Dáil debates

Wednesday, 17 May 2023

Targeted Investment in the Health Service: Motion [Private Members]

 

9:57 am

Photo of Marian HarkinMarian Harkin (Sligo-Leitrim, Independent)
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I move:

That Dáil Éireann:

recognises that: - 2022 was the worst year for overcrowding in Irish hospitals on record, with over 121,000 patients being left without a bed;

- in 2022 University Hospital Limerick was the most overcrowded hospital in the country (18,028) followed by Cork University Hospital (12,439), University Hospital Galway (10,150), Sligo University Hospital (8,136) and St Vincent's University Hospital (7,513);

- 67,000 patients waited at least a day in Emergency Departments (EDs) before being admitted during 2022;

- over 812,000 patients were on national public hospital waiting lists at the end of 2022;

- 584,600 patients were waiting to be seen for the first time by a consultant at an outpatient clinic at the end of 2022;

- waiting list numbers reduced by 4 per cent in 2022, significantly lower than the Government's waiting list reduction target of 18 per cent for the year;

- Ireland remains a laggard in Europe for digitisation in the health system and the introduction of electronic health records, the use of such technology could significantly reduce triage times in EDs;

- there remains a lack of a specific national structure or control for clinical oversight in the care of people admitted to nursing homes and they have difficulty accessing treatment by primary care teams; and

- the lack of such oversight and care can result in unnecessary presentations at EDs; acknowledges that: - the creation of an additional 7,176 patient slots per year across the UL Hospitals Group following the recent introduction of a seven-day service at Medical Assessment Units (MAUs) in Nenagh Hospital and St. John's Hospital;

- the ongoing recruitment by UL Hospitals Group for additional doctors, nurses, health and social care professionals and administrative staff;

- the changing of Health Service Executive (HSE) protocols to allow non-ED doctors assess patients in the ED where there is a significant risk due to delay;

- the Government's allocation of €350 million under the 2022 Waiting List Action Plan to reduce active waiting lists;

- the European Investment Bank loaned the State €200 million to implement electronic health records over three years ago;

- on 14th May, 2021, the HSE was the subject of a major ransomware cyberattack, the most significant cybercrime attack on any Irish State agency, and the largest known attack against a health service computer system;

- Local Injury Units (LIUs) deliver efficient, expert treatment to tens of thousands of patients with minor injuries every year and have been of crucial assistance in relieving pressure EDs during the pandemic; and

- Medical Assessment Units (MAUs) play an integral role in ED avoidance, providing a vital and timely service to General Practitioners and patients; approximately 10 per cent of MAU cases may require admission to the hospital, and the majority will be discharged, with a follow-up review in the unit within 48 hours; and calls on the Government to: - expand MAUs at Level 2 hospitals to 24-hours, 7-days-a-week;

- expand LIUs at Level 2 hospitals to 24-hours, 7-days-a-week;

- appoint a designated Medical Officer in every nursing home, and ensure that patients in nursing homes can access treatment by primary care teams; and

- procure or deliver an electronic health system to replace paper-based health records without further delay.

I am happy to move this timely motion, which includes a number of solutions-focused proposals. It quantifies the scale of the issues we are facing in regard to waiting lists and the numbers of people on trolleys. It also proposes a number of solutions and actions that can be taken in the short, medium and longer term to facilitate our health system to work in a more effective, efficient and timely manner.

The motion notes that 2022 was the worst year on record for overcrowding in Irish hospitals, with more than 121,000 patients left without a bed. It goes on to detail the numbers without beds in certain hospitals. University Hospital Limerick, UHL, was the most overcrowded hospital in the country, with a total of more than 18,000 patients without a bed. It was followed by Cork University Hospital, CUH, with more than 12,000; University Hospital Galway, UHG, with more than 10,000; Sligo University Hospital, SUH, with more than 18,000; and St. Vincent's University Hospital, SVUH, with 7,000-plus. While the motion looks at this issue from a national perspective, it is interesting to note that four out of five of those hospitals are located along the Atlantic corridor. Day after day and week after week, the trolley watch figures show this pattern.

The motion notes that during 2022, 67,000 patients waited at least a day in hospital emergency departments before being admitted. It further notes that at the end of the year, more than 800,000 patients were on public hospital waiting lists. At the end of last year, 584,600 patients were waiting to be seen for the first time by a consultant in an outpatient clinic. It is noted that waiting lists reduced by 4% in 2022. However, the Government's target was to reduce them by 18%. It did not manage to get even 25% of the way to that target. While there has been some progress, waiting lists continue to get longer.

We make the point in the motion that Ireland is a laggard in Europe on the digitalisation of the administration of the health system. The introduction of electronic health records and the use of that kind of technology could significantly reduce triage times in emergency departments. It would also make a real contribution to lessening the number of human errors that inevitably occur when working with a paper-based system. While the cyberattack on the HSE a few years ago may have stalled the process, we all would agree that digitalising the health system is a crucial part of having the system work in a more effective and efficient manner.

The motion notes the lack of a specific national structure and control around clinical oversight of the care of people admitted to nursing homes, who have difficulty accessing treatment by primary care teams. This is an area in which the Minister of State, Deputy Butler, has expertise. It is a significant problem in some nursing homes. The motion notes that the lack of such oversight and care can result in unnecessary presentations at emergency departments.

We acknowledge in the motion that certain actions have been taken. The Government has not sat on its hands. It has created an additional 7,176 patient slots per year across the University Limerick Hospitals Group following the recent introduction of a seven-day service at medical assessment units at Nenagh and St. John's hospitals. We acknowledge the ongoing recruitment by the University Limerick Hospitals Group of additional doctors, nurses, etc., and the changing of HSE protocols to allow non-emergency department doctors to assess patients in emergency departments. We acknowledge the allocation by the Government of €350 million to the waiting list action plan in 2022.

As I have outlined, the motion certainly acknowledges some of the actions taken by the Government. It also notes that local injury units deliver efficient expert treatment to tens of thousands of patients with minor injuries every year and that medical assessment units play an integral role in emergency department avoidance. In that context, we call on the Government to expand the medical assessment units in level 2 hospitals to a 24-7 service. That is important because if people know the service is available 24-7, they are much more likely to attend at a level 2 hospital than to go to the emergency department of a level 3 or 4 hospital. We ask for a similar upscaling of local injury assessment units at level 2 hospitals, with a 24-7 service to be offered.

We ask to appoint a designated medical officer in every nursing home to ensure patients in nursing homes can access treatment by primary care teams. Finally, we ask the Minister to procure or deliver an electronic health system to replace paper-based health records without further delay.

The amendment tabled by Deputy Shortall on the need to speed up the construction of elective hospitals certainly gets my full support.

I will hand over to Deputy McNamara.

10:07 am

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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The motion has been formally moved and I am grateful to Deputy Harkin for that. I note, on formalities, that there is an amendment from Deputy Shortall, which I am happy to accept. I note that there is not a Government amendment, which is appreciated.

The motion is an attempt to be collaborative, or at least to acknowledge the efforts the Government has made. Despite the best efforts of the Government, 2022 was the worst year on record for overcrowding in Irish hospitals, with 121,000 patients left without a bed. Yesterday, University Hospital Limerick, UHL, was the most overcrowded hospital in the country, followed by Cork University Hospital, CUH. That is a record and statistic that, unfortunately, holds true for the entire year as well as this weekend. There were 18,000 people on trolleys in UHL during 2022 and more than 12,000 in CUH. Again, that was mirrored yesterday.

We have a huge problem and it has been acknowledged that part of that problem goes back to configuration in that the cart was put before the horse. There is nothing terribly wrong with the idea of configuration, but the people of Navan who are resisting it should continue to resist it until such time as resources are put in place in the hospital that Navan Hospital will be configured with. The problem with reconfiguration in the mid-west is that to this day the number of beds that were promised when services were being reconfigured and emergency departments were being closed in Limerick and Nenagh have not been provided. No additional resources were provided but all need was channelled into the emergency department in Limerick.

One would not have to be a genius to know that was going to have huge repercussions, and it did. There is a lack of confidence in UHL now and there is fear across the mid-west. It dissipates. It is a beautiful sunny day in Clare at Inch Bridge and across the county. However, we will head into a winter again. I urge the Government to take the initiative to take control of this. From transport to accommodation of recipients of temporary protection and asylum seekers to health, I appreciate the Government is trying but it is losing control of the situation in so many areas. There is no sign of progress. People expect to see things getting better, not worse, yet, in so many facets, things are getting worse. That is the case with health as well, in terms of the number of people on waiting lists and trolleys.

Even this past weekend, in the middle of summer, the numbers on trolleys were what would be expected in the middle of winter pre-Covid. It is not because of Covid. We were told that the numbers of persons in hospitals with Covid are at the lowest it has been since September 2020. It is not because of Covid but it is since Covid that we see this.

We respectfully suggest a couple of initiatives. One is to expand the medical assessment units, MAUs, which is easy to say. Everything is easy to say when you are in opposition and I appreciate that it is difficult in government. However, that is not an excuse for paralysis or not to succeed in government. Expanding the MAUs will take many additional staff and additional beds. There are additional beds. It is 15 years now since an additional block was planned in Ennis at the back of the hospital between the old 1950s hospital and Sandfield House. That needs to be brought on board. Only when that is brought on board can we hope to have a 24-hour MAU. We need to be able to admit people to such a unit. The majority of people who come into the unit are not admitted, which is great. They are brought in, treated and discharged. Instead of going into the accident and emergency department in Limerick and joining the large queues of people there, they are sent into the MAU by their GP and treated. Some of them will need to be admitted. An MAU cannot be open if there are no beds to admit people to, so we will need more beds. That is a one-off spending. I mention Ennis because it is the hospital I know best but it holds true of every hospital across the country.

The State is running huge surpluses. We have no idea where the money is coming from. Arguably, we have lost control of our economy, although we are told it is because of prudent management. Prudent management would suggest that the revenues could be predicted, yet everybody seems to accept that we cannot predict what the revenues will be but, hey, it is not a problem; it is down to our prudent management. We have surpluses and these facilities will need to be built because our population is growing. We have a huge influx of people from Ukraine. Some of them will go back to Ukraine but many will not. Many of them now think they will want to go back to Ukraine but the longer people stay in a place, the more likely they are put down roots and stay. I am not suggesting that the growth in population is down to people coming in; it is not. We have a young population. We will need these facilities. I urge a huge capital programme.

