Thomas Byrne (Fianna Fail) | Oireachtas source

I move:

That Seanad Éireann:

noting:

-the deplorable overcrowding being regularly experienced in hospital emergency departments;

-the record number of patients waiting on trolleys;

-the further delays in scheduled hospital treatments that will result from such overcrowding; and

-the failure of the Government and the Health Service Executive, HSE, to adequately prepare for a situation they fully expected to happen;

further noting:

-the sustained and consistent deterioration in the waiting lists for both outpatient appointments and scheduled treatments since the start of 2014;

-the failure to meet time related targets for waiting times over the past year; and

-the decision of the Minister for Health to extend the target for waiting times to inpatient and day case treatment from eight to 18 months;

agreeing that:

-the overcrowding crisis is causing an intolerable risk and danger to patients;

-that patient dignity is being compromised;

-there are insufficient beds and frontline medical staff to treat the increased number of patients needing admission; and

-the crisis is being exacerbated by the number of patients clinically discharged who cannot leave hospital because the Government and the HSE are not providing sufficient nursing home beds or home care support;

agreeing further that:

-the health services are underfunded;

-the 2015 HSE National Service Plan is not sufficient to fully address the increasing demands and demographic pressures being placed on our hospital system; and

-that key targets in the plan are regarded as unrealistic by its authors;

calls on the Government and the HSE to:

-immediately provide beds and increased frontline staff so that the overcrowding can be eased;

-restore the number of beds funded under the nursing home support scheme to at least the level supported in 2013; and

-fund the health services appropriately and sufficiently in 2015.

I welcome the Minister to the House. It is about time we got answers and solutions. In opposition we are often accused of not having a health policy. We are working on that but it is clear the Government does not have a health policy. That is the truth of it. I acknowledge that the Minister is very good at telling the truth but that is what we should all do. It is part of the job we all try to do. One needs to carry out those actions, it is not enough to sit back and comment. His comment today, that people will die, was appalling because his job, as Minister, is to keep people as well as possible within the available resources. It is not enough to accept death, suffering and outrageous waiting lists.

The overcrowding in the hospital emergency departments in recent months is deplorable. In one case we heard that a 103 year old woman was left on a trolley for 48 hours. In January there were record daily numbers of patients waiting on trolleys. The number of people on trolleys is very high today. That week in January when there was a record number of patients waiting on trolleys saw a five-day weekly total of more than 2,500 people. There was no daily figure of 601 last week but the cumulative five-day total was even higher than the worst week in January, therefore the position is getting worse according to the statistics. On Tuesday there were 514 patients on trolleys. The overcrowding is leading to further delays which is the nub of the issue because it affects a vast number of people. In scheduled hospital treatments the waiting lists soared in 2014, partially because of the reversal of a trick the Minister's predecessor pulled in terms of putting people into one-off appointments to private consultants without any follow up but they have continued to increase in 2015.

It is right to put on record the changes to waiting list targets, the changes that have taken place and the announcements made in recent years but it is very difficult to get this information as one has to start looking around for what was said and when it was said. When the Government came into office, the National Treatment Purchase Fund was effectively abolished. However, it stayed as an organisation and monitored what was going on. It stated in July 2011 that the maximum inpatient waiting time would be eight months and for outpatients a year. In September 2012, the then Minister for Health, Deputy James Reilly, by way of newspaper interview said the waiting list for inpatients would be a year but would be reduced to nine months. That is how these things are usually announced, they are slipped into an interview as if they were already in place.

In 2013, a trick was played by sending a huge number of people off the waiting list to private consultants, not to get anything done but for a one-off appointment. They were taken off the list for a temporary period and the Minister was congratulated on what he had done to reduce the post 12 months waiting list to about 4,000. What actually happened was that he sent a number of people on the waiting list to private consultant appointments. In some cases these consultants were not of the specialty required and once the patients saw the consultants once they were put back on the waiting list and lo and behold the waiting list shot up again.

