Mr. Liam Woods:

I am joined today by my colleagues, Ms Colette Cowan, CEO, University of Limerick Hospital Group, and Mr. Bernard Gloster, CHO area 3, covering Clare, Limerick and north Tipperary.

Each year our emergency departments, see close to 1.3 million patients and, on average, 25% of these patients are admitted. The total number of ED attendances has increased year on year while bed capacity has remained largely unchanged. This has created significant challenges for hospitals which manifest primarily in emergency departments but it is also creating challenges in terms of elective access. In the current year alone, ED attendances are up by 2.3% compared to the same period last year. This is on top of an increase in ED attendances of almost 3% during 2017 and 4.3% in 2016.

A key additional challenge facing our hospital and GP services is the sustained increase in the number of older patients presenting to ED. During 2017, hospitals reported an increase of almost 6% in the number of older patients attending ED with some EDs experiencing upwards of 10%. This year to date, a further increase in this age group has been observed with the number of presentations up by a further 3.4% compared to the same period last year. Typically, patients aged over 75 have more complex care requirements, are more likely to need to be admitted to hospital for treatment and will have longer lengths of stay. This means that the available capacity is under increased pressure as we do not have sufficient patient discharges every day.

The numbers waiting on trolleys at 8 a.m. fell by 3% during 2017 when compared to the full year 2016. The number of patients on trolleys between October and December was consistently lower than for the same period in 2016. These improvements were directly linked to increased capacity in a number of hospitals and sustained focus by hospital groups and community health organisations on reducing delayed discharges and improving patient flow. Targeted funding for emergency services in 2017 enabled consistent improvements in the wait time for funding under the fair deal scheme and an increase of up to 300 beds during the year. The trolley improvements were maintained to year end 2017.

The issues of overcrowding and the length of time patients wait in ED are a concern for both patients and staff, compromising a safe environment for assessing and treating patients. In 2017, the HSE sought to tackle both issues through investment in emergency departments, with UL opening its new emergency department in June 2017, and upgrades were undertaken in St. James's Hospital and at Mullingar. The major capital development of 80 beds, theatres, and an expanded ED in Our Lady of Lourdes Hospital, Drogheda, is opening on a phased basis in 2018.

The HSE has continued to focus on full compliance of no patient waiting over 24 hours and improvements have been made as compliance with this metric is now 95%. A key challenge for most hospitals is the lack of sufficient isolation facilities or single rooms required to ensure that infection control issues are managed appropriately. As a result patients can wait for significant periods for suitable accommodation.

In 2017, funding of €5 million was provided to support the cost of upgrades in EDs and wards aimed at addressing infection control, security and environmental issues. The first four months of 2018 have seen the number of patients on trolleys increase due to increased attendances and the age and acuity of patients presenting. However, there has been a stabilisation from April onwards with May showing an improvement against the same period in 2017 of 2.5%.

The number of confirmed influenza cases and influenza outbreaks during the 2017-18 flu season exceeded all previous records in Ireland, including the 2009 pandemic. The impact was particularly severe for those over 65 years of age, with 2,218 confirmed influenza hospitalised cases and 85 intensive care unit, ICU, admissions in that age group. Key challenges this year have been the sustained increase in influenza cases, insufficient isolation facilities and delays in the discharge of patients to home and other community settings. A further challenge was the incidence of influenza in nursing homes, which prevented new admissions from hospitals for periods in early 2018. Funding of €40 million was made available in winter 2017-18 to support surge pressures. Of that, €30 million was allocated to support additional home care packages, transitional care and aids and appliances, while the remaining €10 million was allocated to support the opening of an additional 260 beds during 2018.

Notwithstanding the extraordinary measures taken over the winter period to manage emergency activity, there is evidence to suggest that access to elective care is being crowded out. The Chairman and members will be well aware of the challenges that the HSE and, more importantly, patients are facing in terms of accessing outpatient and inpatient or day case services in public hospitals in spite of the significant volume of activity undertaken in hospitals on an annual basis, with 3.3 million patients seen as outpatients and 1.7 million procedures carried out. The latest waiting list information shows that at the end of June 2018, there were 511,000 patients waiting for a first outpatient appointment and 78,000 patients awaiting a surgical procedure.

Although a significant volume of patients are waiting for treatment, we have begun to make progress in this area. That is evidenced by a fall of more than 8,000 or 9.4% from the high of 86,100 in July 2017 in the number of patients waiting for a hospital inpatient or day case procedure. The latest figures also show that 58% of patients awaiting an inpatient or day case procedure are waiting less than six months and 83% are waiting less than 12 months. The progress in reducing the number of patients waiting for a hospital procedure comes as a result of Government investment in the area, supported by increased focus and collaboration across the HSE, the Department of Health and the National Treatment Purchase Fund, NTPF. In budget 2018, €50 million was provided to the NTPF to provide treatment for public patients. The inpatient and day case action plan published in April is a joint initiative between the Department, the NTPF and the HSE with the aim of reducing the overall number of patients waiting for treatment. Among its central goals are that by the end of 2018 fewer than 70,000 patients will await treatment, down from the historic peak of 86,100 in July 2017, and that 10,000 fewer patients will be waiting longer than nine months. Under the action plan, the NTPF has committed to provide 20,000 procedures for patients through the purchasing of additional activity in public or private hospitals. The HSE, working with the NTPF, has invited all hospital groups to develop proposals to maximise the use of existing facilities and capacity. For example, in the University Limerick hospitals group, dedicated cataract theatre capacity is being opened in Nenagh Hospital and the NTPF will fund treatment for patients there in 2018.

Although progress is being made in reducing inpatient and day case waiting lists, the outpatient waiting list remains a significant challenge, with 511,000 waiting for an outpatient appointment. Each year, 3.3 million patients attend hospital outpatient clinics. Slightly more than 70% of patients wait less than 12 months and approximately 60% wait less than nine months, while just under 50% wait less than six months. In order to address the issue of rising outpatient waiting list numbers, the HSE and the NTPF are in the process of finalising an outpatient action plan for 2018. The plan will support the HSE’s compliance with the national service plan targets, reduce the growth in the number of patients waiting for outpatient services, improve the accuracy of waiting lists and trial several NTPF-funded interventions, including weekend and out-of-hours clinics.

It is worth noting that almost 500,000 outpatients did not attend their appointment in 2017. The validation of waiting lists is, therefore, an important part of the outpatient action plan and the successful management of waiting lists and clinics. Since the end of 2017, the HSE and individual hospitals have undertaken validation of waiting lists. In order to ensure a consistent approach in that regard, the NTPF, through engagement with the HSE, has developed a proposal to establish a central validation office in the NTPF, which will centralise the validation of all waiting lists across the HSE. The NTPF has begun to engage with the HSE at national and individual hospital level to progress this proposal and envisages being in a position to commence validation of patients from September of this year.

Key enablers to the development of more sustainable solutions for access to services are the implementation of the Sláintecare report and the recommendations of the health service capacity review. The capacity review acknowledges that our acute capacity is not sufficient to meet our current demands, with hospitals operating at almost 100% capacity. The report sets out a clear plan for the delivery of 2,600 beds, as well as sustained investment in primary and social care services. The HSE is working closely with the Department to agree a robust implementation plan for core recommendations of the review, with clear milestones for delivery of changes in the model of care delivery and investment in additional capacity. The HSE has established a capacity steering group and more recently a task finish subgroup to progress this programme of work.

I and my colleagues will endeavour to answer any questions members may have.