Dáil debates

Thursday, 13 January 2011

Priority Questions

Accident and Emergency Services

2:00 pm

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Question 1: To ask the Minister for Health and Children the precautions being taken to protect patients from cross infection from swine flu and other hospital infections in view of the number of patients waiting on trolleys in accident and emergency; the additional capacity put in place to deal with the winter increase in hospital admissions; the way she will defend the closure of beds when demand is high; and if she will make a statement on the matter. [1934/11]

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Question 2: To ask the Minister for Health and Children if she carried out any reviews of the effectiveness of the measures she announced in 2006 to address the national crisis in hospital emergency departments; her views on the waiting times for patients in emergency departments in January 2011; her plans to address this problem; and if she will make a statement on the matter. [1839/11]

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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I propose to take Questions Nos. 1 and 2 together.

The waiting times for patients attending emergency departments in many hospitals during the first week of January were unacceptable and I very much regret the delays that patients experienced. I have discussed plans with the HSE for ensuring that this situation does not recur. The HSE has assured me that it will take all possible steps to improve waiting times in emergency departments, so that all patients are assessed, treated and discharged or admitted without unnecessary delay. The HSE has taken specific steps to cope with the increase in activity that is normally experienced at this time of year. These include opening beds which are normally closed for seasonal reasons.

Other actions taken by hospitals include increasing the number of ward rounds to ensure that any patients who are ready to go home are discharged with support as necessary from community-based services. Hospitals are also ensuring that discharges are carried out early in the morning and over the weekend to make beds available for patients being admitted through the emergency departments. In addition, the HSE is working to have senior clinical decision makers and diagnostic services speedily available for emergency departments. The HSE has also provided for enhanced GP out-of-hours services through the expansion of the GP co-operatives.

The steps I have outlined are taken to address the current short-term difficulties. Improving access to hospital services requires a wider health-care approach. In recognition of this, the HSE has undertaken a number of initiatives in recent years. These include the winter initiative programme, the introduction of the code of practice for integrated discharge planning and actions to reduce the number of delayed discharges, including the introduction of the fair deal. Other innovations undertaken by the HSE include the development of emergency care networks and the acute medicine programme which involves the establishment of acute medical and surgical assessment units, rapid access clinics and minor injury units. The programme seeks to channel patients quickly to the service best suited to their needs and to reduce the usage of emergency department services by those who can be best treated elsewhere. A new acute medical unit was opened at Cork University Hospital last Monday. Other similar units are already in place at Kerry General Hospital and St. Luke's General Hospital in Kilkenny. The HSE service plan for 2011, which I recently approved, commits to the establishment of 12 acute medical units during 2011 with an investment of €8.5 million.

Emergency departments have particular infection control protocols in place for staff to manage patients attending with flu-like illnesses including the H1NI virus to minimise risk to patients and staff. The key to addressing the emergency department challenge is an integrated proactive management by all concerned throughout the system. I have asked the HSE to ensure that minimising waiting times in emergency departments is a key priority in their service to patients.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I wish the Minister a happy new year in her first Question Time of the new year - possibly her last if I hear correctly what is going on outside.

As I raised this issue with you this morning, a Cheann Comhairle, I will now read into the record of the Dáil the question I put and not the question that was issued by the General Office:

To ask the Minister for Health and Children in view of the number of patients waiting on trolleys in accident and emergency, which reached an unprecedented high of 569 in January 2011, the precautions being taken to protect patients from cross infection from swine flu and other hospital infections; the additional capacity put in place to deal with the winter increase in hospital admissions; the way she will defend the closure of beds when demand is high; and if she will make a statement on the matter.

