Dáil debates
Tuesday, 19 October 2004
Leaders' Questions.
3:00 pm
Enda Kenny (Mayo, Fine Gael)
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The crisis in our accident and emergency departments has, unfortunately, become an accepted part of a health system, on which €44 billion has been spent in the past eight years. This afternoon, I am informed that 164 patients lie on trolleys in Dublin hospitals, of whom 49 are in Tallaght Hospital and 39 in the Mater Hospital. Outside Dublin at least another 50 patients are waiting on trolleys for attention. I had occasion to meet members of the families of some of the patients in question outside the gates of the House this afternoon.
As bad as these circumstances are, they have the potential to get much worse. Gross overcrowding in our hospital wards and waiting rooms greatly increases the possibility of transmission of bugs and viruses. The winter vomiting bug has been reported in Beaumont Hospital, there is clear potential for an outbreak in the Mater Hospital and the trend for its spread is already ahead of that of last year. What is the Government's strategy to head off a crisis which will occur if the winter vomiting bug takes a foothold in our hospitals, particularly accident and emergency units?
Bertie Ahern (Dublin Central, Fianna Fail)
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I acknowledge, as the Tánaiste did last week, the number of people in accident and emergency departments. The Government has been endeavouring over the summer to make a number of alterations to improve the situation, as we have done in recent times, by increasing the number of consultants and facilities, trying to improve facilities in accident and emergency departments and dealing with the longer term problem, which has been ongoing in accident and emergency departments for years, that is, people on trolleys and temporary beds awaiting the discharge of other patients.
What we have been endeavouring to do, as Deputy Kenny knows, is to give additional resources to the health boards, not only to Dublin where the problem is most acute, to allow patients to move from beds to nursing homes, while providing for proper medical care and family arrangements. Over recent months we have escalated the process of trying to provide adequate arrangements and we will continue to do that.
Notwithstanding the fact that we have provided more than 900 beds, there still is a problem and we have to alleviate it by putting in the resources to provide additional nursing care facilities in private nursing homes, where there is spare capacity, and provide additional resources for accident and emergency departments. Approximately 78% of the people who attend accident and emergency departments do not require hospitalisation; about 22% do. It is through the efficient segregation and treatment of those patients and following the discharge policies in hospitals that we can try to obtain beds as quickly as possible. Of course, the inevitable reality is, and has been for many years, that there are people in hospitals who cannot be moved for one reason or another so it is up to the hospital authorities and we who fund them to try to provide the facilities and the beds. That is what we are endeavouring to do to an increasing extent. Deputy Kenny is aware of the numbers from replies the Tánaiste and I have given to the House. We will continue to try to provide the beds.
The vomiting flu is always a difficulty at this time of the year. A few years ago some of the major Dublin hospitals were closed to the public for almost the entire winter because of the vomiting bug or other ailments and diseases. There are now well tested policies within the hospitals to deal with these matters.
Enda Kenny (Mayo, Fine Gael)
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The Taoiseach gets one out of ten for that response. The first two minutes were the usual prepared response and the last couple of sentences were about the winter vomiting bug, which is the question I asked. People have been asked to stay away from Cavan General Hospital. In Galway, 60 beds are vacant but an embargo on nurse recruitment means the nurses cannot be employed.
I will make two suggestions to the Taoiseach in respect of the winter vomiting bug. There was a carer outside the gate of this House two hours ago who displayed severe symptoms of this bug, having been minding a patient this morning. Will the Taoiseach make a serious effort to see to it that hygiene is improved in our hospitals? The standard of cleanliness ranges from outright filth in some cases to revolting in others. It is just not good enough that a standard applies whereby, in some cases, the cheapest is the norm. It is perfectly obvious——
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy's minute is concluded.
Enda Kenny (Mayo, Fine Gael)
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It could not be up yet, a Cheann Comhairle.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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If the House is agreeable, the Chair will put a clock up when Members speak.
