John Browne (Wexford, Fianna Fail) | Oireachtas source

I welcome the discussion initiated by Deputy Kelleher on the emergency departments and the need to have a frank, open discussion in this House on how we can resolve the problem. Like the Leas-Cheann Comhairle, I am a long time in this House. I have noted that the health services have used up a lot of debating time and energy down through the years. Despite the efforts of many Ministers, the brains of the country and top-class management, we never seem to be able to come to grips with the problems in the health service throughout the country. The ongoing crisis we are facing in our emergency departments is simply not acceptable and must be tackled without delay.

The Government has failed to keep its election promise to end dangerous overcrowding. It is estimated that 350 patients per year die as a consequence of the latter. The failure of the Minister to take definitive action on the real and serious risks to patients from overcrowding continues to threaten the lives of vulnerable and elderly patients attending accident and emergency departments. We receive e-mails from him stating heads must roll. I do not know whose heads he suggested should roll. Is it the management in the HSE, the management in the hospitals or that in the accident and emergency departments? The Minister has never really spelled out whose heads should roll. At times, he is inclined to blame others rather than tackle the problem head-on himself. This is symptomatic of the overwhelming failure of Fine Gael and the Labour Party to deliver on the programme for Government commitment on health. The problems in the emergency departments are symptomatic of a system-wide problem in the acute hospitals. The capacity issues must be addressed, which requires a system-wide response. What we really need to see is immediate enforcement of the six-hour target for the 1 million patients attending emergency departments every year, with an absolute ban on any patient staying over six hours in an emergency department.

The news that overcrowding in emergency departments increased by 14% during the year to October is yet another indictment of the Minister, Deputy Varadkar, during his tenure in the Department of Health. Last month was the worst October on record, with nearly 8,000 patients cared for on trolleys. I noticed this week that one of the hospitals in Dublin has tendered for the purchase of new trolleys. The Minister might explain who gives approval to buy new trolleys. Obviously, if the hospital is buying new trolleys, patients will be on them for the remainder of this year, next year and for years to come. I doubt that the hospital would invest in new trolleys unless there was a plan for their use.

In the first ten months of this year almost 80,000 admitted patients were on trolleys, which is the highest figure for the first ten months of any year since the INMO's trolley watch began. This comes despite the publication of the emergency task force report seven months ago. I do not know what happened to that report or if any action is planned following it, but it certainly does not seem to have any relevance in the Dublin hospitals at present.

As a Wexford Deputy I have a direct interest in the Dublin hospitals because County Wexford is now aligned with them. It is important that patients coming from Wexford do not have to spend their time on trolleys in accident and emergency units for more than 24 hours, as they do in some cases. Very little thought was put into that alignment because it does not seem as if the Dublin hospitals are able to cater for Dublin patients let alone those coming from rural areas.

The situation has been highlighted of elderly people spending 24 hours on trolleys while awaiting admission for urgent treatment. We had a 93 year old and a 91 year old in this position but those are only the ones whose cases were highlighted. I am sure there are many other elderly people whose cases were not reported in the newspapers. I do not think the Minister would accept that people of such an age should have to spend 24 hours or more on a trolley. Why would hospital management allow such a situation to occur and continue over 24 hours? Some people tend to blame nurses, but nurses in accident and emergency departments are worked to the bone. In many cases not enough nurses are on duty at night so they are not in a position to provide one-to-one support to elderly people.

Last week, the INMO suggested that a specific person should be designated to deal directly with people on trolleys. The designated person could ascertain the age of a patient and therefore try to fast-track elderly people into a hospital bed or at least have them treated without having to wait for 24 hours. It is a good suggestion and one the Minister should ensure hospitals act upon immediately, thus providing a designated person to deal with such a situation.

The six-hour target for 1 million patients attending emergency departments every year was a recommendation of HIQA which should be implemented without delay. I understand it is a four-hour target in the UK, so we should try to reach that target rather than going in the opposite direction with people waiting for up to 24 hours on hospital trolleys.

Dangerous overcrowding persists because it is tolerated and accepted as an unfortunate but normal side-effect of corporate governance failure from the top of the HSE down. I see it in Wexford and other hospitals, although I must compliment the management of Wexford General Hospital because it only had ten people on trolleys last month when every other hospital had huge numbers. That compares with 270 or 280 on trolleys in October 2014. Wexford General Hospital has a strong manager and management committee who have taken action to deal with the trolley situation. Other hospitals should do the same.