While the Minister has given us her answer, I must point out that in January 2007 the average number of people lying on trolleys was 243. It increased to 286 in January 2008, 346 in January 2009 and 387 in January 2010, and so far this month the average has been 464. Whatever plans the Minister has been putting in place have clearly not worked. Given that we know this increase in demand occurs every year during the winter and we end up with this crisis, surely to God there ought to be a plan to deal with this problem, with an additional ward available in the hospitals most at risk. Why has the Minister not, as I have suggested before, put out to tender to nursing homes for additional beds with associated occupational therapy, physiotherapy, and speech and language therapy? That would help to move out of our hospitals 500 patients who have finished the acute phase of their treatment.

I also asked about swine flu and cross-infection. On Monday night I was stopped on the road by a taxi driver who told me his wife had been admitted to the Mater Hospital with emphysema and she now has swine flu. I spoke to a doctor at Beaumont Hospital who told me about a younger man with cancer on chemotherapy who was left beside a patient with swine flu, subsequently contracted it and became very unwell. These are real risks for people that are unnecessary if the situation were handled properly. What realistic plans is the Minister putting in place now? Why have the plans she put in place in the past not worked? The lack of junior hospital doctors is putting even more pressure on our hospitals in their ability to deal with the influx of patients into hospitals. How many junior hospital doctor vacancies now exist?

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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I have no role in phrasing the questions, nor has my office; it is a matter for the General Office. I want to make that clear - in fairness I do not believe the Deputy was suggesting that.

Photo of Charles FlanaganCharles Flanagan (Laois-Offaly, Fine Gael)
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The Minister does not have a role in answering them either.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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The Minister without interruption, please.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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I will not respond to that provocative comment from Deputy Flanagan.

I will not dispute the figures even though the official figures are different from the figures quoted by the IMMO. Arguing between 400 and 569 is a futile exercise; from my point of view too many people have to wait for an unacceptable period of time in emergency departments. The truth is that there has been virtually constant improvement over the years. For example, last year during January an average of 57 people were waiting and the previous year it was 69. Until we get to the end of January we will not be able to see what the average is for this year. However, those figures are still too high.

The initiatives being taken include the fair deal, which has had a dramatic impact on late discharges. Additional capacity is coming on board; for example St. Joseph's in Deputy Reilly's area will greatly relieve pressure at Beaumont Hospital. Owing to HIQA requirements, that needs to be ramped up gradually and cannot be opened all at once. The opening of the new unit in Cork last Monday has already had an impact on Cork University Hospital. Ultimately, the decision on waits in emergency departments relate to the overall functioning of the hospital. In particular, I am not satisfied with the functioning of six or seven hospitals that constantly have problems, which is why the HSE recently appointed a team to go into those hospitals - in the first instance they are in Beaumont, Limerick and Drogheda. Shortly they will go into Tallaght hospital to work with those hospitals. The team is composed of people from here and from the UK - they successfully completed such an exercise in the UK. It will work with those hospitals on the internal mechanisms that lead to long and unsatisfactory waits for patients in emergency departments.

The HSE had closed more than 400 beds, a seasonal measure taken over Christmas, which is always a quieter time for hospitals. Those beds did not reopen on time this year; I accept they should have opened earlier. If they had opened, we would not have had the problem we had last week. Those beds have now been opened, but for cost reasons the remaining beds cannot and will not be opened. I do not believe it is an issue of simply opening more beds. There is a subsequent question on hospital beds. It is a matter for the appropriate functioning of the hospital - daily discharges with senior clinicians on hand seven days a week. The HSE is putting in place structured clinical cover at the weekends in the hospitals to ensure that the emergency departments do not suffer from the kind of problems we experienced last week.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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How long does it take to solve a problem? The Minister stated this was a national emergency in 2006. I would have to dispute the Minister's point, that matters were getting better. There were over 550 patients one day last week, according to the INMO figures, and 442 is the figure for today. If the Minister has been to any of these emergency departments, they are squashed into tiny little spaces in most unsafe conditions.

Would the Minister accept that whatever measures she put in place in 2006 when she stated it was a national crisis have failed? Has she, as I asked in my question, carried out a review of those measures to judge their success and see what has been successful and what has not? She states that the HSE will do this, that and the other now, but this dates back to 2006 on her own admission. We cannot live horse and get grass. There are people lying on trolleys for hours on end who cannot wait until such time as someone somewhere decides to do something.