Enda Kenny (Mayo, Fine Gael)
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What will the Taoiseach do to improve the standard of hygiene in our hospitals, which have become havens for the transmission of bugs and viruses?
Second, will the Taoiseach and the Tánaiste initiate a major campaign to urge patients to visit their general practitioners in the first instance as distinct from going to accident and emergency units, which are already overcrowded and are havens for the transmission of bugs and viruses? This is normally done in January but if it were done now, it would relieve some pressure and possibly avert the closure of a major accident and emergency unit in Dublin hospitals this winter.
Finian McGrath (Dublin North Central, Independent)
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There have been seven and a half years of talk.
Bertie Ahern (Dublin Central, Fianna Fail)
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I am sorry Deputy Kenny thought my first answer did not deal with the issue. We have given the highest priority to emergency medicine departments. We have put in a large amount of resources — I will not rattle off the figures — to facilitate the discharge of patients who have completed their acute phases of treatment. Already, approximately 520 patients have been discharged and resources have also been given this year to facilitate more discharges. These patients are discharged mainly to private nursing homes.
In the Dublin academic teaching hospitals this summer, the Minister for Health and Children provided for the appointment of special nurses for accident and emergency, establishment of rapid assessment teams, a clinical decisions unit and provision of multi-disciplinary teams to assist patients. We have also increased the number of emergency consultants.
Finian McGrath (Dublin North Central, Independent)
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One still cannot get a bed. It is disgraceful.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach to continue without interruption.
Finian McGrath (Dublin North Central, Independent)
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There are 120 people on trolleys.
Bertie Ahern (Dublin Central, Fianna Fail)
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There are 900 additional beds and——
Finian McGrath (Dublin North Central, Independent)
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There have been seven and a half years of talk.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy is not the leader of Fine Gael.
Bertie Ahern (Dublin Central, Fianna Fail)
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In addition, in many of these hospitals large capital works are taking place. The reality is that there are different arrangements in different hospitals for accident and emergency units. Some hospitals do not have these difficulties but all the large hospitals do. We have to try as best we can——
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Taoiseach's time has concluded.
Bertie Ahern (Dublin Central, Fianna Fail)
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——to provide beds in private care so patients who are on trolleys can be admitted.
With regard to hygiene, I hope Deputy Kenny is not correct about the extent of the problem. I accept his point that it is always better to act before the winter when the issue of flu becomes more difficult. Large resources are, and always have been, put into cleaning in our hospitals. We will ensure that where there are problems with hygiene, they are dealt with.
Pat Rabbitte (Dublin South West, Labour)
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The Taoiseach does not demonstrate an awareness of the extent of public anger about this issue. When the country was far less wealthy it did not have the phenomenon of patients, families and nurses picketing Dáil Éireann on this issue. The consultants say there are 3,500 fewer beds in the system now than there were in 1990. In the past, when there was a flu epidemic during the winter, one would be confronted with the prospect of people on trolleys. Now, it is the norm. In every hospital there are patients on trolleys. Even in provincial hospitals, where it never happened previously, there are patients on trolleys. We had the prospect today of a patient in the Mater Hospital being treated in the staff canteen and the prospect of a young man on a drip lying on two chairs.
When will the Taoiseach stop flying around the world and focus on the most acute problem confronting our community? What would we do if we were confronted with the circumstances posited by Deputy Kenny in terms of a flu epidemic or the winter bug, given our current circumstances? A total of 70 beds are inappropriately occupied in the Mater Hospital and there were 132 patients on trolleys in this city yesterday. That is how grievous the situation is. People want to hear what emergency measures the Taoiseach will take. What steps will he cause the Tánaiste to take to relieve this situation?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy's time is up.
Pat Rabbitte (Dublin South West, Labour)
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Relatives of patients do not easily congregate outside Dáil Éireann to express their desperation. It requires a response from the Taoiseach, as leader of the Government.
