Thursday, 16 April 2015
Hospital Staff Recruitment
9. To ask the Minister for Health to set out his views on whether the recruitment embargo and the reliance on staff on temporary contracts was a major factor in the overcrowding crisis in hospitals last winter; and if he will make a statement on the matter. [14708/15]
I am keen to ask the Minister about the impact of the public sector recruitment embargo on the health service. Information is growing that this is leading to a major sucking of resources and costs in terms of agency staff. Moreover, it appears the ban on recruitment has led to serious shortages of staff and has led directly to the bed and trolley crisis as well, because hospitals have been unable to recruit agency staff at key times.
There are many different factors that contribute to trolley waits. Some of those factors vary from hospital to hospital. While there are difficulties recruiting certain specialties of consultants and certain categories of non-consultant hospital doctors and nurses, recruitment was not a major factor in the difficulties faced by the emergency departments in recent months. Indeed, staffing levels were higher in January 2015 than June 2014 and the numbers of doctors employed by the HSE is at an all-time high. Delayed discharges, in particular, have been identified as a critical factor in the difficulties that arose and this reduced effective bed capacity. There was also a higher number of older patients who required a longer stay.
I convened the emergency department task force before Christmas to examine the matter as a priority and to make recommendations. The task force worked diligently on the issue and the report was published at the end of March. The plan being implemented on foot of this work includes additional funding of €74 million to address specific requirements identified, including nursing home places, transitional care beds and community and district hospital beds. I am determined that the task force action plan is put into operation without delay and I will take a personal interest in ensuring this.
In recent years the HSE has had the capacity to recruit where necessary to deliver front-line services. Since the Government came to office, the number of consultants has increased by 150, the number of NCHDs has increased by more than 600 since 2010 and the number of nurses employed by the HSE has increased by more than 500 in the past 12 months. Agency staff was also utilised to support service delivery.
The Minister for Public Expenditure and Reform announced in budget 2015 that he intended to delegate greater autonomy to Departments and agencies to manage their staffing levels within allocated pay frameworks. This change allows further recruitment flexibility, for example, where it is determined that offering permanent contracts can achieve more economical service delivery than agency use. The Department of Public Expenditure and Reform has advised that the HSE and Department of Health are required to submit a 2015 pay and numbers strategy to give effect to this decision. This strategy is currently being finalised. Following approval of the strategy, a letter of delegated sanction for staffing will be issued.
There may have been increases in recent months but staff have been gutted from the health service for six years. There has been a 10% reduction in that time.
There is a relationship between the trolley and bed crisis and the embargo and downsizing in general of our health service in recent years or since 2009. It got worse in 2014 under the watch of this Government. Some 77,091 people had to wait on a trolley in our health services in 2014, while in 2007 the number was 50,000. There has been a major increase of almost 50%.
I have it on good authority from managers of Connolly Memorial Hospital, which is in the Minister's constituency, that the embargo had played a direct role in making that hospital one of those with the highest numbers of patients on trolleys. The hospital could not recruit agency staff over Christmas because they did not want to work over Christmas. Moreover, the Minister has banned hospitals from recruiting staff directly.
Instead he is forcing them to go through a bureaucratic rigmarole. This has led to Connolly Memorial Hospital, in the Minister's constituency, having the highest number on trolleys in the State and the relevant HSE area on four occasions this week.
The figures Deputy Coppinger is using include people who are not on trolleys and who are not in emergency Departments. If Deputy Coppinger does not believe me, she should go to www.inmo.ie/Trolley_Ward_Watch. It will explain exactly how those figures are calculated. Specifically, in Connolly Memorial Hospital the figures include people who are put on the day ward or the surgical day ward when there is an overcrowding problem. They are not on trolleys.
The Deputy's thesis is entirely incorrect. Her thesis is that emergency department overcrowding was worse this January than last January because of staff shortages, but the facts indicate otherwise. The total number of consultants increased from 3,434 to 3,515, the total number of doctors increased from 4,918 to 5,302 and, for the first time in recent years, the number of nurses started to increase again. The number increased from 34,177 at the end of 2013 to 34,509 at the end of 2014, to 34,993 now, and today it is probably above the 35,000 mark for the first time in three or four years. Therefore, the Deputy's thesis that reduced staff numbers have caused overcrowding is clearly nonsense. There have been increased staff numbers and yet despite that there has been more overcrowding, so overcrowding must be caused for a different reason that is not primarily related to staffing levels.
If the Minister had listened carefully, he would have noted that is what I said. Connolly Hospital is one such example, of which I have good knowledge from talking to the managers of that hospital. They told me they could not recruit agency staff at key times such as Christmas and other times as the staff did not want to work. I do not know what the numbers are. My question relates to the fact that the health service has to pay out in this respect. For example, the hospital in Galway, as has been well publicised, had to spend €10 million last year on agency staff, which represents a five-fold increase in one hospital. Imagine the resources that is sucking from our health service. The Minister's ban on recruitment is leading to higher costs throughout the health service. Connolly Hospital has had the highest number of people on trolleys in the State on several occasions and that must be a bit embarrassing for the Minister as that hospital is in his constituency. On 10 April there were 30 people on trolleys in that hospital-----
-----and on 8 April there were 32 people on trolleys, which was the second highest number in the State. The Minister is certainly not looking after the health service in that area. We need a huge investment in public health-----
-----which involves taking resources from elsewhere, taxing the wealthy in society and introducing a financial transitions tax. We cannot continue to keep gutting the health service and making people pay.
I am a little confused about the point the Deputy is making. She is saying that Connolly Hospital could not recruit agency staff over Christmas because staff were not willing to work over Christmas, so it was not that there was some type of Government edict that they could not do it or that the resources were not there. They just were not able to find agency staff willing to work over Christmas, and if that was the case, that was the case.
As I pointed out in the numbers I gave the Deputy, we are creating proper jobs. We will hire at least 500 additional nurses to proper jobs with proper contracts across the country this year, but that will not get people off trolleys. People are not on trolleys because of the number of nurses. It is to do with admission rates, bed capacity and many other different issues. It is not the number of staff that causes people to be on trolleys; it is the fact that they are admitted and, for whatever reason, there is not a bed on a ward for them to go into.
The major problem I believe Connolly Hospital has faced, and this is what I have heard from the managers and consultants to whom I have been talking, is that there has been a very significant increase in the delayed discharges in that hospital. More than 40 people in that hospital, who would account for more than a whole ward, are now awaiting long-term care, and that is why we took the action we did a few weeks ago. I am hoping and expecting that this will alleviate the situation over the coming weeks. It is the case that on a couple of occasions in the past few months Connolly Hospital had more people on trolleys than other hospitals. There are 50 hospitals and it is not unusual for any given large hospital to top the table on a particular day.