Wednesday, 4 December 2019
Saincheisteanna Tráthúla - Topical Issue Debate
I welcome the opportunity to raise the important issue of overcrowding at University Hospital Limerick, UHL. I am disappointed that the Minister for Health, Deputy Harris, has not got the time, inclination or interest to be here to discuss such an important issue. He has no problem, however, travelling to Limerick next week to participate in the opening of what is referred to as the health science academy at University Hospital Limerick. I will read what was stated about that facility, namely, "In collaboration with the University of Limerick, UL, and the mid-west community healthcare organisation, CHO, UL hospital group have developed a health science academy with an emphasis on research, education and training programmes, which will have clear outcomes for patients and impact patient care". The opening has been postponed by two weeks because the last time the Minister for Health was supposed to be present to perform the opening and showboat for the cameras, some 85 patients in the hospital were on trolleys. That event was cancelled hastily, and the Minister was able to duck his responsibility of dealing with the crisis at the hospital.
The Minister of State knows full well, and this is no fault of his, that over the past four years the annual number of patients on trolleys has almost quadrupled. In 2012, there were 3,626 patients on trolleys according to the yearly count. This year, the figure is 12,810 and that is only up to 28 November. That is an appalling situation.
I can go through case after case of constituents of mine who are affected because the Mid-Western Regional Hospital in Limerick deals with patients in three counties, as well as Limerick city. People contact my office daily to tell me about outrageous situations endured by elderly and sick people. An example is that of a farmer in his 70s who was rushed to the hospital when he collapsed on his farm. He remained on a trolley in the accident and emergency unit for almost three days, while still in his dirty farming clothes. He was located beside a patient with an ulcerated leg. It was not possible for his clothes to be changed or for him to have a shower. That man remained on the trolley for almost three days until he was transferred to a ward. That is an appalling situation and is just one of many such cases I hear about daily. People in their 90s are spending 48 hours in what is an accident and emergency department, where the lights are on and there is no capacity to get some sleep. It is a terrible situation in which to treat someone. The nurses and doctors I talk to, who are not alarmist, are saying it is impossible for them to do their job. They cannot get medical equipment through to check blood pressure because of the way the trolleys are stuffed into the space. What we do not want is the Minister coming down to have his photograph taken again outside and inside some new development that is going to benefit people in the future, or at least that is how it is being presented. I want to see the Minister appoint someone, before the end of this week, with a budget and the capacity to look at all of the resources available in the mid-west region and then to try to use them to the greatest extent.
There are closed beds, wards and areas that can be reopened. We need to end this rubbish talk of there not being an embargo on the employment of nurses and doctors, because there is one. That topic has been raised in this House in recent days. There are nurses prepared to come back to this country if they are given full-time contracts. This is a serious situation. I am not crying wolf. I do not play that game. I understand how these things work, but a life will be lost unnecessarily - if lives have not already been lost unnecessarily - because of the overcrowded conditions in which nurses and doctors are expected to deliver services. We need a response from the Minister as soon as possible.
I welcome the opportunity to address the House on the issues raised by Deputy Dooley. The Minister for Health wishes to acknowledge the distress that overcrowded accident and emergency departments cause to patients, their families and the front-line staff working in challenging conditions in hospitals all across the country. The number of patients attending accident and emergency departments continues to increase year-on-year. For the first ten months of 2019, the number of patients attending hospital accident and emergency departments increased by 2.7% and the number of admissions to accident and emergency departments has increased by 0.9% compared to the same period last year. The emergency department at UHL, is one of the busiest in the country. As such, the hospital and the CHO were identified as one of the nine focus sites requiring additional investment, focus and support last winter.
According to HSE TrolleyGAR data, there was a 16% increase in patients waiting on trolleys year-to-date in UHL emergency department in October 2019 compared with the same period last year. In October, however, 883 patients were counted on trolleys in UHL, which was a 1.6% decrease compared with the previous month. It is acknowledged that this figure is unacceptably high and the HSE is actively working with the UL hospital group to ease congestion in UHL, with a focus on facilitating transfers to Level 2 hospitals, assistance from rehabilitation units and CHO services, and prioritisation of diagnostics to aid inpatient discharges. The HSE winter plan was launched on Thursday, 14 November in preparation for the anticipated increase in demand over the winter period.
The Government has allocated an additional €26 million to fund the implementation of the winter plan. Each winter action team has set out a range of initiatives it will undertake within its area to implement the plan. The integrated winter plan for University Hospital Limerick will be delivered by winter action team 3. The initiatives for winter action team 3 include additional home support hours to facilitate early hospital-to-community transfers, additional aids and appliances to facilitate early hospital discharge and emergency department avoidance, mobile doctor service units to manage increased demand for home visits and to facilitate emergency department avoidance, a low-level domiciliary rehab team in Limerick city to facilitate early discharge and emergency department avoidance, additional triage nursing support in Shannondoc to support emergency department avoidance, an additional registrar in UHL to help in addressing workflow and improving patient experience times and additional health care assistant supports in University Hospital Limerick to provide staffing at ward level to support additional surge patients.