There are currently, according to the INMO, 1,672 beds closed in the system. Will the Minister give the authorisation to open up some of those beds so that we can get rid of this scandal of people lying on trolleys? The main reason Limerick and Drogheda - two of the hospitals to which the Minister referred - are in trouble is because they are having to cater for people from all over their regions and because she has closed other emergency departments. Let us get real here and let us solve this problem for the people of this country.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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I say to Deputy O'Sullivan, and mentioned this in response to Deputy Reilly, I will not dispute the figures, except those figures that are not correct. The highest figure at 8 a.m. last week was 414. It suits people to quote an INMO figure one day when it is less favourable and on other occasions to quote a different figure.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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I only always quote the INMO figure.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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In fairness, Deputy O'Sullivan should quote the official figures.

Second, we will not be opening more beds. We have opened over 400 beds that were closed over the Christmas period for seasonal reasons, which is normal and has been normal for umpteen years.

There have been significant improvements. That is not to say that there have not been occasions when there were blips. We all are aware that there is a swine flu problem. That has led to over 300 people being in hospital over the past period.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Even the Ministers officials state that is not a major factor.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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It is a factor. If swine flu patients are taking up over 300 beds and over 70 ICU beds, it is a factor. It is a bigger factor this week than it was last week because we have seen a doubling of swine flu incidents this week over last week. It has been doubling each week for the past number of weeks and there will be a press conference later today to review that.

Among the issues identified by the Comptroller and Auditor General, and everybody else who has looked at this issue, is the need for senior clinicians in the hospital seven days a week, particularly at weekends because there was a high incidence of those who were in hospital on Friday still being there on Monday. That is being put into effect. That is possible, both under the new consultant contract and some other issues to do with the Croke Park agreement which are crucial to staff working differently, particularly as far as diagnostics are concerned. Many patients end up waiting an unacceptable time in the emergency department because they cannot access diagnostics speedily, particularly at night and over the weekends. I look forward to some of the initiatives that have been tabled by the management of the HSE in the context of the Croke Park agreement being agreed in order to address some of those issues.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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We need to keep moving. There is limited time.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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We will keep moving all right, the Ceann Comhairle need not worry about that.

I want to correct the Minister. The figures that I gave in this House are totally at variance with how she can say matters have improved significantly. The figures come from the INMO site. They may be at variance with those of the HSE which has driven the emergency room consultants to draw their own numbers up as they grew weary of arriving in the morning to be told there were three persons on trolleys in their department when they could clearly see there were still eight, nine or ten waiting for a bed overnight. We have consistently quoted the INMO, the Irish Nurses and Midwives Organisation. I repeat that there were 243 on trolleys in 2007, 286 in 2008, 346 in 2009, 387 in 2010 and 464 in 2011. It has got worse year on year and for the Minister to state otherwise is to go back to the GUBU years of former Taoiseach Charles J. Haughey in the belief that if one states it often enough it is so. I say to the Minister it is not so for those who must suffer those conditions in this country and it has gone on too long.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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Let us remember it is Question Time.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I will ask a supplementary question. Why is it not possible to open more beds? Why, when the Minister is paying out €1.1 billion annually in overtime and allowances, can she not take some money away from that through proper organisation - overtime should be an exception - and use it to temporarily open beds? Why has the Minister not brought in generic drugs prescribing and drugs reference pricing, which, the Minister herself admits, could save a couple of hundred million euro but which she has put on the long finger?

Is the Minister saying to this House that the emergency room consultants of this country are talking through their hats when they state they believe the swine flu has very little to do with the significant numbers who are now attending? I am aware that in one hospital, the number admitted up to two weeks ago was only 12.

Since I have come into this House the Minister has muddied the waters. Those who come to accident and emergency looking for an X-ray or some other diagnostic test because they cannot get it in the community-----

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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Deputy Reilly is imparting information.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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-----do not get admitted, are not waiting on admissions and are not counted as persons lying on trolleys. They are people in for a test and they then leave.

