David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann:

recognises that a succession of Fianna Fáil and Fine Gael Governments made decisions which caused and exacerbated the crisis in our emergency departments (EDs) today, including Fianna Fáil's decision to close thousands of beds in their last term in Government and Fine Gael's refusal to invest in an adequate number of beds over the past decade, which have left the public health service with less acute inpatient beds for the last 23 years than when the Tánaiste, Micheál Martin TD, became Minister for Health in 2000;

notes:

— the previous commitments to end the scandal of patients on trolleys made by the Fine Gael party and the Taoiseach, Leo Varadkar TD; and

— that the Taoiseach said that "ED overcrowding is a priority issue for me and for the Government" when he was Minister for Health in January 2015, and has said that overcrowding is "unacceptable" since returning to the Taoiseach's office, and considers that the circumstances in EDs have worsened significantly in the eight years since the Taoiseach became Minister for Health, and that the Taoiseach's rhetoric should be judged against his demonstrable record of failure in Government;

condemns:

— the failure of successive Ministers for Health and Governments to sufficiently invest in hospital capacity, primary and community care, and workforce planning to avoid the record high number of 931 patients on trolleys witnessed on 3rd January, as recorded by the Irish Nurses and Midwives Organisation;

— the current Government's dismal Budget 2023 which failed to provide any additional funding for new acute inpatient hospital beds, failed to set ambitious multi-annual capacity and bed targets, and failed to ramp up or set multiannual targets for healthcare professional training places at the pace which is necessary;

— the decision of the Taoiseach and Tánaiste to retain the same failing Minister for Health, Stephen Donnelly TD, in his post during the recent Cabinet reshuffle; and

— the Government's decision to ignore early warnings last summer of the risk of medicine shortages; and

calls on the Government to:

— immediately make greater use of all public and private health care infrastructure to alleviate pressure on the public system and to minimise disruption for public elective patients;

— increase the number of public beds in the system, including more acute inpatient and sub-acute hospital beds and community step-down beds to speed up admissions and discharges to meet rising demand and demographic change, to expedite the development of elective centres and hubs to provide protected scheduled care capacity in line with Sláintecare, and set out a multi-annual plan for achieving this;

— further increase the number of training places so that we can recruit and retain the doctors, nurses and allied health and social care professionals in sufficient numbers to staff the beds required in the public system on a long-term basis; and

— ensure that the Health Products Regulatory Authority, the Health Service Executive and the Department of Health are engaging proactively to resolve the shortage of medicines and to legislate for a serious shortage protocol to support pharmacists.

A failure to plan and a failure of leadership left patients and front-line healthcare workers high and dry during the winter period. In fact, the pressures that those on the front line are facing today are still as stark as they were in the first week of January. It has to be said that the experience of patients in emergency departments throughout our country, with overcrowding levels that we have not seen previously, was an absolute disgrace. I will be the first to accept that rising cases of flu, Covid-19, respiratory illnesses place pressures on the healthcare system, and they did but we cannot excuse the lack of capacity in our hospitals, we cannot excuse the fact that the winter plan was clearly insufficient and we cannot excuse the fact there was not sufficient leadership coming from the centre either politically or from the HSE leadership to ensure that patients were treated with dignity, that there was humane treatment of patients, as opposed to the inhumane treatment that so many people received, and that we had a health service that could offer the basic levels of care to patients. We all saw the images of trolleys in corridors of hospitals throughout the State. Some of those patients were elderly and some were there for days. They were only the patients waiting to be admitted. Many more waiting for care also waited long periods - in some cases more than 24 hours; in other cases, days on end. Some of them ended up sleeping on the floor in emergency departments.

I will focus on all the solutions that need to be implemented urgently by the Government. We know what we need to do in the short term when we have a crisis and a surge such as this. We have to prioritise care in emergency departments, redeploy staff and do all the things we know need to be done. That is crisis management. However, we have known for some time that hospitals simply do not have the capacity they need. Once and for all, we have to make a decision to put the beds that we need into the public system to enable decision makers on the floor of emergency departments to admit patients much quicker. We need more beds. We also need more staff, including consultants, doctors, nurses, healthcare assistants, radiographers and allied healthcare professionals. We need more diagnostic capacity. I have been saying that to the Minister for some time. The lack of diagnostic capacity in public hospitals makes it more difficult for decision makers to speed up the care for people in emergency departments. That in part is the reason people are waiting too long. All that capacity is needed in our hospitals. We also need to expedite the elective-only hospitals and the surgical hubs that were promised to ensure we have a separation of scheduled from unscheduled care. The capacity in acute care, including elective hospitals, and putting capacity into our hospitals, is the first priority.

The second priority has to be workforce planning. We have to increase training places substantially and ensure we have sufficient recruitment and retention strategies, and deal with all the contractual issues. We need to hire and train more staff to open the beds to provide the diagnostic capacity and to put the physical infrastructure that we need into the hospitals.

The third priority has to be right care, right place, right time. It sounds great. I have heard the Minister say that time and again. It is the cornerstone of Sláintecare but we have people who should be cared for outside of hospitals but the capacity is not there. What angered people during the month so far and in December was hospitals saying, "Do not come to emergency departments - avail of all the alternative care pathways that are available such as out-of-hours GP care, out-of-hours pharmacy care", only for many people to be left ringing numbers and not getting through. There was not a chance of them being able to avail of any of those services because the capacity was not there. We need more GP capacity, more out-of-hours capacity and more community intervention teams doing all the work that needs to be done.

The fourth priority has to be reform. We need good management and good leadership. It has to be said that what is called organisational grip, which in layman's terms is simply good management, is absent from many of our hospitals. We are not using the resources in the way that we should. We also have to expedite the regional health areas, RHAs, and get that part right where we integrate healthcare and not have the layers of management that we have. We need a single tier of management that can make decisions in regard to primary care, community care and acute care. We are not doing any of that. I believe that Deputy Donnelly has failed as Minister for Health properly to support our health services. I believe he should take responsibility for that and he should apologise to all the patients who were left without the care that they deserved. He should apologise to all those on the front line who have been left high and dry without the tools, the capacity and ability to deliver the safe care they want to deliver.

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