Alan Kelly (Tipperary, Labour)
Link to this: Individually | In context | Oireachtas source

I became involved in politics while fighting for my local hospital in Nenagh which, in fairness, the Minister of State, Deputy Jim Daly, visited recently. I have been involved with the Friends of Nenagh Hospital group ever since. There is a serious overcrowding problem in University Hospital Limerick. There are four hospitals in the mid-west, namely, St. John's Hospital, Ennis General Hospital, Nenagh General Hospital and University Hospital Limerick. The first three are model 2 hospitals. University Hospital Limerick has the highest rate of overcrowding in Ireland. We are facing the worst ever overcrowding crisis. There was record overcrowding in the hospital in November, accounting for 15.5% of the nationwide total. It has had the highest overcrowding rate for 18 months in a row, with 1,071 patients on trolleys in recent months. Rather than Members shouting and roaring that it is a disaster, we should work to address it.

Two of my family members who are in their late 70s and late 80s, respectively, were recently admitted to University Hospital Limerick. It is a nightmare to wonder how they will get on in the light of the level of overcrowding.

In the short term, we need to come up with policies and changes that will work and have an impact because the current situation cannot continue. We must consider the role which could be played by the other hospitals in the mid-west, namely, Nenagh hospital, Ennis hospital and St. John's Hospital. The pathways and protocols for accepting patients need to be widened, as does the smaller hospital framework across the country. The minor injuries units do not have enough scope to deal with the type of injuries with which patients are presenting. In addition, too few patients are being directed to those units, which should have longer opening hours. Different protocols in regard to the type of patients who can attend model 2 hospitals post procedure, before procedure and so on are needed. That will require a better ambulance service and intermediate vehicles - not ambulances - to transport patients who are not at risk but need to be transferred to or from hospital. All of this needs to happen quickly.

There is an anomaly in University Hospital Limerick whereby a 60 bed modular unit has been announced for next year but the funding for the unit has not been allocated. Will the Minister of State clarify if that funding will be allocated? The number of consultants in the mid-west is, pro rata, the lowest in the country, as is the number of staff. Last year, 77,600 patients attended the new state-of-the-art emergency department, which includes a new theatre, in Limerick hospital, an increase of 10,000 attendances over three years. The hospital has the lowest length of stay, bed stock, rate of readmission and number of consultants in the country.

I make no criticism of management of the hospital network in counties Limerick, Tipperary and Clare. They are doing as good a job as they can. I have no criticism of the non-acute side either, which is also doing the best it can. The obvious problem is that University Hospital Limerick is too small and does not have enough staff. That will have to be addressed in the coming years. In the meantime, we need to loosen the terms under which the other hospitals in Nenagh, Ennis and Limerick are operating to allow them to relieve some of the pressure. I am fearful about how people will be treated in University Hospital Limerick over the Christmas and winter period. It does not have enough beds and its emergency department is in crisis to such a degree that I doubt it would pass a fire inspection.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for highlighting this issue. Of course, all Members accept the seriousness of the overcrowding issue. On several occasions in various forums I have addressed overcrowding at the emergency department in Limerick. We are determined to tackle it. Deputy Kelly made a valid point about more joined-up thinking and better utilisation of the model 2 hospitals which offer great value for money, service, capacity and huge benefits in terms of dealing with chronic overcrowding. Some 82% of respondents to the recent patient experience survey indicated that they had a wonderful or excellent experience in our hospitals. The issue is access. The only way to be admitted to our hospitals is through an emergency department. We must address that.

As Deputy Kelly rightly stated, we face a particular challenge over the winter months. The winter plan will be published tomorrow. As the Deputy is aware, many of its elements are already in the public domain and more will be teased out. The winter plan is not an annual event. Rather, the HSE has been progressing a three-year plan to deal with the acute pressures in our hospitals throughout the year for some time.

The Deputy is aware of the measures being taken to tackle these issues. He is a member of the Oireachtas Joint Committee on Health and is up to speed on measures such as the 550 intensive home care packages and the €10 million that has been allocated for aids and appliances. We also need to utilise better the capacity in the model 2 hospital system and step-down and transitional care. Efforts in that regard are working very well in some areas. The Deputy is familiar with Bantry General Hospital which is a model 2 hospital in my constituency. It is the only remote rural hospital. This issue was debated at length on Monday with the hospital management group.

I have done a lot of work over the past three or four months with the chair of the University Limerick hospital group, Mr. Graham Knowles, on the issue of delayed discharges. For far too long, our focus has been on the number of people waiting on trolleys. It has been an obsession for some politicians and the media. RTÉ and similar agencies periodically highlight the number of people waiting on trolleys. That misses the point substantially.

Deputy Kelly will agree that it is far more important to put energy into recognising the number of people who are in hospitals but ought not to be. As the Deputy is aware, I have particular responsibility for older people. The most dangerous place for an older person who is vulnerable to infection to be is in an acute hospital for any longer than he or she ought to be.

