Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

In fact, our health service is rated 14th out of 31 by the European Health Consumer Index, ECHI, and mortality and survival rates are above the OECD average and going in the right direction. Life expectancy is increasing, too. This would not be the case if we had the Third World health service the Members opposite seem to believe we have.

Emergency department overcrowding is a chronic problem that has beset us for at least 15 years and turns into a crisis whenever there is a surge of patients or a significant delay in discharges. It is not an emergency department problem per se,but a systemic one that manifests itself in the emergency department. As Deputies will know, I have worked in three emergency departments as a doctor, was on-call senior house officer to three more and have visited three since my appointment as Minister for Health, including two in the past week. I know the territory.

The Leader of the Opposition, Deputy Martin, also knows the territory. He was Minister for Health for four years between 2000 and 2004. During that time, the Fianna Fáil-led Government, supported by Independents, promised to end waiting lists permanently within two years and ensure full bed capacity in hospitals. That was in 2002 and was another case of "A lot promised, little done". That Government remained in power for a further nine years. This Government has been in power for four years. During that time, matters have consistently improved year on year until they started to deteriorate again in the summer, culminating in a spike last week. Comparing like with like, either using the special delivery unit, SDU, or nurses' union trolley watch numbers, the situation has still not reached the levels experienced under Fianna Fáil. It was bad this new year, but was nowhere near as bad as in the 2003-04 period when Deputy Colm Keaveney, who helped propose this motion, attacked Fianna Fáil and Deputy Martin for creating a so-called nightmare in our health service.

All the time there were horror stories in the newspapers, not just in January, but almost every single day. There was the story of the 85 year old woman in May 2003 who was sent home after spending 75 hours on a trolley. Later that same month, a 79 year old grandmother died in Tallaght hospital after spending five days on a trolley. There were stories of patients having to be treated in the car park because there was no room for them inside and other stories of patients sharing trolleys, taking shifts to sleep. I would be happy to share some of the press cuttings from that period with the Deputy opposite.

According to the Irish Independentin 2003, ambulances had to wait for up to three hours at Beaumont hospital's chronically overcrowded accident and emergency department one weekend and their trolleys were used to treat patients. One would swear from the comments of the Members' opposite that this was something new. A headline in The Irish Times read: "Patient dies after five-day trolley wait". The article continued, "Tallaght Hospital has said it is treating seriously a complaint from a Dublin family, whose 79-year-old mother died yesterday after spending five days on a trolley in the hospital's accident and emergency (A&E) unit." In 2000, a 90 year old woman fell off a hospital trolley after she had been left unattended, broke her leg and subsequently died, an inquest was told. Dr. Ciaran McLoughlin, the west Galway coroner, stated that he had no doubt the fall contributed to the death. There was another story of a woman who spent 75 hours on a trolley before being sent home and yet another of a County Galway boy who waited six years for necessary surgery. The latter was particularly condemned at the time by a Galway county councillor, Deputy Keaveney, who went on to say that, if all of the studies commissioned by Deputy Martin were stacked together, one could probably have built an extension to the hospital. The response of Deputy Martin, the then Minister, was a very simple one: it was not a "crisis", the term was being used with "gay abandon" - he did not like the term at all - and, of course, the situation was not his "fault".

How did he address the crisis? Did he stand up and take responsibility? Did he take steps to address it? No, he did not. In May, he insisted in the House that he did not like the word "crisis", complained that it was being used with "gay abandon" and that none of it was his "fault". No wonder Dr. Maurice Neligan, writing in The Irish Times,wondered if "you were right there, Micheál" and criticised the Minister's "capacity for self-delusion". Later, it was revealed that €400 million in new health facilities and hospital wards had remained unopened. Some 147 reports were commissioned, costing €1 million, and €2 million was spent on public relations. Thirty thousand people marched on the streets to protest.

Deputy Martin had four years as Minister, with a budget and staffing levels that increased exponentially each year. Despite having every opportunity, all of the tools and plenty of time, he achieved little. Now he wants to be Taoiseach.

It seems to me, however, that he was the greatest innocent bystander in history, as the health service lurched from crisis to crisis and wild promises were made and then ignored. With such a legacy behind him, I am grateful for his advice. Any Minister for Health could learn a lot from his mistakes and poor leadership. His is a poor example to follow and I do not intend to do so. He suggested recently that I should stop acting like a "commentator and some sort of analyst". Perhaps he is concerned that I actually can analyse the problems, that I am not afraid to comment on them and face up to them. He seems worried that I am actually prepared to take responsibility for solving them, when he would not. He fears being shown up and people being reminded of what he failed to do as Minister for Health and the appalling damage he did to the economy as a member of the previous Government.

