David Cullinane (Waterford, Sinn Fein)
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88. To ask the Minister for Health his plans to prevent emergency department overflows from interrupting scheduled care this winter; if he will provide additional resources to the National Ambulance Service to boost emergency care in the community; and if he will make a statement on the matter. [50783/21]

David Cullinane (Waterford, Sinn Fein)
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We are seeing presentations in emergency departments at record levels for this time of year. It is concerning for hospital managers and the staff on the front line, who are burned out and exhausted and are now facing into what they believe could be a dreadful November, December and January. What will the Minister do about the crisis in emergency departments and its relationship with the lack of GP services, particularly out-of-hours GP services, and the NAS? I have met the NAS several times in recent weeks. It has capacity issues.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for his question. As he mentioned, emergency department attendances have reached 2019 levels and exceeded them in some places. In 2019, 1.34 million people attended emergency departments and approximately 350,000 of them were admitted. I acknowledge the work of our front-line staff in keeping the emergency departments open throughout the pandemic.

Our figures for attendances underestimate the seriousness of the situation. Not only are attendances at 2019 levels, but many of the people attending are sicker, they have deferred their care, they now need more treatment and their average length of stay is longer. All of this is contributing to very significant pressures on our emergency departments. It is only October and we are facing into a tough time.

Tackling the issue of patients having to wait on trolleys is a top priority. Last year, we deployed €600 million as a winter plan. Critically, we locked the majority of that in through the budget for this year. This meant more beds, more diagnostics, more alternative care pathways outside the hospital sector and more home care supports. All of that is still in place, but we are doing more again with the HSE and the Department this year.

The NAS has undergone a significant process of modernisation, but its 2016 strategy did not get the funding for the level of change that was required. I agree that there are gaps in the service and that they need to be addressed. This year, I allocated a full €10 million to the NAS in additional funding, including €5 million in enhanced community funding, which has helped with the see and treat, and hear and treat, alternative care pathways, allowing the National Emergency Operations Centre to manage the low-acuity calls and try to keep people out of hospital.

As the Deputy will be aware, the HSE and the NAS are developing a new five-year plan. To help with that, I have allocated €8.3 million in new development funding next year and I have protected some of the underspend from this year.

David Cullinane (Waterford, Sinn Fein)
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We have to examine why we are seeing this high level of presentations. The Minister is right, in that many of those attending are doing so with more acute needs, which is presenting more challenges for hospitals. Another reason is the lack of out-of-hours GP services. The NAS has told me that there is an absence of a treat and refer policy that is underpinned by clinical governance and that there needs to be movement in this regard. Many people are calling ambulances because they cannot get access to GPs, meaning that more people are presenting to emergency departments. We are still not managing enough people in the community, in particular people with chronic pain, respiratory illnesses, diabetes and other conditions that can be treated in the community.

Every hospital I have visited across the State has said that it has submitted a capital application for new beds in single-bed isolation units - 42 beds in Sligo, 98 in Limerick, 50 in Cork and the same in Galway and Laois - but that, apart from dealing with all of the other problems, there is no urgency to put capacity in place. That is why there is such pressure on the emergency departments, which is causing havoc in those hospitals and stress for the people working in them.

Stephen Donnelly (Wicklow, Fianna Fail)
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I agree with the Deputy's comments on out-of-hours GP services. As part of winter planning and in the spirit of doing everything we can to help keep people out of hospitals, specifically emergency departments, that is an area that we are examining.

The next parliamentary question deals with chronic disease management in the community.

I disagree with the Deputy that not a lot is being done. A significant amount of work is being done and there has been a lot of progress in that area, which we will get into in more detail in regard to the next question.

By the end of this year, we will have added to the acute system more beds than have been added in any year on record and we will have done that in the middle of a pandemic. I am working with the HSE on some of the local issues. I am aware that there are clinicians in CUH, GUH, UHL and other hospitals who are saying that we need more beds and more capacity. That is true. There are a number of capital applications in, but it needs to be appreciated that we have already added to the acute system more beds than have ever been added in any year on record. We need to continue to push forward in that regard.

David Cullinane (Waterford, Sinn Fein)
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That does not tally with what I am being told by hospital managers. Across the State, all of them, with the exception of the Limerick hospital manager because that hospital got a new modular unit, are saying that many of the beds the Minister talks about are beds that were temporarily open anyway. They did not get capital funding to build new units and they are being asked to cram beds into very tight wards, which is not what we need to be doing when we are in the middle of a pandemic as it is not good in terms of infection control. The Minister needs to be looking at all of those capital allocations that will make a real and tangible difference to those hospitals and provide the capital as well as the revenue funding, which he did not do in last year's budget or in this year's budget.

I did not say that there is nothing happening in the community. I welcome the community intervention teams, the community health networks and the additional home help services. My point is that we have not done that quickly enough and we are still not managing enough patients in the community. We are not doing enough community assessments as well. When you have problems in the emergency departments it is because everything else has gone wrong. There are so many things going wrong that, like a volcano, it erupts in the emergency departments. The people on the front line are telling me they have had enough. They genuinely dread and cannot sustain a winter without the capacity, tools and support they need.

Stephen Donnelly (Wicklow, Fianna Fail)
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In terms of capacity and revenue funding, this year has seen a record deployment in that regard. There is revenue available and there is capital available. I can assure the Deputy of that. However, capital applications are not only about new beds. New diagnostics, new operating theatres and new triage rooms have to be looked at and that is happening. Where capital funding is required, it will be provided. The tighter constraint is staff. There is no point putting the beds in place unless we have the staff. There was a very ambitious target for this year in terms of staff. We will be rolling much of that target into next year. Do we need more beds? We do. Do we need more ICU beds, more diagnostics, more rehab beds and more community beds? Absolutely, we do. At the same time, we have to hire and retain the staff to make sure the patients in those beds get the care they need.