I mentioned local injuries units, LIUs. We call for these to be expanded to 24-7. If a person is playing sport on a summer’s evening, to have to be brought into the emergency department in Limerick for something that is relatively minor but still needs to be treated seems to be a waste of resources. If people are on a night out and they fall, even through their own stupidity, they need to be treated. It does not matter why somebody is injured; if they are injured, they need to be treated. We need to have LIUs but, again, that will require beds to admit people to, if required.

We call for the digitisation of records, which is sensible by any stretch, in 2023, in a country that attracts the biggest tech corporations in the world and wants to be an innovator and lead research and development. If those who work in research and development at the cutting edge of technology worldwide fall ill and go to hospital, there is no electronic record. If they are transferred from one hospital to another, there is no record. We need fluidity in the hospital groups in order that people can be readily moved from UHL to hospitals in Ennis or Nenagh or to St. John’s. That is greatly facilitated by having electronic records that staff can access. However, it is not just that. If I fell ill yesterday, I would be treated either in Ennis or Limerick. If I fall ill tonight, unless I have to go back to Inch or something, it will be one of the Dublin hospitals, which would have no idea what treatment I received yesterday if I was not in a position to tell them. That just seems ridiculous.

It is several months since the person tasked with developing this resigned and had very negative comments to make about his experience at the HSE. Where are we with regard to a replacement? I have spoken about this to the Minister for Health, Deputy Donnelly. Where are we with regard to a replacement? It simply beggars belief that we do not have one.

Lastly, the other two recommendations relate to nursing homes. There is a huge spike in presentations of patients from nursing homes in emergency departments at Christmas and holiday periods for a variety of reasons, of which one can be suspicious of. However, they are patients who need to be treated.

They are probably frightened patients because no elderly person wants to present in an overcrowded emergency department, ED, and to be on a trolley. One of the recommendations the first preliminary Covid report made concerned medical officers for nursing homes. Many, but not all, HSE nursing homes have a medical officer assigned to them. It is usually a local GP. He or she is the medical officer assigned to the home so he or she is responsible for the care of all the patients in that home. In many of the private homes, no one person is responsible for the care of all the patients. Frequently, nobody is responsible for the care of many of the patients who is accessible or nearby. The patients may still in theory be on the list of a GP who is in his or her home, which could be 20 or 30 miles away. If needs be, who is going to make a decision on whether the patient needs to present or not? Nobody. Of course, nursing staff on duty are going to err on the side of caution and say that the patient needs to be seen. The only place that he or she can be seen is in an ED, so then we have the patient presenting there.

The other difficulty is that primary care teams routinely do not access nursing homes at the moment. That needs to change, in particular, to prevent people presenting in EDs, and to ensure that those who are admitted to hospital can be discharged back to a nursing home, if that is where they were originally. If they were not in a nursing home and they need to go a nursing home either temporarily or permanently, we need to ensure that they can still be treated by a primary care team so that we get people out of our acute hospitals and into a level of care that more befits their needs. At the moment, everything is channelled into EDs, with the result that frequently, there are those who need to be in an ED alongside those who do not need to be there. They just need to be treated by somebody but our healthcare system operates so as to channel everybody into EDs. Catastrophic events occur as a result of that. We saw what happened in University Hospital Limerick, UHL, over Christmas. There was to be a speedy internal investigation into what happened with Aoife Johnston. That was a frightening episode for the people of Shannon and the mid-west. We need clarity on what happened, and absolute certainty that something like that will not happen again because of the enormous pressure that those who work in EDs are under. It is getting harder and harder, as the Minister of State well knows, to recruit people into UHL, in particular, because of the pressure those who work there have been under. People do not see it as an attractive place to work. We do need to address this. The Minister of State is accepting the motion, but I urge the Government to act on it in order that we do not go through another winter like last winter. We should not accept that the numbers of people on trolleys are inevitably going to rise. That cannot be reconciled with record surpluses. At some point, it points to bad management, and the buck stops with the offices of the Ministers in the Department of Health.

10:17 am

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I welcome the opportunity to address the House on the issues raised by the Deputies tabling the motion. I thank Deputes Harkin and McNamara and all colleagues present for putting forward the motion, and I acknowledge the spirit and the delivery of it. Obviously, I am going to address some of the unprecedented levels of investment in our health service in recent years, but I want to highlight, as I do at every opportunity I have, that Ireland has the highest life expectancy in Europe, as deemed by the WHO. That is something we should acknowledge. More than 140,000 people work in the HSE, day in and day out and they often come in for a lot of unfair criticism. I acknowledge all those people who work in private, public and voluntary health organisations the length and breadth of the country.

The Government has delivered unprecedented levels of investment in our health services in recent years. There should be no doubt that investment in health has been a substantial priority for the Government. In just three years, the net core allocation for our health services increased from €17.9 billion to €22.8 billion, almost €5 billion more, or a 27% increase in core funding between 2020 and 2023. That investment is clear, tangible evidence of the commitment the Government has made to healthcare and healthcare reform. Enabled by this significant investment, the Government has been driving important reform initiatives, working to deliver on the objectives of Sláintecare and building the capacity of our health service to address the changing needs of our growing and ageing population.

The Government has expanded our healthcare workforce. At present, almost 140,000 whole-time equivalents are working in our health service. We have hired thousands more staff since getting into government. Today, there are just over 20,000 more whole-time equivalents in our health services than at the beginning of 2020. The Government’s focus has been clear: to deliver more front-line staff. Of that 20,000, we have hired almost 2,000 more doctors and dentists, and more than 6,000 more nurses and midwives who are serving the needs of patients every day. In excess of 3,000 more health and social care professionals delivering physiotherapy, occupational therapy, psychology, dietetics and more. The years 2020, 2021 and 2022 have seen the largest staff increases since the HSE was established, and that pace of recruitment continues into 2023, despite the pressures and challenges we face in a globally competitive health services labour market. I also acknowledge that our population has grown, and there are still many challenges to meet the needs of the population.

Our health service has faced significant challenges over the past number of years. It has been called on to respond to a global pandemic, and emergency departments faced the most challenging winter in recent years as a perfect storm flu, Covid and other respiratory diseases surged. The Independent Group’s motion quite rightly points to the challenges facing our acute hospitals. It is clear much more needs to be done to tackle the delays in our EDs and numbers waiting on beds in hospitals.

What are we doing? The Government has expanded our healthcare capacity nationwide to address these challenges. As of 16 March 2023, 970 additional beds have been opened since 2020. Adult critical care capacity stands at 323 beds. This represents a very significant increase of 65 beds, or 25%, on the 2020 baseline of 258 beds. To put that in perspective, we had a total net increase of 18 beds in the three years 2017, 2018 and 2019, and more are planned. The HSE plans to add a further 29 beds this year, bringing our critical care capacity to 352 beds by year end. Furthermore, the Department of Health is continuing to engage with the HSE to ensure the timely delivery of the new elective hospitals in Cork, Dublin and Galway. These elective hospitals will specifically cater for low, complex and high-volume cases, and when established, will provide close to 1 million procedures annually. This will represent real change, helping us to utilise our resources more efficiently by separating scheduled and unscheduled care. It is expected that the three elective hospitals will commence providing care by the end of 2027. The Department has asked the HSE to develop an in-year urgent and emergency care plan informed by lessons learned arising from the after-action review of the escalation and broader winter period to which Deputy McNamara referred. The final draft of that in-year plan is due later this month. That in-year plan will also feed directly into a multi-annual urgent care plan being developed alongside it. We need a structured, co-ordinated, and collaborative framework to enable high-impact operational improvements.

The Independent Group’s motion calls on us to look beyond our EDs to address these challenges to LIUs and MAUs to provide care outside EDs. The Department and the HSE are doing just that. LIUs provide a high-quality and timely service for people with a wide range of non-emergency injuries. MAUs provide assessment, diagnosis and treatment for patients referred with medical conditions, including chest infections, chronic obstructive pulmonary disease, pneumonia, urinary tract infections and more. The MAU pathway for patients was introduced in Ennis Hospital on 9 January and Nenagh Hospital on 7 February. The pathway allows patients that meet clinical criteria to be transported to an MAU rather than an ED. Additional staff and targeted initiatives such as the NTPF have enabled the Ennis and Nenagh MAUs to significantly increase the number of assessment slots available over the past two years. In 2022, more than 12,700 patients were referred to the UL Hospitals Group MAUs, which have played an integral role in ED avoidance, patient flow to model 2 hospitals, and appropriate community referrals. As a result, patients in the mid-west are receiving treatment in a hospital closer to home, reducing patient presentations at UHL and releasing ambulances more quickly.

The urgent emergency care plan will include a review of the current operation of LIUs and MAU pathways to recommend how best their service delivery can be expanded to facilitate patients receiving medical treatment in a hospital closer to their home. The Government recognises that a strong healthcare system goes far beyond our hospital doors. Significant expansion of primary and community care is under way to provide people the care they need outside of the emergency department and to improve patient flow in acute hospitals by reducing unnecessary attendances and providing discharge supports such as home support and residential care.

I thank the Independent Deputies for the opportunity to talk about how we are working to improve the provision of healthcare for older people. A key focus of our Sláintecare reform programme is recognising the need to enable older people to age well at home and in their communities for as long as possible with the correct wraparound supports. For example, our community intervention teams facilitate patient care in the community, in the home or in nursing homes. There are now 21 community intervention teams in place across the country, with national coverage secured for the first time in 2021.

Supporting our ageing population is also a key part of our enhanced community care, ECC, programme. The ECC programme is delivering increased levels of healthcare with service delivery reoriented towards general practice, primary care and community-based services. Over 2,500 staff have been recruited as part of this programme of reform. As part of the ECC programme, the integrated care programme for older persons, ICPOP, model aims to shift the delivery of care for older people away from acute hospitals towards a community-based, planned and co-ordinated care model that is closely aligned to primary care and acute sector partners. As of May 2023, 23 ICPOP teams have been established across Ireland. It is envisaged that the full complement of 30 ICPOP teams will be established by the fourth quarter of 2023.