I have also listened to the views put forward by Sinn Féin commentators over the past week. For the benefit of the House, I will refer briefly to some of the news from Northern Ireland, as reported in the Belfast Telegraph. We are told that the Belfast Health Trust stopped all non-urgent elective surgery up to and including 11 January, leaving many people back on waiting lists. Joanne Gibson from Fintona in County Tyrone spoke to a reporter about how she was admitted to the emergency department at Enniskillen hospital at 11.30 a.m. and was still there at 8.30 p.m. She was finally moved to the surgical ward more than a day later, at 1.30 a.m. The Belfast Telegrapharticle includes the following statement by Dr. George O'Neill:

I have people who wait up to a year to be seen, to be diagnosed, and then they are put on a waiting list to have a procedure carried out. We are now getting back to where it was four, five, six, seven years ago.

I could go on but I will not. The point is that emergency department overcrowding is not a new problem and it is not unique to Ireland. There is, for example, a major issue in this regard in England at the moment. It is a sad reflection on our health service and our politics - on all of us - that we have been debating and discussing this for 15 years or more. It really is a case of Groundhog Day at this time of year every year. Why not use this opportunity to do something different? Let us all acknowledge the realities and spend a few hours in this Chamber today and tomorrow and in committee doing what the public actually wants us to do, namely, coming up with ideas and solutions. Let us make this a debate worth having. That is what I would like to do.

Getting on top of this matter once and for all will require sustained attention over the coming months. I am committed to giving it the attention and political priority it deserves but I am loath to make promises. It is clear that this is not going to be an easy issue to resolve. It is not just a matter either of delayed discharges, staffing levels, skill levels, whether staff have a temporary or permanent contract, hospital avoidance, patient flow, management or advance planning. In fact, it is about all these things and more. The health service is like a delicate musical instrument which must constantly be retuned and fine-tuned if it is to work well.

The number of patients on trolleys in our emergency departments reached 525 last Tuesday morning. When one compares like with like, either using the special delivery unit's Trolley GAR measure or the Irish Nurses and Midwives Organisation's trolley watch, this was the highest figure in four years. Today, comparing like with like and time of year with time of year, the number is the lowest in seven years. However, I am not here to talk about statistics but about people. An individual on a trolley does not really care whether he or she is number 300 or 400. He or she just wants a bed and to receive the necessary treatment. While surges will occur from time to time, patients on trolleys should not be a year-round phenomenon in the way they are in some hospitals, and no patient should ever have to spend more than nine hours on a trolley waiting for a bed. Aside from the discomfort, loss of privacy and dignity, it is a patient safety risk, particularly for the frail elderly.

As of 2 p.m. today, there were 217 patients on trolleys in our emergency departments, with 131 in that position for more than nine hours. Most of these patients will be in beds before tonight but, of course, more patients will come in behind them. The situation varies from hospital to hospital and the reasons for this discrepancy also vary. Some hospitals have a problem with delayed discharges and put the on-trolley numbers down to that. Others have very few delayed discharges but still have patients on trolleys, which they put down to other reasons such as difficulty recruiting and retaining senior medical staff. Even though the situation is much improved, we are not out of the woods yet. Looking back to previous years, we have seen peaks in trolleys and overcrowding at various points in a given year, including in February 2011, March 2012 and May 2013. It is clear that a sustained focus will be required throughout the winter and into the summer. There is, moreover, always the risk of a winter vomiting virus, severe respiratory illness or influenza.

A range of measures is being taken to ease the situation. Non-urgent elective surgery has been cancelled, with the extent of and criteria for such cancellations varying from hospital to hospital, depending on the extent of overcrowding. Some less congested hospitals, for instance, have managed to do some elective surgery this week. Elective surgeries for life-threatening conditions like cancer cannot, however, be postponed for more than a few days. That is why I do not agree with calls for a blanket ban on all elective surgery, as put forward by some union groups. Closed wards have been reopened. Additional home care packages are being provided and, as of last weekend, no patient ready to be discharged is awaiting a home care package.

Transition beds in nursing homes are being funded while the paperwork required under the fair deal scheme is being worked out. In addition, 300 extra nursing home places are being funded under the scheme. There has been a delay in getting some patients into nursing homes, but this issue is progressing. It has been claimed that there are 1,200 nursing home spaces out there and there may well be, but they are not necessarily where they are needed. It is not possible to send people from Beaumont or Drogheda, for example, to a nursing home in Kerry and expect their relatives to visit them there. It might be the type of thing the NHS can do, but it would never be acceptable in this country.

