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

I move:

That Dáil Éireann:notes:

— the sharp increase in the numbers on hospital waiting lists since the start of 2014;

— the abandonment of the eight month target for treatment on the adult in-patient and day case waiting lists and the twelve month target for an appointment on the hospital out-patient waiting lists;

— that the new eighteen month targets have not been met; and

— that the most recent figures indicate a further deterioration in the figures and prolonged times patients are on trollies in emergency departments;

further notes:

— the continuing difficulties for patients and staff in hospital emergency departments;

— that the April initiative by the Government has not yet been financed or in any way improved the situation;

— the increase in the number of patients waiting on trolleys during July and August 2015 by comparison to the same months in 2014; and

— the difficulties in the emergency departments are exacerbating the delays in scheduled hospital treatments;

agrees that:

— overcrowding in hospital wards and delays in scheduled treatments pose a risk to patients;

— the most recent announcement of 300 extra beds is not sufficient to meet the demand of the service, in particular for the winter period;

— there is a need for more units to be reopened with an increase of frontline medical and nursing staff to meet demand; and

— health service funding is inadequate to meet the needs of the Irish public; and

calls on the Government to:

— increase further the number of beds and frontline staff so that the overcrowding can be eased;

— restore the National Treatment Purchase Fund to ensure that patients receive needed treatments in a timely manner; and

— fund the health services adequately and honestly so that the demands from the sickest in the country's society are met in a safe manner.

The reason the motion is before us is simply because we feel that after four and a half years of the Government's tenure the difficulties people face accessing health care in this country have got progressively worse. There is no denying the fact there was great fanfare in 2011 when the Fine Gael Minister, Deputy James Reilly, took office. He was going to do an awful lot. Many commitments were made in advance of the general election of 2011, whereby there would be a radical overhaul of our health systems, in administration the HSE was going to be abolished and there was going to be a move to universality and universal health insurance. These major policy decisions would then impact on the ability of the new health services to deliver health care and the Government would end the scandal of people waiting on trolleys. This was a slogan from the then Leader of the Opposition and now Taoiseach, Deputy Enda Kenny. He stated if Fine Gael was elected it would end the scandal of people waiting on trolleys. The difficulty with all of this, of course, is that things have got progressively worse.

I like to keep debates in the House fair and reasonable and not get too personal, but it has not improved under the Minister's tenure. In fact it is getting progressively worse. The figures can be seen on a continual basis through the parliamentary questions we table and in replies to freedom of information requests. Under any matrix used to assess the performance of the health services they are getting progressively worse.

We now have the bizarre situation whereby the Minister applauded himself for moving the targets for outpatient and inpatient waiting lists from one year and nine months respectively to 18 months. He stated this was the right thing to do. On top of that we also find the Minister cannot even meet his less ambitious targets. Every hospital has huge increases in the percentages of people waiting for inpatient and outpatient appointments. What is happening now is people simply cannot access health services. They cannot even get an appointment to see a consultant to find out whether they will need surgical procedures or other forms of therapy. This is happening day in day out in our hospitals.

The outpatient waiting list increased a staggering 60% in the 12 months from August 2014 to August 2015. One or two hospitals have made moves to reduce their waiting lists, but overall the figure has increased by 60%. When we are in the House we throw out figures, but behind every one of those percentage increases are many people in pain and suffering who are waiting for treatment or even to be diagnosed to find out what is wrong with them. The Minister's answer is to move the waiting targets from one year to 18 months. He will be so compassionate that they will meet the new targets, but they are less ambitious and people will be waiting longer. This is what the Minister announced with great fanfare. He stated it would be a realistic target which would be met. The bottom line is any assessment or due diligence of the list shows the hospital system does not have the capacity to deliver on the targets the Minister has now set. As I have stated, these targets are less ambitious than those set by his predecessor. The number of children awaiting outpatient appointments for an inordinate length of time is more than 5,000. In the key areas identified by the Minister where there would be a progressive decrease in the number of people waiting it has simply not happened in any way.

All of this stems from the fact that last October, when the budget and the Estimates for 2015 were announced, the first thing the Minister did when he left the House was state he had achieved a realistic budget. It was far from realistic. It was a fallacy, a nonsense, a figment and a dead duck from the word go. It was never going to deliver the health services the Government had pretended it would with the money available. The Minister is now carrying a €500 million deficit. The health services are already short this much money to provide the care outlined in the HSE service plan for 2015.