We recognise that we need to do more to support people in nursing homes too. Currently, the HSE is in the process of transitioning Covid-19 response teams into permanent structures to be known as community support teams, based on the recommendations of the nursing home expert panel. This is an important step in developing specific and targeted support to residents of nursing homes across the entire sector. We hear a lot of talk about nursing homes so I just want to say that the HSE will always step in. It is the provider of last resort and needs to be staffed accordingly to look after people with a very high dependency or high acuity when there is no other place that can do that. Initially, implementation of these teams will focus on supporting residential care facilities to build their capacity to effectively self-manage in terms of prevention, preparedness planning and effective outbreak management in the event of further Covid-19 surges, influenza and other respiratory infections.

The motion tabled by the Independent Deputies calls for targeted investment, including investment in electronic health records nationally. I agree with that wholeheartedly. The Deputies have also called for the expansion of MAUs and LIUs at tier 2 hospitals. In doing so, my Independent colleagues have acknowledged several areas where significant progress has been made, which is primarily as a result of an unprecedented expansion in our public healthcare capacity. This Government has invested in people and we will continue to do so. We accept the motion and look forward to implementing what is in it. One area in which we need to make progress in quickly is e-health, especially with regard to home care and CAMHS teams.

10:27 am

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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I welcome the opportunity to speak on the motion and thank Deputy McNamara for bringing it forward. I also welcome the fact the Minister of State is not opposing it. That is positive. I also welcome that she is accepting the amendment tabled by the Social Democrats. I have a particular interest, coming from Galway, in the elective hospital, the salaried position for GPs and, following on from Sláintecare, the regional health area, RHA, implementation plan. That is referenced in the amendment Deputy Shortall has tabled and I am sure she will come to that.

I recognise that Deputy Butler is a hardworking Minister of State. I have said this on the record repeatedly. I believe in a public health system, as I think she does. However, we are in a position with the problems in the health service that did not come about today or yesterday. I have often said, at the risk of boring people, that I spent ten years of my life on a health forum. I watched the systematic running down of our public health system. I will put it as bluntly as that. That is exactly what I watched from 2006 to 2016. I stand here today in the knowledge that yesterday, 38 people in University Hospital Galway were on trolleys, out of 565 nationally. On 3 May, there were 50 out of 712 in the country. I have just picked different dates because there is a range of figures. On 3 January this year there were a particularly savage 77 patients on trolleys, the worst since the Irish Nurses and Midwives Organisation started to keep records in 2006, which coincidentally was the year I joined the health forum.

The motion seeks to take the pressure off general hospitals, which are the model 3 and model 4 hospitals. It should have happened years ago, really. Back in 2013, the HSE published a document called Securing the Future of Smaller Hospitals: a Framework for Development. That was ten years ago and we are still just beginning to touch the surface of it. I do not wish to be parochial but looking at Galway, it really puts the focus on the wonderful language and the vision versus the actual reality on the ground like the trolleys. In Galway, we have a nursing home i gcroílár na Gaeltachta i gConamara agus tá an t-aonad lae dúnta. Right in the middle of the Gaeltacht we have a day centre that is closed. Kafka is easier to read at this stage. I always thought he was difficult. I had the privilege of doing German for a very short time and Kafka was impenetrable to me. Now I understand him perfectly, having dealt with the answers from the HSE and various other Government institutions. We had a very positive presentation in March, which indicated that the day centre was to open in April. Since then it has been unravelling. That is just one example. I mention it because such a centre would clearly take the pressure off hospitals. Then there is the Clifden District Hospital, which is lurching from week to week dependent on staff. Again, that would take the pressure off the general hospital.

As it happens, I have somebody near to me in hospital and I know how hard the staff work. It should be taken as a given that I praise the staff. They are absolutely wonderful. What I do not praise is the management on occasion and Government policy. Government policy has gotten us into this mess. In Galway city, we are waiting for an accident and emergency department. Back in 2014, the then Minister for Health, Deputy Varadkar, stated that a new building was the only solution in UHG. We have made progress since but there is no new accident and emergency department. Still, we are making progress. We are getting there. I have a library full of responses, as have other Deputies. We know now that the strategic assessment review has been completed. Changes are to be made to the public spending code and so on but we still have no accident and emergency department, despite the current one being considered not fit for purpose back in 2015. The elective hospital in Galway that was announced on 7 December 2022 was one of three sites. The one in Merlin Park is due to be open in seven years and operational in eight. I welcome that but that timespan is very long. The amendment tabled by the Social Democrats seeks to hasten that.

My frustration comes from a lot of reasons but back in 2019 the options appraisal identified Merlin Park as the site for a brand-new hospital. Nothing happened. We will now have an elective hospital but not a brand-new hospital. Since then there has been an update of the options appraisal and suddenly we are told that the congested site in Galway is the place. The Minister of State can see the level of frustration relating to all of this, as someone who is utterly committed to public medicine.

Photo of Thomas PringleThomas Pringle (Donegal, Independent)
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I thank the Cathaoirleach Gníomhach for the opportunity to speak on the motion. I also thank Deputy McNamara and his office for bringing this forward today. The current situation in hospitals across the country is absolutely dire, as the Minister of State will be aware. The fact that 2022 was the worst year on record for overcrowding in Irish hospitals is sadly not surprising. I have been contacted by many constituents in recent times regarding overcrowding and long waiting lists and some of the situations and wait times patients have been forced to endure are absolutely appalling. The fact that more than 812,000 patients were on national public hospital waiting lists at the end of 2022 is incredibly concerning and should be a clear sign to the Government that our health system is in crisis. The situation will only continue to get worse if drastic measures are not taken as soon as possible.

I have been continuously raising concerns regarding Letterkenny University Hospital and the seemingly continuous scaling back of services there. The staff at the hospital are expected to work under severe pressure constantly and it is just not sustainable or acceptable.

Following an inspection in the hospital in November, HIQA has raised concerns regarding overcrowding in the emergency department and the need for improvements to address clinical governance. It has said that immediate action is required to address medical staffing levels at Letterkenny University Hospital. HIQA also stated that further immediate work is required to address deficits in a number of areas, including the comprehensive infection screening programme for patients, improving learning from patient incidents, fully implementing the clinical handover of patients and fully integrating safe processes to manage emergency department patient attendances at the hospital. In order to effectively address any of these issues, staffing levels need to be addressed immediately. It is clear that understaffing is a significant issue in Letterkenny with one nurse claiming it is unsafe and inhumane. As she rightly states, nurses do not go into nursing to work in crisis management and nor should they be expected to.

Recruitment is only part of the solution. We need to focus on retention too, as many nurses in Donegal have chosen to leave the county and often the country in search of better and less stressful work, particularly over the past year. I want to take this opportunity to recognise the 88 overseas nurses and midwives who have helped in filling this gap by taking up roles in Letterkenny University Hospital since the beginning of last year. I speak on behalf of all the people of Donegal when I say their presence is welcome and very much appreciated. There is no doubt but that the hospital would not be able to function without them. As adjusting to a new country and a new health system is never easy, I urge the Government to ensure that our overseas medical staff are supported in this adjustment.

I also will take this opportunity to once again urge the Government and the HSE to collaborate with Cuba in sending doctors to Ireland to relieve pressure on Ireland's health service. Cuba has in the past provided medical services in 165 countries with more than 605,000 employees. The country currently serves 59 nations but apparently Ireland is very different. The HSE relies heavily on overseas doctors, nurses and midwives to staff hospitals and collaboration with Cuba would be a great opportunity for Ireland to address the severe crisis we are currently experiencing in our health service. The Government should be jumping at this opportunity, yet the Minister has failed to engage with me or the Cuban ambassador on this issue, despite numerous attempts and despite it being raised here in the House and directly with him. There has been no response. Fermanagh and Omagh District Council, the Western Trust in the North and Enniskillen hospital recently started an engagement with the Cuban authorities and the Cuban Embassy about getting Cuban doctors to help to staff the Enniskillen general hospital, which has had severe problems because of staffing levels. They can talk to the Cubans and see if it can be done but we cannot do it here and we cannot even get the Minister to acknowledge that it has been raised with him. That is a sad reflection. It calls into question whether we genuinely want to solve this problem. Sadly, the lack of interest or engagement indicates to me that the Minister is not actually serious about addressing the crisis in our health system. This is incredibly disappointing and I would urge the Minister to act in the best interest of patients at this stage and actually engage.

I also support calls in this motion for the digitisation of the health system and the introduction of electronic health records. The fact that we are still waiting for this to happen despite the fact that the European Investment Bank loaned the State €200 million to implement electronic health records over three years ago is concerning. Our failure to modernise our health system leaves us outdated and lagging behind many other countries. This is where we could be utilising our overseas staff much better. Their experience of other health systems and digitisation is valuable and we have failed to recognise this as the opportunity that it is. The Government needs to wake up and see this crisis for what it is. We should be grabbing every opportunity and not letting it pass us by. We need targeted investment in the health service and I urge the Government to accept this motion today as the first step in recognising and addressing this issue. The reality is that the Government let the public service get run down so badly that people will accept anything to resolve it. That is what we are seeing now with privatisation.

10:37 am

Photo of Verona MurphyVerona Murphy (Wexford, Independent)
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Before we move to the Sinn Féin slot, for the information of the Minister, Deputy McNamara has apologised because he was taken away to a call. He asked me to pass that on.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I commend the Independent Group on tabling this Private Member's motion. The heart of this motion is that we should better utilise model 1 and model 2 hospitals, but particularly model 2 hospitals, to take pressure away from the model 3 and model 4 hospitals. As a previous Deputy said, we are ten years into the framework for smaller hospitals and we are still not using them to best effect. I fully agree with what is being called for regarding the operating hours of medical assessment units and local injury units. That makes sense. In this House, I have repeatedly called for additional hours for Monaghan hospital's minor injury unit and for other hospitals too. We saw during Covid, and have seen a good example in the mid-west in more recent times where Ennis was used to better effect, that we can get more from those model 2 hospitals, including day care procedures and elective procedures, and using those medical assessment units and local injury units. That all makes sense.

