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

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:"acknowledges:

— that timely access by patients to emergency care and improving waiting times in Emergency Departments (EDs) continues to be a primary focus of Government policy;

— that the demand for emergency services is growing in line with overall population growth (1% per year), a projected increase of over 19,000 in the number of people over 65 years; a growing number of people in the old and frail elderly category (nearly 3,000 aged 85 years and over) and the increasing burden of chronic illness in the population;

— that this Government made additional ongoing funding available in 2015 to address ED overcrowding and that a wide-ranging set of actions are being implemented by the Health Service Executive (HSE) and hospitals to achieve improvements in the delivery of care in EDs;

— the difficulties which ED overcrowding cause for patients, their families and hospital staff who are doing their utmost to provide safe, quality care in very challenging circumstances;

— that it is Government policy to support older people in their own homes and communities for as long as possible, that provision for such home and community based services was significantly strengthened during 2015, and that these levels will be maintained in 2016;

— that nursing home placements are required by those patients who can no longer live independently or return home even with appropriate supports, and that waiting times for the Nursing Home Support Scheme funding have reduced from 11 weeks at the beginning of the year to 3-4 weeks; and

— that optimum patient care, improving patient safety and overall population health at all times remain a Government priority;

notes in particular that:

— the Government has prioritised a number of initiatives during 2015 which have had a positive impact on trolley numbers:

— the Additional Winter Capacity and Closed Beds Initiatives were established in July 2015 to fund and support additional bed capacity during the winter peak period; as of Friday 8th January, 2016, 321 beds have opened or reopened with a further 127 beds to open or reopen during quarter one, 2016;

— delayed discharges have reduced steadily from 830 in December 2014 to 533 on 11th January, 2016 which has freed up almost 300 beds to be used by acutely ill patients every day;

— an additional €35 million (over projected 2015 expenditure) of ongoing funding has been provided for the Nursing Home Support Scheme during 2016, which will deliver 1,222,750 total weeks of care, supporting an average of 23,450 clients per week for 2016; this is an increase of 649 clients per week on the 2015 position and an increase of 33,825 care weeks above the 2015 position;

— transitional care funding has supported over 3,800 approvals, which is significantly above the original target of 500;

— over 1,200 additional home care packages were provided by end 2015;

— 173 additional short-stay nursing home beds were open by the end of 2015, 149 of these in public facilities; and

— in addition, 65 short-stay beds opened in Mount Carmel Community Hospital in September;

— for 2016, the Department of Health will have total funding of approximately €13.6 billion (a seven per cent increase on the 2015 Budget) demonstrating the Government’s commitment to addressing the reductions experienced by the health sector consequent on the economic downturn which commenced in 2008;

— a series of focussed campaigns are ongoing to attract frontline staff in order to meet patient care requirements:

— in the past 12 months there are nearly 900 more nurses working in the health service;

— since March 2011, over 300 additional consultants have been appointed to acute hospitals around the country, including 92 consultant appointments between January and November 2015;

— the number of non-consultant hospital doctors employed in the health service has increased by over 390 in the last 12 months and by over 1,000 since March 2011; and

— ED consultants have increased from 56 to 84 under this Government;

— on 11th January, 2016, revised proposals of the Workplace Relations Commission were accepted by the Irish Nurses and Midwives Organisation National Executive in relation to the HSE National Escalation Policy, which will enhance patient safety and care in EDs; and

— the Emergency Department Task Force Implementation Group, convened by the Minister for Health, continues to ensure that a system-wide focus is maintained on addressing ED overcrowding challenges by Hospital Groups, working with the relevant community healthcare organisations; the Emergency Department Task Force Implementation Group has also been overseeing Hospital Groups’ winter preparedness and during this peak winter period, the Department of Health is engaging in weekly meetings with the HSE; and

supports the Minister for Health in his continued determination to bring about improvements in urgent and emergency care services."

I welcome the opportunity to speak to the House again on what is being done to improve access to our acute hospitals, particularly initiatives to alleviate pressures in our emergency departments. I acknowledge once again the distress for patients and their families caused by cramped and overcrowded conditions in some of our hospital emergency departments. I am very cognisant that these crowded conditions make emergency departments a very challenging work environment for nurses, doctors and other hospital staff.

In recent weeks, I have taken the opportunity to visit emergency departments, many for the second or third time. These visits have enabled me to meet patients and families attending the departments. These interactions have often been difficult. My visits have also allowed me to see at first hand the challenges for health care staff who are endeavouring to provide high-quality care in these circumstances.

