Gabrielle McFadden (Fine Gael) | Oireachtas source

I welcome the Minister of State to the House again and thank him for coming here so often.

We are all too aware of the problems with overcrowding that affect many hospitals around the country, particularly at this time of the year. We are all deeply concerned about this. None of us wants to see our relatives, or anybody’s, lying on a trolley, especially if they are elderly.

This problem has been with us for over 20 years. I acknowledge that there is no quick-fix solution. The issues are complex and require creative solutions. We know it is not just a matter of throwing more beds at the problem, and this becomes even clearer when one talks to people working at the coalface. It requires a multifaceted approach. An initiative I believe would lead to a significant reduction in hospital referrals is the rolling out of geriatric teams working specifically in the community. Such teams, led by a community-based consultant geriatrician and including specialist and prescribing nurses, could play an important role in supporting the management of the health needs of older people in community settings and in providing services that avoid the necessity for a hospital admission. There are regular admissions to the Midland Regional Hospital, Mullingar, of elderly people presenting with various needs, such as a requirement for intravenous medication. With more community geriatric teams, many of these elderly patients could be assessed and treated in the community. The team would visit local nursing homes, day care centres, community nursing units or people's own homes to assess and treat elderly patients without the need for the hospital admission in many cases.

People over 65 make up 13.5% of the population but currently account for significantly more than half of all the inpatient beds. This segment of the population is projected to grow significantly in the coming years. Many older people admitted to emergency departments, once assessed by a triage nurse, end up spending prolonged periods awaiting treatment. HSE statistics show that patients over 75 years spend three times longer in emergency departments than those aged 65 or younger. Up to 40% of those waiting for more than 24 hours are over 75 years of age. Would it not be significantly better to bring the care to these people rather than bringing them to the care, where they have to wait for long periods exposed to additional infection and putting pressure on an already strained emergency department?

Such an outreach service, provided in an integrated manner, would be a significant support in maintaining older people in their own homes and communities, where we all know they do better. This would not only help to reduce overcrowding in hospitals, such as that in Mullingar, but also, and just as important, preserve the dignity of older people and reduce the stress on their families. I have been in communication with Nursing Homes Ireland and it has assured me that this initiative is one it would very much support.

When I raised this issue previously with the then Minister of State, Ms Kathleen Lynch, she informed me the HSE was to put in place an integrated care programme for elderly people that would examine the variety of ways that health care services could be delivered to older persons and determine the most effective way to do so. Therefore, I ask the current Minister of State to update the House on the status of the integrated care programme for elderly people and, in particular, outline whether he believes a sufficient number of teams, each comprising a geriatrician and specialist nurses working in the community, could provide a more appropriate service to older users and help to relieve the pressure on emergency departments in hospitals, particularly at times of overcapacity.