Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I move:

That Dáil Éireann:

noting:— the deplorable overcrowding being experienced in hospital emergency departments;

— the record number of patients waiting on trolleys;

— the further delays in scheduled hospital treatments that will result from such overcrowding; and

— the failure of the Government and the Health Service Executive (HSE) to adequately prepare for a situation they fully expected to happen;agreeing that:— the overcrowding crisis is causing an intolerable risk and danger to patients;

— patient dignity is being compromised;

— there are insufficient beds and front-line medical staff to treat the increased number of patients needing admission; and

— the crisis is being exacerbated by the number of patients clinically discharged who cannot leave hospital because the Government and the HSE is not providing sufficient nursing home beds or home care support; andcalls on the Government and the HSE to:— immediately provide beds and increased frontline staff so that the overcrowding can be eased; and

— restore the number of beds funded under the Nursing Homes Support Scheme to at least the level supported in 2013.

The purpose of this motion is to highlight again the difficulties arising from the inevitable crisis we see every January with the number of people waiting on trolleys in accident and emergency departments. This year, by any stretch of the imagination, has seen an extraordinary increase in the number of people waiting on trolleys in our accident and emergency departments throughout the country. There were 601 such people last week. The difficulty is that we as a society have almost accepted this as a fait accompli, politically and, dare I say it, systematically. We owe it to people who present at accident and emergency departments who are genuinely sick and who are very often frail or elderly to have better services than they have received to date.

We tabled this motion to highlight the issue. I will read from an e-mail I received, although I will not mention names in the interests of privacy. It states:

My 76-year-old father was sent by our GP to an accident and emergency department in St. Vincent's Hospital on New Year's Eve. He spent over 50 hours there on a trolley and we had to supply him with pillows and blankets. He did not receive any hot food for the period endured. There was bread and yoghurt for breakfast, a sandwich for lunch and another sandwich for tea every day. Try to survive on that when you are well. I sat on the floor by his trolley. Barely able to breathe, he had to queue for the one available toilet and there were no washing facilities or privacy. There were insufficient numbers of doctors and nurses as we continue to export our expensively trained Irish doctors and nurses to Australia. Meanwhile, seriously ill people are scattered all over our inadequate emergency departments.

When he was admitted, service improved slightly. Sleep was an optional extra. My family spent over €100 on parking over the eight days he was there. As there are not any chairs available, visitors and others had to stand or sit by the patients on trolleys. I am appalled. Sick people must be treated better. Statistics mean little until it is you or your family being treated with such disrespect. This Government's time hand-wringing and blaming the situation on others is no longer acceptable. If a fraction of the money that has been wasted on Irish Water and other white elephants had been invested in primary care facilities and nursing homes, this well-flagged problem could have been eradicated.

The father of this person in Terenure was admitted to St. Vincent's Hospital on New Year's Eve and spent more than 50 hours on a trolley there. He is 76 years old. This motion is meant to highlight the crisis that evolves every January in our accident and emergency departments throughout the country.

The difficulty is we know this will happen so should we accept it as an inevitability or try to put measures in place that would address the underlying problems? The Minister has claimed that he has tried to secure an extra €25 million to deal with delayed discharges and to increase the number of fair deal nursing home beds by 300. By any credible stretch of the imagination, that is insufficient for many reasons. There will be 1,400 fewer fair deal beds this year than there were in 2013. The population is getting older year on year, with the number of people over 80 increasing by 3.5% to 4% every year. The pressure is consistently building because of the demographics of our society.

It is now time for us to park this nonsense on the trolley issue that happens year in, year out and that has gone on for years. We must deal with the issue in a meaningful way. The Minister has made a couple of interventions and although we would all wish a new Minister well, he cannot pretend he is a passive observer, a spectator or an analyst of the health services. He is the person ultimately in charge and he must roll up his sleeves to get involved in ensuring we have systems in place that will prevent an escalation in the number of people waiting on trolleys every January. This is not just about people waiting on trolleys as there is the issue of patient health being compromised, as has been highlighted time and again by front-line service providers such as the doctors and nurses working in our accident and emergency departments. They inevitably work in an environment that is compromising patient safety. Even today, the Taoiseach admitted this environment is not as safe as it should be.

There was a problem from last year that we saw evolving in the health service. When he took up his new post, the Minister was informed of the number of delayed discharges in acute hospital settings and was advised that this would create difficulty with regard to the capacity of accident and emergency departments in dealing with increased throughputs, particularly in the winter months. Nothing was done. Last November, we saw some spin in claims that the Minister had secured a major increase in funding to deal with delayed discharges. The bottom line is that when we work through the figures, we are still worse off than in 2013 with regard to the number of fair deal beds. Everybody accepts that we should not have cases of acute hospital beds being tied up by a patient who does not want to be there and should not be there. Such patients must be moved to a step-down facility or afforded a home care package or a fair deal nursing home bed.

We tabled a motion last November about the fair deal scheme, as people are now waiting 15 weeks to be approved for it. This time last year, the approval time was six weeks, which means that in 12 months, the wait has gone from six to 15 weeks. This is not about statistics as this affects real people who deserve and should expect respect from the health services and this Government. Resources must be provided to ensure an adequate amount of capacity in accident and emergency departments or acute care hospitals to deal with throughput. The motion is important for that and a number of other reasons. It will highlight the issue and put pressure on to ensure that appropriate resources can be put in place.