During the week, Beaumont Hospital had a ward with 30 beds closed due to renovations. With a bit of common sense, management would not have renovations going on in October, November and December when hospitals tend to be busy and overcrowded. Surely the management could have arranged to have renovations carried out in the wards at a less busy period in the year rather than waiting until now. I put that down to bad management and bad decision-making. That matter should certainly be taken up with the management of Beaumont Hospital. However, I must compliment the hospital because my daughter attends there regularly as she suffers from spina bifida. It is a very good hospital providing a very good service. However, decisions such as closing a 30-bed ward at this time of year do not make sense.

The lack of doctors in rural areas seriously impinges on overcrowding in accident and emergency departments. People tend to go directly to hospital rather than their local GP because in certain areas there is no local GP anymore. That is due to decisions taken by the HSE to withdraw funding they had in the past. That situation needs to be re-examined by the Minister. I wrote to him recently concerning a doctor in Adamstown, County Wexford, who finds it difficult to provide a service based on her current income given that many supports have been withdrawn. She introduced small charges for those attending her clinic to try to survive in that rural area of the county. However, she was reprimanded by the HSE because it was a breach of contract. She could not do that despite that patients in that area were only too happy to pay a small fee to ensure the GP remained in the area rather than emigrating to Australia, Canada or elsewhere. That situation also needs to be dealt with.

I welcome that 64 new ambulances are being purchased. However, one ambulance person said to me recently in Wexford that despite the new ambulances, there is no one to operate them due to a lack of drivers. That service should be provided 24 hours, seven days a week throughout the country, but that is not happening. I had a case last week in my town where a woman unfortunately passed away. They rang for an ambulance to be told the ambulance was there but there was no driver. It did not make any difference in that case because the person had passed away. However, it makes no sense to have a state-of-the-art ambulance with no driver. These issues need to be dealt with.

The CareDoc system came in some years ago to keep people out of accident and emergency departments. If a person rings CareDoc now, however, they are usually answered by a nurse or someone else on duty. They will say to go to Wexford hospital, Kilkenny hospital or whichever hospital is nearest to the caller. They no longer provide the type of service that is needed.

Fire brigade action is required to deal with the problem of people on trolleys in accident and emergency departments. The nurses' union says there has been a complete failure of management to address identified areas of concern such as staffing, including recruitment and retention, the maintenance of a safe work environment for staff to enable them to care for their patients to the highest standard, consistent use of agreed escalation planning, enhanced senior clinical decision-making presence throughout the seven-day cycle, and improved access for triage nurses to order diagnostics to aid patient flow.

The INMO is making these requests of management but the buck stops with the Minister to ensure management will introduce such services. The INMO is also demanding safe, adequate and consistently available staffing levels and additional separate staff to look after admitted patients who are on trolleys. That is the point I made earlier, that there should be designated staff to deal with those on trolleys, to keep an eye on them and to ensure that they are not left on trolleys for one or two days but are seen to as quickly as possible.

Emergency departments should be designated as a specific place of employment under the Safety Health and Welfare at Work Act, thus requiring regular inspections to ensure staff health and well-being.

The motion serves to put pressure on the Minister and prompt him to deal with the problems now common and more or less taken for granted in accident and emergency departments throughout the country. Good management can deal with some of the problems but other problems remain, including lack of staff, reduction of staff numbers, difficulties recruiting staff, ambulance problems and doctors in rural Ireland leaving in droves - there is no longer a sufficient service in rural Ireland and this is leading to overcrowding in accident and emergency units.

I call on the Minister to take his responsibilities seriously. As I stated at the outset, there have been many debates in the House during my time here and I have been here a long time - some 32 or 33 years - the same as the Acting Chairman. No one seems to be able to get to grips with the health service despite the fact that so much money has been pumped in. The money is not being spent or used wisely. Despite promises from the top in the HSE and from the Minister, Deputy Varadkar, there seems to be a serious lack of proper management in the accident and emergency departments in all our hospitals throughout the country, but especially in Dublin. There seems to be serious problems in Dublin in respect of accident and emergency departments. I know there is a significant population in Dublin and that large numbers of people attend accident and emergency departments in Dublin. However, it should still be possible to manage the services to ensure that if trolleys are used, at least people are not lying on them for 24 hours plus, which seems to be the case at the moment.

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