Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I compliment Deputy Harty on his work in bringing forward this Bill and I welcome the opportunity to speak on it. Fianna Fáil's priority is to put in place permanent and sustainable improvements to our health service. The focus for us must be on what needs to be delivered and what is deliverable. We are committed to a strong public health service where the impact of public expenditure is optimised. A public health system funded from taxation is more progressive as it ensures that healthcare can be prioritised for the most vulnerable and those who cannot afford to pay towards their care. As my colleague has just said, we accept the good intentions and motivation behind this Bill but we believe more debate is needed. We accept the reasoned amendment put forward by the Government.

According to new figures from the HSE, the number of bed days lost as a result of delayed discharges stood at a shocking 197,000 at the end of October. This calls for direct intervention. The figures are shocking and serve to support the calls my colleagues and I have been making about the urgent need for investment in step-down care and home supports. The monthly average has surged from 17,500 in the first three months of the year. As we all know, January, February and March are traditionally the worst months of the year in hospitals but the figure has surged to 19,700 per month. That the situation has deteriorated so badly over the spring and summer is very worrying and should act as a wake-up call. If the monthly average continues, 236,00 bed days will be lost in 2019, which would be an increase of almost 15% on last year. The numbers are truly shocking. At the centre of all of this are people - those who are being kept in hospital unnecessarily because the Government has failed to provide the supports needed to allow them to be cared for either at home or in their community.

A delayed discharge occurs when a patient deemed suitable for discharge from hospital by a doctor or consultant cannot be discharged because the step-down facilities are not available or are inadequate. This can involve the non-availability of home care supports, slow access to the fair deal scheme when approved or lack of community beds for respite care. The latest figures I have seen show 734 cases of delayed transfer of care. I accept some of these are complex cases and need specialised care that is not always available. However, more needs to be done. I was in University Hospital Waterford last Monday week where there were 21 cases of delayed discharge or delayed transfer of care. On the same day, 22 people were trolleys. There is definitely a correlation between the number of people we cannot discharge from hospital in a timely manner and the number of people on trolleys. We need a centralised, co-ordinated approach to delayed discharges. Each hospital group should have a task force established specifically to identify where issues are occurring and to design a plan to ensure timely access of step-down care for these patients. We could vastly reduce overcrowding and the number of patients on trolleys if the Government got serious about and put a new focus on delayed discharges. While there is a system in place in the hospitals, if we got serious about delayed discharges, it would certainly help on the accident and emergency side. Older people want to be in their own homes with the correct wrap-around supports instead of languishing in a hospital bed simply because the correct step-down facilities are not available while hospitals and medical staff throughout the country struggle with continuous overcrowding and patients lying on trolleys, some for more than 24 hours. Planning for this winter should have begun much earlier in the year. We now have a plan that is only being rolled out in mid-November. I have grave concerns that despite the additional funding, the situation in our hospitals will get worse rather than better this winter.

We are facing a winter of discontent in respect of people waiting on home care supports. I received figures during the summer showing that the waiting list for home care supports was in excess of 7,300. The figures are enormously disappointing as they show the extent of the unmet need nationwide. The importance of home care supports cannot be underestimated. Without them, people are forced into lengthy stays in hospital despite being well enough to be discharged or moved into a nursing or retirement home. While the figures are deeply worrying, they are not surprising. Clear issues emerged over the summer with vulnerable people being unable to access home care supports. I accept that the budget for home care supports is substantial. The question that needs to be asked is whether we are getting value for money. Is the money following the patient? I stand open to correction but I understand that the budget for 2019 was €453 million, which is a substantial budget for home care supports. An increase of 1 million extra hours was announced in the budget for 2020. However, 100% of home care supports in Dublin are outsourced to private and voluntary providers. I received information that reveals high levels of outsourcing across all geographical areas, with 100% of home support hours in Dublin being outsourced. Unsurprisingly, demand for home support hours is high as more people are choosing to be cared for at home if the option is available to them. However, the HSE appears to be failing to cope. We already know that new applications have been restricted, which is a regressive and potentially detrimental measure, and now information supplied to me reveals that over half of all home support provision has been outsourced to private and voluntary providers. Private care can be more expensive than delivering the services through the HSE and these figures raise serious questions about value for money. The State already forks out hundreds of millions of euro a year on agency nursing and now it has emerged that the HSE has adopted a similar practice for home support hours. For example, in community healthcare organisation, CHO, area 5, which covers Waterford, where I live, and Cork, the figure is 26%. The figure in CHO area 4, which covers Donegal, is 19% while in CHO areas 6 and 9, the figure is 100%. I have the list here. The figures vary from 19%, which is the absolute best, all the way up to 100% in two areas. We are spending a huge amount of money. Are we getting value for money? Would it be worth looking at this to see whether it is the best value we can get and whether money follows the patient? We might then be able to do something about the 7,300 people who need supports.

Our population is living longer and we should be putting plans in place to cope with the demands that are coming down the tracks. As previous speakers stated, we need to shift to a more community-based healthcare service, as outlined in Sláintecare, rather than forcing people into hospitals and creating blockages in the system. Home support packages are a key requirement to ensure that people can stay in their homes for longer with the correct wrap-around supports.

I cannot talk about the right to health without mentioning the lack of cardiac care in the south east. Cardiac care at University Hospital Waterford, which serves 500,000 people in County Waterford and the south east, is time-restricted. The service is available from Monday to Friday between 9 a.m. and 5 p.m., with no service available outside these hours. I accept that, working with my Oireachtas colleagues in Waterford and the south east and the Minister, we have made progress and I am pleased that the planning application for the second permanent catheterisation laboratory was submitted at the end of November. We still have to go through several procurement stages and I hope to see the project completed within 18 months. This is only part of the problem because we also need a commitment from the Government to extend the hours to a 24-7 service. I understand that a minimum of seven consultants is necessary for this. We currently have four posts, with a fifth advertised. Access to cardiac care should not depend on where someone lives. When I stay in Dublin tonight, I can have access to a number of the 21 cath labs located in Dublin if I need it. However, if I need access in Waterford any night of the week, the only option available to me and many other people is to take an ambulance to Cork.

We know that all the hospitals are bursting at the seams. Once again, geography, postcode and address determine what care a person receives. This is simply wrong, unacceptable and should not happen. I am, therefore, happy to support Deputy Harty's Bill, which states: "The State recognises the equal right of every citizen to the highest attainable standard of health protection; and shall endeavour to achieve progressive realisation of this right."

I thank all healthcare workers, including nurses, doctors, consultants and all the auxiliary staff, who work in our hospitals and are tonight working hard while we are here speaking about the issue. Confidence in the health service is, unfortunately, at an all-time low. Staff are under pressure. They work hard and should be complimented on that. By working together, we should be able to improve the situation but if we could improve transfer of care from one end of the hospital, we would be able to increase capacity in emergency departments.

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