No aspect of the Minister's pronouncements last year has been delivered. The trolley situation is at crisis point. Consultants, clinicians and front-line medical staff tell us our emergency departments are at breaking point and people are dying as a result of waiting on trolleys for an inordinate length of time. A patient suffering from cancer in a hospital in this country, who was almost 100 years of age, waited five days on a trolley. Patients wait for days on end in emergency departments throughout the country. Our front-line staff tell us it is unsafe. The Minister has stated he likes to listen to front-line staff and take into account their views and concerns and their expressions of concern about patient safety. The bottom line is the Minister has done very little, if nothing at all, to address the deepening crisis in our emergency departments.

Last December, when we were facing a crisis, the Minister announced the establishment of an emergency department task force. It met before Christmas with much fanfare and PR. The Minister strong-armed it and it was going to do an awful lot. It announced its plan in April. Its plan has fundamentally failed. Any assessment of the performance of our hospital emergency departments throughout the country shows they are underresourced and understaffed and do not have the capacity to deal with what presents.

More recently, the task force was reconvened. Again the Minister strong-armed it and it was going to do an awful lot. There was an announcement of 300 beds. Those 300 beds will come on stream at the end of this year, but at the start of the year it was patently obvious, to the Minister I assume, and anybody willing to listen to clinicians and those involved in hospital management throughout the country that there was simply not the capacity in our hospitals to address the overcrowding in emergency departments. There is a number of reasons for this. First and foremost is the number of people stuck in acute hospital settings because they simply cannot transfer to nursing homes, stepdown facilities or supported living in the home through home care packages, home help and other community services. This is still a major problem. Day in day out, more than 500 beds are taken up in a hospital by people who do not want to be there and should not be there, but we simply do not have the capacity or ability to organise a seamless transfer from our acute hospital settings to stepdown facilities or supported living in the home. Is it beyond us, the Minister and the emergency department task force to assess and address this very fundamental blockage in the acute hospital system throughout the country?

As I mentioned, the announcement was for 300 beds to be made available, which will come on stream at the end of the year. Of course, the question that follows is whether these will be additional beds or just the opening of wards that had been temporarily closed. Will we have the usual massaging of figures for the number of hospital beds taken out of the system, the numbers being closed on a temporary basis and those which are being refurbished or which do not have enough staff to manage and support beds?

The 300 additional beds are a start but this issue would have been quite obvious as soon as the Minister took up residence in the Department of Health at Hawkins House when he was made Minister in July 2014. He was told that the fair deal scheme and an inability to move people into nursing homes, step-down facilities, community care or support in the home was a fundamental problem. Almost nothing was done to enhance and increase the capacity of the fair deal scheme to handle the number of people in hospital when they should not be. It took a crisis where people were waiting 18 or 20 weeks for assessment to be granted access to the fair deal scheme before there was any waking up to the problem on behalf of the Minister. The Minister's hands-off approach and aloofness to the difficulties being faced every day are simply not acceptable any more. It is time for the Minister to get involved on a day-to-day basis to ensure hospitals can have the support, capacity and funding to carry out their functions and duties.

The Minister has announced he will penalise hospitals if they do not perform in certain areas. Of course, what the Minister will end up doing is robbing Peter to pay Paul. If hospitals are being penalised because people are waiting on trolleys because of a lack of capacity, the hospitals will simply cancel or postpone elective surgeries. That will happen across the hospital system. There might be a reduction in the trolley numbers in accident and emergency departments but there will be a corresponding increase in the number of cancellations. Cancellation numbers to date have been alarming in outpatient, inpatient and day cases. There have been 12,000 cancellations for day cases or inpatient appointments for the first six months of 2015, and by any yardstick that is a catastrophic failure. Other issues also come to mind. People are waiting inordinate periods, in pain and agony, yet all these mantras were propagated by the Minister and others in opposition. Since 2011, almost nothing has been done, other than the outlining of grand plans and great visions, with no substance in the basic commitments to our public health system.

That system is becoming inaccessible to many people. Our front-line staff are demoralised, we cannot recruit consultants and there have been major increases in waiting lists for speech and language therapy and many other areas across the health services. This is where people should be able to access the basics in health care and it comes under the Minister's watch. He can spin this any way he likes in talking about realistic budgets, achieving a lot and strong-arming the managers in hospitals and all those willing to listen to or bow down to him. The difficulty is that in every matrix that can be adjudicated or judged with respect to whether health services are capable of delivering, the result points to the fact that they are underfunded, under-resourced, lack capacity and simply do not have enough staff to deal with the demands being presented daily.

