David Cullinane (Waterford, Sinn Fein)
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3. To ask the Minister for Health when he will publish a multi-annual plan to resolve the crisis in emergency departments; when he will publish full details of all elective centres; and if he will make a statement on the matter. [26973/23]

David Cullinane (Waterford, Sinn Fein)
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In the first quarter of this year, people waited on average 11.7 hours in emergency departments for access to a bed. Unfortunately, people over the age of 75 waited on average 13.8 hours. For children, the average waiting time was 13.3 hours. We are hearing horror stories, to be frank, every day of every week about older people and children being left to wait even longer than those averages. Will the Minister tell us what more can and will be done to ensure we deal with the crisis in far too many emergency departments?

Stephen Donnelly (Wicklow, Fianna Fail)
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I agree that the current situation in too many hospitals, although not all, is unacceptable. I think we all agree that it is especially the case in respect of older people who are waiting too long. As the Deputy quite rightly said, those figures are averages and do not include the people who are waiting on trolleys for 24 hours, 48 hours or longer. It is not an acceptable situation.

The HSE is now, at my request, finalising two planned approaches to urgent and emergency care. The first is a plan for the rest of this year and through the winter of next year. We will publish that in the coming weeks. It will be published this month, as it is now June. A three-year improvement plan to build on that will be published in the autumn. Overcrowding, as we are aware, is now a year-round challenge and these programmes are looking to make sustainable change and not just the addition of one-off resources for the winter. We are looking at fundamental structural change here.

The Deputy's question also alludes to elective centres. The national elective ambulatory care strategy was agreed in 2021 to try to decouple emergency care from scheduled care to the greatest extent possible. As he will be aware, we are proceeding with stand-alone elective hospitals in Cork, Galway and Dublin. The business cases for Cork and Galway were approved last year and the business case for Dublin will be with me very shortly. The Departments of Health and Public Expenditure, National Development Plan Delivery and Reform and the HSE are proceeding with parallel processing so we can move to sign off on the detailed design as quickly as possible this year before moving out to tender so we can get diggers on site as quickly as possible.

The final piece, as the Deputy will be aware, is the surgical hubs, the locations of most of which I announced last Friday. One of those will go into University Hospital Waterford. Based on the impact of surgical hubs in Tallaght hospital, I believe they can be of substantial benefit to patients and, critically, in a much shorter time than it will take for the elective hospitals to start treating patients.

David Cullinane (Waterford, Sinn Fein)
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Like the housing crisis, we debate the trolley crisis time and again in this Chamber. We want to get to a point where we deal with it comprehensively but it seems to be getting worse. As the Minister said, it is now a year-round problem. The figures for the waiting times for those on hospital trolleys, which are presented to us every day of every week by the INMO, are exceptionally high. The waiting times are far too high. We need to do a lot of things. The seven-day rostering will absolutely help but there is also a need to invest in hospital capacity. We need more hospital beds, more diagnostics, more surgical theatre capacity and more radiography capacity. All of those capacity deficits exist in some hospitals.

We also need to mandate best practice. If things are being done right in some hospitals, that needs to be shared and mandated across all hospitals. It is crucial to resource the community space. Enhanced community care from community intervention teams and all of that, which provides alternative care pathways, is also crucial. There is real frustration that despite all of the money was are spending in the health service, the numbers of patients on trolleys is not going down but up. People cannot for the life of them figure out that why the situation is getting worse when we are spending more money. Why is that the case?

Stephen Donnelly (Wicklow, Fianna Fail)
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That is a frustration. We have seen an unprecedented expansion in capacity. There are nearly 21,000 extra people and 1,000 extra beds, with another 500 on the way. We are progressing new hospitals. There are new operating theatres and outpatient departments. We have built an entirely new community care service in the past two years. What we are seeing here is reflected in what other countries around Europe, and further afield, are seeing. We have an aging and growing population, as the Deputy is aware. There is extra demand as a result of Covid that is difficult to quantify. One of the things the HSE is doing in preparation for the urgent care plan is to understand as well as possible why so many extra people are coming in. Who are they and what can be done? I will give the Deputy one example from the Mater hospital, the emergency department of which I was in recently.

The emergency department team said they have a lot of patients undergoing cancer treatment coming in - they are getting quite sick during treatment. The solution to that is not to bulk up the emergency department; it is to make sure they have direct access to the oncology services. That is the kind of work that is going on to address exactly the questions the Deputy is raising.

David Cullinane (Waterford, Sinn Fein)
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The patterns in the rest of Europe do not match with what is happening here in all areas. There is no good reason so many people are on trolleys if one hospital can arrive at a position where people are not on trolleys. Waterford is a very busy hospital serving a population of nearly 500,000. It has additional pressures now because of what happened in Wexford. If it can be done in one hospital, surely it can be done in others.

Undoubtedly, there are capacity issues in other hospitals. We will get a chance to talk to the Minister about University Hospital Waterford and capital plans that are not being expedited, which need to be expedited shortly as well. These are real issues.

Three things need to be done. First, the culture of how some hospitals are run and managed has to be changed. The seven-day rostering is only part of that. Much more needs to be done. Workforce planning is also crucial. Much more needs to be done in ratcheting up training places. Crucially, capacity, both in hospitals and community care, is needed.

People need to see the benefits of the additional investments because it frustrates and angers them when patients are waiting as long as they are in emergency departments.

Stephen Donnelly (Wicklow, Fianna Fail)
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I agree with all of that. The hospitals need to take a zero-tolerance approach to patients on trolleys. We have seen it. For example, Tullamore hospital is a very good case study where a new management team came in, they were on the ground in the emergency department and challenging why this patient and that patient were on trolleys and following that up right through the hospital. They determined, for instance, that a patient was on a trolley because other patients had not been discharged and asked why had those patients not been discharged. They had not been discharged because the short-term transition bed had not been made available in the community and they decided to go out and talk to the providers. They took a zero-tolerance approach. In Tullamore Hospital today, lines of patients on trolleys will not be seen in the emergency department. Three or four years ago, we would have.

I agree that we cannot expect hospitals and community services to do this on their own. We are expanding capacity at an unprecedented level. At the same time, we need the hospitals to take this very proactive challenging zero-tolerance approach to patients on trolleys accepting that they cannot solve all of those problems on their own and that we in the Oireachtas and we in government have to help them with extra capacity.