Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I apologise for missing the first bit of the meeting. I had a matter to attend to but I read the submission. Representatives from ICTU were before us earlier and they referred to a report commissioned and published in August 2016 which recommended that 107 nurses be employed to nurse patients already admitted and on trolleys. They advised us that, as of last Friday, there was no provision in the HSE service plan for the employment of these nurses. Can the witnesses comment on that? The provision of advanced nurse practitioners has reached 78 but surely we could do an awful lot better. As Mr. Liam Doran said, St. James's Hospital has six advanced nurse practitioners and consistently has the lowest level of trolleys across the country, albeit the figure is not zero. We can very easily make the link between the availability of ANPs and the reduction in trolleys, which we all agree needs to be tackled, so can we not do something quickly in this regard?

My head spins with the figures relating to the winter initiative, not because I do not understand them but because sometimes it seems the same bed is counted twice. How many additional hospital beds are currently open, staffed and operational? How many transitional care beds are there as of today? Where are the 300 additional acute beds referred to in the submission? Are they open? Are they on top of the 55 that were quoted? Are they brand new?

There was an emphasis in the submission on the need to transition to primary care and everybody says this. A fantastic, brand new, beautiful, shiny primary care centre is about to open in Balbriggan. Unfortunately, according to a answer given by the HSE to a parliamentary question, no new staff are going into it. There are no new staff for the north county but the north county is already stretched to capacity. I do not want to dwell on a local issue but this illustrates that there is a lot of talk but not much to back it up. While everybody may say we need to go down the road of primary care, nobody does anything about it. Maybe the witnesses can talk about the siloed nature of the health service and how the acute sector will not give up its budget to fund primary care. Maybe it cannot do this but I would appreciate it if the witnesses would comment on the point.

The representatives from ICTU said that when the ratio of nurses to patients is worse than 1:8, care can become compromised. Would the witnesses agree with this figure? Everybody is a little bit tired of the HSE scrapping with the INMO about figures so I would hope the HSE would agree on this one. Can the witnesses comment on what ICTU said afterwards, namely, that most emergency departments are routinely short-staffed by four or five nurses or more, leaving a ratio of one to 16, which would clearly not be acceptable.

Dr. O'Conor from the Irish Association for Emergency Medicine was asked how we were fixed to cope with a disaster. Staff will probably say they cope with disasters every day of the week but I am talking about an actual disaster.

While there is a critical incident protocol, I am reading between the lines. To be fair, the people who were in did not go as far as I would. I say we are not set up at all to cope with a disaster involving a massive influx. We already rely very heavily on the goodwill of the people who work in our emergency departments, from the man or woman delivering food to nurses and consultants. Sometimes, goodwill is all that gets us through a serious critical incident. In the estimation of Mr. Woods, how well set up are we for a critical incident? In a previous life I sat on the group that looked at critical incident management and I put it to him that we are not very well set up at all. If there were a critical incident, how would we be fixed given that we have 612 people waiting on trolleys? We have now reached that stage. It rarely drops below 500. Would we be lucky if the critical incident happened in one area rather than another?