The amount of time spent on trolleys is of more relevance than the number of people on trolleys. To focus on the latter is to miss the point, but it an easy headline to generate. Many politicians and members of the media focus on trolley numbers rather than examining the more substantive issues in regard to the causes of delays in our hospital, such as freedom of movement into hospitals and the issue of delayed discharges. The chairman of the UL hospital group chaired a working group for me in recent months to identify several initiatives to address that issue in a constructive attempt to create space in our hospitals. We will roll out those initiatives to free up emergency departments and stop the chronic overcrowding.

We obviously have a lot of work to do with general practitioners to ensure patients go to the emergency department only when they absolutely have to do so and avail of healthcare at more local level in primary care centres. That is the objective of the Sláintecare project in the medium term. There is also a short-term objective which comprises the winter plan and the winter initiative. In that regard, a sum of €10 million has been announced. There is a medium-term plan, with which the Deputy is very familiar from his work in the implementation of Sláintecare, key to which is better utilisation of model 2 hospitals.

Alan Kelly (Tipperary, Labour)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for his reply. I live in the mid-west. The Hanly report came and went. Emergency theatres in Nenagh and St. John's Hospital in Limerick were closed. There was no plan. What happened was insane. There was insufficient capacity in Limerick from day one. Instead of standing here giving out, I shall propose some solutions and would appreciate it if the Minister of State put them to the relevant officials.

The opening hours of minor injury units need to be extended. They are open from 8 a.m. to 8 p.m. They could be opened for longer, particularly during the winter. St. John's Hospital in Limerick is only open from 8 a.m. to 6 p.m. Why is it different from the other two? The protocols for accepting patients need to be broader in scope.

The second point is that there is a need to change the pathways associated with how patients are discharged. They could be discharged quickly from University Hospital Limerick to the other three hospitals.

The Nenagh clinical support and recovery unit has 17 beds, but it needs occupational therapists, a social worker, physiotherapists and speech and language therapists. Since it has 17 beds, it means that 17 patients could be moved to Nenagh. People in the general region of Tipperary would go there. The unit needs to be opened with all of the staff I have mentioned. Fifty patients in Limerick are waiting to be discharged, but there is nowhere for them to go.

With regard to winter funding, the acute medical assessment unit in University Hospital Limerick needs to be open 24/7. Also, the surgical short-stay unit needs to have longer opening hours.

Staffing is a considerable issue. The hospital has the lowest number of consultants in the entire country. This is a massive problem and disproportionate. As the Minister of State knows, it causes discharge problems because patients have to be clinically discharged by a consultant.

The medical assessment unit in Nenagh needs to be opened at weekends. The one in Ennis is open.

On a wider issue, primary care facilities in the mid-west are not up to the required standard. There are no rehabilitation beds for anybody below an elderly age. This means that there is nowhere to go for somebody in his or her thirties or forties.

Milford hospice is seeking the opening of a small number of new beds, which would be very helpful. I have said repeatedly that, for small amounts of money, we could have more intermediate vehicles to transport patients between the hospitals in the network in order that they could all work together. I have made eight or nine suggestions. I ask the Minister of State to put them to the HSE.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

There is a bucket full of suggestions for the Minister of State.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I have noted all of them. I will be chairing the implementation group involving the Department and the HSE to address the issue of delayed discharges and determine what solutions we can come up with. I will certainly take on board each suggestion made by the Deputy. It is an absolute fact that, in a budget that is finite, we do not have endless resources for the health service. If €1 million was to be put into Nenagh General Hospital, as opposed to University Hospital Limerick, how much value for money would we achieve in a model 2 hospital? By how much would turnaround times improve? How many more patients would be seen? How many more procedures could be carried out? How many more beds could be freed up in University Hospital Limerick at the same time? There are numerous models such as transitional care, of which I am a big supporter. I have not seen actuarial evidence, but it has been said anecdotally that it could cost up to €7,000 per week to keep somebody in an acute bed and €1,000 per week to keep him or her in a community bed. When it comes to the mathematics, it is not rocket science. Patients do not need to be in acute hospitals for as long as they are. They need to be moved on in a timely manner. If there is no home care package available for them, for whatever reason, placing them in the community setting is a far more ideal option.

Of course, extending the opening hours of the medical assessment unit and the minor injuries unit and making them more accessible would be beneficial. However, there are protocols. We have to work with the National Ambulance Service on where patients are carried to. We must also consider the referral pathway with general practitioners. As we renegotiate the finer details of the GP contract, we need to rely less on emergency departments. Even nursing homes can over-rely on the emergency department. We need to ensure healthcare workers receive the flu vaccine to avoid outbreaks of flu. The Deputy is a big supporter of this. Flu outbreaks cause chaos in emergency departments at peak times.

We intend to implement numerous measures to ensure better health service delivery for those who require it. I thank the Deputy for his constructive and supportive proposals. It is very easy to diagnose problems, but we need to focus more on solutions.