Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I move:

“That Dáil Éireann:

notes that:— the health service is under huge strain following cuts made to its budgets during the austerity years and a lack of sustained investment to meet the growing and changing needs of our population;

— one of the fallouts of this is a chronic lack of capacity within our acute hospitals;

— medical and healthcare professionals are working, and have been working, tirelessly in hospitals around the country with fewer resources, supports and funding;

— the scandal of patients waiting on trolleys was officially declared an emergency by former Minister for Health, Mary Harney, in 2006 when the trolley count reached 469;

— twelve years later on 3rd January, 2018, 677 patients were left on trolleys, the highest ever recorded number of patients on trolleys in the State;

— throughout the whole of 2017, there were a record 98,981 patients left to spend one night or more on a trolley in hospitals throughout the State, representing the worst ever recorded number;

— the Organisation for Economic Co-operation and Development (OECD) data confirms that our acute public hospitals operate at 95 per cent occupancy, which is way above the acceptable OECD average of 77 per cent needed to provide a safe, consistent and effective standard of patient care;

— intensive care units in our hospitals are operating past full capacity daily;

— the Irish Association of Emergency Medicine has calculated that there could be between 300 and 350 excess patient deaths each year due to the trolley crisis and emergency unit overcrowding;

— Ireland had the second lowest number of hospital beds in the OECD leading to a lower than average hospital stay, 6.2 days, compared to the OECD average of 8.2 days;

— in the past decade acute hospital in-patient bed numbers were cut when they should have been increased in line with the country’s growing and ageing population;

— last May, the Department of Health commenced a national bed capacity review, which was due to be published before the end of 2017, however, the Oireachtas has still not seen the final report; and

— unions representing workers in the health service have been highlighting the issue of a chronic lack of capacity in the health service for almost a decade;further notes that:— the recruitment moratorium in the public sector was introduced in the health service two years before all other areas of the public sector;

— there is a recruitment and retention crisis in our health service;

— unions representing workers in the health service have been highlighting the issue of the recruitment and retention crisis in the health service for a number of years;

— the Report of the Public Service Pay Commission identified problems in recruitment and retention, particularly in the health sector;

— in December, 2008, there were 38,108 whole-time equivalent nurses and midwives in the Health Service Executive (HSE) and at the end of September, 2017, that stood at just 36,170 whole-time equivalent nurses and midwives;

— to deal with the shortage of nurses, the health service has an over-reliance on costly agency staff, with the bill for agency nursing running at €1.1 million per week;

— hospital consultants make up less than 2.5 per cent of the overall public health service workforce, which is significantly less than peer countries health services;

— the 2003 Hanly Report recommended that by 2012 there should be 3,600 consultants, yet at the end of September, 2017, there were only 2,951 whole-time equivalent consultants operating in the HSE;

— to cope with the shortage of consultants, hospitals have been hiring doctors without the requisite specialist skills who are now practicing as consultants despite not being on the specialist register;

— the staffing crisis has created a severely challenging working environment, where nurses and doctors routinely work beyond their contracted hours in order to ensure patients are cared for in hospitals, at a significant physical, mental and financial cost to themselves and their families and friends;

— there is another crisis within the health service as Section 39 agency workers, who had their pay cut in line with the public service but have not had their pay restored, have balloted for strike action; and

— this pay disparity is causing gross staff loss, the demoralisation of current staff, which affects delivery of services, therefore placing further pressure on the HSE, and acute hospital sector, which will be further compounded by a possible strike in February;

andcalls on the Government to:— ensure the Emergency Department Taskforce works on a permanent basis monitoring the situation nationwide and reports on problems to be proactively tackled;

— reopen all hospital beds closed during the austerity years;

— meet with unions and representatives of nurses, doctors and allied health professionals in order to comprehensively examine the underlying difficulties in recruitment and retention in those sectors;

— establish a commission on pay in the health service for medical professionals and healthcare workers;

— genuinely invest in recruiting more staff to the health service, while simultaneously addressing the key issues for existing and prospective staff of working conditions, facilities, supports, training opportunities and pay;

— invest in co-locating general practices and acute mental health services next to emergency departments so those patients who do not need emergency department care can be treated in a more appropriate setting;

— increase investment for transitional care beds, adequate step-down facilities, home care packages, and home help hours to ensure that all patients who can be moved home, or to a more appropriate care setting, are given that opportunity;

— speed up the move towards primary and community care ensuring that all primary care centres are adequately resourced with new staff and funding;

— expand community diagnostics and shifting non-acute treatment from the acute sector to the community;

— commit to putting in place a plan for piloting salaried general practitioner (GP) posts starting with 2019 graduates;

— commit to graduated pay restoration for staff in Section 39 agencies;

— liaise with representatives of GPs to ensure that proper out of hours GP services can be established and maintained across the State;

— broaden the awareness campaign to ensure that the public are aware of what needs should be met in an emergency department and what needs should be met in general practice and primary care; and

— agree to the full implementation of all the recommendations in the Sláintecare Report.

