Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I am sharing time with Deputies Butler, Brendan Smith and Crowe. This session concerns emergency bed capacity and, for me, how we can avoid an escalating trolley crisis every year. Before Covid-19 arrived, many of us were debating the trolley crisis in the Chamber. More than 100,000 people were on trolleys on last year, 13,000 of whom were on trolleys for more than 24 hours. Elderly men and women were on trolleys for days on end, and we were all personally very affected, upset and frustrated by that. In preparation for this session, I looked back at some of the testimony from that time. One person stated they had been in St. Vincent's hospital for three days, with tea and polite nurses but no doctors. Another stated their 86 year old mum ends up in the accident and emergency department regularly and had spent days in limbo. Yet another stated their 70 year old mum had spent 105 hours on a trolley in Limerick hospital and expressed fears she would die if a fire started. Our healthcare professionals, as we all know, were overwhelmed, burned out and exhausted.

However difficult it was going to be to fix that problem, the challenge has become much greater because of Covid-19. There has been a significant increase in spending on Covid measures, including personal protective equipment, PPE, testing and tracing. Waiting lists have increased because of the necessary pausing of elective care, with those for inpatients and day cases increasing by 30% since March, approximately an additional 20,000 men, women and children waiting. Cancer screening services, necessarily, had to be closed but that, again, put a great deal of pressure on the system.

The greatest challenge, however, is probably neither of those issues. It is the fact that while Covid is here, the infection control measures the healthcare system needs to use very seriously reduce the capacity we have to treat people, including, critically, the capacity that emergency departments have to care for people. It is estimated that 20% of the beds in hospitals will now have to remain vacant. Surgeons are estimating in some cases that they will be able to see about half the number of patients in a given operating theatre session. Diagnostic capacity has severely decreased, with some people suggesting that more invasive diagnostics such as scopes could see reductions in capacity of up to 80%. As the Secretary General stated when he appeared before the Special Committee on Covid-19 Response a few weeks ago, it will cost more and take longer to do less. That is in a system that was already at breaking point.

As for what we can do, I agree with the Minister that one step we must take is to hold on to some of the positive changes that happened during Covid-19. Additional hospital beds were opened or reopened, and we should ensure they stay open and accelerate the hospital beds in planning or construction. We need to examine opportunities in presentations to emergency departments. During Covid, the number of presentations fell. Some urgent care decreased, which was bad, but so too did some non-urgent care and we need to find ways of engaging with those people and getting them to a better place than an emergency department. The Irish Association for Emergency Medicine has pointed that some referrals to emergency departments are from GPs sending in non-urgent care. They do not want to do that but it is the only place they can send patients for access to diagnostics or to care that they should be able to access in the communities. A public helpline with clinicians, which is available to many people who have private health insurance, could be excellent in helping people decide whether they need to attend or to bring somebody to an emergency department.

Equally, however, we have to increase the resources available to the emergency departments. That includes better staffing ratios for clinicians, better access to diagnostics and better access to beds. The problem is that our diagnostic and bed capacity has taken a massive hit, which will stay with us for a while because of Covid-19. To put that into context, a 20% reduction in bed capacity, given that we have to keep open 20% of the beds normally occupied, would see the number of inpatient HSE beds fall from approximately 11,000, which it is now, to fewer than 9,000. That is a catastrophic loss of hospital beds that will be seen at the sharp end, namely, in the emergency departments.

As for what else we can do, we have to source short-term capacity from outside the public system. We can provide additional funding to the National Treatment Purchase Fund and expand its remit to include areas such as mental health and diagnostics. We can establish strategic partnerships with the private providers while the Covid infection measures have to be deployed. If we need to access 2,000 or 3,000 new beds now, with the best will in the world that cannot be done simply from within the public system. These are the kinds of measures we can use in the short term to build capacity.

Second, we need to work with clinicians to get as much as possible out of the existing capacity in the HSE. We have to examine ways of opening the diagnostic suites and operating theatres longer, starting earlier, finishing later and opening at the weekends. We have to identify quickly some of the wasteful practices in respect of bed use. One way that doctors in hospitals are forced to ensure that someone coming through the emergency department gets an MRI scan is to keep him or her in a hospital bed for days, just so that he or she will stay on the priority list, rather than sending the patient home and saying to him or her that he or she is on the priority list and to come back in two days to be scanned. We have to get these issues sorted out very quickly. All of this is well and good but it will require more clinicians, doctors, nurses, midwives, technicians and scientists. We need to identify the blockages. The number of doctors deregistering has been increasing, as has the number of vacant posts. We urgently need to examine the blockages and sort them out. One step we can take immediately is to consider the clinicians going off cycle this summer. My understanding is that we could put job offers in place for them because many of those who might have wished to travel abroad will not be able to do so.

Third, we must accelerate the parts of Sláintecare that relate specifically to capacity, such as the healthcare gap analysis, the workforce planning, getting the new regional organisations and delivery plans in place, and accelerating capital expenditure.

I imagine that every Deputy wants this problem to be solved, and I agree with the Minister that we are at our best when we work together. Getting the kind of radical action and urgent investment we need will need a new Government. It is my sincere hope, therefore, that coming into next week a new Government will be in place that can get stuck in to some of these urgent matters.

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