Thursday, 18 November 2021
Saincheisteanna Tráthúla - Topical Issue Debate
University Hospital Limerick, UHL, caters for the medical needs of the entire mid-west, including my constituency of Limerick City. The region also has St. John's, Ennis and Nenagh hospitals, as well as Croom Orthopaedic Hospital, but UHL is the large cog in the system. On Tuesday, 16 November, 95 people were on trolleys there, which was the highest number since the Irish Medical Organisation, IMO, started recording the figures. Fortunately, the number has reduced to 58 today. It is still a very high figure but it shows a good reduction.
The first point I want to make is that I am concerned about the coming winter period. The construction of a 96-bed acute block at UHL is currently out to tender. It is a project I have worked on for a number of years with the HSE and local UHL management. We want to ensure that once it goes out to tender, it will be funded and construction can get under way. However, I am more concerned about getting over the immediate winter period. Some 50% of ICU beds in UHL are now being taken up by Covid patients. There are currently 49 patients with Covid in the hospital, 13 of whom are in ICU. Those 13 people are taking up 13 of 28 ICU and high-dependency unit beds. This is a significant portion, which is way above the national average of approximately 40%. There are very few available ICU beds on any given day. Over the recent period, either one or no bed was free. We have seen six beds available, on average, over recent months and eight people in ICU.
The hospital's metrics in this regard are way above the national average. The number of patients with Covid is in the top three and it is consistently at the top of the list in terms of numbers on trolleys. The number of Covid patients is a major factor in the number of people on trolleys, which must be factored into the consideration of the issue.
Some €30 million is set aside under the winter plan. I want to ensure hospitals such as UHL can look for additional funding for staff such as junior doctors and I acknowledge the work done by the staff in UHL. They are under pressure all the time, with no respite, caring for the people of Limerick city and county, the entire mid-west and north Tipperary. I ask that the Government would, with the €30 million set aside under the €77 million winter preparation plan, look to assist UHL in getting over this winter period. It is very serious, when one looks at the metrics. We had 49 Covid patients in the hospital yesterday, 13 of whom were in ICU and nearly 50% of the 28 ICU beds are taken up by Covid patients. That is a consistent trend over the past month. The pressure must come off. We are now into the fourth wave of Covid, which will build up more pressure. I ask the Minister of State that the Government, the Department of Health and the HSE ensure UHL gets whatever help is necessary to get over this winter period in terms of dealing with the overcrowding in the emergency department, ED, in UHL.
I thank Deputy O'Donnell for raising this very important issue around University Hospital Limerick. The Deputy has been passionate on this issue for a long time and raises this matter on a consistent basis, both behind the scenes and in the Dáil Chamber.
I acknowledge the scale of the challenge facing our emergency departments as we head into what is expected to be a very difficult winter. I thank our emergency department staff for their ongoing commitment to delivering a high standard of care to ED patients, while acknowledging the distress that overcrowding causes to patients and their families and to front-line staff. There were 6,996 attendances at the emergency department in Limerick in October 2021, up 24% compared to October 2020 and 16.4% compared to October 2019, although, in the year up to 18 November 2021, trolley counts for UHL remain 35% lower than 2019 levels.
The UL Hospitals Group has reported it is continuing to deal with record volumes of patients attending the UHL emergency department, a pattern that has been sustained over a number of months and is being replicated throughout the country. The hospital is continuing to follow its escalation plan, which includes additional rounds, accelerating discharges and identifying patients for transfer to model 2 hospitals. Surge capacity is open in UHL and in Ennis and Nenagh hospitals to meet the current demand and scheduled care remains under review.
There has been and continues to be substantial investment in UHL and the wider hospital group in recent years, to address capacity issues, including a new emergency department that opened in 2017. In the past year, 132 additional beds have been provided. These include the new 60-bed modular ward block at UHL, a 24-bed single room rapid-build ward and the reconfigured 14-bed high-dependency unit, HDU.
The winter plan 2021-22 was published on 15 November. We are investing €77 million in this year's winter plan, in addition to the 2021 funding, which has been retained. The plan recognises that a whole system response is required and outlines how the HSE proposes to manage winter challenges across primary, community and acute care, including measures to allow the public system to access private healthcare capacity. The plan will provide for the appropriate, safe and timely care of patients by ensuring, insofar as possible, effective levels of capacity and resources are in place to meet the expected growth in activity levels.
I acknowledge the 98 additional beds that have gone into UHL. Some 60 modular beds, for which I campaigned over a long period of time, are in place. However, that 60-bed ward is being used as a Covid unit. It is not being used for that which it was really intended, which was to relieve the existing pressures in UHL. We have 49 patients in UHL with Covid. That is in the top three in the country. We are the top hospital in Ireland in terms of trolley waiting lists.
I believe in trying to manage a situation, rather than being reactive at the end, when it gets very difficult to deal with. When these major warning signs are appearing and 95 people were on trolleys two days ago which is, thankfully, down to 58 today, now is the time to allow UHL apply for funding under the €30 million put aside under the winter plan for acute hospitals, to alleviate the pressures on the recruitment of staff. I acknowledge, once again, the phenomenal work of the nursing and medical staff and management and everyone working there and trying to deal with a very difficult situation.
However, the facts speak for themselves. We have a crisis in terms of the number of patients presenting with Covid in UHL. That needs to be acknowledged by the HSE, Government and the Department of Health. Commitment from Government is now required in order that UHL can look to get these additional resources to get over the winter period, such as the recruitment of staff including junior doctors and other areas, to ensure we can get over these critical winter months and to get the tender through on the 96-bed block and get the building under way. However, a major crisis is presenting that we have to get through in the next number of months and that is under the winter plan. Can we get a commitment from Government that UHL can make that application and that it will work with UHL to deal with this major problem of overcrowding and Covid patients?
I thank Deputy O'Donnell again for raising the important matter around University Hospital Limerick and capacity. The health service capacity review 2018 was clear on the need for a major investment in additional capacity in both acute hospitals and community, combined with a wide-scale reform of the manner and location of where our health services are provided. In January 2020, 795 additional beds have been provided on a permanent basis, over the number available at the end of 2019.
The programme for Government, Our Shared Future, commits to continuing investment in our healthcare services, in line with the recommendations of the health service capacity review and the commitments in Project Ireland 2040. It is accepted a key part of the solution for Limerick is additional beds. The new 60-bed modular ward block at the university hospital is a significant step, but I heard the Deputy's comments on its current use. This ward provides modern, single-room, in-patient accommodation and improved infection prevention and control capabilities, as well as patient flow throughout the hospital. This follows the completion last year of two separate rapid-build projects delivered under the Government's national action plan in response to Covid-19, which provided an additional 38 inpatient beds on-site at UHL.
Furthermore, Project Ireland 2040 includes the provision for a 96-bed replacement ward block at UHL. The project is currently out to tender with tenders due to be returned in late January 2022. The tenders received will then be evaluated and it is anticipated the works contract will be awarded in early quarter 2 of 2022, subject to HSE board approval and funding availability. The Department and the HSE will continue to work with local hospital management to further improve patients' experience in UHL. I will bring Deputy O'Donnell's further comments to the attention of the relevant Ministers.