Dáil debates

Wednesday, 21 January 2015

Ceisteanna - Questions - Priority Questions

Nursing Home Beds

10:00 am

Photo of Joan CollinsJoan Collins (Dublin South Central, United Left)
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5. To ask the Minister for Health the number of patients who have accessed beds in nursing homes from hospitals with the €25 million extra funding for the fair deal scheme; and if he will make a statement on the matter. [2438/15]

Photo of Joan CollinsJoan Collins (Dublin South Central, United Left)
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This question relates to the problem in recent weeks of the large number of people on accident and emergency beds. People who need care in the community, be it hospice care, public nursing home care or home care, remain in acute hospital beds because they cannot access those outlets. No one who does not need to be in hospital should be there. People should be where they are most comfortable.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for her question. Delayed discharges arise when a patient has been judged clinically to no longer have a requirement for acute hospital care but remains in an acute hospital bed, thus rendering that bed unavailable for patients who need admission. In budget 2015, the Government allocated €25 million to tackle the problem of delayed discharges. This additional funding is being applied across residential and community services to reflect the varying needs of patients.

Of the €25 million, €10 million has been allocated to the nursing homes support scheme, resulting in 300 extra approvals and a shortening in the waiting time for approval from 17 weeks to 11 weeks. Some 145 approvals were in acute hospitals and 107 were for long-term residential care. Some €8 million is being used to augment short-term residential care capacity and has provided for 50 additional short-stay beds sourced from the private sector. An additional 65 beds are to come on stream on a phased basis from March 2015. Some €5 million is being used for home care services, which will provide 400 additional home care packages to benefit 600 discharges across targeted hospitals. Some €2 million is being used to strengthen community intervention teams, which to date have facilitated 571 people in being seen in their own homes.

The HSE is considering every possible option for alternative accommodation, including vacant beds in private nursing homes, to address delayed discharges. Since 5 January, the HSE has been working to match patients whose acute care has been completed but who require ongoing residential care with suitable placements. This will see a potential movement of a further 250 patients from acute hospitals to other suitable facilities and is in addition to placements already approved under the €25 million delayed discharge initiative.

Photo of Joan CollinsJoan Collins (Dublin South Central, United Left)
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I thank the Minister of State for her reply. Matters certainly seem to be moving, but how many beds have been released by discharging patients from acute hospitals? How many does the Minister of State expect will be freed up for people by March so that those who do not need acute hospital care can receive the care most suitable to them and with which they are most comfortable?

This crisis in general hospital and community care owes to cuts. Losing 5,000 nurses in recent years is bound to have had an impact. Beds have been closed. Can we open more hospital beds to take in people from accident and emergency departments, which is where the main problem lies?

Later, I would like to hear from the Minister his opinion on the problem of the registration fee for nurses. They will not be able to pay the €150.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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As the Deputy rightly stated, the registration fee issue is for another discussion.

The €25 million has resulted in 300 extra approvals, with 65 approvals to come on stream in March. On top of these is the ongoing fair deal scheme allocation of 515 beds per month, as I outlined before Christmas when this issue was being discussed. The initiative should make some impact, but we must realise that we have an ageing population and this is winter, when even we get little infections that can be difficult to shift. We are determining what long-term plan needs to be in place to deal with this issue. I refuse to call it a problem, as it is simply part and parcel of what happens as we age. We need to plan for that, which is what we are doing. We have the statistics but planning is important and we are dealing with the issue in a comprehensive way.

As far as I know and apart from in community hospitals, which are non-acute, no beds are closed other than those that have been closed for reasons of infection control and so on.

Photo of Joan CollinsJoan Collins (Dublin South Central, United Left)
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I accept the Minister of State's comments, but if the Government is planning, it should have planned for what happened a number of months ago. Why are we in this situation if the Government has the statistics?

We know from yesterday that, by June, a number of public nursing homes could face bed closures.

Has the Government planned for that and the fact that, within six months, there could be fewer beds for people who need the care — I hate saying "step-down care" — that they cannot get in the acute hospitals? I refer to the care they need in their communities or homes. How are we planning for that? Is it being factored in for six months down the line? While I acknowledge it is winter, I believe we still need increased care for an elderly, ageing population. I will be elderly some day and hope we will be able to have in place the care that is needed.

10:10 am

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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It is a different subject but it is all connected. I understand we have a plan in regard to HIQA, standards and nursing home units, or long-stay units. As we all know, events can happen completely unexpectedly, or out of the blue, in the area of health that we do not know about and for which we are not planning. The difficulty is that there are times when we know exactly what we need to do but unfortunately do not always have the money to deal with the problem in a timely fashion owing to the circumstances the country finds itself in. However, we know about the issue being raised and do have a plan. My mantra seems to be that we know about the matter and have a plan but sometimes do not have the money. It is only with great good luck that Deputy Collins and I will reach later life, and we should accept that.