Dáil debates

Tuesday, 2 February 2016

Other Questions

Accident and Emergency Departments

3:40 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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65. To ask the Minister for Health why the overcrowding in hospital emergency departments has not seen a significant improvement despite the initiatives taken during 2015; if the €100 million shortfall in the funding for hospitals will have a detrimental impact on access to emergency department and scheduled waiting list targets in 2016; and if he will make a statement on the matter. [3924/16]

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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Why has the overcrowding in hospital emergency departments not seen any significant improvement despite the plethora of announcements made last year, the establishment of the emergency department task force, the move to address the issue of the shortage of nursing homes and the increase and enhancement in the fair deal scheme to move people from an acute hospital setting into community nursing care? Why do we still have a trolley crisis day in, day out, in our emergency departments across the country?

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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Over the last number of months the HSE has implemented initiatives to reduce emergency department overcrowding and wait times. From mid-January to the end of January there was a very significant increase in daily trolley numbers. This was due to higher numbers of patients presenting with flu-like and respiratory illnesses and a 10% increase in the number of older people presenting. In total, there was a 9% increase in emergency department attendances throughout January, which is an enormous increase. This has eased in recent days and, fingers crossed, that will continue. Today's trolley count is 15% lower than it was on the same day in 2015; it was 388 this morning, of which 190 people were on trolleys for more than nine hours.

In 2015, significant additional resources of €117 million, additional hospital beds and increased staffing have all been put in place in a four-pronged approach to tackling the problem. In order to reduce the number of patients having to attend emergency departments, community intervention teams and services have been expanded. The HSE has also driven a number of initiatives to expand hospital capacity. Some 338 hospital beds are being opened or re-opened, and more than 750 new nurses and 80 new consultants have been employed in the health service during 2015. Also, there have been additional measures in 2015 to support timely patient discharge from hospital, including reducing waiting times for nursing home places to four weeks, an additional 4,002 transitional care places, 224 public community beds and 2,250 home care packages. Mount Carmel also opened last year as a new community hospital. A new escalation protocol has been implemented, which sets out action that hospitals must take when overcrowding occurs, to provide better and safer patient care.

In 2016, health will have funding of almost €14 billion from the Exchequer, which is an increase of 7% on the original allocation for 2015. Of the 2016 health budget, €4 billion has been designated in the HSE national service plan for acute hospital services. This accounts for about one third of the health budget. With the full operation of the expanded services introduced during 2015 and continued productivity and efficiency improvements, emergency care will be delivered at or above the 2015 level.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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Many of this Government's policies on health are based on crossed fingers and a wing and a prayer because as we start into February 2016 we know full well that the acute hospital system is already underfunded. It will not have the capacity to deal with what presents, either through the emergency department or in the area of elective surgery, and that is already happening. There were cancellations of scheduled care on a continual basis during January to deal with hospital overcrowding. The Minister said, and this was an extraordinary statement, that the cancellation of elective surgeries showed that the protocols were working to deal with overcrowding in our emergency departments. Clearly, the difficulty is that we cannot consistently cancel elective surgeries to deal with the issue. We simply do not have the required capacity in the acute hospital setting, primarily in our emergency departments. Today there were 51 people on trolleys in St. Vincent's Hospital and 37 in Cork University Hospital, CUH, and throughout the country, 456 people were on trolleys either in the emergency department or on wards. Clearly, something must be done and the shortfall in hospital funding is not a good start for 2016.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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I do not want not quibble with the Deputy about figures but those figures he used also include people on beds, people in day wards and overflow wards, as opposed to regular wards. The number who are actually on trolleys is somewhat lower than that, but I appreciate it is not about the numbers.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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The Minister will always pick the lowest number.

3:50 pm

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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If I took the lowest number, I would take the number at 8 p.m. in the evening, which is generally lower than 200, even on a bad day, so that is not the case at all. The number at 8 a.m. is always the worst because of the number of people who come in overnight. A huge amount has been done in this space, probably more than in any recent year, but it needs to be sustained. The demands are very significant.

With regard to elective surgery, which is non-urgent and is being postponed, it is not being cancelled entirely. The fact that we are using the private hospitals has allowed us to keep some level of control over the waiting times for inpatient procedures and day cases. In recent months those waiting for long periods - more than 12, 15 or 18 months - for inpatient and day case procedures has gone down.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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When one analyses the full import of the Government's policies in the past five years it has been very scatter-gun. There has been no cohesive strategy whatsoever. We spoke earlier about universal health insurance, free GP access for everybody and the abandonment of the National Treatment Purchase Fund, NTPF, in favour of the special delivery unit. We now find that we are using private capacity to deal with elective and scheduled surgery. What was the logic in getting rid of the National Treatment Purchase Fund in the first place and for us then to be back out in the market trying to secure operations privately? The bottom line is that the Minister must accept he cannot consistently use the cancellation of elective surgery to deal with overcrowding in emergency departments. That is consistently storing up difficulties for the system and, equally it is simply not good enough for all those individuals who are waiting an inordinate period for their elective surgery only to find they are cancelled at short notice.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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The logic of getting rid of the NTPF was twofold. First, it was self-selecting in that people went to it themselves if they were waiting for a period and, second, it never managed to get rid of long waiting lists or waiting times. Instead, the resource was given to the special delivery unit, SDU, which then selected the patients who were waiting the longest and focused on them.

For the past 17 to 18 months the Deputy has taken pleasure in describing me as an analyst or commentator rather than an actor, which of course I dispute given the amount of things that have been done in the past 18 months in the health area.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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No, the Minister is an actor as well.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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The time has come for Deputy Kelleher to stop being a commentator and to set out what Fianna Fáil will do differently.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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We have, within the fiscal space.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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Is Fianna Fáil reiterating its prior commitment to abolish waiting lists and is Deputy Kelleher promising to get rid of trolleys from emergency departments?

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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Within the fiscal space.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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I take that as a "No".