Mr. John McCamley:

I thank members for the opportunity to highlight some issues on this important matter on behalf of the SIPTU health division. We represent around 40,000 workers across private and public health organisations, including many grades involved in the delivery of emergency and acute hospital services. These grades include nurses and midwives, healthcare assistants, paramedics, porters and diagnostics staff.

Over the past two years, healthcare workers have gallantly worked through the unprecedented events that have tested the foundations of our health services and those working in it. They now face a return to the pre-pandemic overcrowding crisis that is developing in our hospitals nationally. In many hospitals the numbers presenting in emergency departments have drastically increased, having a knock-on effect on the rest of the hospital and community services. While issues with overcrowding have always had a detrimental effect on healthcare workers, the years of the pandemic have led to increased feelings of burnout, fatigue and low morale. They now face yet another crisis, and we are receiving increased reports of healthcare workers considering their roles. Coupled with this, the normal delays around recruitment could cause the situation to deteriorate further.

SIPTU represents a number of grades, and how the crisis is developing can be seen uniquely through their experiences. These can be placed in four main areas: pre-hospital emergency services, that is, ambulance services; emergency departments; inpatient wards; and community services.

Staff members working for the National Ambulance Service and Dublin Fire Brigade provide pre-hospital emergency services to the public and are crucial to the delivery of care and emergency services in our communities. For example, the HSE National Ambulance Service provides emergency services, intermediate care transport, mobile intensive care ambulances, neonatal intensive care and aeromedical services. We are seeing an increase in call volumes to these services. In our submission, we provided a number of figures. For example, in a comparison of January 2019 to January this year, calls have increased by more than 5,000. It is a fair assumption that any increase in call volume would have an impact on the availability of ambulances, but this combined with the delays at emergency departments, EDs, has caused additional pressures on services and ambulance crews.

During the pandemic, turnaround times increased due to the introduction of non-Covid and Covid pathways in EDs, with ambulance turnaround times ranging from one to five hours. This has resulted in ambulances being dispatched from further away to deal with the non-availability of ambulances nearer. The national average turnaround time at EDs stands at around 54 minutes, though there are examples of much higher times laid out in our submission. For example, in Letterkenny University Hospital on three occasions in January this year, ambulances could not leave for between seven and 14 hours. In University Hospital Waterford, it was between four and five hours on eight occasions. A number of other incidents are outlined in our submission.

It must be stated categorically that the delays are not the result of the tireless effort of the staff in any of these emergency departments but an overall systems failure in dealing with a number of areas that I will touch on later in this submission.

It is frequently stated that the unique nature of the emergency department is that it does not close. It is open 24-7 and patients can arrive at any time with any type of condition. Members of the public know they will be seen by dedicated and skilled professionals, albeit with increased waiting times. As a result of this, the ED has become a choke point for wider issues within the health service. While it is crucial that those issues particular to EDs are resolved as a matter of urgency, there is a need to look at alternative pathways to care.

SIPTU representatives have noted an increase in the number of complaints around staffing in emergency departments, in particular but not exclusively from nursing and healthcare assistant members, in the past few months. There is no doubt that staff are under increased pressure and the HSE and health employers need to do more to fill deficits in EDs. Additionally, radiographers are seeing an increase in cases, with cases in one Dublin hospital up 30% compared with 2019. There has been an increase in difficulties filling deficits for radiographers in some locations. We believe this is down to offering short-term contracts instead of permanent contracts.

While reliance on agency staff is always a feature in the health service, if recruitment and retention are not given priority, there will be additional reliance on agency staff along with increased costs to the Exchequer. Other locations have had difficulties with regard to staffing in catering and household. Overcrowding and the need for increased transfer of patients have also affected the availability of portering grades which are essential in the transport of patients within a hospital.

Healthcare workers in EDs have seen an increase in the number of patients waiting for a bed, with numbers recently exceeding those in 2019. It is highly likely that being left on trolleys for a long period can have a significant knock-on effect on patients' health. The HSE and health employers, including the Department of Health, need to do more to develop additional bed capacity in acute hospitals to relieve the emergency departments.

To increase turnaround in beds in an acute hospital, the provision of proper public community services is needed, either in a residential setting or with home care packages. Through the years, we have seen a cycle of temporary increases in home care packages only for the funding to be reduced in tandem with the hours allocated to a patient, resulting in them needing to go back to the ED. SIPTU members regard the delay waiting for home care packages to be one of the biggest factors for delayed discharges, although the allocation of a bed in the community is also a major factor. Housing alterations to cater for patients can feed into those delays as well.

Pathways also have to be developed within the community to deal with patient needs, which will reduce reliance on emergency departments, such as the expansion of primary care centres and minor injury units. Additional utilisation of pre-hospital care by ambulance staff can also reduce the need for a referral to the emergency department, for example, the expansion of community paramedics.

We have outlined a number of areas in which work needs to take place. These include the implementation of the ambulance service review on roles and responsibilities which will result in the further professionalisation of the ambulance service; funding to be made available for additional ambulance staff and vehicles; the expansion of community paramedics and other pre-hospital care initiatives; fast-tracking the filling of deficits within emergency departments for nursing, healthcare assistants and support grades; incentivising roles for ED staff, with a view to stemming the drain of staff from the service; and express roll-out of phase 2 of the task force on safe staffing in all EDs to assist and maintain adequate staffing of nurses and healthcare assistants.

Other areas include the expansion of enhanced care teams into EDs to free up healthcare assistants currently carrying out enhanced care; implementation of the radiographer review recommendations to deal with adequate safe staffing for radiography departments and advanced practice; full roll-out of the Sláintecare strategy across the health service; continued investment in the roll-out of home care packages in line with Sláintecare and HSE service delivery plans, with focus on delivery of hours via direct HSE employees; a clear commitment from Government to direct provision of home care services, including a more focused emphasis on HSE recruitment of home care support assistants; and an increase the number of publicly-owned community beds to reduce reliance on private nursing homes. I thank the committee for the opportunity to make our submission.