The sad point on which I will finish is that the bulk of the on average 464 patients each day this year are sitting on plastic chairs with IV drips hanging out of them, in distress, with no privacy and exposed to cross-infection. That is the reality. In Beaumont alone, there are only 12 trolleys and yet there were 47 at one stage waiting admission. There were four Buxton chairs, which leaves 31 patients waiting in admission on plastic chairs.

That is the Minister's legacy in health in January 2011 and it saddens me to say it. She has been an utter failure. Her plans have failed at every turn. She has no new plans. She stands here before us today and tells us there has been significant improvement. Tell that to those who get cross-infection and to those with cystic fibrosis who risk the needless additional anxiety.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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Deputy Reilly needs to conclude his contribution at this stage.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I would try to keep it short if I could get answers to questions that were based in reality, not in cloud cuckoo land fantasy.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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As Minister for Health and Children, I do not like having to say this. Deputy Reilly is a doctor and he should think carefully about the kind of things he says, both here and outside, because a number of his colleagues have spoken to me about the scaremongering in which he engages.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Nothing I ever said has not been repeated by the Minister's document.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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The Deputy should listen.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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Second, I do not misinform the House or tell lies in this House. Deputy Reilly is a relatively new Deputy. He should be careful about making allegations of that kind.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I will cite the Minister three incidents and I will send them in writing to her and the Ceann Comhairle.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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Can Deputy Reilly listen? The information I have put on the record in this House is the information that is available to me and given to me by my officials in good faith.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Massaged by the HSE.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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If mistakes are made they are corrected.

Notwithstanding the fact that there has been an extra 100,000 people visiting emergency departments over the past five years and even in that context, there have been significant improvements. All of the research, both in Ireland and elsewhere, on emergency departments is that quick access to diagnostics and key clinical decision makers are the two most important ingredients in ensuring speedy access through the emergency department.

The reforms that we have been putting in place are leading to significant improvements, and most of those reforms have been opposed by Deputy Reilly because every vested interested is represented by him, as health spokesperson for his party.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Including the patients.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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The total market for generic drugs in Ireland is €300 million. Unless we got the drugs for free, we could not get more than €300 million. If they gave us all the drugs for free, we would get €300 million. Deputy Reilly constantly states, when the information is at his disposal, that we would save hundreds of millions of euro by simply introducing reference pricing. We are introducing the legislation this year and it will save an extra €7 million this year. I have taken a couple of hundred million euro in costs out of the drugs bill and Deputy Reilly has opposed it. He would not even stand up to the pharmacists when we were reducing costs in the way they were remunerated. I will not take any lecture from Deputy Reilly about drugs because he opposed all of the changes we made.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Including the prescription charge, which I do still.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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Deputy O'Sullivan on a brief supplementary. We need to move on.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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I think I am entitled to half of the time for these two questions.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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Yes. We do the best we can for Deputy O'Sullivan.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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I want to ask a simple question of the Minister. Why will she not sanction the opening of more beds in order to relieve this pressure and take those poor patients out of their misery when they are lying on trolleys?

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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First, we do not have the money to do so. Second, it is not the only way of dealing with the problems that arise in the emergency department.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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It is the only quick way.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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The other ways are not working.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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They are. In a moment, I will give data on beds. With fewer beds there are more than 1 million more people being treated in our hospitals. The solution is not more of the same and pouring more money into doing things the way they have always been done. There must be change through innovation like the acute medicine programme, which I know Deputies opposite have been briefed on and which is to be introduced in some of our hospitals. As some hospitals are not performing to the standard expected, we have brought in teams to help them. It is being done in the UK. The teams that were involved in the UK are here to help our hospitals.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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That is fine but why are new beds being opened?

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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They are not being staffed. As the Deputy knows, it is not about the physical bed.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Absolutely. What is the point in having them?