A capital budget of €19.5 million has been approved for the provision of a modular 60-bed inpatient ward block at University Hospital Limerick, with funding of an additional €10 million allocated in 2019. The HSE has advised that the enabling works are complete and the main contractor has commenced work. It is anticipated that the construction will be completed in 2020. This important project will go some way towards addressing the acknowledged lack of bed capacity in the region. It is recognised that there is a deficit in diagnostic capacity at University Hospital Limerick. A capital development proposal for an extension of the radiology department at University Hospital Limerick to include a second MRI unit has been prioritised by the HSE to progress to design stage in 2020. In the interim, the University of Limerick Hospitals Group has tendered for a modular MRI managed service. The National Treatment Purchase Fund will work with the HSE to fund the activity associated with the MRI scanner as part of the agreed extension in the fund's support for hospital emergency departments for diagnostics at the end of the year.
All of that sounds fantastic, but the reality is that it is not having an impact on the ground. Trolley numbers at University Hospital Limerick are still unacceptably high and are entirely out of sync with every other hospital in the country. The only solution is for the Minister to appoint a senior official within the HSE or the Department of Health, or an external independent consultant, to decamp to Limerick to take up control. Such a person should report to the Minister on a daily basis with identified outcomes, actions that will address the seriousness of the situation and workflows that will ensure the numbers on trolleys return to the normal average that exists. Of course we understand that there are peak times when numbers are expected to escalate for various reasons. It cannot be acceptable that on two occasions in recent times, University Hospital Limerick has broken all records for the number of patients on trolleys. This is within the control of the Minister. A little forward thinking is required. It is certainly not about establishing an academy. If one were developing an academy around best practice, one would not start at the ground operations in Limerick.
We need intervention and management control. There should be a direct line to the Minister that enables him and the HSE to respond. The appropriate moneys should be put in place to resolve the problem. It is not rocket science. It is about nurses and doctors. It is about money. It is about utilising every available bed in the region. There are private nursing homes that are not at full capacity. It should not be beyond our capabilities to have people decanted into these facilities, where adequate and appropriate nursing care is available to them. Bed capacity in the tertiary hospital should be left to those who need it. We need action. We do not need another photo opportunity with the Minister standing in front of some new development that will be of benefit some time in the future. We need action now. We need to address the people who are on trolleys. We need to have in place a service for the people who will find themselves in hospital over the coming days and weeks, as the winter conditions have a significant effect on older people.
I apologise to the Deputy for having to disappoint him on the double. I disappointed him when I appeared here on behalf of the Minister, Deputy Harris. I am going to disappoint him again when I inform him that I will be representing the Minister in Limerick next week. It may be a consolation for the Deputy to know that I will be there for the photo opportunity he mentioned instead of the Minister.
It must be acknowledged that attendances at our emergency departments are increasing each year. According to the health service capacity review, Ireland has one of the highest acute bed occupancy rates in the developed world. It is widely agreed that additional beds must be a key part of the solution at University Hospital Limerick. Over the past two winter periods, an additional 25 beds have opened in Limerick, including eight as part of the 2018-19 winter plan. The new emergency department, which opened in May 2017, provides modern and safe facilities that are fit for purpose and meet the expectations of patients and families. The high-quality accommodation provided at this new facility better protects privacy and dignity. In response to the Department of Health's health service capacity review, a new 60-bed ward block has been established as a rapid-build interim solution to the bed capacity issue at University Hospital Limerick. The University of Limerick Hospitals Group has welcomed the commitment in Project Ireland 2040 to construct a new 96-bed ward block over the current emergency department. A design team has been appointed for this project.
Improving timely access for patients is at the heart of Sláintecare. The 2019 Sláintecare action plan, which has been published by the Department of Health, builds on the progress made in this area in recent years and includes a work stream on access and waiting lists. Many of the other service reforms and enhancements included in the action plan will support timely access to care for patients in the coming years. Progress has been already made this year in implementing the actions under the Sláintecare action plan. We all acknowledge that there is little doubt that the challenges we face are significant. I firmly believe that every Member of this House wants to find patient-centred, evidence-based, results-focused and sustainable solutions to the challenges facing our health services. Investment alone will not deliver the health service to which we aspire. Equally, this will not be delivered by reforms or productivity improvements on their own. Investment, reform and productivity improvements and additional capacity must be delivered in tandem if we are to have a realistic chance of meeting healthcare needs over the coming decades.