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

I move:

That Dáil Éireann:

agrees that:— prolonged waiting times in emergency departments are associated with poorer outcomes for patients;

— the safety and quality of patient care must be a primary focus and timeliness is a crucial component of quality care;

— patients should receive a high standard of treatment irrespective of when or where they seek emergency care and they should not experience excessive waiting times in emergency departments;

— elderly patients, in particular, should not be waiting more than six hours; and

— consultants are obliged and entitled to highlight conditions that may jeopardise patient care;recognises that:— last month was the worst October on record with 7,971 admitted patients cared for on trolleys; and

— over the first 10 months of this year almost 80,000 admitted patients were on trolleys;notes that:— the April 2015 initiative, while reducing waiting times for the Fair Deal and the number of delayed discharges, has not reduced the overcrowding in emergency departments; and

— the introduction of a system of fines to penalise hospitals that do not meet non-emergency care targets could further aggravate the difficulties in emergency departments;calls for the Government and the Health Service Executive to:— ensure safe, adequate and consistently available staffing levels for all emergency departments;

— recruit additional designated staff to look after admitted patients who are on trolleys;

— ensure the total patient time spent in the emergency department is less than six hours;

andfurther calls for:— the recommendations of the 2012 Health Information and Quality Authority report (entitled Report of the investigation into the quality, safety and governance of the care provided by the Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital [AMNCH] for patients who require acute admission) to be fully implemented; and

— the strategy to improve safety, quality, access and value as set out in the 2012 National Emergency Medicine Programme to be implemented.

The purpose of the motion is to highlight the continual overcrowding our emergency departments face nationally. Day in and day out, we see the trolley watch numbers and hear harrowing stories of patients lying for inordinate lengths of time in emergency departments. I would be failing in my duty if I did not raise this issue consistently. It is not something that happens every now and again. It is consistently a failure of determination by the Government to address the fundamental problem of lack of capacity across our hospital system. We had some very serious personal issues being brought to public attention recently having regard to the number of elderly people waiting on hospital trolleys in emergency departments. In that context, it is significant to acknowledge first and foremost the work of front-line emergency medicine consultants, nursing staff and all of the support staff required to ensure our hospitals are working. Unfortunately, they are expected to deliver more than the capacity will allow.

Issues were raised last week about overcrowding at Tallaght and comments were made by an emergency medicine consultant there. It was dealt with in a distasteful way. He was raising the plight of a patient under his care in the emergency department. I found it amazing that there was an attempt to damage the messenger. He said a patient was waiting for over 27 hours in an emergency department which was not appropriate. Unfortunately, the guns were turned on him notwithstanding the fact that he was a whistleblower. It is his duty to advocate for the patients in his care. It was very distasteful that the Minister would dismiss it summarily and try to undermine the message he was bringing. I found it incredible that, according to reports, the Minister decided to contact the particular patient. I find it almost unethical that a Minister of the day, regardless of whether he or she is a doctor, would contact a patient in the care of a doctor to ask whether or not he or she was satisfied with the treatment and service. It is wholly inappropriate. The Minister should reflect on that.

Commitments have been made time and again since 2011 to tackle head on the overcrowding in our hospital system and emergency departments and on our outpatient and inpatient waiting lists. We could go back and revisit the stewardship of Deputy James Reilly when he was Minister for Health. At the very least, it was inept in the handling. That was acknowledged by the Taoiseach himself who said at one stage on the floor of the House that he was taking a hands-on approach to the management of the health service because, obviously, he felt the Minister was not capable of doing it by himself. That was a sad indictment and undermining of the Minister of the day. However, a decision was made to shift him on. What has happened subsequently is that the story and how it is told has changed. That is all. The underlying circumstances for patients across our emergency departments has not changed. In fact, it has got progressively worse. We now have continuous incremental increases month on month of people waiting for inordinate lengths of time on hospital trolleys throughout our emergency departments. Some hospitals consistently breach the requirement for a timely throughput of patients. The idea that we can point fingers at or blame consultants because they speak out is distasteful to say the very least. The Minister should bear in mind that when he was Minister for Transport, Tourism and Sport, he lauded and applauded whistleblowers who stood up to champion the issue of the quashing of penalty points. He said they were very brave people. As Minister for Health, he was delivered the message by a whistleblower in an emergency department that people are waiting inordinate lengths of time, that their health is being put at risk and that basic human rights were not being afforded to them. His response was to undermine that person. He tried to attack the whistleblower and bring him into ridicule. That is something he should reflect on.