I welcome the fact that, for the first time since I was made Minister for Health, Sinn Féin has chosen to use its Private Members’ time to debate the issue of health. It has taken it almost two years, but I welcome that it has chosen at long last to rate health as an issue for Private Members’ time. However, the fact that it is only doing so in the dying days of this Dáil is clear evidence that health is not a priority for it. The party offers little more than soundbites during Leaders’ Questions. Unlike the water charges and property tax, improving health is not a red-line issue for Sinn Féin in entering coalition with Fianna Fáil, should it have the opportunity to do so. That also speaks volumes.

By contrast, this Government is committed to improving the health services, and we have adopted a four-pronged approach to address the causes and challenges of emergency department overcrowding: measures to reduce numbers coming into hospitals; measures to expand capacity within hospitals; changes to work practices and processes in hospitals; and measures to get people out of hospital sooner.

In addition to supporting major recruitment campaigns for doctors and nurses, the Government has allocated more than €117 million in additional funding during 2015. This funding was provided to enable the HSE and voluntary hospitals to implement a range of actions to reduce emergency department overcrowding, such as increasing bed capacity, reducing waiting times for funding for the fair deal scheme, and increasing access to alternatives to emergency department services.

From the Opposition benches, I have heard, and will again no doubt hear again today, much talk about the need for additional resources to solve the problems in our emergency departments, but, unfortunately, talk is all it is.

The dream team of Sinn Féin and Fianna Fáil provided in their alternative budgets for 2015 nothing at all to address emergency department pressures. In contrast, we have provided €117 million and a further €51 million to reduce waiting lists. It is fair to acknowledge that the parties recognised the issue in their more recent alternative budgets for 2016, having ignored the matter entirely for 2015. Sinn Féin promised to provide €86 million and Fianna Fáil promised more, €90 million, but that is still less than the €117 million the parties in government actually provided in 2015 and the further significant funding we are providing this year. The parties opposite call for more resources but their own policy papers promise less. I look forward to hearing the speakers opposite explain this contradiction in their contributions, referring specifically not to their recently published pre-election policies but to their existing alternative budgets for 2015 and 2016.

Both parties talk a lot about the need to hire more staff, but Sinn Féin's plans are to cap consultant and management pay and increase their taxes, in a move that would be guaranteed to make recruitment even more difficult than it is already. They propose to pay general practitioners €120 per year per patient for unlimited visits, which would surely render many practices unviable. I doubt that it would be possible to agree it by negotiation with general practitioners.

Fianna Fáil, in its alternative budget, made no provision for the Lansdowne Road pay restoration for nurses, young doctors, ambulance drivers, paramedics and therapists. I do not see how we could possibly recruit more staff if we did not fund or reneged on the commitments made in the Lansdowne Road agreement.

It is little surprise that, in the case of Fianna Fáil, joined-up thinking is so absent. After all, it ran away from the health Ministry in 2004 after Deputy Martin's period as Minister for Health and Children. During this time, the Fianna Fáil-led Government, supported by Independents, promised to end waiting lists permanently within two years and ensure sufficient bed capacity in hospitals. Perhaps this is a matter for its next billboard. Instead, Fianna Fáil set up the HSE. Thereafter, it was so scarified by the experience that it was happy to leave the Ministry to Ms Mary Harney, even after the demise of the Progressive Democrats in 2007. It was prepared to leave it to an Independent rather than take on responsibility itself.

As part of the health strategy developed during Deputy Martin's period as Minister, 3,000 additional hospital beds were to be provided. In fact, in the period that followed, 2005 to 2011, the number of acute beds was reduced by 1,245, or 10.3%. Trolleys remained a persistent problem. Yesterday, the number of patients on trolleys, according to the Irish Nurses and Midwives Organisation's Trolley Watch figures, was 356. This is down 27% on the same day in 2011. I am using Trolley Watch figures because Ward Watch figures were not collected at that time. The problem was 27% worse under Fianna Fáil after 14 years of rule. On the relevant day in 2011, the figure was 492.

As for Sinn Féin, we have seen its health policy in action in Northern Ireland. Just like Fianna Fáil, it has done everything possible to avoid taking direct responsibility for health ever since its awful tenure in the portfolio from 1999 to 2002. The then Sinn Féin Minister, Bairbre de Brún, became famous for setting up inquires and review groups during her four years in office. Perhaps she was taking lessons from Deputy Micheál Martin, who was Minister for Health and Children at the time in this jurisdiction. In medical circles, her unwillingness to make any decisions was called "paralysis by analysis". It was even wondered whether she would reach the point at which she would have to order a review of the reviews because so many had been commissioned. Under Sinn Féin's watch in Northern Ireland, waiting lists hit a record high, with the longest treatment queues in the whole of the European Union. That is Sinn Féin’s record on health.