Bertie Ahern (Dublin Central, Fianna Fail)
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I am aware of the problem and I have been aware of it for 30 years.
Pádraic McCormack (Galway West, Fine Gael)
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It is time to do something about it.
Bertie Ahern (Dublin Central, Fianna Fail)
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With the onset of the winter period there is always pressure on accident and emergency departments. There are now more acute difficulties and there are many reasons for that. The Mater Hospital and other hospitals have always had a difficulty in their accident and emergency departments.
Many things have happened in the past seven years. There are now 900 more beds in the system.
Olivia Mitchell (Dublin South, Fine Gael)
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It is only 500 beds.
Bernard Allen (Cork North Central, Fine Gael)
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It is a misprint.
Bertie Ahern (Dublin Central, Fianna Fail)
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In the recent past we have been putting in dedicated facilities, including staff at consultant, medical and nursing level. In the Mater Hospital, which has been the subject of discussion in recent days, the project of upgrading the accident and emergency department by the ERHA has been completed. The facilities include a dedicated triage area, a new resuscitation area and a wound care area. Deputy Kenny made the point that it improves the situation to have general practitioner services on campuses, as at St. James's, which I accept.
Finian McGrath (Dublin North Central, Independent)
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That is no excuse.
Bertie Ahern (Dublin Central, Fianna Fail)
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However, the most immediate issue, which we have been addressing for months, is to provide as many places as possible for stand-down facilities, in the most appropriate circumstances for patients who, for one reason or another, do not need an acute hospital but are not in a position to return home. We can provide for them nursing home and care hospitals appropriate to their medical needs and to their family circumstances.
John Gormley (Dublin South East, Green Party)
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The Government has been in power for more than seven years.
Bertie Ahern (Dublin Central, Fianna Fail)
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I am talking about this week. The Government is this week trying to enhance those facilities and trying to provide more beds so that patients can move from acute care, when they do not need it, to stand-down beds.
Pádraic McCormack (Galway West, Fine Gael)
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The Government should lift the embargo on hiring nurses.
Pat Rabbitte (Dublin South West, Labour)
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After seven and a half years in Government, the Taoiseach is still theorising about the solution. I have no idea what he intends to convey to the public by stating he has been aware of this problem for 30 years. Most people would draw the conclusion that, after that period, he should move out and let someone else try his or her hand at the problem.
The hospital consultants state there are now 3,500 fewer beds in the system than in 1990, which is not 30 years ago. I remind the Taoiseach of the fanfare with which he assembled a number of Ministers with the then Minister, Deputy Martin, to announce a health strategy that promised 3,000 beds. Where are the 3,000 beds? Are these press conferences any more than a fanfare to attract the media and to get soft headlines for the weekend?
Pat Rabbitte (Dublin South West, Labour)
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We have had many reports from the former Minister for Health and Children but little action. Some 3,000 beds were promised in the health strategy. Will the Taoiseach tell us precisely how he intends to utilise the spare capacity in private nursing homes to deal with the phenomenon of patients retained in acute hospitals who ought not be there? Will the Government open the facilities which have been built but not commissioned? The Mater Hospital is short 60 nurses, four in accident and emergency alone. Will the Government do anything to assist recruitment? The public are looking for tangible, speedy, emergency measures as well as a longer-term solution to the problems that confront our community.
Bertie Ahern (Dublin Central, Fianna Fail)
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Some 520 patients have already been discharged and work is ongoing to facilitate the discharge of more patients. That is the current position, not a plan for the future. More than 1.2 million people are treated in our accident and emergency departments, a much higher figure than ever dealt with before. A greatly increased number of consultants are meeting, dealing with and assessing patients. While there were only three or four consultants in the country previously, there are now 51. There are dedicated accident and emergency nurses, rapid assessment teams and clinical decision units.
John Gormley (Dublin South East, Green Party)
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That will not help people today.
