David Cullinane (Waterford, Sinn Fein) | Oireachtas source

All the warning signs were there well before December and January hit. In fact, Mr. Mulvany and his colleagues appeared before this committee during a very lengthy discussion on the winter plan. At that hearing, we told them that the winter plan was insufficient. Mr. Mulvany and his officials told us that many of the objectives in the plan would not be met because the staff simply could not be recruited and it would be the middle of this year if not next year before many of the resources that were committed would be delivered. Not just this committee but patient advocacy groups, the Irish Nurses and Midwives Organisation, INMO, emergency department doctors, the IMO and people working on the front line all said during the summer trolley crisis that we were in for one hell of a winter and that is what came about. What did not come was the leadership and urgency from the HSE centre and HSE leadership must take some responsibility for what happened. Obviously rising infections and sickness in the community put pressure on any healthcare system so I will take that as given but this has been matched and exacerbated by the failure to put in place the capacity.

A few moments ago, Mr. Mulvany said that we are not talking about scheduled care but about unscheduled care. He made the point that the references to elective hospitals are not relevant, which is staggering because it is directly relevant. One of the reasons trolley numbers are down is because hospitals are using day beds and medical beds as inpatient beds. The result of this is wholesale cancellation of elective procedures, which we know happens when a surge occurs. That is why we need elective-only hospitals. We have talked and talked about them, members of this committee have raised the issue for many years and it could be years before we see them. There is a direct relationship between that clash of scheduled and unscheduled care and its impact on citizens. I am afraid to say there has been a failure of leadership.

In his opening statement, Mr. Mulvany made a point that beggars belief and has angered people. He said that the HSE will bring forward a three-year unscheduled care improvement plan that will combine process improvement, expedite infrastructural investment and learn from sites performing well, which would be great. However, this should have been put in place years ago. In 2018, we had the overall health capacity review, which outlined the beds, staff and capacity that were needed in hospitals. In 2018, we had a delayed discharge review that made recommendations, not all of which have been implemented. In 2019, we had the unplanned care review or emergency department review, which the HSE kept under wraps and of which it fought the release.

It was only because of the Irish Patients Association that the report ever saw the light of day. We have had HIQA reports, many of them in recent years, which have laid bare capacity deficits. Mr. Mulvany talked on three occasions in his opening statement about lessons learned. This is not about learning lessons. We have long passed the point of hearing this rhetoric from the HSE and its senior management. This is about delivery and failure to deliver on plans that we are putting in place. This is the reality.

Why was the plan Mr. Mulvany referred to in his opening statement, the unscheduled care improvement plan that he said would be put in place and which I would welcome being multi-annual, not put in place in 2017 or 2018 when we had all the same warnings and all those reports I have spoken about that pointed to all of these problems in accident and emergency departments? Here we are, four years later, only now talking about a plan.