We have a perfect storm in healthcare at the moment. It does not take a rocket scientist to figure out what is happening. We have waiting lists that have gone up this year. From the start of January this year up until the end of April, acute waiting lists were up by 20,000. I got a reply to a parliamentary question this week which showed that 80,000 hospital appointments were cancelled from January to April of this year. That is a huge number of people who have had inpatient and outpatient procedures cancelled. Some were surgical appointments, some were medical appointments and many were outpatient appointments. The reason for this, as we see in our emergency departments, is that the system is not integrated and is not working. We are not delivering the right care in the right place at the right time. We have huge pressure on our emergency departments in our major acute hospitals. That pressure leads to longer wait times. On average, people are waiting for 11 or 12 hours for admission to a bed. In some hospitals in Cork and Dublin, that can be up to 24 hours. That is all because of the pressures we have in those emergency departments.

About 40% of people who are attending emergency departments are people who are there because they have no other pathway. They cannot get access to out-of-hours GP care. They cannot access supports in the community. For example, most of the teams promised for people who have chronic pain have not been established or are not working and they cannot access a GP for many different reasons. Many could be seen if we had 24-hour cover in minor injury units and medical assessment units in those model 2 hospitals. The fact that we are not making best use of them and that we do not have the capacity in primary and community care means we are creating further bottlenecks and capacity problems in our hospitals. We then do not have enough beds, as we know. The Minister is now talking about 1,500 beds.

Talking to any hospital manager, they will say they cannot admit patients quickly enough because they do not have the beds. They also do not have access to recovery beds and step-down beds. Another parliamentary question response I got back last week was about home help and home supports. The number of patients who have been approved for home support but who are still waiting for a package has increased from 4,000 to 6,000 over the course of a year. People are waiting for longer for home supports. The acute hospital waiting list has gone up. Community waiting lists have been out of control for far too long. This all screams that there is a lack of integration between acute, primary and community care. It is not rocket science. We know we need more beds, so we should deliver it.

Hospitals also need surgical theatre capacity and diagnostic capacity because the absence of diagnostic capacity also slows up the patient flow time in hospitals, because people are waiting hours on end for a scan and for that to come back. That also needs to be part of this. If we only look at what is happening in the hospitals and do not step back to look at primary and community care, and at the relationship between overcrowding and hospital waiting lists, then we will never solve the problem. Waiting lists have gone up this year despite the promise that they would come down and a multi-annual plan which never materialised, and the Minister's plan for last year, which clearly has not worked, because tens of thousands of procedures are being cancelled. They are cancelled every month, every week and every day because of the pressures on our emergency departments. Hospitals have no other choice and no option left but to cancel elective procedures and planned procedures. That creates another problem. We are shifting the problem from one part of the health service to the other.

I fully support this motion and what it calls for. It is one of the ingredients that we need to sort out what is happening in our emergency departments. It will not be a panacea and it will not solve all the problems but it will solve some of the problems. We need to look at those model 2 hospitals and have a plan for each and every one that makes best use of them to deliver that elective care, planned care and day care.

Photo of Rose Conway-WalshRose Conway-Walsh (Mayo, Sinn Fein)
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I too thank the Independent Group for tabling this motion and giving us a chance to debate it in the House. I want to concentrate specifically on Mayo University Hospital because what is happening there is really dire. It is getting worse day by day. Some 212 appointments were cancelled in just the first three months of this year. This is an increase of 136 compared with the same period last year. A couple of weeks ago, more than 170 patients attended the emergency department, which is 30% higher than the average attendance.

The capacity just is not there. We have announcement after announcement from Government Deputies. I cannot understand this carry-on. We have three Government Deputies in Mayo and they go on the radio and call on the Minister. I really feel like saying it is a pity they are not in government. They are not doing anything about it. They are bystanders in the situation. They are watching it happen. They are watching the staff in Mayo University Hospital being run into the ground. They are watching patients on trolleys. They are watching people with their lives in danger and their lives at risk. They are watching many other patients who should go to the hospital but do not because they do not want to put pressure on the staff and they are afraid of what they facing. Yet we have Government Deputies going around the country calling on the Minister and the Taoiseach to do things.

We have been promised an emergency department there for a long time. It has been announced 1 million times and we still do not have it. Beds in Belmullet Community Hospital were shut down as were others beds in Ballina hospital and Swinford District Hospital. What was expected to happen when all of these beds were shut down? There is no place for people to go. This health system has been designed and constructed by people. We have a whole load of money being wasted on agency staff because contracts are not being given. The very hard-working staff in the system are not given decent contracts. What is going on is absolutely crazy and people are tired of it.

10:47 am

Photo of Johnny GuirkeJohnny Guirke (Meath West, Sinn Fein)
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I welcome the debate we are having this morning on tier 2 hospitals. I thank the Independent Group for bringing it forward. The issue I will raise the future of Navan hospital and what the reconfiguration means for it. I thank the staff at Our Lady's Hospital, Navan, and all hospital staff throughout the State who work tirelessly for the people.

It is absolutely incredible how shabbily my constituents in Meath West, doctors, nurses and other staff and patients of Navan hospital have been treated by the Government. As we debate the motion this morning, Navan hospital is under continuing threat of losing its emergency department and ICU. Delays in emergency departments and waiting lists for beds will not improve if we close emergency departments in hospitals such as that in Navan. As recently as April, in reply to a parliamentary question the Minister, Deputy Stephen Donnelly, said no decision regarding the HSE proposal for the transition of the emergency department at Navan had been agreed by him or the Government. I am glad our hospital and its services remain open but the uncertainty that hangs over Navan hospital is unsustainable and completely unacceptable.

I am sick and tired of having this argument with the Government every few months. Who in their right mind in 2023, with a massive capacity crisis in our health service, would consider shutting down emergency services? If the Government is saying that current facilities in Navan are unsafe then it is very simple. Make them safe with investment and resources. Tier 2 hospitals have to be part of the solution of addressing our hospital capacity crisis. The motion calls for an extension of operating hours of medical assessment units and local injury units to a 24-7 service from the current general service provision of 12 hours a day five days a week to provide an alternative to emergency departments available at all times. This would be and should be supported by us all. We need additional resources and not the cutting of existing services.

Meath has a population of more than 220,000 people. It is time to get real. The people of Navan and Meath have fought for years to keep services at Our Lady's Hospital, Navan. We are not going away and neither is our hospital. We need investment to take pressure off other bigger hospitals, such as those in Blanchardstown and Drogheda. We need to protect and enhance services in Navan, put the necessary resources into it and have no more downgrading of services in Navan.

Photo of Paul DonnellyPaul Donnelly (Dublin West, Sinn Fein)
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I welcome the motion tabled by the Independent Group. It serves to highlight again and shine a spotlight on our health service. I acknowledge the hard work and dedication of the doctors, nurses and all of those on the front lines and everyone who works in the services. Recently my mother was released from the Mater hospital after being there for five weeks. I can attest to the absolutely outstanding care she received there. The problem is trying to get into a hospital. Our fears start when going into an emergency department and trying to get into a hospital. Once people are in hospital, the care is absolutely outstanding.

As Deputy Cullinane said earlier, cancellations for day services in hospitals is at an all-time high. In the first quarter of 2023, almost 200 patients had their appointments cancelled at Connolly Hospital in my constituency of Dublin West. This, combined with startling figures from hospitals throughout the State, show another failure in healthcare services.

I have read the speech of the Minister of State and one part in particular interested to me. This was the focus on Sláintecare reform and recognising the need to enable older people to age well at home. It is striking because it is something that upsets me when somebody wants to live at home, stay at home or get home from hospital in particular. At present in Dublin West, we have a two-year waiting list for occupational therapy. Someone going to the local authority looking for a grant needs an occupational therapy report from the hospital to show exactly what needs to happen. The wait for an adaption grant from the local authority to be able to bring somebody home to live downstairs is four years.

We can do all the work we want in hospital and we can get the occupational therapy report but if the work is not done and will take four years, and if there is no funding in the local authorities to do the work, the person will be stuck in hospital. We all know there are people stuck in hospital for months and months on end using acute beds when they do not need to be there because they cannot get occupational therapy or they cannot get the work done to enable them to return home. I acknowledge it was mentioned in the Minister of State's speech. It is one of those very important things that we need to tackle in our health service and hospitals.

Photo of Martin BrowneMartin Browne (Tipperary, Sinn Fein)
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I welcome the motion tabled by the Independent Group. We hear a lot from the Government about care in the community being a way to take pressure off acute hospitals and emergency departments. I have no issue with this. There are communities, some of them in Tipperary, that shudder to hear the excuse of providing care in the community when centres that do precisely this are targeted for closure. We had this argument about the Dean Maxwell community nursing unit in Roscrea. We heard it when St. Brigid's District Hospital, Carrick-on-Suir, was closed by stealth. St. Brigid's was closed after initially being repurposed temporarily as a step-down facility for Covid patients. However once it was vacated, we were told the HSE had suddenly deemed it unfit for the purpose for which it had been used for decades and it was never reopened.

In discussing its plans for these units last year, the HSE and the Department of Health told me their focus was shifting to care in the community, which would replace the need for the beds. This is a false argument. First, people have to travel further from their communities and second, while the HSE planned to provide 33,522 home support hours in south Tipperary that year, only 24,238 hours were actually provided. A similar situation was recorded in north Tipperary. Three years after the residents were transferred from St. Patrick's Hospital, Cashel, to Our Lady's, in anticipation of the development of the community nursing unit on the St. Patrick's site, we have been told there was another change of mind and that the St. Patrick's site is not suitable. As with St. Brigid's, no details or reports to support the assertion that the site was not suitable were made available. When we queried it, we were accused of fearmongering.

Let me say we are concerned that yet again a decision has been made that would affect the level of service in a centre. We are concerned about the lack of detail being provided to us and that we will be sold another pup. We are concerned that a member of the regional health forum south and all but one Tipperary Oireachtas Member were excluded from a meeting on the matter that took place last week. This was despite my unanswered request that the Minister meet all Tipperary Oireachtas Members and relevant councillors. As far as anyone outside this cosy arrangement can see, nothing new was divulged at the meeting apart from the message that we are all expected to take the Minister's word on St. Patrick's at face value. The Government accuses people who are genuinely concerned about the future of St. Patrick's and the plans for it of playing political football with the matter but it is the Minister of State and her Government colleagues who are doing precisely this through their actions.

We need investment in the health service, which the Government has made a shambles of. If the Government wants to be taken seriously, we also need honesty and openness on its intentions for communities which, sadly, I must say is lacking from the Government benches at present.