Bertie Ahern (Dublin Central, Fianna Fail)
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All of these facilities are in place. While there is a longer-term plan to have 3,000 beds, 900 are in place. Longer-term developments are ongoing at James Connolly Memorial Hospital and at hospitals in Naas, south Tipperary, Roscommon and elsewhere, including at the Mater Hospital.
Liz McManus (Wicklow, Labour)
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The wards are closed at the James Connolly Memorial Hospital.
Bertie Ahern (Dublin Central, Fianna Fail)
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The provisions to which I refer have been in place since the summer and show we are addressing this issue.
John Gormley (Dublin South East, Green Party)
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The Minister, Deputy Martin, is a happy man.
Bertie Ahern (Dublin Central, Fianna Fail)
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With regard to my reference to the past 30 years, during the busy time of year for the medical system in Europe, there is never a period without problems in accident and emergency. What is needed is to try to quickly provide the best facilities within accident and emergency, and the best discharge policies compatible with the patient's medical and family needs. That is precisely what we are endeavouring to do.
Liz McManus (Wicklow, Labour)
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That is nonsense. Shame on the Taoiseach.
Finian McGrath (Dublin North Central, Independent)
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The Taoiseach is talking rubbish.
Trevor Sargent (Dublin North, Green Party)
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The Taoiseach has informed us in many ways that he feels people's pain. Does he appreciate, given everything he has experienced over many years, that the 2001 health strategy commitment of funding for 3,000 extra hospital beds by 2011 is completely inadequate, that the time frame is neither real, appropriate nor adequate and that it must be re-assessed and a new plan brought forward?
Is it not clear, despite the money invested in the health system, that there were 3,500 more beds in 1990? Does this not suggest that we have not done enough and that those waiting in accident and emergency wards have an extremely good reason to feel angry at this Government? Despite the Celtic tiger investment, the greyhound industry licking its lips at the extra €55 million in funding and horse breeders neighing with delight at the tax breaks received, are those who are hospitalised or need hospitalisation not right to be apoplectic with anger?
What of the case of the 84 year old woman who was the focus of protests outside the gates of Leinster House today? She has been seriously ill since last Saturday but was left waiting and is still waiting on a trolley beside the area where the bed pans are emptied, as I was informed today by people at the hospital. That type of treatment for someone of 84 years of age who was brought to hospital by emergency ambulance is all too common. How many stories like this, reflected in the reality of people's lives, will be necessary before the Taoiseach realises that 2011 is never-never time and that 3,000 beds are needed now?
Other countries are able to provide this with less of the economic success to which the Taoiseach constantly refers, yet he is failing to do it in this country. Does the Taoiseach realise that people must be prioritised? Greyhounds and horses have had the running for long enough.
Bertie Ahern (Dublin Central, Fianna Fail)
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Some 900 beds were provided of the 3,000 beds which were to be provided over a decade. Deputy Sargent will agree that this target was based on the professional assessment of all involved in the health sector.
John Gormley (Dublin South East, Green Party)
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The consultants say we need more beds.
Bertie Ahern (Dublin Central, Fianna Fail)
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It is a third of what was to be provided over a decade. The long-term aim is for more beds, which is already happening.
Bertie Ahern (Dublin Central, Fianna Fail)
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It is happening at hospitals at Temple Street, Castlebar, Limerick, Cork University, Naas and James Connolly Memorial.
Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Rabbitte asked me about the short-term facilities. We have already announced a package for this and the facilities are opening. However, a current problem exists. Not everywhere but in a number of locations, there is a requirement to better operate the accident and emergency discharge policy-——
Bertie Ahern (Dublin Central, Fianna Fail)
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——so that patients in beds who do not require intensive, specialist acute care are moved to an appropriate location in accordance with their medical needs.
Liz McManus (Wicklow, Labour)
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What will the Government do about it? Where will they be put?
Bertie Ahern (Dublin Central, Fianna Fail)
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In private nursing homes.
