David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I welcome the opportunity to have a discussion on safe staffing in our hospitals. Last summer was the first time we had a serious problem in our hospitals, namely a summer trolley crisis. Before that summer trolley crisis arrived, people working in our healthcare systems throughout primary, acute and community care were flat out during Covid. There was a cyberattack and long before Covid they told us they were burned out. Along came the summer with some hope of relief for those on the front line, which did not come. In fact, we had serious overcrowding in hospitals for the first time in a significant way last summer.

That continued into the autumn, as the Minister knows. It became worse into the winter. We had what was possibly one of the worst winters on record, exacerbated by the lack of capacity in the system as well as the mix of illness circulating in the community which put enormous pressure on our front line healthcare system.

Over the past number of weeks we have had, on average, 500 patients on trolleys every day. Last week, there was not a day where the number was less than 600. It seems to many people who work on the front line in healthcare that this has become the new normal. It is now acceptable that every day, week, month and year we have to tolerate that level of overcrowding in our hospitals. There are a lot of reasons for it.

We have had many discussions on why we have the levels of overcrowding we have in our hospitals. Part of the reason is that there are not enough staff in our hospitals, primary care centres, out-of ours GP services, community care infrastructure and so on. We know there are a lot of reasons we end up with the crisis we have in our emergency departments.

Unsafe staffing is one of the problems. If we talk to any hospital manager - at this stage I have spoken to most of them - they will say surgical theatre, diagnostic and bed capacity are all important, but none of that is possible without staff.

Over the past number of months we have had threatened strike action from the INMO. The Minister has spoken at length about all of the things he and his Government have done. While additional staff and beds, a movement towards universal healthcare, a new consultant contract and many other positive developments have been put in place, which I have of course welcomed, the backdrop to this discussion is that we have seriously overcrowded hospitals and record numbers of patients on trolleys. People aged over 75 waited, on average, 40 hours in one month last year in our acute hospitals in Cork. That is the backdrop to this debate.

People who are waiting for access to care on healthcare waiting lists and all of that is a product of a system that does not seem to be working despite all of the resources and capacity Minister spoke about. The system does not seem to be delivering the levels of care at speed that need to be delivered. He will accept that the waiting times and the length of time people are waiting in emergency departments is too long.

In the early days of January when we first came back and had a discussion on was happening in hospitals, I said to the Minister that we have to take what happened from last summer onwards as a watershed moment in healthcare and, once and for all, we as an Oireachtas were going to say that we are not going to tolerate those levels of overcrowding in our hospitals. It simply cannot be accepted as normal. The only way we are going to be able to deliver on that promise is to put the capacity in place. Part of that is staffing.

I listened to what the Minister has said over the past number of months. He spoke about doubling training capacity so that we can train more healthcare professionals. I support that. It should not be a competition about numbers, where he refers to doubling the numbers and I say the figure should be more or less. It has to be based on what we need.

We need a new workforce plan and strategy underpinned by what the health care system needs. We have the science. The safe staffing and skills mix framework should tell us what we need in terms of staff across wards, hospitals and emergency departments, and we should then roll that into community services and primary care in terms of HSE and public sector staff.

The INMO has, justifiably, asked the Minister and Government to underpin that framework by legislation. That would mean the State and Minister would be legally obliged to provide safe staffing levels in hospitals. That is something that I am committed to. I can clearly say in the Chamber that if I were sitting where the Minister is and I was Minister for Health I would introduce legislation to underpin the framework. That is the science. That tells us what we need. That will change based on demographics and the additional capacity we put into healthcare. It will not deal with all of the problems or tell us everything. It is only based on what capacity we have in the system. At least it would be a starting point and should be underpinned by legislation. Unless we have a workforce plan that is of substance, talking about more beds or capacity in the system or all the other capital investment and any other investment we want to put into healthcare will come to nothing because we cannot open beds and put the capacity we need into our hospitals without staff.

At its core, healthcare is about people treating people. It is about healthcare professionals and front-line healthcare workers treating sick people, and we need more of them. We will not have more of them unless we train more and have more placements, which is important. We cannot increase the number of training places and not have placements in healthcare settings so that we can make sure people can get training as well as placements. We need investment to make that happen.

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