Dáil debates

Tuesday, 16 December 2014

Topical Issue Debate

Accident and Emergency Services Provision

10:10 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I welcome the opportunity to raise the issue of the number of people waiting on trolleys in Beaumont hospital. This issue does not pertain solely to Beaumont, however, because we now have a major crisis on our hands in emergency departments throughout the country. Mr. Duffy, the CEO of Beaumont, rightly expressed concern about the more than 100 people on late discharges who are tying up bed availability in that hospital. Shall I wait until the Minister for Health has finished his conversation?

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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He is trying to sort his life out. He is a busy man.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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More than 45 people were waiting on trolleys in the emergency department in Beaumont recently. There is a lack of urgency in dealing with this issue. At any one time, 100 people are in Beaumont hospital when they should be in nursing homes, in receipt of home care packages or in other step down facilities. The funding provided as recently as the budget shows that the Minister is not taking this issue seriously enough to provide adequate funds to shift people from acute hospital settings to more suitable facilities. Forever and a day we have been debating the numbers waiting in emergency departments and on trolleys. The HIQA report on the ambulance service found inordinate delays in transferring people from ambulances to emergency departments because of overcrowding. The Minister has to take a hands-on approach with this issue. He cannot say it needs a long-term solution. Four years ago the Government committed to resolving the problems affecting emergency departments. This is a national crisis which persists without any effort on the part of the Minister or the Government to address it in a meaningful way.

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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Beaumont hospital, which is located in my constituency of Dublin North Central, faces a serious crisis. The Minister needs to wake up and face the reality because many families of patients have the impression that he does not understand what is happening on the ground. One nurse who worked in one of the wards expressed disgust that people were being left on trolleys for 70 hours and that 20 patients were waiting on chairs. Beaumont can only accommodate 26 extra patients on trolleys and the rest have to go on chairs. In recent weeks, there were 49 more patients than beds. Nationally, in the region of 300 patients are on trolleys. This is a national emergency. Beaumont hospital had to go off call during the week because it could not deal with the crisis. In 2007, the former Minister for Health, Deputy Reilly, was prancing around the Dáil on this issue as Opposition spokesperson on health. The silence on that side of the House has since become deafening, however. Approximately 100 beds in the hospital are occupied by patients who should be accommodated in nursing homes or other long-term care. This is part of the solution. We need to fund these packages and nursing home places if we do not want to leave more senior citizens and ill people on chairs and trolleys. That is not acceptable in 2014.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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I thank Deputies Billy Kelleher and Finian McGrath for raising this issue. Many emergency departments are currently experiencing overcrowding, although Beaumont is one of the worst. It is a busy time of the year, with increased numbers presenting for treatment and requiring extended observation or admission. This is compounded by a rise in winter-related illnesses.

As well as larger numbers attending emergency departments, including those attending Beaumont, the older age profile and nature of their medical needs result in longer than average stays in hospital and delays in discharges. This is a further difficulty in the management of patient flow. Additional funding of €25 million has been provided in 2015 to address delayed discharges. These funds are targeted at hospital and community services which can assist in discharging patients by addressing their care needs outside of an acute hospital setting and will free up bed capacity and, therefore, reduce emergency department overcrowding. An extra €3 million was allocated in this year's recent Supplementary Estimate for health to allow the delayed discharge initiative to start this year, rather than next year as originally intended. This has facilitated the allocation of 1,000 additional fair deal and nursing home places in the past week, compared to the usual 700, an additional 400 home care packages and the provision of step-down and community beds, including 19 for Beaumont, for patients who do not yet have a long-term care place or an appropriate support package to facilitate their return home. A number of patients who had been awaiting discharge from Beaumont have been able to leave hospital as a result. Many others have been approved for funding but there have been delays in getting them to the nursing home or back home.

As well as allocating additional physicians to the emergency department to assess patients, Beaumont hospital has cancelled elective surgery and is currently accommodating patients who have been waiting the longest in its day ward. The media have highlighted the pressures on the hospital, and this has helped reduce presentations. Patients have been advised, where possible, to attend GPs or other health care clinics. GPs are also being asked to consider referring frail elderly patients who require rapid geriatric assessment to the Mater-led clinic in Smithfield so they do not have to wait in busy emergency departments.

Hospitals have been working with the special delivery unit on winter planning initiatives to address the anticipated seasonal surge arising principally from changing weather conditions. However, the successful management of access to emergency and acute care cannot be solely dependent on intensive, short-term solutions. The emergency department task force is being re-established to develop such solutions. It will meet for the first time on Monday, 22 December - I intend to be present - and monthly thereafter in order to address solutions to problems being experienced by emergency departments.

