Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I apologise about the timing. It was entirely my fault.

I very much welcome the opportunity to address the House on emergency departments. Like many Members, I have visited emergency departments across the country to hear about the first-hand experiences of patients and staff. I have seen the distress that overcrowding causes to patients and their families and to front-line staff working in what can be very challenging conditions.

This experience is being replicated across Europe - in Northern Ireland, Britain, France, Spain, Portugal, Germany, Austria, Finland, Switzerland and many more countries. Some of the best-resourced and best-run healthcare services in the world are under intense pressure due to a perfect storm of flu, Covid and respiratory syncytial virus, RSV. At the peak in Ireland in early January, when we had three days in particular with a very high number of patients on trolleys, there were around 1,500 patients in hospital with either flu, Covid or RSV. However, regardless of winter pressures, there is simply an unacceptable number of patients on trolleys in too many hospitals too often. This is not a new problem but one we must solve.

Our population is growing. Over the past 20 years it has grown by about one third. Our population is also ageing. It is good to see that Ireland now has the highest life expectancy in the EU. However, a population that is growing and ageing means significant additional demands on our healthcare services every year. The demand is growing in the context of a public health service that historically has not had the capacity to ensure patients get the care they need when they need it, in terms of both workforce and infrastructure. Recognising this, the Government has invested in the health service and growing the permanent capacity of our public health service at a level that has never been seen before.

We have added almost 1,000 hospital beds, over 360 community beds and 65 critical care beds. This is the greatest number of beds added since the HSE was established. We have increased the HSE's workforce by more than 17,400. This includes more than 5,000 nurses and midwives, nearly 3,000 health and social care professionals and 1,800 doctors and dentists. In fact, 2020, 2021 and 2022 have been the three best years for the expansion of the HSE's workforce since it was founded. This year will make the four best years.

Of course, all of the solutions to overcrowding in emergency departments are not to be found in the emergency departments or even in hospitals. We are creating integrated services for patients between community and hospital care. To do this, we have built over the past two years an entirely new community service. That means more than 90 new primary care teams have been created around the country, as well as new specialist teams in elderly care and chronic disease management. Around 2,500 staff have been recruited into the community care programme.

We have added millions of extra home care hours and we acknowledge that more are needed. Last year, we funded more than 200,000 diagnostics, directly accessible to GPs for their patients. This year, there will likely be in excess of 300,000. We are investing in the National Ambulance Service and expanding the number of injury units.

We are investing in general practice. We need more GPs, as we all know, and more out-of-hours cover. We need to help GPs move to more nurse-led care, including nurse prescribing and advanced practice nursing. To this end, we are increasing medical college places in the coming years. In fact, the number in 2010 will be tripled. We are investing a lot more in general practice so more nursing staff can be trained and hired. We have built a new network of primary care centres around the country and will continue to open new primary care centres this year. These advances in community care are new. This is a new way of running integrated health services. As the new services bed down this year and become better integrated with hospital care, community care and general practice, we will see more benefits for patients. This means more patients being treated in their communities and supported in their homes. It also means freeing up the hospitals to provide care to the sickest patients. While we have delivered a record number of hospital beds, the current processes do not produce new healthcare infrastructure quickly enough. Put plainly, it takes too long to build healthcare infrastructure. New beds, hospitals and theatres take too long. I am working with my Department, Government colleagues and the HSE to find a way to accelerate the bed programmes. We know we need more beds and that they are part of the solution to easing the pressure on emergency departments. We have to find a way to add them quicker than the current processes allow.

I recognise the deficits in capacity that exist in the HSE. When it comes to pressures in emergency departments, I believe that mistakes in implementation were made in some previous reconfigurations. Capacity should have been provided where emergency departments were being consolidated. It was not always done. My belief is that some of the pressures, particularly along the west coast and in Limerick and Galway, are being experienced in part because, when the changes were made to the emergency departments in question, sufficient capacity was not provided for. The Government is doing something about that now. We are addressing the deficits, putting the beds in place and building up the workforce.

More capacity is only part of the answer, however. The other part, which is also essential, lies in reform, which entails consistently providing patients with the quickest access to care using the capacity available to us.It is simply the case that some parts of our health service fare better at this than others. What is needed is consistency across the health service in applying the approaches we know work best for patients. Changes to working practices are needed, including having senior decision-makers rostered in the evenings and at weekends. In the hospitals, this includes senior decision-makers for patient assessment, treatment, admission and discharge. This is one of the critical changes we are bringing about in the new consultant contract.

It is not of course just about consultants, many of whom already work evenings and weekends. Consultants and their patients need regular access to theatres and diagnostics. Many healthcare professionals are involved in patient discharge, including health and social care professionals, both in the hospitals and in the community healthcare teams. Over the past few weeks, we have seen just how impactful it is when weekend discharge is increased. We have seen just how big a difference it makes to the number of patients waiting on trolleys and we know some of the best performing hospitals, including those that rarely, if ever, have patients on trolleys, already operate much higher weekend and late evening discharge levels.

There needs to be a relentless focus by managerial and clinical leadership on patient flow. We know many hospitals do this very well and we must see this done consistently across the country. Changes to discharge planning and funding are needed in some areas. This includes block-booking of private capacity, block-booking step-down beds in nursing homes and working with nursing homes to avoid unnecessary presentations to accident and emergency departments.

It is this combination of capacity and reform that leads to better access for patients to the services they need. I am determined to continue with the progress being made, adding more beds, diagnostics and theatres, hiring more healthcare professionals, adding more home care packages, finishing the roll-out of enhanced community services, modernising working practices to ensure the services needed are available when patients need them and supporting hospitals and community healthcare teams to ensure there is consistency of the best approaches seen right across our health services. This is what will provide us with the health service people in Ireland need and deserve, and that our healthcare professionals want to provide.