Colm Burke (Fine Gael)
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I welcome the Minister to the House and thank her for dealing with this matter. I welcome the decision by the Minister and the Minister of State in dealing with the emergency that has arisen in recent weeks with regard to the overcrowding in accident and emergency departments, with the large numbers increasing. As I said to someone recently, if we take the figures for last year we see that, on average, 20,000 people attend accident and emergency departments every week. If there is a 20% increase, that is an extra 4,000 people and, therefore, a huge change can occur at very short notice.

An emergency task force was set up to deal with this problem. Nursing Homes Ireland, which represents the private nursing homes, accommodates over 22,000 people in private nursing homes. I understand that in setting up the emergency task force to deal with the accident and emergency problem in the sense of trying to get people out of hospital and make beds available for people who need to be admitted, there was no representative from the private nursing homes. The private nursing homes are a key ingredient in dealing with this issue as well as the doctors, nurses, hospital administration staff and all the back-up support needed, whether it is home care packages for people being discharged from hospital or whatever. My understanding is that the nursing homes are not represented on the emergency task force and it would be appropriate that they would have a representative to ensure that all the issues can be dealt with, that a service that is made available continues to improve, and that we have a response as soon as possible.

Kathleen Lynch (Cork North Central, Labour)
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I thank Senator Burke for raising this issue. Emergency department, ED, overcrowding is a priority issue for me and for the Government and I acknowledge the difficulties the current surge in ED activity is causing for patients, their families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances. The Minister for Health convened the emergency department task force in December 2014 to develop long-term solutions to overcrowding by providing additional focus and momentum in dealing with the challenges presented by the current trolley waits. The task force comprises senior doctors, lead hospital consultants, Health Service Executive national directors, union representatives and senior officials from the HSE acute hospitals directorate and the Department of Health. The task force will provide additional focus and momentum in dealing with the challenges, complementing the ongoing work of the special delivery unit and taking a service-wide approach including social care, primary care and acute care. The aim is to develop effective measures that will achieve sustainable, integrated and effective improvements across all services related to the ED trolley waits.

At their meeting last Monday, the task force discussed a draft action to specifically address ED issues with a view to a significant reduction in trolley waits over the course of 2015.

The Minister for Health and I are determined that the action plan be completed as soon as possible, taking the views of the task force into account, and then operationalised without delay. The task force is due to meet again on 9 March. In the interim, 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. These plans include opening the establishment of additional overflow areas, the reopening of closed beds, the provision of additional diagnostic scans and additional ward rounds by consultants to improve the appropriate flow of patients through the hospital system. The Government has provided additional funding of €3 million in 2014 and €25 million in 2015 to address delayed discharges. The actions being taken include the provision of additional home care packages, additional transition beds in nursing homes, 300 additional fair deal places and an extension of community intervention teams.

With regard to the issue of appointing representatives from the private nursing home sector, both the HSE and the Department of Health have given the matter serious consideration. It is acknowledged that private nursing homes have a valuable contribution to make in respect of specific issues such as delayed discharges and patient flow from acute or transitional care into long-term care. The position of private nursing homes does mean that, given their business interests, they have a very specific interest in how services are provided. It is considered that the existing membership of the task force is well placed to best cover the broad nursing home requirements. That said, the HSE will engage positively with private nursing homes and invite input and submissions from them on the work of the ED task force and other relevant issues under HSE's remit.

On a personal basis - this is something I will discuss with the officials - I do not have a difficulty with representatives of the private nursing home sector being on the group. They are key to how it is managed. Also, it would be remiss of us if we did not ensure GPs were part of this as well. The only way to stop the type of crisis we have seen this year and in the past from happening in the future is by ensuring that people are well maintained within their own community, and GPs are key to all of that.

Colm Burke (Fine Gael)
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I thank the Minister of State for her comprehensive response. The nursing homes represent the private sector. As the Minister of State has said, unions are represented on the task force, which is extremely important. Around 22,000 beds are provided by the private sector and, therefore, it plays a major part in dealing with the issues involved.

It would be interesting to discuss the transfer of people from nursing homes to accident and emergency departments. Would they have been better off staying in the nursing homes? If they had, they would probably have got equally good care and treatment. This issue arose at a meeting of the Oireachtas Joint Committee on Health and Children held last Thursday week, when Senator Jillian van Turnhout mentioned what happened when her father fell ill. His regular GP was unavailable so the family called the doctor-on-call service. That doctor immediately responded by suggesting that the Senator's father should be transferred to an accident and emergency unit. Such admissions, particularly when they happen at weekends, create problems in EDs. If nursing homes were represented on the task force they could play a key part in working to reduce the number of people who are transferred from nursing homes to accident and emergency units.

Kathleen Lynch (Cork North Central, Labour)
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I will be very brief. The pilot study of two nursing homes in Cork was on long-stay care and not transitional or short-term care. Following training at the nursing homes, admissions to accident and emergency departments were reduced. In saying that, the nursing homes where the training was carried out did not have a high incidence of admissions because they were very good at what they did. Clearly, there are GPs who would not be familiar with the person concerned on an ongoing basis. There are also some nurses who are worried about how to deal with people in later life who have become acutely unwell. We have to understand those factors too. It is about the type of training we can introduce to ensure that people do not end up in accident and emergency departments unnecessarily. Nursing homes must be part of the argument, but centrally, GPs have to be part of it as well.