When the Minister became Minister for Health last summer he said there would be a maximum waiting time of 18 months, so it has changed again. At the end of 2014 he promised the waiting list would be reduced to 15 months by the end of this year, as set out in the Government's amendment. It also states there will be an 18 month target by the middle of the year. The question is what is the target today? What is acceptable? By my calculations, if the target is a maximum waiting time of 18 months, although I suspect it is higher, plus 12 months for an outpatient appointment, a person could wait 30 months for a hip replacement, for example, and that would be deemed acceptable and as meeting the targets set by the Department of Health. It is crazy. As far as I can see, waiting times and the targets have been changed eight times since the Government came to power. In other words, we have had eight variances in what are regarded as acceptable waiting times. There is also allegedly a maximum waiting time of 20 weeks for children. Will the Minister confirm whether it still applies? It seems doubtful in the context of a case brought to my attention recently, in which a three year old is waiting since last April for an ear, nose and throat outpatient appointment. That is absolutely extraordinary.

The crisis in the health system is being exacerbated by several things that are going wrong or have gone wrong in the management of the hospitals service. There are not enough beds and not enough front-line medical staff. Announcements on the appointment of new staff will not solve the problem today. There are record numbers of patients who have been clinically discharged but cannot leave hospital. Only in a very small number of cases can we attach blame to the patient in such instances; there have always been a few who do not want to move. Generally, however, the problem is arising because the Government and the Health Service Executive are not providing sufficient nursing home beds and home care supports.

One of the tricks pulled by the Minister's predecessor was installing a waiting period for the fair deal scheme. Prior to this, the Government would fund any waiting period retrospectively, either by reimbursing the nursing home or giving a refund to the patient where he or she had covered the cost of the waiting period through personal funds. The change is effectively a really stealthy cutback. The Government is now stating that for the 12, 14 or more weeks people are waiting for their application to be accepted, cover will not be provided. In the vast majority of cases people are in nursing homes because they have to be. The very definition of a requirement for such care is that the person cannot live at home. It is a last resort for families and, when it gets to that stage, elderly people cannot hang around waiting to be admitted. In many cases, the obligation to fund the waiting period is bankrupting families. It is utterly unfair.

It is essential that beds be opened immediately and staffing levels increased without further delay. It is not enough to tell our emigrants to come home and that they will find a great welcome. The problems I have detailed require immediate resolution, but the Minister is not doing what needs to be done. As I outlined, he has changed the maximum waiting time target a number of times since he came to office last summer. That is not acceptable. He has had plenty of warnings about what is going on. The former chairman of the HSE's emergency department task force and national director of acute hospitals, Dr. Tony O'Connell, warned last September that delayed discharges were putting lives at risk. Dr. O'Connell has since left the HSE. Instead of examining the issues he raised, the Minister took another opportunity to complain about pay levels in the health service without doing anything about them. Incidentally, the headline comment was that Dr. O'Connell had left for pay reasons.

The cancellation of elective surgery was a massive mistake. The involvement of the Irish Nurses and Midwives Organisation, INMO, in making representations supporting that move, as I understand it, was retrograde. I understand SIPTU did not support it. Trade unions should represent their members, which the INMO generally does very well. In this instance, however, its stance gave the Government cover for cancelling large numbers of operations for people who were in pain, particularly on the orthopaedic side. That is adding massively to the waiting lists. Will the Minister consider bringing back the National Treatment Purchase Fund in some form to have these operations carried out and help people who are in pain? It was not a perfect system, but it got the work done.

What exactly is the special delivery unit doing or does it even still exist? If it does, nobody seems to be clear on its role. The programme for Government promised that this initiative would be the be all and end all, the greatest thing since the sliced pan, as the phrase goes. However, we hear very little about it now. It was mired in controversy over expenses, consultancy payments and so on and it has not really shown anything in the way of progress. Will the Minister set out exactly what it has achieved?

It is time to get stuck into the nitty-gritty of the work that has to be done to resolve the health crisis and keep people well and alive. The Minister put it very starkly when he said people were dying, but it is not good enough to talk about it if he is not going to take the action needed. He is required not to be a commentator on health matters but an action man. He must show that he can get things done and is capable of doing what so many deemed him to be capable of doing. Instead of simply telling us what is wrong , he must right those wrongs.