Tuesday, 21 October 2014
Topical Issue Debate
I thank the Ceann Comhairle for selecting this topic for discussion and the Minister, Deputy Varadkar, for being in the Chamber today to respond to it. The emergency department at Galway University Hospital is the busiest or second busiest in the country. On 17 September last, a number of nurses and health care staff who work in the emergency department at that hospital held a one hour lunchtime protest to highlight their difficulties in caring for patients, in particular elderly people, the extreme pressure on staff and the large number of people on trolleys and so on. Following this, I had engagements with management at Galway University Hospital and with the nurses during which a few issues came to the fore.
The statement issued by the hospital in terms of its acknowledgement of the difficulties being experienced by patients was honest. It also stated that despite the ongoing efforts of staff and management, not all emergency department patients are afforded privacy and dignity. The statement that not all patients in one of our busiest emergency departments are afforded privacy and dignity is powerful. Mr. Bill Meagher, then group CEO, said he would not want that service for himself or any of his loved ones and he did not want it for any of his patients or staff. That hospital management was able to acknowledge this was good and constructive. It allows us to move on and try to solve the issues. The management and staff agreed that staffing levels needed to be increased. As far as I am aware, that is now happening, which is very positive. However, there are still issues with the physical infrastructure that is the emergency department at Galway University Hospital. Bed management is also an issue. I welcome that construction of a new 70-bed ward will commence next year.
In response to a parliamentary question to the HSE about the emergency department at Galway University Hospital, I received the forthright and stark response that the original emergency department was constructed in the 1950s and the interim development of the late 1990s is still in place. I was also informed that annual emergency department attendance had increased from 57,000 in 2006 to 65,000 in 2014 and that the existing emergency department does not allow effective patient streaming, is not compliant with infection prevention and control standards and does not enable compliance with the emergency medicine programme or targets for unscheduled care patients experience. It is very honest of the hospital to put that on the record. In effect what the hospital is saying is that regardless of what is done in terms of the special delivery unit, increased bed management and re-routing services out of the emergency department, the physical infrastructure is not fit for purpose. I understand an application has been made to the capital steering group for two possible outcomes: a two-floor emergency department or a six-floor emergency department. I would appreciate if the Minister could tell the House when a decision in that regard will be made. The existing emergency department does not meet the basic requirements of an emergency department. Can provision of a new emergency department at Galway University Hospital, which meets the standards for patients, staff and the wider community in Galway and the west be a priority for the capital programme?
I thank Deputy Nolan for raising this issue today. Galway University Hospital has approximately 700 beds and is a tertiary referral centre for the western region, as part of the south hospital group. Its emergency department has approximately 66,000 attendances annually. Like many other major emergency departments in the country, it has experienced an increase in activity over recent months. The HSE is working closely with the special delivery unit to better manage patient flow through the hospital, and this collaboration has reduced the overall number of patients awaiting admission from the emergency department by 2,038 when compared with 2011.
The HSE advises me that Galway University Hospital is approving and recruiting experienced general and paediatric nurses for its departments. A recent interview process resulted in the creation of a panel of 21 experienced staff, 11 of whom are approved to commence in the coming weeks in the emergency department. Last week a fourth advanced nurse practitioner was appointed for the emergency department, with a specific function in the management of minor injury treatment.
To reflect the central importance of patient experience, GUH has appointed a patient advice and liaison officer with the role in the emergency department of addressing the needs of patients and attempting to improve patients' experience as they wait for access to services. Staff members also receive mindfulness training to assist in their approach and management of their ongoing workload. All these initiatives are of benefit to the public, patients and the staff.
The hospital has carried out a feasibility study to examine the benefits of an internal reconfiguration project of the existing emergency department versus a new build solution. This was completed in line with the development control plan for the site and accepted by the HSE capital steering group on 19 October 2013, subject to a cost-benefit analysis being undertaken. This cost-benefit analysis is under consideration. Future plans for the ED will incorporate capacity to meet the requirements of the emergency medicine programme and include capacity to meet the requirement of any future reconfiguration of services across the group. The HSE has been engaging on a consistent basis with the main unions, principally the INMO and SIPTU, regarding the activity levels within the department and the capacity issues therein. As part of this, a number of initiatives are being implemented to improve the pathways of care, including the navigational hub and the early discharge programme. A specific pathway for frail elderly is also being considered.
It is becoming evident from the data that the rising number of patients over 75 who are attending and requiring admission is rising but as the Deputy rightly points out, any of these measures around patient flow, greater use of community beds and so on will only be stop-gap measures. It is a very old emergency department and the medium to long-term solution will have to be a rebuild so that it is fit for the purpose we would all intend.
I thank the Minister for his response. It should be put on the record that an enormous amount of work has been done by hospital management, together with hospital staff, to make the best of that facility. One of the ideas put forward in the interim as a stop-gap measure, as the Minister put it, is to have an independent external person - a fresh pair of eyes - come into the emergency department to see what we can do in the meantime in terms of moving services out, looking at the way we do triage, looking at the way we allocate nurses, advance nurse practitioners and so forth, with a view to using that space in the best way possible. As the Minister said, where it is at the moment is simply not good enough.
The cost benefit analysis was submitted on 19 October 2013. That is a year ago, which is a very long time in which to consider and debate a cost benefit analysis. First, can the Minister give me a commitment that he will contact the Health Service Executive and get an answer on the option it intends to go for? Does it intend to go for a new two storey or six storey building?
Second, given that what we are talking about is not a luxury but a clinical need and that we are not meeting key requirements for emergency departments in terms of medicinal programmes, patient streaming, infection control and so forth, can we be assured that the infrastructure we so badly need is put as a priority for the HSE and that the 66,000 people who attend Galway University Hospital emergency department every year will not go into a substandard facility but one that is fit for purpose? Will the HSE make that a priority?
Third, would it be possible for the Minister to come to the emergency department and meet with the staff nurses? Ministers frequently attend conferences in Galway and it might be easy for him to come and meet the staff for 20 minutes or half an hour. It might put in his head the absolute requirement for a new building and to influence the capital project and make sure we get this as a priority capital project for the HSE.
Every Adjournment debate another invitation is forthcoming. As the Deputy is aware, hospitals are only one small part of the health service. There is much more to the health service than acute hospitals, and there are almost 50 of them so if I were to bunk off one day a week and do site visits it would take me a year just to get around them. That is something I intend to do but it will take quite some time to get around to visiting 47 acute hospitals, never mind all the other health care and primary care institutions.
It is the intention of the HSE in the coming months or certainly over next year to bring in outside consultants - people who are experts on how hospitals are run in other parts of the world - have them go into particular hospitals and work out the way those hospitals can be better run and better managed. It is obvious when we examine the trolley numbers - the fact that they peak on Wednesdays, fall back down on Fridays and peak again late on Saturdays and Sundays, that if we could smooth out activity in our hospitals we could make much better use of existing resources. There is a good deal that can be learned from overseas in that respect, and we hope to identify a few hospitals next year that are up for it, so to speak. That means changes in working practices and in the way things were always done to make better use of our facilities. Some hospitals will be chosen to take part in those type of projects.
When it comes to the new build, if there is a two-floor new build to replace the existing emergency department and put in an acute medical assessment unit, AMEU, and an ASU, which is what would be needed, we are talking about €30 million, and a six-storey building would cost about €60 million. It is a very substantial amount of money within a capital budget which only runs to 2016, but I will chase it up with the HSE to determine what is happening with the interim reconfiguring project.