Dáil debates

Friday, 3 December 2021

Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Hospital Procedures

10:40 am

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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93. To ask the Minister for Health the number of hospital appointments including but not limited to elective surgeries which have been cancelled due to capacity constraints and particularly the lack of critical care beds; and if he will make a statement on the matter. [59112/21]

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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This question relates to the cancellation of outpatient hospital appointments and scheduled care and treatment. I am specifically looking for the number of hospital appointments, whether for consultations with a consultant or procedures, that have been cancelled over the course of the last year.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy. I looked into this and was advised that the HSE does not collect that specific information centrally. When I was preparing for this session, I noted that the Deputy's direct question had not been answered so I asked the Department to see if that information could be collected. The HSE collects data on cancellations locally but not centrally. Arguably, that is something that should be done. Capacity is obviously one of the big issues. There is an acknowledged deficit in critical care capacity in the country. We came into this pandemic with 255 beds. The capacity review says that we should have in excess of 400 beds. The target for the end of next year or early in the following year is 340 beds. This would represent a 33% increase in our permanent standing critical care stock since the start of the pandemic last year. That is a very significant increase.

One of the big constraints is critical care staff so highly specialised nurses and doctors are required. There is a lot of investment, building and recruitment to build up critical care capacity and, indeed, the entire patient flow so that we do not have these cancellations, which obviously are absolutely awful for the patients and their families. Indeed, it is awful for the healthcare workforce who are trying to provide these patients with the best possible care.

In terms of the private capacity, we have used about 65,000 private hospital bed days this year so far and that is about 20,500 patients. In critical care units, surge plans remain in place and are being activated, as needed. The latest information that I have from the HSE is that we have surge capacity, if needed through the winter, for about 380 critical care beds. Obviously that is not a surge capacity that we hope to activate.

10:50 am

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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The cancellation of hospital appointments and scheduled care is not sustainable. It now happens routinely. Covid has exacerbated the problem but it happened long before it for which there are a number of reasons. Obviously there is the lack of capacity, as the Minister mentioned, in terms of ICU. There is a lack of recovery beds so surgeries cannot be scheduled. There is a lack of specialist staff, as the Minister mentioned. Finally, there is a lack of stepdown beds in the community.

I wish to raise an issue with the Minister that was raised with me in Letterkenny recently when I met representatives of the Lifford Hospital Campaign Group. It is a community hospital that provided long-stay beds. HIQA advised that the hospital be closed temporarily and it is still closed. My understanding is that the HSE may have funding to provide for short-stay beds, which would a great use of the hospital. I do not presume that the Minister has the information to hand and ask him to provide me with a detailed note on exactly how much funding will be provided to the community hospital and give a timeframe for delivery. It is crucial that we get all of these elements right. There are many reasons treatments and care are cancelled. Some of it is because of capacity and late discharges in hospitals, and the reason for that is that there are not enough stepdown beds.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes, I agree with the analysis by the Deputy. It is not about simply providing more home care, outpatients, operating theatres or diagnostics. We have got to look at the entire patient pathway. Can they get to the GP quick enough? Can the GP refer to a consultant or, better still, is there an intermediary, like an advance nurse practitioner scheme that we have seen treat and discharge between 70% and 80% of patients who, in many cases, would have had to wait to see a consultant? Do the consultants have the outpatient facilities that they need? Do the consultants and GPs have access to the diagnostics that they need?

When someone is scheduled for a procedure we must ask the following. Can we get the operating theatre space? Can we get the day space? Can we get the diagnostics on the day? Can we get the recovery bed? Is the critical care capacity there, if needed? Are the ward beds there? Is there an option to discharge? Are there stepdown or rehabilitation beds? Can home care packages be put in place? We have found that in different parts of the country it is different things. We have a very comprehensive level of investment right across all of that to make sure that more and more patients get seen.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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On that note, in the last number of months I have visited 17 hospitals. I have met 17 hospital managers and all of their clinical teams. I have met the CEOs of hospital groups. I have also met people who work in primary and community care settings. While some good work has been done through the enhanced community care programme there is still an awful lot more to be done so that we can have admission avoidance in acute hospitals, which is one of the things that we need to do to reduce the cancellation of surgeries and hospital appointments because that is not sustainable. I will draft a report on all of my visits. I will do a synopsis of what I have been told and what I have learned from GPs. There is an issue in terms of GP access. We know that we need more GPs. There are problems in terms out-of-hours GP access for patients. For far too many people, such as people who suffer chronic pain, respiratory illnesses or other illnesses, care management in the community is not happening quickly enough. The infrastructure does not exist so the integrated care piece is critically important. If we get that right then we can reduce wait times and increase hospital avoidance, which is important.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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If the Deputy is willing to share his note then I will be delighted to take a look. There is no better insight that I get, no more than the Deputy, than meeting clinicians, healthcare providers, social care providers, patients and their families and seeing what is going on. An awful lot is working and people have done incredible work but, as the Deputy has quite rightly said, more is needed.

While we have seen record recruitment into the HSE this year and lasts year, and record acute beds, the community care side of things has proven more challenging. While we are broadly on target for adding acute beds that is not the case for community beds or community recruitment. We have very ambitious targets.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I ask the Minister to give me a note on Lifford Community Hospital.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will. We have put in a vast amount of funding to significantly increase the community-based workforce and therapeutics. It has proven very difficult. There is a lot that we are doing, working with the HSE, to see what more we can do to train up, attract and retain people to work in community care.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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Deputy Mattie McGrath has sent his apologies regarding his question.

Question No. 94 replied to with Written Answers.