Michael Harty (Clare, Independent)
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4. To ask the Minister for Health the actions he has taken to reduce the number of persons waiting on trolleys, chairs and temporary beds for hospital admission; and if he will make a statement on the matter. [17263/18]

Michael Harty (Clare, Independent)
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What actions has the Minister taken to reduce the number of patients waiting on trolleys, chairs and temporary beds for admission to hospital? The trolley queue is a reflection of the problems in our health service. It brings up health and safety issues for patients and staff, such as with the transmission of infections and diseases when waiting for admission. This has a detrimental effect on patients. What actions is the Minister taking to alleviate this problem?

Simon Harris (Wicklow, Fine Gael)
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I agree with the Deputy's analysis of the problem. It still beggars belief that we reduced the number of hospital beds in this country long before the troika arrived in town. I believe we can do much more in community and in primary care. Even as we do that, there is a clear, compelling and indisputable case that we need to provide more acute hospital beds. There will be certain things we can never do in the community, even with all the investment we appropriately should make in general practice.

Against a background of growing demand for unscheduled care and high acute hospital occupancy rates, the Government provided €30 million in 2017 and a further €40 million in 2018 for measures to increase acute hospital capacity and alleviate overcrowding in emergency departments. Almost 50% of this funding was used to deliver home support packages and transitional care beds to reduce the incidence of delayed discharges. More than 200 beds have been opened this winter and more beds are due to come on stream later in the year. My colleague, the Minister of State, Deputy Jim Daly, will undertake some work in the Department to ensure all elements of the health service are working together on late discharges.

Notwithstanding the increased level of resources provided, this winter has been particularly difficult for our health services, with emergency department attendances up 3.7% and admissions up 3.3% during the first quarter of the year. Despite the fact people in the health service are working extraordinarily hard and additional investment has been made, capacity to meet attendances needs to be put in place.

The situation was further exacerbated by Storm Emma and the severe weather that followed. In response to this, I allocated a further €5 million in emergency funding to provide additional home support packages and transitional care beds to assist the safe discharge of patients who required support to return home following the adverse weather.

11 o’clock

In light of the conclusions of the health service capacity review, raised at the Joint Committee on Health yesterday, that the system will need nearly 2,600 additional acute hospital beds by 2031 as a low-end figure even after we do all of the reforms that we need to do, I have asked my Department to work with the HSE to identify how we can front-load some of them. In other words, how we can put some of the reforms in place by the end of this year, and identify the location and the variety of build methods that could help to achieve that. The demographic pressures are very clear and we need to get on with delivering on the capacity review. I am pleased that it is now fully funded, but I now need to look at options to front-load it, because in the Deputy's part of the world, it is not good enough to tell University Hospital Limerick that it will be several years before a 96-bed ward block can be delivered. We need to see if there is an interim solution to put more beds into that facility.

Michael Harty (Clare, Independent)
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I thank the Minister. Many of the actions he has outlined deal with the problems of lay discharges after they have happened. It is poor excuse to talk about the weather as being a problem where our hospital trolley count is concerned. It is not about the weather. The Taoiseach has said that we should not dwell on trolley numbers or waiting lists because they do not reflect the excellent work that is done in our hospital system. Of course excellent work is done in our hospital system, but that is despite the system rather than anything else.

Trolley numbers are a reflection of inadequate bed numbers, the failure to recruit and retain staff and a weak and under-resourced primary care service. They are a reflection of the growing population, as the Minister has identified, and the ageing population. It is a reflection of management structures that are 40 years out of date, and unless there is substantial reform in our health service, we are going nowhere. It is akin to a slow puncture. We are now running out of air in our tyres, and soon we will be running on the rim.

Between 2014 and 2017, average trolley numbers rose by 47%. If one takes the first month of the last five years, they have risen by 51%. We are not dealing with the problem. The average trolley number this month is 515, an all-time record. My question to the Minister is what is he going to do about this now. I do not refer to measures he is going to take in the distant future. When will the Minister realise that a fundamental reform of our health service is required, and not just the attempts to adjust a failing service we have at the moment?

