Peter Burke (Longford-Westmeath, Fine Gael) | Oireachtas source

I am taking this Topical Issue matter on behalf of the Minister for Health, Deputy Stephen Donnelly, who has been concerned for some time about the congestion experienced in the emergency department at UHL, which has led to long patient experience times and patients waiting on trolleys for admission. According to the HSE’s TrolleyGAR, there were 470 patients counted on trolleys at 8 a.m. in February 2023. This represents a 25% reduction on February 2019 when it was 629 patients and a 6% reduction on February 2022 when it was 500 patients. There were just under 80,000 attendances at the emergency department in Limerick in 2022. This is up 12% compared with 2019 and is 13% higher than the average for the period 2017 to 2021. This makes UHL the second busiest emergency department nationwide.

There has been, and continues to be, substantial investment in capacity in UHL. This includes a 42% growth in workforce since the end of 2019, the opening of an additional 98 acute inpatient beds and a 19% increase in budget in 2022 compared with 2019.

The Minister met with the hospital group management and elected Oireachtas Members from the mid-west on 11 January this year to discuss the emergency department situation in the hospital and future developments. The hospital crisis management team was convened in January to de-escalate UHL and took various actions. Extra staff, including nurses and doctors, were asked to present for duty, with additional consultant and support staff working over the weekends to effect discharges. A medical assessment unit, MAU, at Nenagh hospital has been operating seven days a week as a temporary measure since 7 January and will continue over the coming weeks. Additional surge beds opened in Ennis, Nenagh and St. John’s hospitals. Outpatient appointments for UHL were cancelled during the first week of response. Sanction was given for the use of bed capacity in private hospitals in the region and outside the region. These actions brought about a significant reduction in trolley numbers.

The medical assessment pathway for 112 and 999 patients has commenced at both Ennis and Nenagh hospitals. The new pathway allows stable medical patients meeting agreed clinical criteria to be treated in model 2 hospitals. A key element is a telephone referral from a treating paramedic to the receiving MAU doctor, which ensures that the right patient is brought to the MAU. This pathway facilitates patients receiving medical treatment in a hospital closer to their home, assists in reducing patient presentations to emergency departments and helps to release ambulances more quickly to respond to other emergency calls. Those 112 and 999 patients who do not meet these clinical criteria will continue to be transported to the emergency department for assessment and treatment. The medical assessment units in Ennis and Nenagh hospitals treat patients referred by GPs, Shannondoc and now National Ambulance Service paramedics. It is envisaged that similar measures will be introduced at St. John’s Hospital in the near future.

In addition to the national winter plan, there are bespoke site-level plans, including for Limerick. The local plans focus on local needs and build on integration between the community and acute hospital services. UHL’s plan includes measures such as the recruitment of extra staff, including but not limited to two whole-time equivalent emergency medicine consultants, additional emergency department registrars and discharge co-ordinators to target patient flow; improving access to diagnosis for both urgent and emergency attendances in the emergency department and for GPs; the enhancement of GP out-of-hours supports; the recruitment of administrative staff; and the creation of a performance management office to drive the ongoing service improvements in the University of Limerick Hospitals Group.

The Minister, Deputy Stephen Donnelly, has asked the HSE to prepare longer-term unscheduled care performance improvement plans for all our emergency departments, including that at UHL. The Department of Health is working with the HSE to ensure winter plan initiatives continue to be implemented.

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