Michael McNamara (Clare, Independent) | Oireachtas source

The motion has been formally moved and I am grateful to Deputy Harkin for that. I note, on formalities, that there is an amendment from Deputy Shortall, which I am happy to accept. I note that there is not a Government amendment, which is appreciated.

The motion is an attempt to be collaborative, or at least to acknowledge the efforts the Government has made. Despite the best efforts of the Government, 2022 was the worst year on record for overcrowding in Irish hospitals, with 121,000 patients left without a bed. Yesterday, University Hospital Limerick, UHL, was the most overcrowded hospital in the country, followed by Cork University Hospital, CUH. That is a record and statistic that, unfortunately, holds true for the entire year as well as this weekend. There were 18,000 people on trolleys in UHL during 2022 and more than 12,000 in CUH. Again, that was mirrored yesterday.

We have a huge problem and it has been acknowledged that part of that problem goes back to configuration in that the cart was put before the horse. There is nothing terribly wrong with the idea of configuration, but the people of Navan who are resisting it should continue to resist it until such time as resources are put in place in the hospital that Navan Hospital will be configured with. The problem with reconfiguration in the mid-west is that to this day the number of beds that were promised when services were being reconfigured and emergency departments were being closed in Limerick and Nenagh have not been provided. No additional resources were provided but all need was channelled into the emergency department in Limerick.

One would not have to be a genius to know that was going to have huge repercussions, and it did. There is a lack of confidence in UHL now and there is fear across the mid-west. It dissipates. It is a beautiful sunny day in Clare at Inch Bridge and across the county. However, we will head into a winter again. I urge the Government to take the initiative to take control of this. From transport to accommodation of recipients of temporary protection and asylum seekers to health, I appreciate the Government is trying but it is losing control of the situation in so many areas. There is no sign of progress. People expect to see things getting better, not worse, yet, in so many facets, things are getting worse. That is the case with health as well, in terms of the number of people on waiting lists and trolleys.

Even this past weekend, in the middle of summer, the numbers on trolleys were what would be expected in the middle of winter pre-Covid. It is not because of Covid. We were told that the numbers of persons in hospitals with Covid are at the lowest it has been since September 2020. It is not because of Covid but it is since Covid that we see this.

We respectfully suggest a couple of initiatives. One is to expand the medical assessment units, MAUs, which is easy to say. Everything is easy to say when you are in opposition and I appreciate that it is difficult in government. However, that is not an excuse for paralysis or not to succeed in government. Expanding the MAUs will take many additional staff and additional beds. There are additional beds. It is 15 years now since an additional block was planned in Ennis at the back of the hospital between the old 1950s hospital and Sandfield House. That needs to be brought on board. Only when that is brought on board can we hope to have a 24-hour MAU. We need to be able to admit people to such a unit. The majority of people who come into the unit are not admitted, which is great. They are brought in, treated and discharged. Instead of going into the accident and emergency department in Limerick and joining the large queues of people there, they are sent into the MAU by their GP and treated. Some of them will need to be admitted. An MAU cannot be open if there are no beds to admit people to, so we will need more beds. That is a one-off spending. I mention Ennis because it is the hospital I know best but it holds true of every hospital across the country.

The State is running huge surpluses. We have no idea where the money is coming from. Arguably, we have lost control of our economy, although we are told it is because of prudent management. Prudent management would suggest that the revenues could be predicted, yet everybody seems to accept that we cannot predict what the revenues will be but, hey, it is not a problem; it is down to our prudent management. We have surpluses and these facilities will need to be built because our population is growing. We have a huge influx of people from Ukraine. Some of them will go back to Ukraine but many will not. Many of them now think they will want to go back to Ukraine but the longer people stay in a place, the more likely they are put down roots and stay. I am not suggesting that the growth in population is down to people coming in; it is not. We have a young population. We will need these facilities. I urge a huge capital programme.

