Seán Crowe (Dublin South West, Sinn Fein) | Oireachtas source

Staffing levels in the health service have been a problem for decades and successive Governments have failed to get to grips with the fundamental issues of recruitment and retention. At the core of these issues is the working conditions our healthcare professionals, in particular nurses and young doctors, are forced to face every day. When gruelling 24-hour shifts or the threat of violent abuse or assault are the reality, is it any wonder that our young graduates are heading to Britain or Australia?

Since the beginning of 2021, more than 3,400 nurses have been assaulted in our hospitals. If we consider all staff, that figure goes up to 5,600 incidents of physical, verbal or sexual assault. A nurse described an accident and emergency department as a pressure cooker with aggression causing junior nurses to quit. She no longer feel safe in the workplace. None of us would put up with that if there was an alternative. I was shocked to hear recently that there is a two-tier system whereby a doctor gets longer than a nurse or other staff member to recuperate if he or she is assaulted in the workplace. This does not make sense.

The worse the staffing crisis gets, the worse the overcrowding and so on gets. It is a vicious circle. The Government and HSE must put measures in place as a matter of urgency to ensure the safety of all our nurses and hospital staff. The obvious tension and pressure cooker atmosphere in accident and emergency departments, in particular, must also be relieved.

A plan needs to be brought forward to tackle waiting times and overcrowding. Part of that has to involve alternative pathways to care and a greater emphasis on care in the community. Thousands of people experienced unnecessary delays in discharge from hospitals last year due to a lack of step-down beds and care packages in the community. The pressure a lack of focus on issues such as home care puts on the hospital system is enormous.

Home help is one area where we will see greater demand as time goes on.

Our population is ageing. Our population aged over 65 is one of the fastest growing in the world in fact. Many families have gotten smaller as time has gone by. Where there may have been three or four siblings to look after an ageing parent, there may only be one or two now. This means that home help will be more crucial as we move forward. We can see clearly the issues caused in our hospital service when elderly patients are medically discharged but have no supports once they leave, so they are stuck on a hospital bed.

We call it a health system because it is made up of many moving parts. When one breaks down, the whole system suffers. A lack of home help or step-down beds means that patients are not discharged and someone on a trolley in the accident and emergency department cannot be moved upstairs to a bed or an ambulance sitting outside the door cannot discharge a patient into the hospital because there is no space inside. That, in turn, means that ambulance is not responding to the next call, which is why our emergency response times are way outside the targets set for them.

We need to examine options that will alleviate pressure in areas where we need to build up staffing numbers. Let us consider GPs. We do not have enough GPs, which is putting further pressure on our emergency departments as people feel they have no other choice but to go to hospital if they cannot see a doctor. This is yet another example of one part of the system breaking down and causing problems down the line.

Irish Pharmacy Union representatives were before the Joint Committee on Health two weeks ago and they spoke about the enhanced role that community pharmacies can play in providing capacity in our health service. By operating minor ailment clinics, they could triage a great number of people who may not need to see a doctor or go to a hospital. This would free up appointments in GP surgeries, which would then allow people to see their doctor rather than go to the accident and emergency department.

We need higher levels of staffing in our hospitals. Everyone accepts that and that is a given. The pressure and unfair working conditions that our healthcare professionals are subject to are simply unacceptable. We are creating pressurised situations in our hospitals that are jeopardising the safety and welfare of patients and workers alike. We need, however, to look beyond the simple arithmetic of more workers equalling greater capacity. We need to innovate and be proactive when it comes to treating people in our community and preserving our hospitals for those that need to be there.

Programmes such as Pathfinder, which aims to have ambulance personnel treat people in their homes where possible and prevent a hospital visit are invaluable in that respect. We need, however, to see that value sooner and roll out these programmes throughout the State far sooner. By creating and strengthening these alternative pathways to care, we can alleviate some of the pressure on our hospital network and allow ourselves breathing room to both improve the working conditions and build staffing levels.

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