Marian Harkin (Sligo-Leitrim, Independent) | Oireachtas source

I move:

That Dáil Éireann:

recognises that: - 2022 was the worst year for overcrowding in Irish hospitals on record, with over 121,000 patients being left without a bed;

- in 2022 University Hospital Limerick was the most overcrowded hospital in the country (18,028) followed by Cork University Hospital (12,439), University Hospital Galway (10,150), Sligo University Hospital (8,136) and St Vincent's University Hospital (7,513);

- 67,000 patients waited at least a day in Emergency Departments (EDs) before being admitted during 2022;

- over 812,000 patients were on national public hospital waiting lists at the end of 2022;

- 584,600 patients were waiting to be seen for the first time by a consultant at an outpatient clinic at the end of 2022;

- waiting list numbers reduced by 4 per cent in 2022, significantly lower than the Government's waiting list reduction target of 18 per cent for the year;

- Ireland remains a laggard in Europe for digitisation in the health system and the introduction of electronic health records, the use of such technology could significantly reduce triage times in EDs;

- there remains a lack of a specific national structure or control for clinical oversight in the care of people admitted to nursing homes and they have difficulty accessing treatment by primary care teams; and

- the lack of such oversight and care can result in unnecessary presentations at EDs; acknowledges that: - the creation of an additional 7,176 patient slots per year across the UL Hospitals Group following the recent introduction of a seven-day service at Medical Assessment Units (MAUs) in Nenagh Hospital and St. John's Hospital;

- the ongoing recruitment by UL Hospitals Group for additional doctors, nurses, health and social care professionals and administrative staff;

- the changing of Health Service Executive (HSE) protocols to allow non-ED doctors assess patients in the ED where there is a significant risk due to delay;

- the Government's allocation of €350 million under the 2022 Waiting List Action Plan to reduce active waiting lists;

- the European Investment Bank loaned the State €200 million to implement electronic health records over three years ago;

- on 14th May, 2021, the HSE was the subject of a major ransomware cyberattack, the most significant cybercrime attack on any Irish State agency, and the largest known attack against a health service computer system;

- Local Injury Units (LIUs) deliver efficient, expert treatment to tens of thousands of patients with minor injuries every year and have been of crucial assistance in relieving pressure EDs during the pandemic; and

- Medical Assessment Units (MAUs) play an integral role in ED avoidance, providing a vital and timely service to General Practitioners and patients; approximately 10 per cent of MAU cases may require admission to the hospital, and the majority will be discharged, with a follow-up review in the unit within 48 hours; and calls on the Government to: - expand MAUs at Level 2 hospitals to 24-hours, 7-days-a-week;

- expand LIUs at Level 2 hospitals to 24-hours, 7-days-a-week;

- appoint a designated Medical Officer in every nursing home, and ensure that patients in nursing homes can access treatment by primary care teams; and

- procure or deliver an electronic health system to replace paper-based health records without further delay.

I am happy to move this timely motion, which includes a number of solutions-focused proposals. It quantifies the scale of the issues we are facing in regard to waiting lists and the numbers of people on trolleys. It also proposes a number of solutions and actions that can be taken in the short, medium and longer term to facilitate our health system to work in a more effective, efficient and timely manner.

The motion notes that 2022 was the worst year on record for overcrowding in Irish hospitals, with more than 121,000 patients left without a bed. It goes on to detail the numbers without beds in certain hospitals. University Hospital Limerick, UHL, was the most overcrowded hospital in the country, with a total of more than 18,000 patients without a bed. It was followed by Cork University Hospital, CUH, with more than 12,000; University Hospital Galway, UHG, with more than 10,000; Sligo University Hospital, SUH, with more than 18,000; and St. Vincent's University Hospital, SVUH, with 7,000-plus. While the motion looks at this issue from a national perspective, it is interesting to note that four out of five of those hospitals are located along the Atlantic corridor. Day after day and week after week, the trolley watch figures show this pattern.

The motion notes that during 2022, 67,000 patients waited at least a day in hospital emergency departments before being admitted. It further notes that at the end of the year, more than 800,000 patients were on public hospital waiting lists. At the end of last year, 584,600 patients were waiting to be seen for the first time by a consultant in an outpatient clinic. It is noted that waiting lists reduced by 4% in 2022. However, the Government's target was to reduce them by 18%. It did not manage to get even 25% of the way to that target. While there has been some progress, waiting lists continue to get longer.

We make the point in the motion that Ireland is a laggard in Europe on the digitalisation of the administration of the health system. The introduction of electronic health records and the use of that kind of technology could significantly reduce triage times in emergency departments. It would also make a real contribution to lessening the number of human errors that inevitably occur when working with a paper-based system. While the cyberattack on the HSE a few years ago may have stalled the process, we all would agree that digitalising the health system is a crucial part of having the system work in a more effective and efficient manner.

The motion notes the lack of a specific national structure and control around clinical oversight of the care of people admitted to nursing homes, who have difficulty accessing treatment by primary care teams. This is an area in which the Minister of State, Deputy Butler, has expertise. It is a significant problem in some nursing homes. The motion notes that the lack of such oversight and care can result in unnecessary presentations at emergency departments.

We acknowledge in the motion that certain actions have been taken. The Government has not sat on its hands. It has created an additional 7,176 patient slots per year across the University Limerick Hospitals Group following the recent introduction of a seven-day service at medical assessment units at Nenagh and St. John's hospitals. We acknowledge the ongoing recruitment by the University Limerick Hospitals Group of additional doctors, nurses, etc., and the changing of HSE protocols to allow non-emergency department doctors to assess patients in emergency departments. We acknowledge the allocation by the Government of €350 million to the waiting list action plan in 2022.

As I have outlined, the motion certainly acknowledges some of the actions taken by the Government. It also notes that local injury units deliver efficient expert treatment to tens of thousands of patients with minor injuries every year and that medical assessment units play an integral role in emergency department avoidance. In that context, we call on the Government to expand the medical assessment units in level 2 hospitals to a 24-7 service. That is important because if people know the service is available 24-7, they are much more likely to attend at a level 2 hospital than to go to the emergency department of a level 3 or 4 hospital. We ask for a similar upscaling of local injury assessment units at level 2 hospitals, with a 24-7 service to be offered.

We ask to appoint a designated medical officer in every nursing home to ensure patients in nursing homes can access treatment by primary care teams. Finally, we ask the Minister to procure or deliver an electronic health system to replace paper-based health records without further delay.

The amendment tabled by Deputy Shortall on the need to speed up the construction of elective hospitals certainly gets my full support.

I will hand over to Deputy McNamara.

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