Overcrowding in emergency departments has been a feature and failure of our health service for as long as I can remember. It was a problem this time ten years ago when I was a senior house officer in Beaumont's emergency department, and it was a problem when I visited the emergency department last week to speak with patients on trolleys and chairs. Overcrowding waxes and wanes and its severity varies from place to place but I want to get a handle on the issue in the coming year. The report due to be published later this week will show a significant improvement in ambulance hand over times, which is evidence that the actions we put in place are producing results. Short-term actions are under way but they are not enough. We also need long-term solutions. On the northside of Dublin and in other parts of the country there are simply not enough nursing homes, even if fair deal packages were available.

Generally, people in Dublin are not willing to send their relatives to nursing homes hundreds of miles away and, frankly, they are right.

It was not, in fact, the last Minister who described this as a national emergency, but a Minister ten years ago. He was an Independent Minister in a Fianna Fáil-led Government. Declaring it a national emergency ten years after it was declared a national emergency seems a little silly. What is important is to get things done.

10:20 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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The Minister's difficulty is that it is a national emergency, because 45 people were waiting on trolleys in Beaumont Hospital a few days ago. Despite all the excuses and the pretence, this did not sneak up on the Minister. The problem has been evident for some time. It has also been evident in the context of nursing homes. As everybody knows, the demographic trends clearly show that our population is getting older annually. There is a 4% increase in the number of people over the age of 80 every year. The idea that this just happened all of a sudden and everything had been fine all along is not the case. The Minister was forewarned about this, as was the previous Minister.

We simply cannot have a situation where over 700 people who are defined as late dischargers are in beds in hospitals throughout the country every night. Mr. Duffy said there are 100 in his hospital who should be elsewhere. However, there is a paltry sum for nursing homes in the Supplementary Estimates and in next year's funding as well. The bottom line is that there is a huge scarcity of nursing home beds and that issue has not been addressed either in the context of extra funding for the fair deal scheme or in the incentivisation of the provision of extra nursing home beds. Until such time as the Minister resolves that, there will be people on trolleys for a very long time.

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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The Minister's response shows that it is a national emergency and crisis. It also shows the priorities of this Government. Intelligent people can plan for the seasonal problem issue and the cold winters. There will be times when there are build-ups, but there can be a long-term plan and a crisis or emergency plan put in place. As Deputy Kelleher said, there is the wrong patient in the wrong bed syndrome. Liam Duffy said that during the week with regard to the 100 beds in his hospital. The patients should be placed in proper nursing home care environments or be given home care packages.

The catchment area of Beaumont Hospital on the north side has an older population with many senior citizens. Also, last August the Minister was warned by people who work in the front-line services that a crisis was coming down the line. I urge the Minister to focus on this issue and to get his priorities right.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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There is no pretence. I am very aware that there is a serious problem with overcrowding, trolleys and delayed discharges in our hospitals. In many ways, they are symptoms of a more systemic problem within our hospitals. Warnings are not solutions. Solutions require plans, money, action and co-operation. It was mentioned that there are approximately 800 delayed discharges. The additional €25 million is not paltry. It is 300 additional long-term care places and 400 additional home care packages. That is a total of 700. It is not as simple as 800 minus 700 because, of course, new delayed discharges arise every week. However, it will allow us to get a handle on this for a period in the short term. It will not solve the problem.

Part of what is being put in place for the longer term is the opening of Mount Carmel as a community hospital in Dublin. Dublin, uniquely, does not have a community hospital for step-down care. It will now have one for the first time, with the first beds opening next March. We are putting in place additional community intervention teams. These are nurses who can see patients at home. Patients can be discharged more quickly and get their IV, intravenous therapy, at home. Nurses can also go to nursing homes. For example, if an elderly person in a nursing home has a urinary tract infection, UTI, or an infection, they can be treated in the nursing home and not be required to go through the emergency department.

We have a suite of short-term solutions and a suite of long-term solutions. There are also big issues around patient flow, and that will require a lot to happen. It is disappointing, but true, that in many of our hospitals ward rounds are not happening at weekends and during the day. Patients are not being discharged by consultants as they might be. It is also unfortunately true in our hospitals that when beds become available they go to elective admissions, even when there is overcrowding in the emergency department. It is a very difficult issue to tackle.

It is interesting to see the huge variations from hospital to hospital. Two miles away from Beaumont Hospital is the Mater Hospital, which has a very similar catchment area and a not dissimilar budget, and not far away from there is St. James's Hospital. They have their problems, but certainly not on the scale of Beaumont Hospital. Beaumont Hospital has had problems since the day it was opened.

These are not straightforward issues. It is not a case of Action Man Minister going there with a bag of money or a ministerial order-----

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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The Minister was an Action Man in opposition.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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-----but it will be a very high priority for me next year. I will not promise that I can magic it away through action and money. It will require a persistent focus over a long period of months.