Photo of Thomas GouldThomas Gould (Cork North Central, Sinn Fein)
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I thank the Independent Group for tabling this important motion. There is real fear among people about attending emergency departments because they are looking at spending nights on trolleys and long waiting times in overcrowded emergency departments. In 2022, more than 12,000 people waited on trolleys in Cork University Hospital.

As for the Mercy University Hospital, its emergency department is in prefabs and Portakabins and has been for the past couple of years. How can it be right that a hospital would have its accident and emergency unit in Portakabins? I was in there in February with my own father, sitting on a plastic chair with cubicles between people. People knew me because I am the local Deputy and they asked me how it was allowed to happen that people are sitting in there. How is it possible in this day and age? It is a complete failure by the Government and the Minister for Health, who has not tackled this issue.

I commend Deputy Michael Collins, who has run buses to Belfast. Last month, I got a phone call from a lady who had been taken by Deputy Collins from my constituency to Belfast to get cataract surgery. She is a pensioner with many health issues and she was nervous about being so far away from home to get this surgery, but she would be waiting at least three years in Cork. In 2020, the Government announced with great fanfare that a regional eye care facility would be opened in Cork in 2021 but it is still not open. Why? It is because they could not get a microscope. Can you believe that? They could not get a microscope and now there are thousands of people in Cork who cannot get eye surgery and who have to travel to Belfast because of the incompetence of the HSE.

I will leave the Minister of State with this. I have made representations for a man who has had his operation cancelled three times in three years. He is in constant pain and unable to move, all because of incompetence..

10:57 am

Photo of Pearse DohertyPearse Doherty (Donegal, Sinn Fein)
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Hospital overcrowding has become an endemic part of our health service, not least at Letterkenny University Hospital. This is despite the hard work of the staff there, who at all times are putting the interests of patients first. Last year, over 7,000 patients went without a bed at Letterkenny University Hospital, the worst year for overcrowding at the hospital on record. It should come as no surprise. At the beginning of this year, the chief executive of the Saolta University Health Care Group, which includes Letterkenny University Hospital, made it known that it had not received a single additional bed in the past three years. This difficult environment has continued right into this year. In the first weeks of this month, patients reportedly spent lengthy times at the emergency department of the hospital and, in the last week, we heard representatives of nurses and midwives claim that Letterkenny University Hospital needed an additional 60 members of staff to respond to patients’ needs.

Figures released this week to my party's health spokesperson show that more than 85,000 hospital appointments were cancelled in the first four months of the year across the State, and at Letterkenny University Hospital, more than 1,000 appointments were cancelled in the first four months of this year. When we talk about waiting times and cancelled appointments, we are talking about far more than the nuisance of patients being forced to wait. We are talking about delayed diagnosis and about the development of further complications that would not have happened had patients been treated when they needed to be; we are talking about life and death. The fact is that patients are dying in my county and in the north west as a result of all of this. It has to stop.

The situation at Letterkenny University Hospital is unacceptable. It is failing to meet the needs of the people of Donegal and, indeed, of the staff of that hospital. I and my colleague, Deputy Mac Lochlainn, have raised the issues of concern at Letterkenny University Hospital for years now. We have repeatedly raised the need for additional capacity and for more staffing, calls that have fallen on deaf ears within the Government. A multi-annual plan is needed to expand hospital capacity and to increase staff numbers and that plan must be put in place. While Sinn Féin in government would invest in health and services in Letterkenny University Hospital, action needs to be taken now. We cannot wait any longer. It is ridiculous what is happening and lives are being put at risk as a result.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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We move to the Labour Party. I call Deputy Sherlock.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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I support the motion. I will talk specifically about Mallow General Hospital, which is categorised as a level 2 hospital, but in our minds in north Cork, we think it is somewhere between level 2 and level 3 in terms of what it delivers for the people of the region that I represent.

In 2007, we in Mallow underwent quite a difficult process, prior to people like myself ever being in government, where the sword of Damocles was hanging over the accident and emergency unit there. We sat down and we figured out what it was that would make a hospital like Mallow thrive. When the accident and emergency services were reduced or diminished significantly, we made our pitch for endoscopy services, medical assessment units and a local injuries unit and, thankfully, all of those are in place today. That is thanks in no small part to the gargantuan efforts of voluntary organisations, local political effort and a recognition of the fact of a changing medical environment, where we recognised that the nature of medicine was changing such that more and more procedures would be done on a short-stay, elective basis. What we have today is a hospital that we are extremely proud of, and not only do we have those services, but we are also now expanding the hospital further again and we have the construction of a 48-bed unit under way.

The questions I have for the Minister of State today are these: when will that unit be complete, when will it be fitted out and what exactly is it that will go in there? We believe locally that we can take capacity from CUH, which is under massive strain at the moment. I have had reason over recent months to visit CUH on a number of occasions, including visiting the accident and emergency unit where, clearly, there are massive pressures and there does not appear to be any alleviation of those pressures. One thinks that hospitals like Mallow General Hospital, if the capacity was built out and staffed appropriately, could take a lot of pressure off a hospital like CUH, which is a tertiary facility, and more and more services could be circulated or brought to hospitals like Mallow. That is the ambition we have for Mallow General Hospital because we believe there is an excellent professional staff there who will deliver, and if additional staff are allocated for that purpose, we believe more services could come to Mallow. That would benefit everybody. It would benefit the Government and, most importantly, it would benefit the people because if they can be treated locally in their own local hospital, their outcomes are far better.

My ask today in supporting this motion is that, in regard to hospitals like Mallow where there is capital expenditure by the HSE at present, some vision is created for a service that would ensure we can take more capacity out of CUH and treat people locally within their own community, as I have said.

There is an issue for us when one considers Cork. There was a Government announcement around an elective hospital for Cork that is to be located in Glanmire. This was announced with great fanfare by the Government some time ago but what we have not seen since is any articulation of what exactly that would look like, what kind of services would be offered there and how that would operate in practical terms. We have no sense of what the capital expenditure for that will be and, as I said, while we know where it will be located, to date, we have not had sight of any planning application or information on when the sod will be turned on that. We need clarity around Government announcements, in particular in respect of elective hospitals. If we acknowledge that medicine is increasingly moving towards acute elective procedures on a short-stay basis, the capacity to deliver that in the county of Cork is still far short of where it needs to be. There is a long way to go.

To come back again to Mallow General Hospital, what I want to see within those 48 beds is some capacity for rehabilitation services. For example, Mallow is located in the heart of Munster but a lot of people have to go to Dún Laoghaire for services. If a certain number of beds were allocated and if the vision is right, a hospital like Mallow could provide such rehabilitation services.

In essence, we support the motion. We are making a call for greater capacity in hospitals like Mallow General Hospital. If we increase the capacity, more and better care can be delivered. We must ensure that there is a greater referral pattern directly into level 2 hospitals like Mallow. We could triage a lot of people away from CUH if the referral protocols were robust and fit for purpose. More and more people could be treated in hospitals like Mallow if the referral pathways were fit for purpose and that needs to be looked at as a matter of urgency.

We were told that the South/South West Hospital Group and the National Ambulance Service were implementing a referral pathway for clinically appropriate patients to the medical assessment unit in Mallow on a pilot basis. I asked a parliamentary question on this in February 2023 and was told that the outcome of the initial pilot which was conducted over a three-month period demonstrated the safety of this pathway model for patients and hence, this model is expected to continue into the future. What we have not been able to get are the metrics, or the numbers of people who have benefited from that referral pathway. We strongly believe that if somebody has presented to a hospital like Mallow General Hospital and has to come back in, via ambulance, again, the referral pathway should not be to CUH but directly back to the hospital where the person was treated. We need to see more of that. At present, the ambulance protocols for hospitals like Mallow are such that it is bypassed and patients go straight to CUH. Often that is clinically appropriate and that is acknowledged by those of us who are reasonable. However, we could treat a lot more people and prevent a lot more people from going to hospitals like CUH by creating greater pathways of care in level 2 hospitals.

Given that I have a few seconds left, I want to acknowledge the retirement of Mr. Gerry O'Dwyer, the CEO of the South/South West Hospital Group. I want to acknowledge the fact that he was always available to people like me. I have had many a heated debate and argument with Gerry O'Dwyer down through the years-----

11:07 am

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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Hear, hear.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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-----but to be fair to the man, he has always delivered for the people of Mallow through Mallow General Hospital. We have seen the outworkings of his efforts in that regard. We have had to push back on him on numerous occasions but I want to acknowledge that he had the best interests of Mallow at heart.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I move amendment No. 1:

To insert the following after "replace paper-based health records without further delay": "further calls on the Government to accelerate the development of elective hospitals in Cork, Dublin and Galway; make provision for salaried GPs to strengthen out of hours services; and complete and publish the Regional Health Areas Implementation Plan".

I want to talk about what I regard as an important further call on the Government to accelerate the development of elective hospitals in Cork, Dublin and Galway, to make provision for salaried GPs in order to strengthen our out-of-hours services and to complete and publish the regional health areas implementation plan. These are three major areas that are now long overdue and I am calling for them to be accelerated.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I just want to let the Deputy know that her amendment is accepted by the Government.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I very much welcome the opportunity to speak on this very important motion and thank the Independent Group for bringing it forward. The motion is very wide ranging, from nursing homes to electronic health records, and it reflects the scale of the challenges we face in relation to serious problems within the health service. At present, our health service is disjointed and operating in silos. We have nine CHOs and six hospital groups, all with their own separate boundaries, management teams and budgets. This disconnected and competitive model is a far cry from a system of integrated care and it is failing patients as well as healthcare staff.

The dysfunction at the very heart of the system is addressed in Sláintecare with the introduction of regional health areas, RHAs. Although often overlooked, the importance of restructuring the HSE and combining community and hospital services within regions cannot be overstated. While I believe the Minister for Health is committed to this structural reform, I am concerned that he is ignoring some critical aspects of the regionalisation project, particularly in relation to the need to decentralise power, decision making, responsibility and accountability from the centre to the regions. It is very disappointing that the business case chosen by the Government for RHAs did not include full decentralisation and a slimming down of the very heavy command-and-control centre of the HSE because that is a huge impediment to the regions taking on the responsibility and the accountability for the provision of services and for the spending of budgets. Without full decentralisation it is difficult to see how we are to address the current centralised approach to decision making and the spending of budgets. That has to change urgently. Senior management in the new RHAs must be fully empowered to take decisions locally. Obviously those decisions must be based on national health policy but the responsibility and the accountability must lie locally. This project will only be successful if there is a legitimate devolution of power and accountability to the regions. That is why the Minister must publish the RHA implementation plan without any further delay and clearly state his intentions regarding governance and accountability.

