Dr. Colm Henry:

There is a huge array of tasks in trying to improve trolley numbers and patient experience. As has been alluded to, it requires resources, but equally important is how those resources are used, including admission avoidance, seeking alternatives to presenting to emergency departments, reducing length of stay, improving flow through hospitals, expedited discharge and links with the community. Members of the committee will be aware of our work on enhanced services in the community. Focusing on two particular hospitals, in UHL earlier this year, where we tried to do exactly that, namely, share the lesson from a good practice site, such as University Hospital Waterford, and applying it in UHL, notwithstanding whatever capacity issues there may be. While there clearly are trolley issues in Limerick, we see some early improvements.

The total patient experience time, for example, in Limerick last year was 9.7 hours. It is now down to 8.9 hours, which, when it is applied over the entirety of patients, takes a huge amount of work based within existing capacity. That included patients who were awaiting admission, which reduced from 14 hours to 13 hours, and those who were not and were discharged, which reduced from 7.7 hours to 6.8 hours.

In Cork University Hospital, CUH, equally, it is about breaking it down, looking behind the trolleys and lifting the bonnet, so to speak, on all of the actions that are required. Mr. McCallion already referenced the reduction of turnaround time for ambulance response. A few years ago, it was at 57 minutes and now it is at 21 minutes. It is a major risk, not just in terms of the patients waiting in the ambulance but the availably of ambulances for people who need them in the community. Likewise, CUH has focused on, again through looking under that figure of trolleys, many different quality improvement projects that require leadership and resources but also changing the way people work, and it has reduced its conversion rate. That is the proportion of people who present who are admitted. It was well over 50% for those aged over 75 a couple of years ago and now it stands at 40%. To get that figure down to that level requires huge work in terms of senior decision-makers, availability of diagnostics, linking people to community and early discharge to GPs. It does not happen easily. The total patient experience time in CUH requires more work but its work on admission avoidance is a product of the kind of spread of learning we have from sites such as Waterford.

We need to act as quickly as possible. We would like all sites to be as good as Waterford or the other well-performing hospitals. That involves not just resources but changing the way people work.