Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

It requires much more than that. The reasons for overcrowding vary. Some hospitals put it down to problems with delayed discharges, others to a difficulty recruiting and retaining senior medical staff or a lack of acute beds. Experience has taught us that it is not just a matter of delayed discharges, staffing or skill levels, hospital avoidance, patient flow, overall management or advanced planning. It is about all of these factors and more. An integrated approach implementing changes in how we deliver health care is required and simple actions such as ensuring discharges take place at weekends and working with primary community care providers to deploy home care resources are essential if we are to get patients who need care into hospital beds and get those who have completed their treatment out safely. Since the current period of sustained pressure began, we have approached the issue with a hallmark of transparency and honesty. The Minister of State, Deputy Kathleen Lynch, and I have spoken regularly and at length about the numbers affected and we have not shied away from admitting this cannot be fixed instantly. How could it be? The infrastructural and resource constraints have built up over a number of years of austerity, and repairing the system will take time too. While sticking plasters are all right for minor grazes, deep wounds inflicted by previous Administrations require extensive reconstruction if we are to build a system that can respond to future need.

In the meantime, it is important to reassure people that all hospitals can and do manage patient flow and safety in a way that supports and ensures the delivery of optimum patient care. They are supported in this by the HSE, which plans appropriate ongoing actions by teleconference seven days week. As has been outlined, an additional €3 million has been provided in the Supplementary Estimates of 2014 and €25 million this year to address delayed discharges. I have already pointed out how it has been deployed. In the past couple of hours, I received figures that show that the number of delayed discharges is down to 705 from a peak of 850 a few months ago. At least it is going in the right direction, albeit there is a long way to go.

The HSE has put in place arrangements to recruit front-line staff where it has been established that there is an urgent service requirement. This has led the HSE to enhance the use of smaller hospitals, such as Louth County, Nenagh, Ennis and Bantry, for patients who require non-complex care after they have been medically stabilised. The extension of the community intervention teams, comprising nurses who go into homes and nursing homes to provide intravenous therapy, IVs, and other treatments, has been introduced in Naas and Drogheda and it has allowed 2,500 people to avoid hospital admission. I want this to be expanded further. All these additional actions underline the fact that the solution does not lie solely in the realm of acute hospitals, rather, a multidisciplinary approach is essential to care for patients appropriately.

We need to do much more. The Minister of State, Deputy Kathleen Lynch, and I have expressed time and again our view that social supports such as the fair deal, home help and home care packages should be demand-led, which is a fancy way of saying it should be a right or an entitlement in the same way as a pension, welfare benefit or school place. If a person qualifies for the support, it should be provided, not rationed. Matters such as this require the approval of the Government as a whole and I am exploring ways we can achieve it, whether by reprioritising in my budget or bringing forward spending planned for later in the year. We cannot ignore it.

Inevitably, the cancellation of elective surgery to help manage the need for immediate emergency or trauma care will affect waiting times where it is necessary to prioritise cancer or other urgent cases. The HSE assures me this is being done. The challenge is to minimise the need for cancellation at short notice and to manage the impact of such cancellations effectively.Realistically, I do not envisage significant improvements in elective waiting times in the early part of this year. However, based on the high priority attached to this area in the HSE service plan, the provision for an additional 20,000 day cases this year and the first overall increase in the HSE budget in seven years, I expect we will turn the corner on that later in 2015.

The movement of care and treatment from in-patient to day case and from day case to outpatient departments is very important. There is a commitment in the national service plan to pilot the provision of additional minor surgery services in primary care centres to allow GPs to do more minor surgery, hopefully reducing some of the waiting lists. My Department is also working with the HSE to develop a plan to address waiting lists with a focus on very long waiters such that by mid-year the maximum waiting time will be no longer than 18 months for in-patient services, day case treatment or outpatient appointments. A further reduction will bring the maximum waiting time to no greater than 15 months by year end. This will involve both productivity improvement and rigorous waiting list management. This does not mean the existing targets have been changed. The 20 months target for children, the eight month target and the 12 month target remain and will continue to be reported on in the HSE PAR on a monthly basis. We are setting maximum waiting times which is a different thing.