Wednesday, 17 January 2018
I dtús báire cuirim fáilte roimh an Aire Stáit, an Teachta Jim Daly, as bheith anseo inniu. Ba mhaith liom labhairt faoin seirbhís sláinte. Tá cúpla ceisteanna simplí agam. Dhá seachtain ó shin bhí scéal dochreidte sa Sunday Business Post. People were rightly shocked to see the headline "Life or Death: Top doctors say life support now being 'rationed' " in a newspaper at the weekend. The relevant story by Susan Mitchell, which was published in The Sunday Business Post, goes on to state that doctors were forced to make "tough decisions" and prioritise some critically ill patients. It is clearly stated in the article that the crisis stems from a shortage of intensive care beds in hospitals.
I preface my concerns about the problems relating to the intensive care units by stating that the vast majority of people who use the public health system have extremely positive experiences. Let us look at what has been said about the intensive care unit, ICU care. Dr. Tom Ryan, a consultant in intensive care and anesthesia in St. James's Hospital is president of the Irish Hospital Consultants Association, IHCA. Two weeks ago, Dr. Ryan noted that we are effectively rationing life support. Dr. Ryan is a senior medical professional who knows what he is speaking about. Dr. Emily O'Connor is President of the Irish Association of Emergency Medicine and a consultant in emergency medicine in Connolly Hospital Blanchardstown. She stated that doctors were having to make "tough decisions about which critically ill patients to prioritise.". I could quote from members of the Irish Nurses and Midwives Organisation, INMO, SIPTU and other unions who are on the front line in intensive care units. The Irish Medical Organisation, IMO, and the Royal College of Surgeons in Ireland have repeatedly warned about cuts in bed capacity and the impact on patient safety. What do unnecessary risks or tough decisions actually mean?The absence of a post-operative bed in an intensive care unit, ICU, means that critical life-saving surgery is delayed, deferred or - God forbid - cancelled. No doctor ever wants to be in this position. It runs contrary to our Hippocratic oath, contrary to the guidelines of the Medical Council, and contrary to the reasons many of us decided to get into medicine and health care. Doctors routinely have to sit down with family members and loved ones and say that in their professional opinion, having reviewed and assessed all of the options, the likelihood of survival is slim. Some of us have to give this bad news thousands of time in our professional lives. I can remember the first time I had such a conversation. I assure the Minister of State that it never gets easier. I never thought that one of these reasons might be that an ICU bed was not available.
In 2018 we were told by the Government that we were the richest in Europe and had the fastest growing economy in the eurozone. There is something profoundly sick about the fact that ICU beds are being rationed. This is why the type of problems being experienced within ICUs is so alarming. The failure to provide emergency surgery because of the absence of an ICU bed is nothing short of a national scandal. There can be no surprise that there is a shortage of ICU beds. It was highlighted for the HSE in 2009, but cuts of €576 million have been made to the capital budget for acute hospital care in the last ten years. What makes it worse in the case of ICUs is that it directly impacts upon serious elective surgery, such as procedures for treating cancer, and hinders doctors from escalating really medically sick patients, for example a patient with pneumonia, from the medical ward into an ICU bed.
Knowing what I know and speaking to people on the front line I can only conclude that the medical outcomes of people have been compromised and that people are dying as a result. This is a very serious thing to say but it is unfortunately the case. People are dying as a result of the absence of ICU beds.
I thank Senator Swanick for raising this issue and giving me the opportunity to provide an update to the House.
I fully accept that there are critical care capacity deficits in hospitals across the country. I recognise the ongoing challenges this presents and also its impact on patient flow within emergency departments. Currently, the annual national adult critical care bed capacity census reports a capacity of 240 adult critical care beds as of 30 September 2017. The HSE national service plan for 2018 recognises that, following the organisation of hospitals into hospital groups, it is clear that critical care capacity building is required in the hub hospitals in order to meet the ongoing and increasing critical care requirements of complex, multi-specialty, severely critically ill patients.
I assure the Senator that the 2018 service plan identifies increase of critical care capacity as a priority for this year. In particular it identifies the opening of additional high-dependency and critical care capacity at Cork University Hospital and the Mater Hospital as specific priority actions. Hospital groups are also facilitating the implementation of the national critical care nursing workforce plan, Career Pathway, to recruit nursing graduates.
The Senator may also be aware that my Department is undertaking a health system capacity review, in line with the Programme for a Partnership Government commitment, which is examining health service capacity across all key areas of primary care, acute care and services for older people. This includes examining current and future demand, capacity for adult critical care and the need for additional adult critical care capacity up to 2031, taking into account demographic growth.
I thank the Minister of State. It is worth noting that the HSE commissioned the Prospectus report in 2009, which recommended that the number of ICU beds be increased by 45% immediately and be doubled by 2020. These recommendations have not been acted upon and no additional ICU beds have been provided. An additional 1,500 acute hospital beds have also been closed. Dr. Fergal Hickey, who was a consultant in emergency medicine in Sligo University Hospital, said that an estimated 300 to 350 patients - real people - are dying every year due to a shortage of critical care beds.Does the Minister of State agree that the number of ICU beds must increase? What timeframe does the Government have for this? Does the Minister of State agree with the hospital consultants that the number of additional acute hospital beds that are required to provide an internationally accepted standard in Ireland is 4,000? By OECD standards, Ireland is one of the top spending countries in health. Something is seriously wrong when the number of acute hospital beds here is one of the lowest of all OECD countries. That is the fundamental problem.
I assure the House that my Department is committed to working with the HSE to address the clearly identified need for critical care capacity over the coming years. I absolutely agree with the Senator. I acknowledge the issue and, as I said earlier, it is recognised as a priority for the year ahead by the individual hospital groups. The implementation of hospital groups facilitates further reorganisation of these services across hospitals in line with the hub-and-spoke model. Over the medium to long term, the health service capacity review will provide the basis for determining the extent of the capacity requirements over the next 15 years and the type of capacity needed. The findings will also inform the development of a new ten-year national development plan. Work on the HSE capacity review is at an advanced stage and I expect to receive the final report very shortly. I intend to bring the report to the Government and have it published as soon as possible thereafter.
The Government is committed to making tangible and sustainable improvements in our health services. The health service capacity review was a key element of this and the Sláintecare report provides a framework and direction of travel for improvement. The Government has already given its approval to move ahead with the establishment of a Sláintecare programme office in the Department of Health. The role of executive director of the Sláintecare programme office was advertised on Friday 12 January, as the Senator is aware, by the Public Appointments Service.
On his specific question about consultants and the 4,000 beds, the Senator will appreciate that prior to the publication of the capacity review it would not be appropriate for me to comment on any numbers or figures in that regard.