The recently published Sinn Féin health policy, Better for Health, gives us an insight into its current plans. It is a strange combination of old ideas that were tried and failed elsewhere and good ideas that would require a level of investment that is just not realistic. Sinn Féin's approach to policy is almost childlike. Its approach to finite resources is to want to have it all anyway, so it promises to put an extra €5 billion into health and billions of euro into education and housing. At the same time, it promises to abolish the property tax and water charges. I am not even sure it could fund everything if it raised taxes to the highest they have ever been in this country. Even if it robbed a bank, it would never pay for it all.

We know from experience that the winter period, and particularly the new year period, is a time of peak activity for emergency departments throughout the country. None the less, from mid-November up to this week, there have been improvements in the numbers of patients on trolleys. This week, trolley numbers are somewhat higher, given the increase in influenza, but an analysis of recent performance through a 30-day moving average shows a 10% improvement in the overall numbers on trolleys against the same period last year. There is some significant variation, with hospitals such as Letterkenny, Portiuncula, Mullingar, St. James’s, the Mater, Tallaght and Connolly showing significant improvements, while others have fared less well, and some have disimproved.

In the first couple of weeks of 2016, emergency departments are seeing a 7% increase in the number of patients attending, with some sites showing a 17% increase in attendances by comparison with the number for this time last year. Putting that in context, there are, on average, up to 3,000 patients presenting to emergency departments daily, with nearly 200 patients presenting at larger emergency departments each day.

In order to manage this particular peak period, the emergency department task force implementation group has been overseeing hospitals' winter resilience plans. My Department and key members of the implementation group hold a weekly meeting to monitor emergency department performance and patient waiting times on trolleys. When we examine the factors that contribute to overcrowding in emergency departments, it is clear that the response needs to be at a number of levels. All relevant parts of the health service - namely, acute hospitals, social care and primary care - have to work collaboratively and in a joined-up way, so the Government has been driving a response by all elements of the health service.

In December 2014, I convened the emergency department task force to provide focus and momentum in dealing with the challenges presented by emergency department overcrowding. The task force action plan, published in April 2015, contains 88 actions, which are solutions tailored specifically to address the key challenges and causes of overcrowding. I have attended all the emergency department task force implementation group meetings to oversee the implementation of actions arising from the plan, and I can see that the plan is being implemented. The 88 actions consist of a combination of immediate measures to target the pressure areas and long-term sustainable solutions to reduce emergency department overcrowding.

During 2015 and into 2016, a number of initiatives have been implemented to ease emergency department overcrowding and impact on trolley numbers. These include initiatives to increase bed capacity in hospitals for the winter months; reduce delayed discharges from hospitals by improving access to nursing homes, convalescence and home care packages, with, for the first time, the latter being provided to patients awaiting discharge almost on an on-demand basis; recruit more medical and nursing staff into the health service; provide specific care pathways in emergency departments for older and frailer patients; ensure more efficient planning and management of patient discharge from hospitals, including early discharge planning from when the patient is admitted and weekend discharges in order that patients can leave as soon as they are medically fit; improve access to primary care services, particularly nurse-led community intervention teams, to reduce reliance on hospitals; make best use of all the non-emergency department facilities available, such as medical assessment units, surgical assessment units, minor injury units and urgent care centres; and reduce the length of stay for patients who have been admitted by faster access to diagnostics, among other actions.

The Government is commitment to reversing the budget cuts experienced by the health services due to the economic downturn which commenced in 2008. This is evident from the extent of funding provided to the health service in 2015 and 2016. In 2016, health will have funding of approximately €13.2 billion for current expenditure and €414 million for capital expenditure, which is an increase of €900 million and €36 million, respectively, on the 2015 budget. These increases to do not take into account Supplementary Estimates. These figures constitute a 7% increase on the budget for 2015 and a 12% increase on the voted budget for 2014. In contrast, in the final three years of the previous Fianna Fáil-led Government public health expenditure was cut from €14.59 billion in 2008 to €13.73 billion in 2011, a reduction of €860 million, as our population and its health needs grew and aged.

Of the gross 2016 health budget of approximately €15 billion, €5 billion has been designated in the HSE national service plan to services delivered by acute hospitals. As such, roughly one third of health funding is allocated to hospitals, with the remainder allocated to primary and social care, medicines, mental health, public health and disability.

In 2015 the Government made available €117 million to implement specific measures to reduce emergency department overcrowding. This included a sum of €74 million, which has enabled significant progress to be made on reducing delayed discharges, lowering the waiting time for fair deal funding and providing additional transitional care beds and home care packages. The number of delayed discharges peaked at 850 and has declined to below 500. On deeper investigation, the figure is even lower than this, as 80 of these 500 patients are not in acute hospitals and many more are not fit for discharge. The €117 million figure also included €18 million to support acute hospital services over the winter period by providing additional bed capacity and other initiatives to improve access to care. Of the 300 additional beds being funded, more than 200 have opened. The remaining €25 million has been provided for services that provide alternatives to acute hospitals, some of which I alluded to.