The Minister has said time and again it is not necessarily about resources and that there are other issues. Of course, there are other issues. There are issues in regard to how we manage elective surgeries and the changeover of staff, including non-consultant hospital doctors, etc., every January and July. There is a spike because of that, with new people coming into a new department and maybe unsure of the work practices and the rostering and all that flows from that. However, the bottom line is that we are aware of it. There is this idea that the Minister can sit passively by and establish an emergency department task force, which did very little as far as I can see. It met prior to Christmas and only for the fact it was dragged kicking and screaming to a table, it would not have met yet. There is this idea that we can accept 300 or 400 people on trolleys as the norm. It is not the norm. These are 300 or 400 people week in, week out whose lives and whose health is being compromised by the fact that the system cannot manage itself. The reason it cannot manage itself is obvious in the sense that delays in discharging patients is a critical issue. We just do not have enough front line staff in our emergency departments. They are two key issues. Management and the rostering of elective surgeries and the changeover of non-consultant hospital doctors at certain times are clearly creating huge difficulties also. Those issues must be addressed.

If it were about just changing the management structures and sending out a few memorandums from Hawkins House, I am quite sure the issues would have been resolved already. The Minister said he can issue an edict from the ministerial office but that it is not always implemented. However, the bottom line is that should be implemented. If the Minister sends out an edict or an instruction that something should be done, it should be done. If it is not done, there are a number of reasons for that.. Either the Minister is sending out edicts that cannot be implemented because of a lack of resources or people simply do not believe the Minister has the solutions to the problems. For whatever reason, they are not always implemented and that will have to be looked at as a matter of urgency.

I looked back over statements made by the Taoiseach and the previous Minister for Health when in opposition and even when in government. They clearly show they are not dealing with the difficulties the health service is facing on a continuous basis with the urgency and importance they deserve because the funding provided to the health services in recent years has consistently undermined the system in terms of being able to deliver health care. We instanced the whole issue of the fair deal scheme.

The other key area, which everyone in this House agrees should be implemented to ensure we address the problems in our emergency departments and in our acute hospitals, is the whole issue of the primary carer strategy. It is a wonderful strategy which has been bought into by every stakeholder. The difficulty is that it has not been implemented. We are very slow to roll out the whole process of funding primary care. We have said previously in this Chamber that primary care is in crisis. There is a difficulty there and we cannot dismiss it. There are major problems in GP practices throughout the country. Many of them are financially below the waterline and are incapable of providing the services they want to provide and which their clients and patients need. That, in itself, is a key area that must be addressed.

If the Government was in office for only a matter of months or a year, we could accept that it takes time to find its feet and bed down but it is now going into its fifth year in office. It is no longer in its infancy; we are well into the latter years of the lifetime of this Government. It must accept it has some responsibility and it is time it shouldered that in a meaningful way.

The Minister highlighted last year's budget as a major increase in funding but when one goes through the figures, no matter what way one tries to dress it up, our health service is starting from a very challenged position in 2015. The Minister is hoping, in terms of the figures, that there will be a major drop in the number of people who will qualify for medical cards on the income guidelines to make up the shortfall that will invariably come about. That is for what the Minister is hoping. That is the gamble but it has not paid off to date in terms of making up false savings that have been presented to this House by the previous Minister. We had almost fraudulent, bogus budgets which were signed off on by the Taoiseach and the Cabinet, of which the Minister was a member. It is time the Government not only rolled up its sleeves but actually showed commitment to our health service to give people dignity when they present at emergency departments so they do not have to lie on trolleys for more than 50 hours like the 76-year-old man in the emergency department of St. Vincent's Hospital on new year's eve. He was given a yogurt for breakfast, a sandwich for lunch and a sandwich in the evening and he had to queue for the one toilet. That is what is happening in our emergency departments. The Minister knows that well from his previous profession. He saw that at first-hand and now he has an opportunity to do something about it.

I urge the Minister to at least accept that the budget, which was presented to this House in November of last year, is simply not sufficient and that these once-off savings and these additional income streams will not provide a sound and sustainable funding model so that the health service can plan ahead and achieve its targets and outcomes but, more important, can treat patients with dignity and respect in a safe environment. That is what has to be done.

One of the issues put forward as a solution to the problem was the cancellation of elective surgery. That is just shifting one problem to another area. How many people have been geared up, ready to go into hospital for a procedure, for surgery or for some diagnostic procedure to be told at short notice that it has been cancelled? That is no way to run a health service. The difficulties in reassessing that person and re-entering him or her into the system continually grinds to a halt the waiting list system, which is already increasing exponentially. The idea that one of the great solutions is the cancellation of elective surgery as a means to address the crisis in our emergency departments is not good enough. It is something that has to be addressed quickly to ensure we do not consistently end up delaying elective surgeries and elective diagnostics to deal with the issue of trolleys in our emergency departments.

If the emergency department task force is the solution to the problems, I fear for the people working in our health service who must continually, under huge pressure and in unsafe work practice environments, deliver health care in this country. They are the people who are being let down and denied the opportunity to fulfil their professional mandates and to honour their commitments in terms of their professions, whether as a doctor, a nurse or another allied medical professional. They are the ones who want to help people but this Government has tied their hands behind their backs in terms of a lack of funding.

I commend this motion to the House. It highlights the difficulties but also asks Government to at least accept that the funding provided is not sufficient to deal with the crisis.

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