Tuesday, 9 November 2021
Saincheisteanna Tráthúla - Topical Issue Debate
I thank the Minister of State, Deputy Rabbitte, for coming in tonight to take this important debate which I was keen to table here in the Dáil. I am disappointed that the Minister, Deputy Stephen Donnelly, is not here. I mean no disrespect to the Minister of State, who is doing an outstanding job in her area. I have been hugely impressed with her work and with her energy in her specific area within the Department of Health but this is a matter relating to an acute hospital and I would have expected that the senior Minister would have shown up for the debate. It is not good enough. It is happening far too often that senior Ministers are not coming in to take debates from Deputies under Topical Issues. It is not the Minister of State's fault. I appreciate the Minister of State, Deputy Rabbitte, being here. I know that she will take back what I am about to say here tonight.
From speaking to consultants, doctors, patients and everyone at University Hospital Kerry, UHK, the situation never seems to have been as bad at the hospital. As someone who cares deeply about that hospital, it pains me to say that. It is our hospital. It belongs to the people of Kerry. To sum up the challenges that are there at present, I will read into the Dáil record and convey to the Minister of State some of the highlights from a letter that was sent recently by consultants at UHK to the CEO of the South/South West Hospital Group. I will take snippets from it. It makes for grim reading:
We have lost confidence in the ability of the Health Service Executive locally, regionally and nationally to provide safe, timely and effective care for our patients in UHK.
We do not see evidence of strategic leadership to bring about the necessary changes to enable UHK to maintain and develop services for the population it serves.
We feel management processes have not progressed with each successive crisis. UHK, and the people we serve deserve better.
In relation to patient safety, it states that patient safety is at risk due to the current bed limitations in UHK.
UHK still cannot provide PCR testing for Covid after 8 p.m. and has been asking for this solution for more than a year. Reduced bed capacity and daily staff shortages continue to cause huge delays in patient flow. On bed capacity, UHK has a totally inadequate number of single rooms which increases infection control risk by leading to frequent outbreaks as well as causing a loss of further beds to deal with these outbreaks. The lack of single rooms has been highlighted repeatedly by infection control teams. UHK has never had a full-time permanent consultant microbiologist. This has been noted by HIQA which indicated that an urgent and permanent solution must be put in place. The consultants also highlight significant bed losses due to Covid and development works and ask why a contingency plan was not put in place in respect of these works. They also highlight the fact that an isolated modular unit has been urgently requested by the infection control teams to improve isolation facilities in UHK.
On surgical services, there has been no elective surgery in UHK since mid-September, with reduced activity for the last 18 months since the day ward capacity was reduced by more than half.
UHK is disadvantaged as its ability to record data accurately is seriously at fault. About 30% of physician activity in the emergency department is not recorded in iPIMS. UHK has no IT manager and no IT committee. It gets worse. Like other hospitals nationally, there is a shortage of nurses. Nurses in UHK are under additional pressure carrying out non-nursing duties. The director of nursing and her management team have repeatedly asked for extra support staff to perform these duties, but that support has not been forthcoming. The five fundamentals project to improve processes and pathways is now at risk because staff have been redeployed.
On the acute floor model the acute medical unit, AMU, opened for a few months during summer 2021 and demonstrated its effectiveness. Due to staffing issues the AMU is currently closed more often than it is open. On integration with community services, the consultants advocate that a formal integrated decision-making forum be created. On scheduled services, virtual clinics can only be done by telephone because the IT equipment and the WiFi will not allow video calling. On accommodation, consultants have a lack of office space as do secretaries and other grades of staff. There is no plan to address this. Finally, the consultants ask what is the plan in relation to the new oncology unit. They do not have a deputy manager in place since last summer.
I thank the Deputy for bringing this matter to the House and taking the time to read in to the record exactly what the consultants wrote to him. It was hard to listen to. They were obviously pained that they felt they had to go to this extreme. I sense the Deputy's annoyance with the Minister not being here this evening to take this response. I have a response but I feel it falls far short of what it should be. I thank the Deputy for raising this and giving me the opportunity to provide an update to the House on University Hospital Kerry, UHK. I want to acknowledge the incredible work and commitment made by the staff of UHK in the provision of services during the Covid-19 and cyber-attack emergencies and in managing many difficult cases presenting in very challenging circumstances. UHK is currently experiencing significant pressure caused by a number of factors. These include increased presentations of acutely unwell patients with complex medical needs, as well a rising number of Covid patients presenting to the hospital in recent weeks.