There is a significant number of strands to the current crisis in our health service, from waiting lists for acute surgery to children waiting more than a year for speech and language therapy and everything in between. However, one of the most scandalous and recurring components of the crisis afflicting our health service is that of patients being left waiting on trolleys in emergency departments across the State. In 2017, a record 98,981 patients were left to spend one night or more on a trolley in hospitals throughout this State. This is the worst ever recorded number of such patients. The health service is under huge strain following cuts made to its budgets during the austerity years and the lack of sustained investment to meet the growing and changing needs of our population. Two of the main consequences of this are a chronic lack of capacity within our acute hospitals and a shortage of staff. For many years now medical and health care professionals have been working tirelessly in hospitals around the country with fewer resources, supports and funding. In spite of the brave work of these medical and health care professionals, the crisis of patients on trolleys has recurred year on year, worsening all the while. The scandal of patients waiting on trolleys was officially declared an emergency by the former Minister for Health, Mary Harney, in 2006 when the trolley count reached 469. Twelve years later, on 3 January 2018, 677 patients were left on trolleys, the highest number ever recorded. These are not just statistics; they are human beings - grandparents, mothers, fathers, brothers, sisters, sons and daughters.

This crisis happens because we have neither the capacity nor the staff to deal with the volume of patients presenting at our emergency departments and acute hospitals. OECD data confirm that our acute public hospitals operate at 95% occupancy, which is far above the acceptable OECD average of 77%. An occupancy rate of 77% is what is needed to provide a safe, consistent and effective standard of patient care. The Irish Association of Emergency Medicine has calculated that there could be between 300 and 350 patient deaths each year due to the trolley crisis and emergency unit overcrowding. In the past decade, acute hospital inpatient bed numbers were cut when they should have been increased in line with the country's growing and ageing population. Last May the Department of Health commenced a national bed capacity review, which was due to be published before the end of 2017. Oireachtas Members still have not seen the final report but sections of the media clearly have seen it. That is disrespectful to people in this House and to those working in the health service.

Accompanying this crisis of capacity is a crisis of recruitment and retention. It is always worth noting that the recruitment moratorium in the public sector was introduced in the health service two years before all other areas in the public sector. Unions representing workers in the health service have been highlighting the issue of recruitment and retention for a number of years now. Indeed, the report of the Public Service Pay Commission identifies problems in recruiting and retaining staff, most especially in the health service. In December 2008 there were 38,108 whole-time equivalent nurses and midwives in the HSE but at the end of September 2017 that stood at just 36,170. The fallout from this is that to deal with the shortage of nurses, the health service is overly reliant on costly agency staff, with the bill for agency nursing running at €1.1 million per week. The Minister has agreed with me on more than one occasion that this does not represent good value for money but not only does it continue, it gets bigger every year.

Similarly, hospital consultants comprise less than 2.5% of the public health service workforce, which is significantly less than the percentage of consultants in the health services of peer countries. In 2003, the Hanly report recommended that this country should have 3,600 consultants by 2012, but there were just 2,951 whole-time equivalent consultants operating in the HSE at the end of September 2017. The practice of hiring doctors who are not on the specialist register to act as consultants is another feature of the chaos in recruitment and retention. The staffing crisis has created a severely challenging working environment in which nurses and doctors routinely work beyond their contracted hours to ensure patients are cared for. This often happens at a significant physical, mental and financial cost to those involved and their family members and friends.

Solutions are required to stabilise the situation in the short term. We need to ensure the emergency department task force works on a permanent basis to monitor the situation across the country and report on problems that need to be tackled proactively. The Government needs to ensure as a matter of urgency that all beds closed during the austerity years are reopened. This has to mean setting targets and putting funds aside to ensure those targets are met. If we are to deal with the increasing population and the changing demographics, we need to start building additional capacity into the acute hospital sector. This should be reflected in the Ireland 2040 plan. The underlying difficulties causing this crisis, including working conditions, facilities, supports, training opportunities, promotion opportunities and pay, must be tackled so we can address the recruitment and retention crisis across all grades in the health service. Workers and their representative organisations must be consulted on how to address these issues. We must find a new way forward to resolve the recruitment and retention crisis. We cannot pretend the issue of pay is not a factor. I suggest that if this aspect of the problem is to be overcome, the Government should establish a commission on pay in the health service for medical professionals and health care workers. If these issues are not addressed, we will not be able to recruit more staff into the health service.

A broader awareness campaign is needed to ensure the public is aware of what should and should not be brought to accident and emergency departments. As part of this approach, the Government needs to hasten the move towards primary and community care and ensure all primary care centres are adequately resourced with new staff and funding. The Minister and I have discussed a primary care centre in my constituency on many occasions. It is not good enough that the HSE has said it will not allocate any additional staff to the centre. It is possible that new GPs will go into it, but I am concerned with HSE staff. Some patients are often left in acute care, which is not in their best interests, when they could and should be cared for at home. It is clear that increased investment in transitional care beds, adequate step-down facilities, home care packages and home help hours would help to ensure all patients who can be moved home, or to a more appropriate setting, are relocated in such a manner. While many of the measures called for in the motion before the House seek to stabilise the trolley crisis in the short term, we also need to address the systematic problems in the long term. This can be done if there is sufficient political will to implement in full all the recommendations in the Sláintecare report.

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