The broader issue in the motion is the requirement to recognise that last month was the worst October on record. It saw 7,971 admitted patients cared for on trolleys. Over the first ten months of 2015, almost 80,000 admitted patients were on trolleys. The Minister said he would tackle the issue. He set new targets to reduce the use of hospital trolleys and he established an emergency department task force last year. The task force eventually met just before Christmas and it then resurrected itself on 6 January when there were over 600 people waiting on trolleys in emergency departments nationally. The task force eventually published recommendations in April. In June, the Department sent a one line email to the HSE asking it how it was getting on with regard to the recommendations. All in all and on a continual basis, a very hands-off approach is being adopted by the Minister and the Department in respect of addressing the national crisis. It is a crisis of huge proportions. The continual glib commentary that things will get worse before they get better is not a sustainable position for any Minister for Health to hold. The Minister continually diminishes expectations and talks about things getting worse before he will have an opportunity to improve them. The Minister has been in place for well over a year and the Government has been in place for almost five years but the position has consistently and rapidly deteriorated.

The motion notes that while the April 2015 initiative reduced waiting times for the fair deal and reduced the number of delayed discharges, it has not reduced the overcrowding in emergency departments. That was a key tenet of the proposals brought forward by the emergency department task force. We were told that if we could reduce the waiting times for the fair deal, there would be a more efficient transfer of patients from acute hospital settings into step-down and nursing home facilities. Of course, it has not addressed the fundamental problems because there are more fundamental problems in our hospital service. The Minister and his predecessor consistently said that it was not all about resources and hospital beds. At times, the Minister has said the problem would not necessarily be solved by providing additional hospital beds. The bottom line, however, is that it is impossible for our emergency departments to cater for what is presenting itself on a continual daily basis throughout this country without an expansion of capacity. The idea that we can pretend on a continual basis that things will improve without actually addressing the fundamental, underlying nature of the problems is not a tenable position to be in. Dampening expectations continually and putting presentation, spin and PR on it is not acceptable.

The motion calls on the Government and the Health Service Executive to ensure safe, adequate and consistently available staffing levels for all emergency departments. The Minister should know and I am quite sure the emergency department task force has highlighted the fact that we do not have adequate staffing in our emergency departments. We have front-line staff who are worked to the bone and put to the pins of their collars on a continual basis. They work under inordinate pressure and give above and beyond what is considered normal duty. There seems to be no acknowledgement of that but when people speak out, there is an effort to quash any dissent and undermine their views and ability to express freely their concerns and advocate for patients. The Tallaght case is indicative of the view that is held by the Minister and the Department of front-line staff, particularly our emergency medicine consultants who are working under extraordinary pressure.

We could go through the Government's record on health and the funding of same. Today, I asked the Taoiseach about the amazing utopian announcement of universal health insurance, UHI, that was made in 2011. It was to transform fundamentally how we delivered and funded health care, but the opposite has been the case. There is a paralysis in the consideration of how to fund health care for the years ahead. For a long time we have been discussing the abolition of the HSE and how we are to establish hospital groups that will formally be transferred into trusts. However, we discovered that the Minister recently made a case for the potential privatisation of the management of some of those groups. He seems to be trying to absolve himself and the Government of responsibility for the health service, which is a public health system. He must examine this matter quickly, as the people should be informed of what the Government intends to do with that service if returned to office.

We cannot get a credible opinion from the Minister or the Taoiseach regarding UHI. The Minister consistently refers to universal health care. We all know what that is, and UHI is a different animal. Some Ministers with whom the Minister serves have consistently tried to undermine him. For example, the Minister for Public Expenditure and Reform has called UHI a non-runner in off-the-record briefings, given the costs that would be incurred by people who retained private health insurance and those who would be obliged to get some. A bit of honesty in the Minister's proposals for funding the health service would be important this side of an election. The commitment as regards the publication by the ESRI and others of a scoping exercise after many years of prevarication on the UHI project was also important.

If the Minister does not believe me that health services are in rag order, including our emergency departments and outpatient and inpatient waiting lists, he might observe that the members of the Irish Nurses and Midwives Organisation, INMO, have balloted for industrial action and highlighted the need for some acknowledgement of the crisis in hospitals. Front-line staff in emergency departments are warning the Minister that the crisis is jeopardising people's health. Across modern health systems, empirical evidence has shown that inordinate delays in assessing, triaging and treating a person result in adverse outcomes. People who are waiting inordinate lengths of time on trolleys in our emergency departments are dying because of delays in assessments. This is a fact. The Minister may not want to accept it, but people are dying on his watch because of his inability to deal with the crisis in our emergency departments. He should weigh on this heavily when responding to the motion.

The Government's amendment is self-congratulatory and restates what the Government will do, but it does not acknowledge the crisis in the health system. It lauds the Minister, stating: "supports the Minister for Health in his continued determination to bring about improvements in urgent and emergency care services."

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