Colm Burke (Fine Gael) | Oireachtas source

The health committee meeting is starting at 1.30 p.m. and as we are under pressure to attend that meeting it is unfortunate it is clashing with this debate. However, I appreciate the Minister coming in to the House to attend the debate.

It is interesting to look at the figures relating to accident and emergency medicine. As I understand it, last year there was approximately 1.3 million people who attended accident and emergency departments. My understanding is that figure is up around 6.5% or 7% across the country, which means that in real terms there are some 1.35 million to 1.4 million attendances, which is approximately 26,900 per week. That is a huge number of people attending accident and emergency departments. If there is a sudden increase of 20% in any one week, that is an increase of over 3,500 or 4,000 people into the system. It works out at around 3,800 per day. That is the challenge that the people who are working in the hospital system face. About 25% of that number are being admitted to hospital.

Demographic changes are an important factor and it presents us with a major challenge. I met with a hospital before Christmas. In 2015 it cancelled 40% of its elective surgery because of accident and emergency admissions. Its biggest challenge was a 12% increase in the number of people over 80 years of age who were admitted to accident and emergency. That is a huge problem because it is very difficult to say that a person in that age group can be referred home easily or sent back to a nursing home. There is a higher level of risk and therefore there must be a higher level of service provided to that age group. That is a major problem that we are going to have to address over the next few years.

Having studied the set-up of the health service over the last few months, I understand we are on about 2.8 beds per thousand. The OECD equivalent is 4.3 beds. I understand Germany has 8.3 beds per thousand. The Minister is right to say that there has been no major hospital centre built since 1998. Nothing was built between 1998 and 2008 at a time when we were flush with money. Even to start the process of building new hospitals takes time. We have been talking about the new children's hospital for almost 25 years. We now need to start planning for new building programmes. The Irish Association of Emergency Medicine, the IAEM, produced a report in 2012. We need to look at that now and take on board what it is saying as we have parked this issue for far too long. It sets out clearly what needs to be done regarding trauma networks, emergency networks, emergency care networks, clinical decision units, staffing levels and advanced nurse practice. Very little of it has been implemented. It is something that we need to urgently look at, including discussing with the IAEM to see how we can best deal with it.

We seem to have a big problem - my colleague Senator Kelleher is also involved in this in regard to the gynaecological services in Cork - where there appears to be one set of plans by the administration and another set by the medical workforce. As a result patients are suffering because there is no co-operation and co-ordination between the two, which is unfortunate. Some 4,000 people are now waiting for gynaecological services in Cork. I would agree with the Minister, and am surprised that this has been allowed to happen. It appears that we have a problem with the administration not reacting fast enough to such situations. Even in 2009 there was a substantial waiting list of over 2,900 people. That has grown since then because it was not dealt with. We have a problem with building a new maternity unit and providing two theatres for gynaecological services. Only one has been opened in the last ten years, and that is only open for 3.5 days per week. That does not make sense. Many hospitals are looking for theatres. This is a hospital that has theatres but the staff cannot be provided.

There have been a number of proposals to deal with these issues one of which, the National Treatment Purchase Fund, the Minister referred to. I am not satisfied that is the solution in Cork. One of the solutions put forward in regard to gynaecological services was about buying space in another facility.The available doctors would then be allowed to perform the procedures in another facility so that the care was continuous and patients were not passed from A to B and back to A again, which does not allow for the same continuity. This needs to be examined. My understanding is that space is available in other units to deal with these patients. We should not have to debate this matter today. It should have been highlighted and dealt with long before 4,000 people were on waiting lists.

Cork has identified that a six-bed day care unit for gynaecological services should be prioritised, as it would allow for fast-tracking. Approximately 42% of all patients waiting for gynaecological services are doing so at Cork University Hospital. This matter needs to be addressed.

The Minister referred to hospitals and the need for increases, but he should remember that, between 1986 and 2016, Ireland's population increased by 1.2 million. Cork alone increased from 410,000 people to 542,000, or more than 30%, but we did not receive one new hospital bed in those 30 years. That is why we need to prioritise a second major facility for Cork. We have good hospitals in the Mercy University Hospital and South Infirmary Victoria University Hospital, but they are no longer capable of dealing with their workloads. The 1960 Fitzgerald report set out clearly what needed to be done in Cork, including two major hospitals. We built one, but we do not even have a site for the second. This issue needs to be given priority and accelerated as soon as possible.

I thank the Minister for the work that he and his Department are doing, but we must prioritise a number of issues over the next 12 months.