David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I commend the Independent Group on tabling this Private Member's motion. The heart of this motion is that we should better utilise model 1 and model 2 hospitals, but particularly model 2 hospitals, to take pressure away from the model 3 and model 4 hospitals. As a previous Deputy said, we are ten years into the framework for smaller hospitals and we are still not using them to best effect. I fully agree with what is being called for regarding the operating hours of medical assessment units and local injury units. That makes sense. In this House, I have repeatedly called for additional hours for Monaghan hospital's minor injury unit and for other hospitals too. We saw during Covid, and have seen a good example in the mid-west in more recent times where Ennis was used to better effect, that we can get more from those model 2 hospitals, including day care procedures and elective procedures, and using those medical assessment units and local injury units. That all makes sense.

We have a perfect storm in healthcare at the moment. It does not take a rocket scientist to figure out what is happening. We have waiting lists that have gone up this year. From the start of January this year up until the end of April, acute waiting lists were up by 20,000. I got a reply to a parliamentary question this week which showed that 80,000 hospital appointments were cancelled from January to April of this year. That is a huge number of people who have had inpatient and outpatient procedures cancelled. Some were surgical appointments, some were medical appointments and many were outpatient appointments. The reason for this, as we see in our emergency departments, is that the system is not integrated and is not working. We are not delivering the right care in the right place at the right time. We have huge pressure on our emergency departments in our major acute hospitals. That pressure leads to longer wait times. On average, people are waiting for 11 or 12 hours for admission to a bed. In some hospitals in Cork and Dublin, that can be up to 24 hours. That is all because of the pressures we have in those emergency departments.

About 40% of people who are attending emergency departments are people who are there because they have no other pathway. They cannot get access to out-of-hours GP care. They cannot access supports in the community. For example, most of the teams promised for people who have chronic pain have not been established or are not working and they cannot access a GP for many different reasons. Many could be seen if we had 24-hour cover in minor injury units and medical assessment units in those model 2 hospitals. The fact that we are not making best use of them and that we do not have the capacity in primary and community care means we are creating further bottlenecks and capacity problems in our hospitals. We then do not have enough beds, as we know. The Minister is now talking about 1,500 beds.

Talking to any hospital manager, they will say they cannot admit patients quickly enough because they do not have the beds. They also do not have access to recovery beds and step-down beds. Another parliamentary question response I got back last week was about home help and home supports. The number of patients who have been approved for home support but who are still waiting for a package has increased from 4,000 to 6,000 over the course of a year. People are waiting for longer for home supports. The acute hospital waiting list has gone up. Community waiting lists have been out of control for far too long. This all screams that there is a lack of integration between acute, primary and community care. It is not rocket science. We know we need more beds, so we should deliver it.

Hospitals also need surgical theatre capacity and diagnostic capacity because the absence of diagnostic capacity also slows up the patient flow time in hospitals, because people are waiting hours on end for a scan and for that to come back. That also needs to be part of this. If we only look at what is happening in the hospitals and do not step back to look at primary and community care, and at the relationship between overcrowding and hospital waiting lists, then we will never solve the problem. Waiting lists have gone up this year despite the promise that they would come down and a multi-annual plan which never materialised, and the Minister's plan for last year, which clearly has not worked, because tens of thousands of procedures are being cancelled. They are cancelled every month, every week and every day because of the pressures on our emergency departments. Hospitals have no other choice and no option left but to cancel elective procedures and planned procedures. That creates another problem. We are shifting the problem from one part of the health service to the other.

I fully support this motion and what it calls for. It is one of the ingredients that we need to sort out what is happening in our emergency departments. It will not be a panacea and it will not solve all the problems but it will solve some of the problems. We need to look at those model 2 hospitals and have a plan for each and every one that makes best use of them to deliver that elective care, planned care and day care.

See this speech in context