It is also important that we review the models of care and authority in other areas of health and social care. I want to speak particularly about elder care. In terms of home care, the Minister for Health and the Minister of State, Deputy Butler, in particular must provide the funding required to progress the recommendations of the strategic workforce advisory group. That is long overdue. We are now into a five- or six-month extension of the existing tender and that is simply unacceptable. The strategic group did its work and reported last October but we have yet to see action on that. An offer was put on the table that was based on the validated costs involved in this. I do not know why the Department asked Grant Thornton to do a validation of costs and then proceeded to ignore the results.

Let us not forget that there are 6,500 older people on waiting lists for home care. That is a shocking figure. It is very hard to reach what is a very high bar for being awarded home care and yet 6,500 very vulnerable people are left in their own homes, in very urgent need of support to remain at home. Those waiting lists are persisting and have been at that level for quite some time. It is also time to be serious about the large number of delayed discharges from hospitals. At any one time there are around 600 delayed discharges. I refer to people who are ready to be discharged but for whom the necessary supports are not available, either in the form of step-down beds or home care. A very significant number of those whose discharge has been delayed are waiting for home care and that needs to be addressed.

Alongside increased funding in the medium to long term, we need to take a serious look at the home care model. We know that only 38% of home care is provided directly by the HSE and that must be increased. However, home care appears to be an afterthought for this Government. Increased provision would help to tackle our stubbornly high waiting lists. We need a new model. What we have seen over recent years is a rush to privatise and outsource services for older people, whether that is in relation to home care or nursing home care. We have seen that headlong rush to absolve the State of its responsibility to provide care for older people, whether in a residential setting or in their own homes. What is happening is that the State is shirking its responsibility to provide public services.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I agree.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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What we are seeing is the widespread monetisation of the care of older people. Is the Minister of State going to do anything about this? Her colleagues in government have been promoting this privatised, outsourced model, for many years but when we were in the throes of Covid-19, we saw all of the difficulties that arose as a result of the large-scale nursing homes that so many of our elder people are forced to enter because of the absence of other models of care.

Even at that stage, in 2020, the then Taoiseach said we needed a new model of care. There does not seem to be much work going on in developing those new models of care. It is critical also that the HSE has to work with local authorities to provide a combination of supported and sheltered housing that provides the extra supports that are needed over time for people in the later years of their lives. The model of care that is being used at the moment is not serving the need.

We need to see the long-promised elective hospitals. We need to see them. They make absolute sense. If we have those three elective hospitals, we can make real progress through the waiting lists without those lists being impacted by the emergency departments. It is really important that this happens.

Finally, there is a dire shortage of GPs. The model for GP practices does not work in a modern context. It is fine for those who are already in it and can continue but there needs to be a second model which will provide salaries for those who want to work as GPs rather than as business people. That issue is long overdue to be tackled.

11:17 am

Photo of Paul MurphyPaul Murphy (Dublin South West, RISE)
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I am sharing time with Deputies Gino Kenny and Wynne. I thank the Independent Group for this motion. I want to take the opportunity to ring the alarm bells about what has been happening at Tallaght hospital emergency department. For over a week now it has been in an extreme crisis situation. The full capacity protocol has been in operation. People have been waiting for more than 24 hours to get a trolley. It is a really horrendous situation for patients and for the staff. I will read some of the messages I have received from people who have relatives in the hospital. Someone wrote to me one evening in the course of the last week saying their partner who suffers with Crohn's disease was taken by ambulance one morning at approximately 11 a.m. to Tallaght University Hospital. He had a viral infection. His immune system had a vulnerable infection which was now in his stomach. He was put on antibiotics and had a CT scan and chest X-ray. He was told he would be put on a ward at 1 p.m. the next day but a day and a half later, he was still sitting upright on a chair in the emergency department in agony with stomach pains. I have another message from someone saying, "I am here with my daughter in Tallaght hospital from 2 p.m., now it is 9.30 p.m., nobody cares, she is very bad." A journalist, Suzanne Kane, posted about it on social media. She says our hospital system is "so incredibly broken" and "Tallaght hospital the past few days is like nothing I have ever experienced. When you're so sick and they're so stretched, there's people everywhere, no beds, trolleys, no space. We are lucky that there are so many unreal people working in our hospitals but they are on their hands and knees." That sums up the attitude of people who are extremely appreciative of the incredible work being done by workers in our health service but see that the whole system is absolutely creaking, at the expense of the patients and the staff.

This is not the first time the full capacity protocol has been triggered in the last number of months in Tallaght hospital. It happens again and again. At the bottom of this, the underlying issue is that of capacity in our health service and in particular the absence of beds. In the early 1980s Ireland had 17,500 hospital beds in our health system. Today we have just over 11,000. We have the same number as we had in 2009 when we had a population that was half a million lower than it is now. We have almost half as few beds per capitaas the average across the EU. At the same time, the private health operators are making massive profits. Larry Goodman's Blackrock Clinic reported a doubling of profits last year. The two of those things are related. We need investment in our health service.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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I congratulate the Independent Group on the motion. It is quite wide ranging. We would like to see all of that implemented as soon as possible. The pandemic showed us many things about our health service, our country and ourselves. There was a collective spirit. It was a very dark time in our history but there was a collective effort to look after each other in our public service. The front-line workers were up against something that was unprecedented in the history of any health service in the last 100 years. Massive sacrifices were made. Collectively we came out of that in a better way in some ways. However, serious inequalities showed themselves in respect of private and public healthcare and the historical legacies of capacity in Ireland. Over the last 30 or 40 years, thousands of beds have been taken out of the public health service. We are living with that capacity issue today. There is a lot of debate around universal healthcare. The majority of people in this country would support universal healthcare. A good example is the NHS in Britain. It is not perfect by any means but it is a much better system than we have here at the moment. Some 50% of people in Ireland still rely on private health insurance. That is not the fault of those people but they think they will have a better chance accessing healthcare privately rather than through the public system. That has to be addressed. They are historical inequalities that lead to really bad outcomes for a lot of people.

Retention and recruitment is the most important issue of our time. It is about keeping staff in this country while there is a crisis in housing. We need to keep staff here rather than having to go abroad.

Photo of Violet-Anne WynneViolet-Anne Wynne (Clare, Independent)
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I thank People Before Profit-Solidarity for lending me the time to speak on this very important issue. It is arguably the most pressing issue facing my constituents in Clare, tied with the ever-growing housing crisis. I have been on the record of this House many times in support of the reinstatement of the accident and emergency department at Ennis hospital. I would like to take the opportunity to reaffirm my unequivocal support once again for the full reinstatement of the vital accident and emergency department at Ennis. There is not one member of the Government or in this wider House who would deny that reconfiguration failed. It was not backed up with the necessary or promised resources and funding. I got the Minister for Health and the Taoiseach to admit it here in the House in just the last few months. As far as that is concerned, we are all on the same page. What we are not on the same page about is what must happen now. In the 13 years since the vital service was ripped out of my county, it is impossible to ascertain how many people have needlessly died. For anyone who is not aware, there are 68 people on trolleys in UHL this morning. While 68 people abandoned on trolleys should never be acceptable, we would actually consider it to be a good day because instead of lying abandoned for two to three days, patients might possibly only be waiting 18 hours. This is Ireland, the second richest country in Europe, in 2023. It feels like a fever dream. In UHL, nurses in the ICU and in the high-dependency unit have been forced to initiate a work-to-rule because they are being paid significantly less than agency staff doing the exact same job. Every single ICU care practice guideline is being flouted there every day as a result of the chronic understaffing. This recruitment and retention crisis is not an alien entity. It is a result of Government policy. It is entirely of their own creation. We have heard that nurses are retiring early because of the pressures they are facing in UHL. That is in order to protect their mental health because UHL is the infamous war zone and morale is on the floor. However, they have said that they will work in Ennis. These nurses, our heroes in our time of need, are working with a major deficit in the mid-west region and are clearly adding to the ever-growing argument for the need for a model 3 hospital in Ennis. I support the spirit of the motion and what it is trying to do but we need to go a little bit further with a long-term goal. We need to extend the local injuries unit and medical assessment unit hours to full-time and the reinstatement of the emergency department is the inevitable result. My constituents and the people of Limerick and north Tipperary seem to be viewed as lesser by this Government, which seems to think those people do not deserve the same quality of care as everyone else in Ireland. This is the policy of the Minister of State, the Government and the HSE. Enough is enough.

Photo of Peter FitzpatrickPeter Fitzpatrick (Louth, Independent)
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I welcome the opportunity to speak on this motion on targeted investment in the health service. Although it is centred around the University Limerick Hospitals Group, the points raised are also applicable to my constituency of Louth and east Meath. The 2010 report of the national acute medicine programme alongside the 2013 framework for smaller hospitals outlined the need for smaller and larger hospitals to operate as a single local hospital group.

Hospital services working in groups to provide acute care, integrated with community and primary care, were outlined from model 1 to 4, based upon the evidence-based needs of the population area. This was termed "the safe provision of patient care within the constraints of available facilities, staff provision, resources and local factors" and resulted in the downgrading of Louth County Hospital and the advised closure of the Navan ED. In that system, a process of reconfiguration commenced in June 2010 with the closure of the 24-7 emergency department in Louth County Hospital. This emergency department was replaced with daytime urgent care centre providing emergency medicine services for patients with non life-threatening or limb-threatening injuries. This was to comprise a medical assessment unit and a local injury unit open seven days a week between 8 a.m. and 8 p.m., with the provision of on-site GP out-of-hours services, subject to local consultation.

In April 2023, it was announced all that the MAUs in the University Limerick Hospitals Group would be open seven days a week following an allocation of a multimillion euro funding package to extend the operational hours of MAUs in St. John’s Hospital and Nenagh Hospital. While the MAU and LIU services provide some relief by easing pressure in County Louth, it is evident our ED and ambulance services are still struggling. In 2022, ED waiting times were at their highest in years, with 67,000 patients waiting at least a day in EDs before being admitted. On top of this, over 812,000 patients were on national public hospital waiting lists at the end of 2022, with 584,600 patients waiting to be seen for the first time by a consultant at an outpatient clinic. The population in the larger catchment area is only going to grow, so action needs to be taken now. For example, one of my constituents has been waiting two years on a urology consultation in Drogheda that keeps getting postponed. While I acknowledge planned consultations, procedures and operations can be postponed or cancelled for a variety of reasons, it is most commonly due to capacity issues stemming from increased scheduled and unscheduled care demand.