Simon Harris (Wicklow, Fine Gael)
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I realise that fully, and the Deputy knows from our detailed discussions, both in one-on-one meetings that we have had in his capacity as Chairman of the Oireachtas Committee on Health and in my public actions and comments, that I fully recognise it. Mentioning Storm Emma is not about making an excuse, but about recognising what front-line staff and management tell me, which is that the already overcrowded situation was further exacerbated. Certainly the storm did not cause the trolley situation. I never said that or suggested that it did.

Capacity is a key issue here. I do not want to see primary care and community care pitted against acute hospital care. If one actually looks at the capacity review, it is very clear that even after all the reforms very clearly articulated in Sláintecare, which we need and want to make, there will still be a need for additional bed capacity in the health service. That is bed capacity that was not put in during the Celtic tiger years, or was taken out long before the troika arrived in town.

I have been very clear that I have the funding to deliver the 2,600 additional acute hospital beds through Project Ireland 2040. That is a ten year capital plan. Some projects, such as building a wing in a hospital, take time. We know that, but what can I do now, quickly, to get additional beds into the system? The HSE is carrying out an audit of where new beds could go into existing buildings, and where other methods like modular build could significantly increase capacity in the system for this winter. That is absolutely vital. Some hospitals are paving the way. If one looks at the trolley figures in Beaumont Hospital or Our Lady of Lourdes Hospital Drogheda, one sees how we can make progress where capacity is added to primary care and acute hospital care along with appropriate management.

Michael Harty (Clare, Independent)
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I thank the Minister. He mentioned University Hospital Limerick. I note that University Hospital Limerick consistently has the highest number of people waiting on trolleys. The average number waiting on trolleys for this month alone is 56. It is double the number for the next worst hospital in the country on a daily basis. I get representations, I am sure like every other Deputy, including the Minister himself, on the trolley numbers and the experience that people have waiting for admission. I have had cases where people have had to bring food to their relatives while waiting on trolleys, because they were not being offered sustenance while they were there. What has happened in Limerick and elsewhere is a cart-before-the-horse reconfiguration.

Simon Harris (Wicklow, Fine Gael)
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Yes.

Michael Harty (Clare, Independent)
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In Limerick, beds were taken out of our small peripheral hospitals, but they were not put into Limerick. It was a cart-before-the-horse reconfiguration, and it is a salutary lesson for any other areas where there may be reconfiguration. If services are not put in place in the central hospital before they are removed from the peripheral hospital, we will have what happened in Limerick. It is important that the Minister treats this matter urgently. There needs to be a commitment on the fundamental restructuring and reform of our health service. The Minister has had a report on his desk for the past 11 months and he still has not delivered a response to it. It is a shocking indictment of the Department that it has failed to address the solutions in the Sláintecare report.

Simon Harris (Wicklow, Fine Gael)
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We are going to deliver the Sláintecare report. As the Deputy knows, I have three big asks and projects that I had to bring to the Government for approval, and on which I had to work with colleagues in other Departments to make sure they are backed up by significant resources. One concerns the capacity report on capital. Health has been starved of capital for years, even during the Celtic tiger era. Schools and motorways were built, but somebody forgot that it was actually important to invest in capital build for our health service. Beds were taken out, which was bizarre. Capital projects, the capital plan and the capacity plan have now been funded. Some €11 billion has been allocated to capital for health in the next ten years, compared to €4 billion for the past ten years.

The next piece was the GP contract, an issue Deputy Curran and I have discussed many times. Negotiations are to commence by the end of this month, backed up by resources to invest millions of euro. The next big piece of work is to bring the Sláintecare implementation plan to Government. I expect to do that by next month. I have been working very hard with colleagues across the Government to make that a reality. I also expect recruitment for the lead executive for the implementation office to conclude by the end of this month, and to be advised by the Public Appointments Service of an appointment shortly after that.

On Limerick University Hospital, the Deputy is entirely correct. It is absolutely an example of how not to do reconfiguration. Our promise is that change will happen now, and we promise that a better, brighter service will follow in the future. Limerick is owed beds, and needs beds. I am very determined to work with representatives from that area and hospital management to get that capacity quickly. Limerick sees more patients than Beaumont every year, and has fewer beds than Beaumont. We have to address that issue.