tipperary. On one side there is Limerick and on the other there is Clonmel, two of the worst emergency department situations in Ireland. They are chaotic. People in Tipperary are afraid to attend emergency departments. In her submission, Ms Cowan made clear that the solution is to take a large portion of her budget from her and put it into the community to prevent people ending up in the emergency department. It was an amazing submission. I presume the priority for the Committee on the Future of Healthcare will be the investment needed in the community side of health care, and how quickly we can get that out there. My colleagues can correct me if I am wrong.

I found it immoral to hear news reports on RTE or Today FM or Newstalk of the trolley watch figures during the emergency followed by advertisements from private hospitals for patients to come to their accident and emergency departments. What is Dr. O'Conor's opinion of this? Personally, given my political philosophy I believe in public services but for a period there is capacity in these private accident and emergency departments. I know they cannot do everything but they can deal with normal knocks and bits and pieces. They should be seconded during crises such as the recent one because their capacity is not being used to the full.

There has to be a statistical analysis or a heat map of why in some locations some general practitioners, GPs, have a higher rate of referral than others, even in the same town. Why are the ambulance personnel in the mid-west telling me they cannot work because of the volume of referrals from some GPs while others make very few referrals yet their case loads are more or less the same? What are we going to do about it? All these things are intertwined.

I accept that we need to change the way consultants and clinicians are paid. We also need to change their work practices.

The idea that we work five days per week and are closed for eight days over Christmas is insane. There must be a seven-day roster. We must have clinicians, consultants and so forth coming in, discharging people and doing their job seven days a week. That must be part of the contract. In addition, we must ensure GPs have a contract that deals with unsocial hours in a realistic way, so we do not have a situation such as the one in the Chairman's county where Shannondoc went from 58 hours down to eight when it went from 12 doctors down to ten, which is scandalous.

Part of an issue here, aside from staffing and beds, is that the IT infrastructure is crazy. I have been through the emergency department in Limerick a number of times. What is happening there is crazy. It is not the fault of anybody there but it is crazy. It takes up so much time.

On the minor injury units and the pathways through which patients are put into emergency theatres, I am not convinced it is working as well as it should. People are ending up in accident and emergency departments when they should be in the minor injury unit. That area must be re-examined. When one arrives in Ennis or Nenagh hospitals there is a massive sign in front which says, effectively, that one must go to Limerick if there is basically anything wrong. The management of that pathway is not working to the maximum and more people are ending up in accident and emergency departments. I keep referring to Limerick hospital because it is the model one hospital in my area. That should change.

On the issue of opening transitional beds, and I accept there are issues across the board in terms of staffing, beds and so forth, there is capacity to open transitional beds in many areas of the country without too much funding. There is a former hospital in Cashel on which X amount has been spent, which I will be reviewing in the Committee of Public Accounts. It does not have a single patient, which is incredible. If that cannot be used for transitional care, when the hospital a few minutes down the road has one of the worst emergency department crises in Ireland, I do not know what can.

I have a final few comments or questions. I am very much taken by the issue of modular building. I support it. It appears to be taking a long time from procurement. I do not know what it will be but, personally, I believe it will be extensions in all but name albeit perhaps modular in nature. Obviously, it will not be full build. From a capital point of view, I am not convinced that this happening as quickly as we need it. I take on board the views on nursing homes. People should have end-of-life facilities in those homes because obviously that will take away pressure. It is all about diverting pressure away from accident and emergency departments through multiple decisions.

My final comment is on transport. I am deeply frustrated with the way in which ambulance personnel are left waiting. To see the queue of ambulances left outside University Hospital Limerick over the Christmas period was frightening. There is also the knock-on impact of what happens if there is an emergency in the locality. That process must be dealt with in a more efficient way. Second, and this refers to what I said earlier, I realise funding was provided in respect of other transport facilities to bring critical patients. Most of them do not operate outside normal working hours. They need to be expanded and, in particular, they need to be used to bring patients to a step-down facility after being in a model one hospital and for GP referrals for non-critical patients. A situation where ambulances are being used for all of this is causing even greater problems and risks when it comes to accident and emergency departments.