Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

The Minister of State, Deputy Butler, might answer specifically on the availability of nursing home beds. I will just give a view on the initial question around the acute beds and the ambulance response times. There are a few different things at play here. First, the National Ambulance Service needs significant additional funding. That is happening now. In the budget for 2021, the budget for this year and the budget for next year, the national ambulance strategy, which was launched in 2016 and has been refreshed this year, is getting a substantial amount of money. With that, the National Ambulance Service is rebuilding the bases. This is because many of the ambulance bases throughout the country are not fit for purpose. It is also building and modernising the fleet. Critically, it is hiring more paramedics and advanced paramedics. There are some very good things going on. It is also adding more and more capacity in the call base up in Tallaght. The National Ambulance Service knows the response times for high-priority calls are not where they need to be. We need to recognise that. They are missing some of them by far too much and there is also too much variability around the country. We are responding by significantly increasing the funding available to the service for that. I recognise that it is not yet where it needs to be and some parts of the country are worse than others.

The Chairman asked about beds and patient flow and making beds available so that when people come in they are not on a trolley and if admitted they can get a bed as quickly as possible. I will just say two things. In part, more beds are needed. As per the paper that was circulated, albeit too late - and I fully accept that - more beds have been added to the system since Covid than in any period in history. Members will see from the graph that we are now significantly ahead of the Sláintecare target. Looking at the investment profile for the coming years, our intention is to pull further and further ahead of the Sláintecare targets in terms of those extra 2,400 beds. At the same time, working practices within the hospitals need to change. When we look at the discharge rates across the seven days, we can see that on Saturdays and Sundays, a small fraction of the number of patients are discharged as during the week. That means there are people in hospital beds on Friday, Saturday, Sunday and Monday who should not be there and there are people on trolleys in the emergency department who should not be there and should be up in those beds. Similarly, there is quite a variance in hospitals in the number of senior decision-makers being on-site in and around the emergency departments, that is, people who can make discharge decisions and admissions decisions. Some hospitals are doing incredibly well. The Minister of State, Deputy Butler, referenced University Hospital Waterford. It probably has the highest performance of the emergency departments. I was in there recently and it is very impressive. There are other hospitals where we do not have decision-makers on the floor when we need them. Unfortunately, those decisions are being left to nursing staff and NCHDs. There needs to be movement right across the board both in terms of changes to working practices and the availability of senior decision-makers, while at the same time acknowledging that far more beds, diagnostics, theatres and ambulance infrastructure are required as well.