Colm Burke (Fine Gael) | Oireachtas source

I move amendment No. 2:

To delete all words after “That Seanad Éireann” and insert:

“acknowledges: - the difficulties which overcrowding in emergency departments causes for patients, their families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances;

- that the Government regards the current emergency department overcrowding situation as a major problem and that optimum patient care and patient safety at all times remain a Government priority;

- the wide-ranging set of actions which have been put in place by the HSE to achieve improvements;

- the specific measures which have been put in place to address hospital waiting lists more efficiently and effectively, for example through initiatives on colonoscopies, special funding for scoliosis and ophthalmology, the appointment of additional consultants and the extension of ultrasound access to additional primary care sites; and

- the targeted, integrated approach being adopted by the HSE in relation to the needs of elderly patients who no longer require acute care; notes in particular that: - all hospitals have escalation plans to manage not only patient flow but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care;

- actions taken to date to address emergency department overcrowding include the opening of additional overflow areas, providing additional diagnostics and strengthening discharge planning with a range of measures including:

- 900 transitional care beds funded in private nursing homes (500 in January, and a further 400 in February), to assist in the discharge of patients from acute hospitals;

- 173 short stay public beds being opened across the country for a three month period;

- agreement on additional nursing posts: this year the number of nurses directly employed in the public health service will increase by at least 500 (excluding the increase in mental health nurse numbers);

- up to 300 overflow beds opened in acute hospitals; and

- additional Community Intervention Teams introduced in Naas and in Drogheda, with 11 such teams now in operation;

- the Minister for Health convened the Emergency Department Taskforce last year to find long-term solutions to overcrowding by providing additional focus and momentum in dealing with the challenges presented by the current trolley waits;

- the HSE is finalising an action plan under the auspices of the Taskforce to be implemented immediately to specifically address emergency department related issues across hospital, social care and broader community services with a view to a significant reduction in trolley waits over the course of 2015;

- actions being taken by the HSE to address waiting lists include observation of the National Waiting List Protocol, prioritising day of surgery admission where clinically appropriate; and provision of new patient care pathways such as medical assessment, minor and local injury units and urgent care centres and provision of care in non-hospital settings to support the efficient use of hospital resources;

- that waiting list targets have not been changed and the HSE is finalising an action plan for waiting lists with a focus on very long waiters, such that by mid-year, nobody will wait longer than 18 months for inpatient and day case treatment or an outpatient appointment, with a further reduction thereafter to no greater than 15 months by year end;

- the HSE has committed in its National Service Plan 2015 to the publication of waiting lists on line at consultant and specialty level and aims to reduce waiting lists by way of process redesign, consolidating further the work of the Special Delivery Unit to date;

- the Government has made provision for a welcome increase in the total financial resources available to the HSE in 2015, the first in 7 years;

- the HSE is now in a position, where it knows there is an urgent service requirement, to recruit the necessary staff including additional nurses, doctors and therapists;

- the Government provided additional funding of €3 million last December and €25 million in 2015 to address delayed discharges: this funding is being targeted at hospital and community services which can enable initiatives to address specific needs of delayed discharge patients positively and thereby aims to improve timelines for admission from Emergency Departments and reduce waiting lists;

- the Review of the Nursing Homes Support Scheme which is currently underway and is due to be completed shortly will consider the future funding and sustainability of the Scheme as well as how community and residential services are balanced. Following the Review’s completion the Government will consider how best to meet the health, and related community and social care needs of older people;

- the failure of Fianna Fáil to make any proposals in their alternative budget for 2015 to address waiting lists and emergency department pressures, their leader’s broken promises when Minister for Health to eliminate waiting lists and the direct link between the constraints in recent years on the health budget and the economic crisis caused by Fianna Fáil’s reckless behaviour in Government;and supports:- the Minister for Health in his continued determination to bring about improvements in Urgent and Emergency Care services and in hospital waiting lists.”

I welcome the Minister to the House. It is good to have a debate on this matter but it is also good to talk about the real issues. It is important to recognise and give credit to the Minister, the Department and the HSE for their response over the past two months. A total of 900 transitional care beds have been opened, 500 in January, 400 in February, 173 short-stay public beds have been opened and 300 overflow beds have opened in acute hospitals but there remains a great deal of work to be done.

When dealing with this issue, however, it is important to consider what is happening in accident and emergency departments. For example, in 2014 there were 1,104,000 attendances in accident and emergency departments, that is over 3,000 each day. If there is even a 20% increase that means an additional 600 people attending each day. That is the challenge we face. There is a feeling that the whole hospital service is collapsing but we need to realise that last year there were over 3,189,000 outpatient attendances. There were 451,000 emergency admissions and approximately 100,000 elective procedures. That is the work hospitals deal with outside the accident and emergency departments.

There are major challenges in the service which I will continue to highlight. Due to the shortage of funds in recent years and the cutbacks, there was a reduction in staffing levels. One of the major challenges we face is consultant vacancies. There are many locums and agency consultants employed but according to my calculation, 325 positions require to be filled. When they are filled hospitals can start dealing with the waiting lists. We need decision makers. We need to give priority to this area.

I refer regularly to the Hanly report of 2003. There was a lack of action in the following ten years while we expected junior doctors to provide a high level of care in hospitals, the Hanly report set out a clear guideline. We should set out new targets over the next five years to implement that report. The target was to have 3,600 consultants by 2012 but now we have 2,500. We would then reduce the number of junior doctors. We have lost a huge opportunity to use nursing staff in the hospital service. Every nurse is competent but they have acquired additional skills which we are not using sufficiently. We need to consider their responsibilities to make sure they can make the contribution they want to make.

I note that Senator MacSharry has left the Chamber but the 2005 report on accident and emergency departments described access and long-term planning. According to that report, the lack of consistent development of services outside hospitals is a primary cause of the volumes being experienced by the acute sector. International experience indicates improvements in primary care services as part of the health reforms reduces accident and emergency attendances, hospital admissions, occupied bed days and delayed discharges. Those commenting on the report said they experienced in many areas in the review an over-focus and emphasis on the acute sector as providers of all services to local populations from highly specialised interventions to very routine outpatient services such as phlebotomy, monitoring and dressing clinics, all of which should have been more appropriately happening within a community setting both as a first line service and a follow up.

There were several recommendations in that report but we have not made much progress on diverting work from accident and emergency departments to primary care, particularly when there was adequate funding between 2005 and 2008-9. I have spoken to several GPs in recent days who talked about their lack of access to diagnostic services.They know what is wrong with the patient but they cannot get anything done unless the patient is admitted to hospital, although they are quite capable of delivering a service. We must prioritise this issue so that GPs can access diagnostic services in the hospitals without having to refer patients to consultants or clinics. When GPs refer patients they are put on a waiting list and can be waiting to be seen for four to six weeks. The only way around that is to refer them to the accident and emergency department. This is something we could tackle immediately and it would help to deal with the overflow in our accident and emergency departments.

It would be worth the Minister's while to read that report from 2005 and to tick the boxes beside the recommendations that were followed through. He will find that there are a lot of boxes that cannot be ticked because we have not acted on them.