To speed up patient flow, additional diagnostic scans are being made available and consultants are being asked to do ward rounds twice a day to speed up discharge. Community intervention teams are being extended, thereby allowing more patients to go home or stay at home or in their nursing home, where they will be visited by a nurse to give them their IV medicines or change their drip. Planning is under way to extend this measure to Drogheda, Naas and Waterford. It will also need to be available at weekends.

Extra beds or trolleys on wards reduce overcrowding in emergency departments, relieve pressure on department staff and offer a much safer solution for patients. This is done in other countries and is known as the "full capacity protocol" in the United States. Crucially, it breaks down silos and ensures overcrowding becomes a problem for the whole hospital rather than solely a problem for the emergency department, thus encouraging medical and other staff to expedite interventions and investigations and secure earlier discharge. However, extra beds on wards should never be seen as normal and it is appropriate that they should be counted. Whatever the methodology used, we should always be accurate in describing and interpreting our statistics and only ever compare like with like.

It is clear that an unprecedented number of delayed discharges is contributing to the problem of emergency department overcrowding, but there is more to it than that. The delayed discharges numbers peaked at 850 in early December and are now falling because of the measures that have been put in place. They now stand at 751. In Beaumont, for example, there are 81 delayed discharges, down from 100, and 23 patients on trolleys. In St. James's Hospital, there are 100 delayed discharges but very few patients on trolleys. In Letterkenny, there are no delayed discharges but there are four people on trolleys. In Cavan, there are 17 delayed discharges and no patient on a trolley. I am offering these examples to show there is no direct correlation between delayed discharges and emergency department overcrowding.

The actions we are taking to address overcrowding will help to deal with the surge we are experiencing at present and, we hope, get us through the winter. However, this does not represent a long-term solution. The long-term solution involves a shift from worsening ill health in our population to greater well-being through societal change supported by the Healthy Ireland programme and initiatives on obesity, smoking, alcohol misuse and greater physical activity. Without an improvement in population health, we will always be running up an escalator, working harder and employing more resources merely to match increasing demand. To make progress on the health and well-being agenda in 2015, we will carry out and publish the first survey of the health of the nation since the SLÁN report in 2007. We will then repeat it annually to see what progress we are making. Other measures will include new policies on obesity, the physical activity plan and the public health (alcohol) Bill, the heads of which I hope to publish within the next few weeks.

We also need to invest more in better primary care and social care. Better primary care will ensure people do not end up in hospital in the first place or at least not as frequently. This will require better management in the community of chronic diseases like asthma, chronic obstructive pulmonary disease and diabetes and better management and care of the frail elderly. I expect this approach to be at the centre of the new GP contract. I anticipate negotiations on that contract will begin later in the year once the talks on the provision of free GP care to under sixes are concluded. Deputy Calleary may be interested to know that the primary care service plan for this year includes provision for a minor surgery pilot programme under which 30 GPs will perform minor surgeries on GMS patients. There is also provision for access to ultrasound facilities, particularly for GPs in the southern part of the country, as well as a pilot programme to allow GPs to provide venesection for haemochromatosis. We also need much better social care in order that patients fit for discharge can get home or into a nursing home much sooner.

None of these things can be done quickly or without additional costs, at least initially. However, I will do my best to drive them forward. Ireland should be a country in which one can grow old with dignity. Today, unfortunately, that is not always the case.

Deputy Calleary asked if I accept that additional nurses and beds might form part of the solution. I do accept this, and that is why additional beds have been opened. I expect that these will remain open for months. We need to recruit additional nurses, and discussions are under way regarding a campaign in this regard. I am absolutely sure, however, that extra beds and nurses do not constitute the entire solution. One of the great successes in recent years has been the reduction in average lengths of stay. The average patient used to spend nine days in hospital, but this has been reduced to 6.7, which means that a great deal more work can be done. Even though budgets have remained flat, the number of surgeries carried out last year was 13% higher than the number carried out in 2010. The latter is due to greater efficiencies and increased use of day surgery in particular.

I look forward to listening to Members' contributions to this debate. I will provide the Joint Committee on Health and Children with a further update on this matter tomorrow. I will attend that meeting in the company of my senior officials and the director general of the Health Service Executive, Mr. Tony O'Brien. I take this opportunity to reject the Fianna Fáil motion before the House.

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