Thomas Pringle (Donegal, Independent) | Oireachtas source

I welcome the opportunity to contribute to the debate on the health services. Three aspects have to be addressed at the same time in relation to improving the service for all our citizens, namely, our hospitals, primary care, and community hospitals. Currently, our hospital works on a nine-to-five basis with consultants. That needs to be extended to working on a 24-7 basis, or at least from 8 a.m. to 10 p.m., 11 p.m. or 12 a.m., so that diagnostics and investigations can be carried out and people can get their X-rays, CAT scans and everything else at weekends as well as during the week. That would go some way to lessening the pressure on emergency departments and easing the burden.

In talking to staff and consultants in our local acute hospital in Letterkenny, I was shocked to hear the consultant explain to me that there are currently three orthopaedic surgeons operating in Letterkenny General Hospital, but they are only doing slightly more operations than were done in the 1980s - 30 years ago - when there was only one surgeon. That is a damning indictment. The reason is that they do not have access to the theatre space or theatre staff to enable them to carry out operations. Under the escalation policy in the emergency departments, for five weeks in a row the orthopaedic surgeons' elective surgery list was cancelled, even though there were available beds in the orthopaedic wards. Those beds could not be used for emergency department patients because of the risk of cross-contamination with surgical patients on the same ward, yet the beds had to lie idle and the elective surgery was cancelled. That does not do anything to address the crisis in the emergency departments; all it does is lengthen the waiting lists in the hospitals. The staff in Letterkenny believe that by using the theatre space they have and making it work hard, they could halve the waiting lists within a year and end them entirely within a couple of years. That should be the goal of any Government and Department of Health.

Within primary care, as Deputy Harty said, we need to resource primary care teams, not primary care centres, to ensure ancillary staff like physiotherapists and occupational therapists, and everything else are available to those GPs so that they can work, and to allow GPs to refer people directly into the hospital system for diagnostics, rather than having patients going in through the emergency department simply to get diagnostic scans and procedures carried out. Allowing them to be referred straight from general practice into the diagnostic system would streamline the whole process, remove people from the emergency departments and allow GPs to do the work they could and should be doing. That would tie in with the management of chronic illness, like diabetes, as well. GPs are integral to managing that process and could consult with the relevant consultants, rather than tying up hospitals with outpatient appointments, so that people can get further investigations.

Alongside that, we must invest in community hospitals and community care for our elderly people. That is absolutely vital. In my local community hospital in Killybegs, up to two weeks ago, there were five patients in that hospital who could not be released because there was no home care available. In fact, one of those patients will be in that hospital a year this June, simply because there are no home care packages available for them. The HSE is desperately trying to recruit people to provide home help and home care but cannot get them because of the system that has been allowed to develop whereby people might be offered half an hour of work a day over the five days, which is absolutely useless to anybody who wants to get involved and provide that community care. The HSE cannot recruit because of the system that is in place. Who could sign off the dole to take a job where they work seven hours a week over five days? It just does not make any sense. We need to make a career path for people to get involved in community care so that they can have a reasonable contract that allows them to be available to people. Then those five beds in the community hospital can be freed up, which will free up five beds in Letterkenny General Hospital, which will, in turn, free up the emergency department and starts things moving along.

The reason I believe this does not happen is that this actually costs money. Having those five patients move out of Killybegs Community Hospital requires an investment in the community care package for them and that also means those five beds will be taken up straight away. The five beds in the acute hospital will be taken up straight away and there is no saving for the Department of Health. When one wants to save money, one allows waiting lists to lengthen and does nothing. That is the only way to save money in the health services.

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