On top of high ED waiting times and overcrowding, the decision to close the Navan accident and emergency department will have a significant knock-on effect on Our Lady of Lourdes Hospital in Drogheda, which is already experiencing a deficit in medical staffing. In December 2022, 17 senior clinicians at Our Lady of Lourdes expressed their concerns for patient safety if the accident and emergency department in Navan is downgraded. They warned that the Drogheda hospital is at full capacity and indicated the experience of Our Lady of Lourdes Hospital would mirror the pressure being experienced at University Hospital Limerick if the Navan ED is closed down. Proposed improvements in Our Lady of Lourdes Hospital could never be an acceptable substitute for 24-hour acute medical care in Navan.

In January I spoke about an issue with recruitment, namely, the HSE has gone out to recruit but has not been successful. This is consistent throughout the health services and mental health services in County Louth, whereby in addition to no psychiatrists being available, the only pediatrician available was Dr. Maeve McCormack, who had a four- to five-month waiting list. When I raised the issue with the Minister last year, he agreed the required resources have not been in place for a long time. Deficits in staffing and bed capacity in Our Lady of Lourdes Hospital have a knock-on effect on ambulance turnaround times and the transfer of risk from one hospital to another leads to poorer clinical outcomes for patients.

I fought for Louth County Hospital and reaffirm that the closing of key capacity, within a time of capacity crisis, will not be accepted. Urgent action and funding needs to be allocated to the acute services in counties Louth and Meath. Nobody in this region wants to see what is happening in UHL happen in our region. There is a strong role for smaller hospitals in which they can provide more services, not less. The reopening of Louth County Hospital should seriously be considered. The treatment of stable medical patients who meet the agreed clinical criteria in hospitals closer to their homes, such as the model 2 hospitals, is aimed at reducing ED wait times and releasing ambulances more quickly. However, MAUs and LIUs are only open between 8 a.m. and 8 p.m.

According to an OECD report released in February, Governments should urgently adapt their health systems to better respond to future shocks, given the huge impact of the Covid-19 pandemic on people and the global economy. Even the most advanced health systems in the world were not resilient to the pandemic. The report affirmed that major investment is needed in the health workforce, alongside increased spending on prevention and digital infrastructure. I therefore advocate for the procurement of an electronic health system to replace paper-based health records. This is especially critical after the major ransomware cyberattack in 2021. While I acknowledge the establishment of hospital groups signalled a fundamental modernisation of our health system organisation in line with best international practice, Ireland remains a laggard in Europe for digitisation in the health system and the introduction of electronic health records. The use of such technology could significantly reduce triage times in EDs. Although I acknowledge the significant investment in health and social care services in budget 2023, we need to reduce acute hospital and community waiting lists.

Overall, LIUs deliver efficient, expert treatment to tens of thousands of patients with minor injuries every year and have been of crucial assistance in relieving pressure on EDs, while MAUs play an integral role in ED avoidance. Consequently, I agree with the proposed expansion of MAUs and LIUs to 24-hour, 7-day-a-week operation. However, in order to succeed we need to look into the recruitment and retention issues. I also push for the reopening of Louth County Hospital. There is infrastructure and capacity available immediately which would alleviate the pressures put on our other hospital in Louth, namely, Our Lady of Lourdes Hospital. I and my colleagues in the regional group previously brought a motion on the improvement to regional pre-hospital emergency care and community care. An overhaul in the delivery of pre-hospital emergency care services is also required, to include better training for staff in schools and childcare facilities to an expanded role for MAUs and LIUs. This would help in reducing the numbers of patients attending emergency departments in the first instance. However, in order to succeed we need to invest in our local health service, make efficient use of current infrastructure and invest in our digital infrastructure, specifically the introduction of electronic health records.

On Monday, 15 May, I thought I was going in for a normal day in my busy constituency office, but it was not a normal day. On four different occasions people came into my office and threatened to commit suicide. The first person who came into my office got a lethal injection last week and was taken to Our Lady of Lourdes Hospital. The staff kept him alive. The second person was walking the streets, had no accommodation and wanted to jump off the bridge. The third person was a lady who was going to be evicted and had nowhere to go. She wanted to commit suicide. The last person was there due to a family dispute. Two brothers did not get on together and one of them was put out of the house. He was sleeping in a graveyard. People found him there. He wanted to commit suicide. Louth County Council does a fantastic job, but its staff cannot look after medical issues. I plead with the Minister. Does he think it is right for people to sleep in graveyards, in parks or on the streets? I have been a Deputy for the last 12 years, but I have never seen things as bad. When people come into my constituency office, they think I can give them a house or put them in a hostel. We need the Minister's Government to help these people. I have the phone numbers and contact details of the four people and I will work closely with the Minister, but my staff are finding it nearly impossible to deal with these people. We need help, we need training and so on. Please help us.

11:27 am

Photo of Carol NolanCarol Nolan (Laois-Offaly, Independent)
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Insím don Aire gur mhaith liom mo thacaíocht a thabhairt don rún seo atá curtha os ár gcomhair ar maidin ag an nGrúpa Neamhspleách agus is rún oiriúnach agus fíorthábhachtach é.

This motion rightly acknowledges that MAUs play an integral role in ED avoidance and that LIUs deliver efficient, expert treatment to tens of thousands of patients with minor injuries every year. There is clearly something profoundly wrong with how our health system functions. I have been making the point for years that one of the key issues is the management culture within the HSE itself. Writing in The Irish Times yesterday, Paul Cullen correctly noted the HSE as organisation is "stubbornly resistant to ... change". It is not just about money and we know that. This was also recognised by the Tánaiste. When I raised the issue with him in January, he acknowledged the governance and management issues of the overall edifice of the HSE need to be looked at.

We have staff deficits in almost every area now and the problems associated with this are only going to increase as demographics change. We can see a massively increased level of population growth in addition to an ageing population who require more intensive levels of care. While this motion makes critically important and pragmatic suggestions, their implementation will not take effect until and unless the culture of bureaucratic overmanagement in the HSE changes. How can change come to any organisation that resists change on almost every level?

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
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This is an important motion, which I fully support. Down through the years we have fought bravely to keep services in Bantry General Hospital which looks after the people of Cork South-West and south Kerry and does so excellently. I pay tribute to the hospital staff.

However, we are fighting to keep services there. We are fighting every day of the week to have endoscopy and stroke units built. As I have stated in the Dáil time and again, if a block was laid for each time a Government Deputy told the House that an endoscopy unit was going to be built in Bantry hospital, five or six units would have been built long ago, yet there is none. I do not even have an opening date. I do not have a date for the start of the stroke unit, yet there has been announcement after announcement. The then Taoiseach, Deputy Micheál Martin, came down to west Cork last August and made a famous announcement. Within days, though, we found out that the mental health unit was being decreased from 18 beds to 11. Now it is being called a success story because the number is only decreasing to 15. In a shockingly difficult time for people when mental health is a major issue throughout the country, the Government is decreasing bed numbers in the only mental health unit west of Cork city.

People are travelling from south Kerry and west Cork to CUH for medical procedures. CUH is an overcrowded bottleneck. There is nothing wrong with its staff - they are top class and under immense pressure - but most of these procedures could be carried out in Bantry General Hospital. The Government has decided to turn its back on small hospitals, though, as well as on pharmacies that could carry out some procedures. I recently had a procedure carried out. I had to go as far as Clonakilty because Bantry General Hospital could not perform it even though it was a simple procedure. The hospital was medically capable of performing the procedure, but its insurance would not cover it. The local doctor in the Clonakilty Medical Clinic looked after me. In fairness to him, he was not even my doctor.

When the overnight accident and emergency unit at Bantry hospital was being discussed in 2009, the then Taoiseach, Brian Cowen, said he did not see a need to save it. Unfortunately, 67% of patients were attending after 8 p.m. Accident and emergency services at Bantry close overnight and CUH is crowded. This is the crisis we have in this country. The Government let the small hospitals go.

11:37 am

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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I thank the Independent Group for tabling this important motion. I thank the Minister for visiting Kerry last week and I appreciate that he visited the site of the new community nursing unit in Killarney. It will be an important unit, a fact I wish to highlight to him.

The motion is timely. We can all agree that the health service is not in good shape. The system has more than 830,000 people on waiting lists, up from 550,000 when this coalition entered government. In overall terms, the Government's ineptitude is the root cause of the national hospital overcrowding crisis. Today, Ireland has fewer hospital beds than it had in 1980. This is a damning indictment of what is happening and of Government policy.

I do not know how many times we will have to say it before the Government eventually starts listening – it will have to listen eventually – but we want our community hospitals to be able to carry out more procedures. If there was a proper network of GPs throughout the country and if all of our community hospitals – we cherish them and the people working in them – could offer a larger number of basic health services to their communities, we would reduce the nonsensical overcrowding caused by people with minor problems attending accident and emergency units in acute settings. That overcrowding is wrong.

It is not that we are pointing fingers and blaming the Minister for everything, but we are asking, and will ask over and over, for a change in policy. Will the Government please use and enhance our community hospitals? I thank the people in County Kerry who are working in our hospitals.

Photo of Richard O'DonoghueRichard O'Donoghue (Limerick County, Independent)
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Who cares that, in 2022, UHL was the most overcrowded hospital in the country? I care, but does the Government care? Since the Government entered power, waiting lists have increased significantly to 830,000 people. Ireland has fewer beds now than we had in 1980 even though we have a larger population. The policy of Sláintecare is to remove the private rights of consultants within the public system and pay them a salary only. This will not work in our hospitals because we do not have consultants who work weekends or after 5 p.m. Consultants have rejected this policy, as they are already being paid a premium for only working five days in a hospital.