The National Treatment Purchase Fund was cancelled some time ago and to this day I cannot understand the logic behind that. It was a scheme that was efficient and cost-effective and which dealt with the delays in people accessing health care, specifically inpatient or day cases. It purchased the treatment from a private source but at least people were not waiting the extraordinary lengths they are now waiting. That must be examined as there is no point in continuing this pretence. The Minister should announce what is happening and proceed in a proper, structured way to re-establish the treatment purchase fund. Such a scheme would be able to access health care for the people waiting an inordinate period on lists throughout the country.

When we put down this motion we wanted to highlight the difficulties that people face throughout the country but we do not have to highlight the issue beyond stating the facts. We do not have to exaggerate or speak with emotive language. All one has to do is visit a hospital, speak to a public health nurse or doctor working at the coalface or listen to patients and their families who are simply fed up of waiting great lengths to access basic health care. In the meantime, the Minister pretending that the Government has a plan in how to fund health care, and in particular that we will move to universal health insurance. The idea is the scheme will be rolled out to address every issue. Deep down in the Minister's heart he knows well that this has been abandoned but the Government does not have the decency to admit it. The Government has no intention of moving to universal health insurance but it does not want to be seen announcing a U-turn at this stage. The bottom line is that even the building blocks are not in place to move to universal health insurance. It is also a flawed model that undermines public health and the concept of a public service, and it would hand over our health system to private operators. Instead of the Minister rationing the health service and health care, those private operators would decide what health care would be available to people depending on the public health system.

For all those reasons, much more needs to be done to be honest about the issue by assessing our difficulties and trying to address them. Public relations spin and a pretence of having grand plans simply will not wash any more. We need definitive action that will target key areas and difficulties in our hospital system. Consultant recruitment is an obvious issue and we need more nurses, front-line staff and clinicians across the hospital system. Our primary care system is falling apart. The Minister should know, with his professional competency, that a key cornerstone of all stated policies of parties here and stakeholders outside Leinster House is the need to shift resources and fund primary care in order that it can be meaningful in delivering health care in this country, keeping those with chronic illnesses out of the acute hospital setting and shoring up community-based services. This would ensure people would not present in acute hospitals day in and day out. Unfortunately, general practice just does not have the wherewithal and support to take that on board. These people are willing and - more important - able, but the Minister must become an advocate for primary care rather than pretend it is okay. Our GPs are leaving this country and heading to Canada or the UK, so it is not okay. It is a sad indictment of this country that we are forcing the best and brightest out of it when we need them most to deliver primary and community care.

There is a lack of public health nurses and we are incapable of supporting elderly or sick people in their home. We are diminishing home help hours and our home care package assessment system is simply not efficient. People have to beg to try to secure home care packages. There is no seamless transfer from the acute hospital system through to community or home care. The process is simply not working. Rather than a pretence of a plan, we need to accept the failings and deal with them in a targeted and focused way. The Minister must be the first to accept that primary care has been starved of resources, leading to a diminished capacity to deliver meaningful health care in this country.

Our motion also agrees that "overcrowding in hospital wards and delays in scheduled treatments pose a risk to patients".

People are dying because they are waiting on trolleys. That is a fact. People are dying and people are in pain and in agony because they cannot access inpatient or outpatient appointments. People are under huge stress and anxiety because they may be waiting a long time for a diagnosis. That is wrong and it is being exacerbated on the Minister's watch in recent times.

The motion goes on to call on the Government to increase the number of beds and front-line staff so the overcrowding issue can be eased. We accept that there are huge challenges. We do not expect it to be delivered overnight but we would like to see the people behind the figures being dealt with in a reasonable timeframe. The idea that targets should be shifted to make oneself look good because they cannot be met is simply wrong and that must be acknowledged quickly. The motion also calls on the Government to restore the National Treatment Purchase Fund, as I referred to.

This is the Minister's last chance in terms of honesty in the health budget. He must fund the health services adequately and honestly so that the demands from the sickest in society are met in a safe manner. Last year, the Minister walked out of this Chamber and went on a tour of the radio stations to pronounce that he was the first Minister to get a realistic budget in the last few years and that it was an honest budget, which would address all concerns. This was a fallacy from the beginning. What we need him to do this year is to become an advocate for public health at the Cabinet table, to argue for a realistic budget and, in arguing for it, to present what he will do with the funds he will get. Rather than chasing the grand plan that is a figment of his imagination, the Government must commit itself to the public health system, to funding and to resourcing it and to bringing in staff to ensure it can operate efficiently. For all those reasons, this is an opportunity for the Minister to grab between now and budget day, to point out to the Ministers for Finance and for Public Expenditure and Reform that there is a gaping hole in the budget, year after year. The pretence that the Government has adequately funded the health services must stop and it must commit itself to the health services.

See this speech in context