I mentioned local injuries units, LIUs. We call for these to be expanded to 24-7. If a person is playing sport on a summer’s evening, to have to be brought into the emergency department in Limerick for something that is relatively minor but still needs to be treated seems to be a waste of resources. If people are on a night out and they fall, even through their own stupidity, they need to be treated. It does not matter why somebody is injured; if they are injured, they need to be treated. We need to have LIUs but, again, that will require beds to admit people to, if required.

We call for the digitisation of records, which is sensible by any stretch, in 2023, in a country that attracts the biggest tech corporations in the world and wants to be an innovator and lead research and development. If those who work in research and development at the cutting edge of technology worldwide fall ill and go to hospital, there is no electronic record. If they are transferred from one hospital to another, there is no record. We need fluidity in the hospital groups in order that people can be readily moved from UHL to hospitals in Ennis or Nenagh or to St. John’s. That is greatly facilitated by having electronic records that staff can access. However, it is not just that. If I fell ill yesterday, I would be treated either in Ennis or Limerick. If I fall ill tonight, unless I have to go back to Inch or something, it will be one of the Dublin hospitals, which would have no idea what treatment I received yesterday if I was not in a position to tell them. That just seems ridiculous.

It is several months since the person tasked with developing this resigned and had very negative comments to make about his experience at the HSE. Where are we with regard to a replacement? I have spoken about this to the Minister for Health, Deputy Donnelly. Where are we with regard to a replacement? It simply beggars belief that we do not have one.

Lastly, the other two recommendations relate to nursing homes. There is a huge spike in presentations of patients from nursing homes in emergency departments at Christmas and holiday periods for a variety of reasons, of which one can be suspicious of. However, they are patients who need to be treated.

They are probably frightened patients because no elderly person wants to present in an overcrowded emergency department, ED, and to be on a trolley. One of the recommendations the first preliminary Covid report made concerned medical officers for nursing homes. Many, but not all, HSE nursing homes have a medical officer assigned to them. It is usually a local GP. He or she is the medical officer assigned to the home so he or she is responsible for the care of all the patients in that home. In many of the private homes, no one person is responsible for the care of all the patients. Frequently, nobody is responsible for the care of many of the patients who is accessible or nearby. The patients may still in theory be on the list of a GP who is in his or her home, which could be 20 or 30 miles away. If needs be, who is going to make a decision on whether the patient needs to present or not? Nobody. Of course, nursing staff on duty are going to err on the side of caution and say that the patient needs to be seen. The only place that he or she can be seen is in an ED, so then we have the patient presenting there.

The other difficulty is that primary care teams routinely do not access nursing homes at the moment. That needs to change, in particular, to prevent people presenting in EDs, and to ensure that those who are admitted to hospital can be discharged back to a nursing home, if that is where they were originally. If they were not in a nursing home and they need to go a nursing home either temporarily or permanently, we need to ensure that they can still be treated by a primary care team so that we get people out of our acute hospitals and into a level of care that more befits their needs. At the moment, everything is channelled into EDs, with the result that frequently, there are those who need to be in an ED alongside those who do not need to be there. They just need to be treated by somebody but our healthcare system operates so as to channel everybody into EDs. Catastrophic events occur as a result of that. We saw what happened in University Hospital Limerick, UHL, over Christmas. There was to be a speedy internal investigation into what happened with Aoife Johnston. That was a frightening episode for the people of Shannon and the mid-west. We need clarity on what happened, and absolute certainty that something like that will not happen again because of the enormous pressure that those who work in EDs are under. It is getting harder and harder, as the Minister of State well knows, to recruit people into UHL, in particular, because of the pressure those who work there have been under. People do not see it as an attractive place to work. We do need to address this. The Minister of State is accepting the motion, but I urge the Government to act on it in order that we do not go through another winter like last winter. We should not accept that the numbers of people on trolleys are inevitably going to rise. That cannot be reconciled with record surpluses. At some point, it points to bad management, and the buck stops with the offices of the Ministers in the Department of Health.

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