When the Minister was in UHL, he spoke to staff there. They asked him what he was going to do to improve healthcare and he replied by asking them what they would do. They asked the Minister to consider having 24-hour emergency department consultants to get through the backlog instead of the consultants coming in the following morning or after the weekend, by which time there would be a backlog. He said he would consider this. They also asked him for better working conditions and pay for the hospital's nursing staff. These are the front-line staff who work tirelessly day and night looking after us, but he will not tackle the broken management system in the hospital. Morale is on the floor. When the Minister asked them, the staff told him what to do. Will he please examine the management system and the structures at UHL? Without a shadow of a doubt, the system is broken and needs to be fixed. Doing so would raise morale in the hospital and we would be able to retain experienced staff, who are leaving in their droves.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I echo the sentiments of my colleague, the Minister of State, Deputy Butler, in her opening remarks to Deputies, particularly the Deputies who tabled what is a constructive motion and have made positive contributions to this important debate on targeted investment in our health service. As colleagues will be aware, our health service has been through extraordinary challenges. A global pandemic, a cyberattack and a recent winter season like no other, with the flu, Covid and respiratory syncytial virus, RSV, combined to put our health service, patients and health service professionals under extreme pressure. This pressure has been compounded by a population that is growing and ageing and, therefore, has more care needs that we have to meet.

It is crucial to acknowledge the outstanding efforts of our front-line workers across the country's health services. The Government has been working to match their commitment by investing more than ever before in expanding and reforming healthcare. The Minister of State outlined in detail the scale of that investment. We have put in place an additional nearly €5 billion in core funding since 2020. We have overseen the largest expansion of healthcare staff since the establishment of the HSE. Since 2020, we have hired more than 20,000 additional people into the health service, comprising more than 6,200 nurses and midwives, more than 3,000 health and social care professionals, and nearly 2,000 doctors and dentists. There has never been as much recruitment into our public health services.

However, the debate speaks to how this is not just a question of investment. We are expanding services and capacity at a level that has not been seen before, but meaningful reform is also vital for patients and the future of our health and social care services. Our goal is universal healthcare – a public health service that gives everyone the care he or she needs when he or she needs it. We are making progress. While I fully acknowledge the challenges in emergency departments, in accessing GPs and of too many patients on waiting lists, we must also acknowledge that important progress is being made. Last year, the number of people waiting over the agreed targets of ten and 12 weeks fell by 11%. This means that 56,000 fewer men, women and children were waiting longer than the agreed Sláintecare targets. Since the peak of the pandemic to the end of last month, there was a reduction in those figures of 21%, or 135,000. It is not enough, as there should be no one waiting, but let us acknowledge that our healthcare providers and professionals are doing the business. That reduction of 135,000 matters.

The motion rightly calls for measures to tackle overcrowding in our hospitals. We know it is a problem. We have seen the numbers. I have visited many emergency departments and spoken with patients and front-line staff. The situation in too many emergency departments on too many days of the week is simply not acceptable. We are rethinking, as we must, how our emergency departments work and are provisioned to tackle the issue of overcrowding and people waiting for too long, including on trolleys. We are considering discharge rates over the weekend, the availability of healthcare workers and the provision of community teams to support the transition of patients out of hospitals.

I have asked the HSE to develop an urgent care plan for this year, drawing on the lessons learned from winter and what is known to work. I am expecting a final draft of that plan later this month. I have also asked for a three-year plan because not only do we have to tackle these problems in the short term, but we have to put structural solutions in place. The Independent Deputies who tabled this motion quite rightly point to medical assessment units and local injuries units. The urgent care plan is looking at these and at expanding provision. Personally, I believe we need to standardise the LIUs. It does not work for people to have figure out what their local injury units do and to wonder whether they deal with paediatric cases or whether they are open at 7 p.m. or on Saturday. It should be standardised in the same way as emergency departments throughout the country. There is more we need to do with regard to LIUs and MAUs.

We also know that most of the solutions to overcrowding are found outside of the emergency departments, either through providing people with care so they do not need to go the emergency department or getting them out of hospitals and into appropriate community or home-based care as quickly as possible. To this exact point, I am focused on an unprecedented expansion of primary and community care. The ECC programme has seen the establishment of 94 community healthcare networks, so 94 of the 96 teams are now in place. Each of these serves a set population. In every one of our constituencies, there are now these new community healthcare teams that simply were not there three years ago. We are putting in new specialist teams for elderly people and chronic disease management. More than 2,500 staff have been recruited and I have provided funding for 3,500. They are bedding in and the feedback is very good but this is brand new. These services did not exist two years ago. They are bedding in, linking into the hospitals and linking into the GPs and the feedback we are getting is very positive. More needs to be done. Further integration is required and we still have to hire approximately 900 people into the teams but the feedback is very good.

We are developing services for our ageing population through the provision of integrated care teams for older people. We are looking at the impact of chronic conditions through community-based chronic disease management teams. The GPs are working with these teams and, again, the feedback I am getting from patients is very strong. Rather than being referred to a consultant in a hospital by their GP, people who have diabetes, heart issues or respiratory issues are now being managed by their GP or the specialist team in the community. They are not having to go near the hospitals and that is making a big difference.

The GP access to diagnostics programme, which we launched two years ago, is giving GPs and their patients direct access to diagnostics, something for which they have been asking for many years but have not had. Last year, there were more than 250,000 scans of various modalities through this programme. The programme is again well ahead of target this year. We are at approximately 115,000 scans so far. Preliminary research from the Irish College of General Practitioners, ICGP, suggests that, in the absence of this programme, the GP would have had no other choice but to refer nine out of every ten of these patients for an outpatient appointment or to an emergency department.

I am also strongly committed to pursuing the e-health agenda with regard to capital, revenue and resources. We all know that Ireland is a laggard on e-health. The situation is completely unacceptable in many of our hospitals and community services. My Department and the HSE are working together to put in place a new digital strategy and a plan to implement that strategy so that we can get to digital health and get the electronic health records that are needed. Deputies will be aware that we are working on a health information Bill to provide the legislative framework for all of that.

I thank them for their contributions and again acknowledge the Independent Deputies who tabled this motion. It is genuinely a very constructive and very positive motion that recognises the problems and calls for the right solutions. I am absolutely determined to continue to increase capacity right across our health system in many ways, including some broad ways and some of the very targeted ways the Deputies have called for. While expansion of capacity is absolutely essential, it is only half of the solution. The other half of the solution is fundamental reform of how our health services work. I agree with many of the points that have been raised, including those regarding productivity. Are we running our hospitals with the information we need? No, we are not. Do our healthcare managers, our hospital managers, the HSE centrally, I, as the Minister, or we, as the Oireachtas, have access to the kind of productivity data we need to hold the HSE to account and to make sure that everyone is doing the jobs they are meant to be doing? No, we do not have that information and so we are putting it in place.

We are fundamentally reshaping where patients are cared for. As Deputies will be aware, more and more care is being delivered in the community. We are supporting our healthcare workers to work to the greatest extent of their training and practice through new GP programmes such as the chronic disease management programme, through advanced practice for nurses, midwives and health and social care professionals and through enhanced roles for pharmacies, where we are also working. Critically, we are extending the normal working times for our health services into the evenings and weekends. We are reorganising the health service into RHAs to deliver properly integrated care. It is only through this combination of very significant investment and expansion of capacity coupled with fundamental and meaningful reform to how patients are cared for that we will achieve our goal of universal healthcare.

11:47 am

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We are running very much over time. Can Deputy McNamara wrap up within five minutes?

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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Yes. I thank the Minister for his response. It is clear that a lot of work is under way in his Department and in the HSE. It is also clear that a lot of work is needed. My question is not whether the Minister, the Government or the HSE is doing something, but whether enough is being done to keep pace. Notwithstanding all the recruitment and all the efforts at reform, all of which are positive steps and absolutely necessary and some of which are long overdue and relate to issues that existed long before the Minister came into office, are they enough because, on the ground, what we see are ever-increasing numbers on trolleys and on waiting lists? There was a decrease in the number on waiting lists, which is acknowledged in the motion, but it was not to the extent hoped for.

Both the Minister and the Minister of State pointed to the perfect storm over the winter with the Minister of State stating, "Emergency departments faced the most challenging winter in recent years as a perfect storm of flu, Covid and other respiratory diseases surged." However, on Monday of this week, when I am told we had the lowest number of persons with Covid and when there was no great outbreak of respiratory disease, we had 574 people on trolleys in Ireland. As per usual, the highest share in the country, 82 of these people, were in UHL, while 76 were in CUH. On Tuesday, there were 565 people on trolleys, 68 of whom were in UHL and 88 of whom were in CUH. This morning's nationwide figure is 497. Some 76 of these are in UHL while 80 are in Cork. Those kinds of figures are unprecedented for the end of May. They are the kinds of figures we would previously have had in winter. That is my concern. The Minister of State said that it is important to bear in mind that we have one of the longest life expectancies in Europe and that a large part of that is down to improvements in the healthcare system. While it is important to bear that in mind, it also means that we have a growing population as people are living longer, resulting in more and more demand. I appreciate that it is a question of running to stand still but that is not enough. We need to run to get ahead of the curve. That is my concern.

I welcome the positive spirit in which the motion is being taken and the acknowledgement that MAUs will be very important in alleviating some, although not all, of the pressures on emergency departments, that LIUs are also important and that the hours need to be standardised. I urge the Minister to move towards a 24-hour service in both kinds of service but I appreciate that it is not as simple as just saying that we are going to open these units 24 hours a day. They need to be staffed and there needs to be beds. We cannot talk about expanding a medical assessment unit unless there is additional capacity. That means additional beds in Ennis, Bantry, Mallow and every other model 2 hospital. Many people in the mid-west are calling for the emergency department in Ennis to be reopened.

I greatly look forward to the day when it is but it requires an intensive care unit and practically a new hospital. It is not realistic to think that will happen in the lifetime of this Dáil or very soon. We will have to see it in time but it will not happen very quickly. What can happen more quickly is an expansion of MAUs. There have been increases, which I acknowledge and appreciate. More increases are necessary to avoid people having to go to the emergency departments.

Regarding the e-health aspect, as I pointed out earlier, we have cutting-edge technology in this country and leading research and development in the technology sector; if those people get sick, the people treating them will be confined to paper records without adequate digitisation. It must be addressed as a matter of extreme urgency. I thank the Minister for the spirit in which he has taken the motion, I thank the Social Democrats for its amendment and I commend the motion to the House.

Amendment agreed to.

Motion, as amended, agreed to.