Currently we are seeing extensive community transmission of Covid-19 throughout all parts of the country, including Kerry. There are cases in all age groups and particularly among the unvaccinated. The 14 day incidence rate in Kerry 1,061. As of this morning, there are 12 Covid-19 positive inpatients in UHK. In addition, there are approximately 141 staff on unplanned leave including 18 staff absent due to Covid-19 leave. This level of absence is contributing to the greatest risk in resourcing existing level of service and staffing surge capacity, in particular in critical care.
The HSE has advised me that the South/South West Hospital Group is currently providing support to UHK management for a minimum of two days a week for the coming month in order to support, stabilise and urgently address identified risks at the hospital and there can be no greater risk than not having access to an updated IT system within the emergency department. The focus of this support will be to identify delays within UHK patient flow streams and to propose solutions. This arrangement has been put in place to ensure that the hospital group is assured of the ongoing safe management of patients in UHK. The HSE has advised that a number of measures have been implemented at UHK to ensure the highest standards of patient care and safety are upheld. These include access to private hospital capacity, engagement with community healthcare services and additional staffing supports from the hospital group and other hospitals.
On staffing issues, the HSE has advised me that the approved consultant cohort for UHK has increased from 39 whole-time equivalents, WTE, in September 2017 to 52 WTE in September 2021. In addition, significant developments have taken place in the department of nursing with the appointment of advanced nurse practitioners, clinical nurse specialists roles and clinical facilitators. Locally, hospital management has ensured ongoing recruitment and further support is being provided at a regional level by the wider HR support network, including SSWHG.
The HSE and the South/South West Hospital Group have assured me of their commitment to augmenting the services delivered in UHK to meet identified local demands. This includes the provision of additional resources and staffing, and a capital investment plan of €69.75 million. Nationally, the winter plan is in active development by the HSE and will set out the measures to be implemented and the expected impacts. The Department of Health is continuing to engage intensively with the HSE on the issue. The winter plan will provide for the appropriate, safe and timely care for patients
I appreciate the response but it does not address the many issues raised in the letter from the consultants. For any Deputy to have to come into this House and read a letter of that seriousness from consultants in any hospital in this country is an absolute shame and a disgrace. The people of Kerry deserve better than that type of shocking, embarrassing and depressing information which is effectively being ignored by the Minister's office. I have conveyed all that information to the Minister's office in writing previously. I have not got anything satisfactory back. There are rumours that senior people from the HSE will come to the hospital on Friday. Nothing has been confirmed to the hospital staff and today is Tuesday. That is fine. It has happened before but we need to know what is the plan beyond Friday? Will that be another box-ticking exercise so that they can say, "Yeah, sure we sent down people to Kerry. They had a good chat and heard all the problems.", and then they go away again for another while until the next crisis. It is not good enough. There has to be a full audit of what is going on at that hospital because it has degenerated beyond belief at this stage. The shocking stories of patient experiences that I have heard through my office and from meeting people in the constituency are infuriating and I am not sensing the urgency from the Minster on solving the problems there. It is time for the special delivery unit to come in all guns blazing. We cannot hold back any longer on this because what is going on is the worst it has ever been. I want the Minister of State to convey that back to the Minister. I hope he gets to see some of this debate and realises that we are not messing here. This is serious. It is critical and some feel it has gone beyond the point of no return. I am an optimist; I still think the situation can be retrieved but they have almost crossed the Rubicon and the Minister needs to get involved personally.
I will take on board everything the Deputy has said. I want to acknowledge that things are at a critical stage, whether due to the Covid numbers or absenteeism. Absenteeism can include those with long-Covid but people are also absolutely exhausted working in horrific conditions, trying to support patient care and patient safety. It is unbelievable to think that the IT system in an emergency department is not up to standard. That will be conveyed directly back to the Minister. The lack of single rooms is one of the gravest areas which the Deputy just presented. Only recently, a nursing home near me was closed because it did not have single rooms. HIQA's view was that it was done for health and safety and the protection of the patients.
I will take on board what the Deputy has said. I will get confirmation from the Minister's office as to whether the visit to Kerry is taking place this Friday. The Deputy, his constituents and, most important, the people who work there need to know that it is taken very seriously.
We can see from the commitment in respect of University Hospital Kerry and the increase in the number of whole-time equivalent staff there that the Government is very serious in supporting the hospital. What the Deputy needs to see, however, is that those outstanding issues the consultants have written about will be addressed and that the special unit will prioritise the hospital in his area for the people he represents. Those people need to know that it is getting the priority it needs and, no different from any other hospital in any other part of the country, it is being treated equally and with the same level of urgency. I will get the Deputy those answers.