Michael Harty (Clare, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for coming in to address this matter, which is very topical. It concerns our accident and emergency departments and the length of our trolley queues, which are growing year on year. Compilation of the numbers started in 2013. Each year they have increased and each month of this year they have increased. It is a year long issue now. The Department of Health today produced its winter plan for 2018 and 2019 to try to address this issue and blunt the peak that occurs between December and March every year. However, the peak is just a peak in a continuing escalation of the crisis in our hospital and emergency departments. In March of this year we had a peak of 714 trolleys. Earlier in November we had a peak of almost 600. This is clearly not just a winter problem; it is a year-round problem. There does not seem to be any improvement in it. The winter plan was produced today, 6 December, which is much too late to deal with the problem this year. It addresses issues which should be addressed the whole year around.

How are the Minister of State and his Government going to address the health service? The trolley count is purely a symptom of what is happening within our health service. The problem is not in our accident and emergency departments. It is throughout our health system. Unfortunately, however, it is manifest in the long delays in people being admitted to hospital. We have an aging population and changing demographics. Some 20,000 people reach the age of 65 every year and the population above the age of 85 is due to double in the next ten years. These are the people who occupy our hospital services and take up most of the time. Yes, it is a tribute to our hospital system that people are living into their old age. Nevertheless we have to try to deal with these acute and chronic illnesses.

We must move away from a system which directs every patient to the hospital service. It is the default position. When people get ill, they end up in our accident and emergency departments. There must be a system which prevents that. Sláintecare is a ten year plan that has still not been implemented. There will be a three year run-in period between the start of the implementation of Sláintecare and its affect on our hospital services. What is this Government going to do to address the crisis?

The bed capacity plan stated that there should be an increase of 2,600 beds over the next ten years. That is predicated on the fact that if we start to reform our health service now we will need 2,600 beds. If we do not reform our health service now we will need 7,000 or 8,000 beds. The issue is inefficiency and a need for integration. We need an electronic healthcare record and a single patient identifier. These will be the first steps in trying to bring efficiency and cost-effectiveness, which is most important, to our health service. Unless we start to do that we will continue to have the trolley numbers that we have. Our system is locked and loaded for the next three years. Unless we start to reform, this problem will continue. Unless we start now, in three years we are going to have the same problem but it will be substantially worse.

Finian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context | Oireachtas source

I thank Deputy Michael Harty for raising this very important issue. I also thank him for his own contribution in the broader area of health. He has made many sensible and practical proposals, particularly in recent years. I welcome the opportunity to address the issues he has raised.

The Minister for Health acknowledges the distress caused by crowded emergency departments to patients, their families and front-line staff working in very challenging conditions in hospitals throughout the country. Hospitals are increasingly operating at or above capacity, with year-round demand pressures that increase in the winter months. According to the provisional data more than 93,000 patients have been reported as waiting on trolleys across the acute hospital system to date in 2018.

This reflects the increasing demand for unscheduled care so far this year, especially among patients in the 75 and over age group. However, it is important to put the trolley figures in context. More than one million people have attended our emergency departments so far this year. From May to October 2018 there was a consistent improvement in trolley figures when compared to the same months in 2017.

The Minister for Health, Deputy Harris, has welcomed today’s publication of the HSE winter plan 2018-2019 which will run from 1 December 2018 to 31 March 2019. The Government has committed significant resources to assist the health services across the winter period and the publication of the HSE service plan outlining how those funds will be spent is to be welcomed.

The Department of Health has been working with the HSE throughout the year to ensure the most effective response to the pressures on our hospital system associated with the winter period. As part of that process, integrated winter preparedness plans have been developed by hospital groups and community healthcare organisations to meet the anticipated surge in demand for healthcare services during the winter months. The plan will run until 31 March 2019 and includes a period of focused action from 17 December to 13 January on nine key hospital sites and their associated community healthcare organisations. Improved integrated working and enhanced community supports are central to the focus period. Bed capacity and home supports are being increased over the winter period.

This is a new and innovative approach by the HSE which seeks to build on the learnings from previous winters and the success in handling major events this year. Importantly, the plan optimises the use of existing resources and provides an alternative to emergency departments for patients, including extended opening hours and expanded services at local injury units, minor injury units and key primary care centres.

A central component of the plan which is already under way is the provision of an additional 550 homecare packages over the winter period to help patients return home from hospital with the supports they need. The winter plan will also seek to increase capacity in the first quarter of 2019. The national service plan 2019 will identify the sites for investment and the associated number of beds as well as the agreed capacity programme for 2019.

These initiatives will increase the number of available inpatient beds in the acute hospital system to more than 11,000, a level last seen in 2009. While I accept that the coming months will be very challenging, this plan represents a system-wide response to this challenge across the health service. It will be led at national and local levels by integrated teams representing community and hospital services.

Michael Harty (Clare, Independent)
Link to this: Individually | In context | Oireachtas source

The measures outlined in the winter plan are very good in theory but will be very difficult to implement in practice. They are superimposed on an already congested system which has no spare capacity. Hospital capacity in Ireland runs at approximately 95% to 97%. It is well recognised that a hospital which runs at 85% of capacity or more works very inefficiently, so we are already in a congested system which is working inefficiently. One should not propose putting extra pressure on that system.

The winter initiative proposes reducing the number of outpatient appointments over the period from 17 December to 13 January, but that will further congest the appointments system. More than 500,000 people are waiting for an outpatient appointment but the Government's winter plan proposes extending their wait. It also proposes reducing elective admissions. Our elective admissions run in the region of 72,000 patients. Reducing elective admissions during this period will, of course, free up beds for urgent cases at the winter peak, but that will postpone the calling of patients for elective admissions and extend that waiting list. The plan refers to decreasing diagnostics within hospitals to free up those diagnostics for acute and emergency care but those diagnostic services are already at full capacity.

It proposes discharging patients early, having extra accident and emergency department consultants available and extra consultants on wards to discharge patients. The community cannot cope with the current level of discharges. Our community intervention teams and public health nurses are worked to the bone, but the Government proposes discharging more patients into a system that cannot cope.

Finian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context | Oireachtas source

It must be acknowledged that attendances in emergency departments are growing year on year and that the health service capacity review indicates that Ireland has among the highest acute bed occupancy rates in the developed world.

The objective of the plan is to ensure the most effective response within available resources to the winter challenges in terms of unscheduled care provision. The four-week enhanced focus period targeting nine sites of concern builds on the experience the HSE has developed in the successful management of recent major events. The winter plan seeks to increase home supports, transitional care beds, and bed capacity in acute and community settings. In addition to winter measures, €10 million will be ring-fenced in the national service plan 2019 to increase bed capacity.

I acknowledge the concerns of the Deputy regarding theory and practice and the capacity issue and reducing pressure on the system. Those are valid points. However, we must deal with urgent cases as a priority.

Taken together, these initiatives will increase the number of available inpatient beds in the acute hospital system to more than 11,000, a level last seen in 2009. Although the focus is often on new and additional measures that will be introduced, it is essential that the health system maximises the use of existing resources and facilities, including model 2 hospitals, minor injury clinics, GP out-of-hours services and primary care centres.

All Members know that the challenges we face are significant and we all want to find the right solutions. We want patient-centred, evidence-based, results-focused sustainable solutions to the challenges currently facing our health services. The winter plan published by the HSE today is a good plan which optimises the use of existing resources. It represents a system-wide response to the challenges the health system will face in the coming months and it will be led at local level by integrated teams representing community and hospital services.