Finian McGrath (Dublin North Central, Independent)
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People cannot afford nursing homes.
Bertie Ahern (Dublin Central, Fianna Fail)
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Some 520 patients have been discharged to date. The Department of Health and Children has already identified the areas where we can find more spare capacity. That must be matched by the doctors and medical staff being happy that the patients they discharge — it is not just a question of moving them — are discharged compatible with the medical needs and family circumstances of the individual patient, which is happening.
Bertie Ahern (Dublin Central, Fianna Fail)
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In addition, we provided many initiatives over the summer, as I stated we would——
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach speak without interruption, please.
Bertie Ahern (Dublin Central, Fianna Fail)
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——and appointed additional nurses, doctors, consultants and stand-down facilities. This is not a plan; it happened last summer.
Trevor Sargent (Dublin North, Green Party)
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I am not sure the Taoiseach appreciates the urgency of this matter. Whether the report and the target date of 2011 seemed fine, the date is not fine now. When the Taoiseach refers to private nursing homes, which seem to be seen as some form of panacea, does he not realise that 20 people were waiting for beds in the Mater Hospital just one hour ago? Some have been waiting since last Thursday. One lady has waited since 10.15 a.m. on Saturday. Her doctor stated his hands were tied, that he could not treat her in casualty and that she needed a bed on his ward. Fortunately, she got a bed approximately one hour ago after waiting all weekend.
Regarding private nursing homes, I have a reply to a question to the Minister for Finance about the introduction in the Finance Act 2001 of capital allowances in respect of capital expenditure on private hospitals. We asked how much money is involved and the reply was that the Revenue Commissioners state that tax relief for such schemes is not at present captured in any way as to provide a specific basis for compiling Estimates of cost to the Exchequer. Effectively, the Government is talking about pennies for the public sector and for beds in hospitals but it cannot say how much money is spent on tax breaks for individuals who will become rich out of the misfortunes and illness of others. Will the Taoiseach get the figures so that we can calculate the extent to which the Government has abandoned the health service in the interests of people who want to benefit and profiteer from it?
Bertie Ahern (Dublin Central, Fianna Fail)
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That is totally incorrect. We are spending €10.5 billion which is a three-fold increase in the health budget. We have 35,000 more people working in it. There is a capital programme in practically every county in the country.
John Gormley (Dublin South East, Green Party)
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We are below the EU average.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Is the Deputy not satisfied with his leader's handling of the question?
John Gormley (Dublin South East, Green Party)
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I am very satisfied.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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I ask him to afford the same courtesy to the Taoiseach as was afforded to the leader of his party. He is entitled to be heard in silence and Deputy Sargent is entitled to hear his reply in silence.
John Gormley (Dublin South East, Green Party)
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He is talking waffle.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach to speak without interruption.
Bertie Ahern (Dublin Central, Fianna Fail)
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The reason for giving incentives a number of years ago was an increase in the aged population. It was correctly argued that in order to provide more facilities for elderly people we should involve the private sector, under clear regulations, in building more nursing homes. That has worked. That is how, in the short term, we have been able to provide discharges of 520 patients to assist in this area. The capital programme and the provision of additional beds is a long-term issue. I instance what we are doing now to identify where additional places are needed and to deal with people who everybody accepts have major problems. We have put in specialist nurses, consultants, rapid assessment teams, clinical decisions units, multi-disciplinary teams. We must continue to do that. These initiatives will help people——
John Gormley (Dublin South East, Green Party)
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They are not helping the people.
Bertie Ahern (Dublin Central, Fianna Fail)
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——more than merely engaging in political chat about it.
Bertie Ahern (Dublin Central, Fianna Fail)
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Regarding the hospital system, we continually try to put in better facilities. It would be a good idea if people acknowledged the major improvements in areas of our hospital system other than accident and emergency.
John Gormley (Dublin South East, Green Party)
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Tell that to the people outside.