Thursday, 16 September 2021
Ábhair Shaincheisteanna Tráthúla - Topical Issue Matters
I am glad the Minister of State is here this evening to take this question regarding Sligo University Hospital and the overcrowding in the emergency department there. We share the same constituents so I am sure he is as aware of these issues as I am. Over the summer I have had various contacts from both patients and staff who have expressed their concerns in regard to the overcrowding situation, which they see as dangerous. I have an email here that I received on 28 July:
I am a nurse in the Emergency Department in Sligo University Hospital ... I don’t think you or your colleagues will ever begin to understand the fear and stress [that working in an ED] has caused me. I continued to work there as wave after wave of COVID hit. I worked in there when my colleagues were hit with COVID and I luckily never succumbed to it. We were so short staffed on days and nights that we were lucky if we got a 30 minute break in our 13 hour shift and yet we kept giving.
We are now in dire straits we start days at 8am and some mornings the patients we left in the waiting room the previous night are still sitting waiting to be seen! Admitted Patients are spending more than 48 hours on trolleys! The lowest point I saw was when admitted patients were taken off trolleys and put sitting on hard chairs down an X-ray corridor for the day waiting for a bed on the ward to become available and given back a trolley for the night if they remained in ED.
I know the Minister of State is aware of this situation, as many people in Sligo are. It has gotten some publicity in the media over the summer because this is an absolutely ridiculous situation with so many people in the emergency department and it is so overcrowded. Last Thursday my own young fella broke his finger playing hurling and I spent four hours there with him. He was seen and looked after very well by the staff there and there was no issue with that. However, I saw first-hand the stress of people waiting there, who were worried about loved ones who had been admitted, wondering where they were and what was happening with them. One man said he was waiting 27 hours sitting on a chair to find out what was going on. The stress that this puts on people is unacceptable in this day and age. Much of this comes back to the central point that the staffing is not in place.
I also spoke to a nurse about this issue this morning. She sent me an email yesterday and I rang her and talked to her about it. She told me that today at 3.30 p.m., 71 people had been through the emergency department in Sligo and in that time, from 8 o'clock this morning, there were five staff nurses and three care assistants. That is all there was for the huge volume of patients they were trying to deal with. There is clearly a huge problem with staffing in this hospital.
The level of staffing that is required and meant to be in place is between 12 and 14 staff nurses, in addition to care assistants and other backup staff. That is not in place nor has it been. Management told unions on various occasions that it is recruiting more staff to be put in place. Quite frankly, they are now in a situation where they do not believe that it will happen having been let down so many times by promises of this nature. It is not appropriate in this day and age that this kind of situation should continue.
This is not just an issue in the emergency department. It is an issue for the entire hospital. In most wards, there are beds along corridors and additional spaces are used to cater for people in an attempt to take the pressure off the emergency department. There are clear problems relating to space - there is a new wing being built at present - and the staffing, which is the primary issue and needs to be dealt with as quickly as possible. Many people have told me that when nurses qualify, they apply for positions in hospitals and they are actually not being recruited. That is a matter that needs to be addressed in some way. Staff are being taken on by the hospital in other ways besides being directly recruited by the HSE and that needs to end. We need to get as many staff in place as quickly as possible to resolve this issue. I look forward to the Minister of State's reply.
I thank Deputy Kenny for raising this important issue and for the way in which he has articulated it. At the outset, I acknowledge the stress that overcrowded emergency departments cause patients, their families, and the front-line staff working in very challenging conditions in hospitals throughout the country. I acknowledge the work and commitment of staff in ensuring the uninterrupted provision of emergency care throughout the pandemic. I am aware of these issues, in particular, those in Sligo University Hospital.
I have had numerous meetings with management at Sligo hospital, the most recent of which was yesterday, along with the Minister, Deputy Donnelly, where we heard first-hand about the challenges facing the hospital and the commitment of all staff to deliver high-quality care to patients. Both the Minister and I expressed our full support for the extensive development plans for Sligo hospital. The HSE reports that emergency department attendance figures have now reached 2019 levels, and exceed them in some sites. The number of patients waiting on trolleys has been increasing steadily since June 2021, although trolley counts for September to date remain 25% lower than the 2019 level.
The emergency department at Sligo University Hospital, SUH, as outlined by Deputy Kenny, has been extremely busy with an increased number of people attending in recent months. In addition, a surge in Covid admissions and a Covid outbreak have impacted on the hospital's capacity to deal with both Covid and non-Covid admissions. These factors have resulted in an increase in the use of trolleys to provide care. Trolley numbers for July-August 2019 versus 2021 have increased from 491 to 811, which represents a 65% increase. This is contributing to pressures in the emergency department and in the wider hospital. While attendance and admission numbers have now returned to pre-pandemic levels, the continued requirement to provide separate Covid-19 and non-Covid-19 pathways presents an additional challenge to patient flow in all hospitals and emergency departments, including SUH. The winter plan 2020-2021 has provided several hospital avoidance measures to support SUH. These include the appointment of a dementia adviser and frailty intervention team to avoid admissions and reduce length of stay. In addition, seven-day cover has been in place in SUH since January 2021.
