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

I apologise because I had to leave between the contribution of the previous witness and Mr. Woods' presentation. I have read his presentation, however.

I wish to raise just a few issues. We are primarily inviting witnesses here to discuss the issue of overcrowding in our emergency departments. This is basically what Mr. Woods referred to in his presentation. He mentioned the winter initiative and all that flows from that.

The Minister for Health, Deputy Leo Varadkar, convened a task force in December 2014 and outlined that its objectives were to establish a communication platform, to inform, drive and support the HSE acute hospital division’s implementation plan, to identify collaborative working arrangements, to anticipate potential problems or issues and to ensure appropriate structures, processes and controls.

I said to the witnesses in the earlier session that, as an Opposition Deputy, I could have drafted the press release on overcrowding on the first Tuesday of 2017 as far back as October. That is the reality of the matter. Every week, on Tuesday mornings, we will have the highest number of people on trolleys in our emergency departments. That is also a given. These are the known knows. In that context, accepting that there are considerable capacity issues across the hospital system affecting acute beds, care unit beds, step-down facilities and transitional beds, how much closer are we to making our hospitals work over a greater number of hours?

Reference is made to senior clinical decision makers being available between 8 p.m. and 8 a.m. That is the case in emergency departments but not in other areas. How far have we gone towards providing access to senior clinical decision makers and diagnostics on an eight-to-eight basis, or seven days per week? What are the obstacles to that? Is IR issues one of them? Are there contractual issues or capacity problems in recruiting additional staff to oversee expanded diagnostics and extended hours?

Emergency medicine consultants have been before us today and other people have appeared before the Committee on the Future of Healthcare, chaired by Deputy Róisín Shortall. It seems that we have made very little progress in the area of elderly people presenting in our emergency departments across the country. I refer particularly to the transfer of elderly patients from nursing homes or community settings to emergency departments, primarily for intravenous antibiotics, catheters and things that could and should be done in the community setting. Given the major challenge facing us in terms of demographics and our life expectancy and ageing profile, our geriatric services and supports to the communities are not what they should be. Should we not deal with this issue with some urgency? If we do not we will end up, year after year, with the same problems with overcrowding and the almost inhumane treatment of transferring people in ambulances from their home care setting, such as a nursing home or a high-dependency home care package, to an acute hospital system which is anything but ideal? Capacity in the shape of geriatric services, consultant geriatricians, nurse specialists and public health nurses does not seem to be expanding by much. Are we making progress in that area?

We have 80 emergency medical consultants and 29 who provide acute and emergency cover at hospitals. What are the obstacles to recruiting emergency medical consultants? The recommendations are that the number should be at least doubled. Is it a matter of the remuneration packages or that we have not been recruiting? Are the staff just not there? Why can we not expand the service, knowing that it would address the issues?

In a presentation to the Committee on the Future of Healthcare, Mr. O'Brien said that if we stay as we are in terms of capacity, within a short number of years there will be no capacity in the public health system to deal with elective care, such as surgery and both inpatient and outpatient treatments. We would effectively be an acute public health system dealing with elective surgeries when they become acute. That will have profound implications for our ability to deal with patients in a timely manner. How much of this is at play in the pressures in our acute hospitals and emergency departments on a daily basis? On Monday morning people come in for elective surgeries but they take up the space required for those admitted through the emergency department. Is there any way to look at a seven-day week, or putting on elective surgeries over the weekend to deal with the weekly overcrowding crisis we see on Mondays and Tuesdays?