Alan Kelly (Tipperary, Labour) | Oireachtas source

I am sorry for being late. I am trying to multitask today. I am also a member of the Committee of Public Accounts, which launched a report earlier.

First, I am sorry Deputy Donnelly has left because I was switching documents after the previous meeting and I saw his contribution. On nurses' pay and conditions, I am not sure what planet the Deputy is on. As far as I am concerned, he was not comparing apples with apples or oranges with oranges.

There is a crisis in nursing in the country. There is a crisis in the area of workforce planning in relation to doctors, GP contracts going nowhere and consultants. It is the biggest issue, along with capital expenditure, in the country.

When it comes to nurses' pay and the conditions under which nurses must work, the process by which increments come in, the training required and the scaling up of their work at a fairly quick pace, Deputy Donnelly was not comparing any rate of pay that I could recognise as being a correlation. That issue will have to be dealt with.

I have a real issue. Members of my own family work as nurses in hospitals. We need a health and safety trolley watch. The public needs to know what is going on out there. I hear it every week. The public does not actually know. It will come to a crescendo soon. We need to be monitoring this and producing statistics on what is happening to staff, including doctors, particularly nurses, and, dare I say it, porters as well, in the HSE. I would encourage some way in which that could be done through the unions.

On bed capacity, obviously there is the famous capital plan that is coming out and the modular builds. Through everyone's evidence here today, do they believe that there is a pace afoot in order to deal with the bed capacity in the capital build and the modular build that is being brought about? I represent Tipperary. I have got the two worst accident and emergency departments in the country either side of me - Limerick, which is closer to me even though I am in Tipperary and South Tipperary General Hospital. Both are looking for modular builds and need them fairly quickly. If the witnesses have evidence on that, it would be helpful.

I have been talking about the issue of e-health for three years. My background is in technology. I have not seen much progress. It is a significant part of the Sláintecare report. I fundamentally believe work practices will change if we can advance in certain areas here.

My evidence from talking to people, and I talk to many people in healthcare, is that this is going higgledy-piggledy and where there is progress it is not replicated. I would like comments on that. The real question I want to home in on is the issue of pathway of care. This is my last question and I am being brief by my standards. I come from the mid-west. We had a number of reports down through the years, including the report of the national task force on medical staffing, the Hanly report, on change in Ennis hospital, Nenagh hospital and St. John's Hospital, as well as the situation in University Hospital Limerick.

The manifestation of that is what we have now. I am not saying all the parts of the Hanly report were wrong - some of it was right. The issue is the process by which we got there flooded University Hospital Limerick. There is an issue where GPs, in the circumstances, are referring a large amount into Limerick. I refer to the pathway by which people can be serviced in the minor injury clinics in the other three hospitals. St. John's Hospital is closed at the moment and it is ridiculous that more cannot be done in Nenagh and Ennis hospitals. As the Chairman is well aware, both have excellent facilities, as does St. John's. Nenagh has the best operating theatres in Ireland but patients are not being transferred into these hospitals for after care and minor surgery for many different reasons.

There is a lack of a discharge protocol and in some cases it is something basic like not being able to get intermittent vehicles to transfer patients to after care. I have experienced this with my own family. On pathways for referrals into hospitals, we had an accident and emergency unit which ended up three and a half times the size of the original but the volume of patients increased by 24% because it was thought more could be accommodated. We have to improve the pathways in and out of the network of hospitals. An example of something done well recently is the centralisation of cataract surgery in Nenagh because it has the theatres and it is going to have extra beds as more blocks are being built etc. It is in the centre of Ireland, surgeons like operating there and it has very good theatres. The lists are off the Richter scale.

That is a good example but the pathways for electives and how patients are cared for post surgery and after being in the main hospital have to be improved to ensure there are more beds. The discharge policy and the policy under which patients are being serviced in the network is not working. It can be helped easily without much funding or change. Those are my comments because everything else has been covered.