Staffing and recruitment plans are under way to address deficits across the hospital. A significant overseas nursing recruitment campaign is being actively progressed nationally, with a strong intention to bring additional resources into the service. Localised recruitment has also been under way. Therefore, we expect 14 additional nursing staff to start in the emergency department in the next two months. The modular emergency department will become operational in the coming weeks and will provide additional waiting, triage and minor injury spaces for patients. It will also provide a decanting space for patients arriving by ambulance. Also included in this unit are additional facilities for staff such as restrooms, seminar rooms and office spaces. This area will provide much improved staff facilities going forward. In addition, the internal reconfiguration works within the existing emergency department will also take place over the next 12 weeks to provide improved patient space within the department.
I acknowledge the email - it is very stressful - written to Deputy Kenny about the situation. We hope the nurses will be recruited as quickly as possible.
I appreciate that the Minister of State understands the plight of the staff and patients in SUH. The management have made promises and are working with unions and the nursing staff to try to resolve this issue, but so far it has delivered very little. The email referred to was written at the end of July. I received another one yesterday. It stated:
Last weekend was a weekend that none of us wants to see again. There were too many horrific traumas with negative outcomes. There were 6 staff nurses on night duty for some of these and there were nights where they didn't even get a break all night. Not even a cup of tea to try to mentally process or prepare themselves for the next patient.
No profession should have to do this sort of thing or put up with this kind of situation.
It further stated, "We are in a desperate situation...". They need help as quickly as possible.
I was told today that management has said that it expects to recruit eight additional staff by the end of September. The Minister of State referred to 14 staff in his reply. That would be excellent if it were to happen, but the problem is that these promises do not seem to be delivered, either on time or at any stage. That is the real difficulty in all of this. I spoke to a nurse recently who is newly qualified, is waiting to be recruited and has applied for numerous positions but simply cannot get one. She has been told through the grapevine that she first needs to work with an agency for a while and then she will eventually be recruited by the HSE. The agency staff working for the HSE are being paid but the agency is taking its cut. This is costing the State twice as much to employ agency staff as it is to employ them directly. This is a folly and it needs to end. We all know that, yet no one does anything about it. That is one of the issues that need to be tackled immediately. We need to sort out this situation so that nurses can be recruited as quickly as possible. The nurses who are working there do not want to stay. They are looking around at the chaos and are thinking that they could have a better job and life if they were to go across the channel to England or to another country, such as Australia, where there are proper terms and conditions, and working conditions for nursing staff. This will continue unless we sort out this problem. The only way we can do that is to get the management right and the adequate number of staff to provide the service that people demand and need.
We expect 14 additional nursing staff to start in the emergency department in the next two months. We will work together to ensure that it is progressed as quickly as possible. The health service capacity review 2018 was clear on the need for a major investment in additional capacity in both acute hospitals and the community, combined with a wide-scale reform of the manner and the location of where health services are provided. Approximately 800 beds have been provided on a permanent basis over the number available at the end of 2019.
As I outlined, ongoing and planned developments at Sligo University Hospital will provide additional facilities for staff and patients, including additional beds, and space for waiting, triage and minor injury patients when the modular emergency department extension becomes operational in the coming weeks. Additionally, the internal reconfiguration works within the existing emergency department will also take place in the coming weeks to provide improved patient space within the department. These additional facilities cannot come quick enough. They will improve the experience for patients visiting the emergency department and, hopefully, the staff who work there.
Action plans are in place to deal with the current overcrowding, involving senior management, to ensure the focus remains on optimising the efficient and effective delivery of necessary treatment to all patients in a timely manner. Already, these actions are seeing an improving situation in the hospital. Staffing and recruitment plans are under way and we must work together to address these deficits. Local recruitment is also under way with additional nursing staff due to start in the emergency department in the coming months.
I remain active on this issue, because I am aware of it within the Department, and will work with colleagues in the Department and the HSE, and with management and staff in the hospital, to support the provision of high-quality, innovative and safe care to patients served by Sligo University Hospital and the wider Saolta University Health Care Group.
I will inform the Minister of the Deputy's views on agency staffing. This has been a very serious situation and I thank him for how he has articulated it today. I hope, working together will all the stakeholders, that we can to get through this. It is very difficult for the management, staff and patients in the hospital. I will do everything I can, as Minister of State and as a person for whom Sligo is my local hospital, to work with the stakeholders to address this issue.