It is Government policy to support older people to live in dignity and independence in their own homes and communities for as long as possible. Despite continuing pressure on the public finances, the level of home and community based services was significantly strengthened last year and this will be maintained in 2016. These services will not be cut back. What this means is that the Health Service Executive will provide approximately 10.4 million home help hours, more than 15,000 home care packages and in excess of 300 transitional care beds. In addition, some 130 intensive home care packages will be provided to support the discharge from acute hospital settings of people with more complex needs, many of whom are individuals who would not be accepted by nursing homes.

There will always be people who require quality long-term residential care. The nursing homes support scheme, known as the fair deal, is crucial to achieving this. It is worth highlighting that this year the budget for the scheme is €940 million, an increase of €35 million on last year's projected spend. This year, the scheme will deliver more than 1.2 million weeks of nursing home care to 23,450 clients per week. This is an increase of 649 clients per week on 2015. In addition, waiting times for applicants approved for funding should not exceed four weeks, as is currently the case. This scheme remains a key component of our supports for older people and involves a very significant financial commitment on the part of the State.

Providing additional bed capacity has also been a key initiative. In July 2015, I introduced the additional winter capacity and closed beds initiatives to ensure additional capacity would be in place in hospitals during the winter peak period. As I indicated, €18 million has been provided to open new beds and re-open beds which had been closed. The HSE and individual hospitals - the voluntary hospitals - have made considerable progress in opening and re-opening beds. As of Friday last, 209 new beds had opened, 112 previously closed beds had been re-opened and a further 127 beds will open or re-open in the first quarter of this year, subject to staffing. The new and re-opened beds have been a crucial resource for many hospitals in allowing them to manage to an extent they would not have otherwise been able to do.

Recruitment of medical practitioners and nurses into the health service has been a major priority throughout 2015 and this continues to be the case. No one can have failed to notice the major recruitment campaigns run by the HSE and hospitals to attract front-line staff. Anyone who used Dublin Airport over the Christmas period will have seen advertisements placed at the airport by Tallaght hospital, which has staffed and opened all of its beds.

Since this time last year, the number of nurses on the health service payroll has increased by almost 900, while the number of non-consultant hospital doctors, NCHDs, has increased by almost 400. Under this Government, the number of NCHDs has increased by more than 1,000, the highest figure ever recorded. The number of doctors registered in the State is also the highest ever recorded, having recently exceeded 20,000.

On consultants, Government policy is to move to a consultant-delivered service. The number of consultants has increased significantly in recent years to 2,700 full-time equivalent posts. Since March 2011, the month in which the Government took office, more than 300 additional consultants have been appointed, including 92 consultant appointments made between January and November 2015. Also, the number of emergency department consultants increased from 56 to 84 under the Government, which highlights our efforts to improve the quality of senior decision-making in emergency departments.

Outside of the acute hospital setting, measures are also being implemented in primary care to strengthen existing alternatives to hospital. Community intervention teams involve nurses visiting patients in their homes or nursing homes, to administer intravenous medications, monitor bloods, dress wounds, etc. These teams have been expanded, with the most recent new service opening in Waterford some weeks ago.

Other primary care initiatives which alleviate emergency department pressures include expanding general practitioner out-of-hours services; increasing GP access to diagnostic services, such as X-ray and ultrasound; developing minor surgery capacity in general practice; and increasing palliative care capacity in the community to ensure people can die with dignity by providing additional hospice beds, including 24 in Blanchardstown and six in Galway. A further 16 hospice beds have been funded under the service plan and will open in County Kerry later this year. I am disappointed Deputy Martin Ferris did not acknowledge this development.

In November 2015, with the HSE director general, I issued a national emergency department congestion escalation directive to hospitals on how best to deal with emergency department congestion. The framework is intended to ensure that appropriate escalation procedures are in place during high demand periods in emergency departments. Under the directive, it is compulsory for each hospital to take specific steps to address overcrowding, such as extra ward rounds if trolley figures reach red status on the TrolleyGAR or if a patient has been waiting for more than nine hours on a trolley since a decision was made to admit him or her.

The HSE informs me that the national escalation framework has been implemented in all hospitals and that the special delivery unit is undertaking an audit of the framework's implementation in ten hospitals to ensure it has been implemented. These audits will provide feedback on how effectively the escalation procedures are working in different hospitals and enable further improvements to be made. To respond briefly to Deputy Tóibín's remarks, the budget of the National Ambulance Service will be increased this year by €7 million, which is additional to the extra €5 million provided last year. Needless to say, these increases need to be sustained.

See this speech in context