Thursday, 23 June 2022
Saincheisteanna Tráthúla - Topical Issue Debate
I thank the Ceann Comhairle for allowing this matter to be debated. I represent the constituency of Limerick City.
We have severe overcrowding at University Hospital Limerick, UHL, emergency department, ED. HIQA carried out an inspection of the ED at UHL on 15 March and issued a report. The report found that there were 88 people on trolleys. That figure has been consistent every since. There was a welcome change this morning when it dropped to 63. When the report came out, my view was very simple, namely, that the people of Limerick and the mid-west are entitled to the same delivery of healthcare as those in any other part of the country. At the moment, that level of healthcare is not being provided due to of the crisis of overcrowding at UHL. Staff are working very hard and are under great pressure. There is great fatigue among them.
I called on the Taoiseach on Tuesday to have the HSE provide assistance at a national level. I welcome that the Minister for Health, Deputy Donnelly, last night requested that the chief operations officer of the HSE write to the CEO of UHL and the chief officer of Mid West Community Healthcare informing them that she had mandated that the performance management improvement unit of the HSE is to engage urgently with the hospital and Mid West Community Healthcare in the context of addressing the issues raised in the HIQA report. My understanding is that officials from the performance management improvement unit are now in UHL and will be there for the next four to six weeks to assist management to ensure that we can address the issues that HIQA found, such as an inadequate number of nurses in the ED on 15 March. Notwithstanding the fact that we have had 98 additional acute beds and ten ICU and high dependency unit beds provided in recent years, the report states that these did not seem to make a significant difference in the context of the number of people on trolleys in the ED.
I know many of the families involved. I know that this matter had reached the point where the performance management improvement unit needed to come in to UHL. The Minister has committed to providing whatever resources are needed. What I want is an update to the effect that officials from the performance management improvement unit are in the hospital and that an action plan will be put in place. I am also seeking information on how quickly that action plan will be implemented. We have regularly seen more than 100 people on trolleys in the hospital. That is unacceptable.
The medical, nursing and other staff at the hospital are doing their level best, but they are battling against a situation in our region where we have the second highest number of ED presentations and the lowest number of ED inpatient beds. In fact, we have the second lowest ratio of any of the model 4 hospitals in terms of the number of inpatient beds, which stands at 530. We need additional beds. A 96-bed acute is due to come on stream, but we also need an elective hospital. The more immediate issue is to ask when will the action plan to be drawn up by the performance management improvement unit be issued? When will we see improvements for the people and the patients of Limerick and the mid-west?
Great urgency is required in respect of this matter. I very much welcome that officials from the performance management improvement unit are in UHL, but I want an update from the Minister of State as to when the action plan will be put in place.
I welcome the opportunity to address the House on this important issue raised by Deputy O’Donnell.
I wish to acknowledge the distress that overcrowded EDs cause to patients, their families and front-line staff who are working in very challenging conditions in hospitals throughout the country. The Minister has visited UHL and has been concerned for some time about the emergency care performance there. It must be recognised that UHL continues to deal with record volumes of patients attending its ED. To the end of May, attendances at the ED were up 11% compared with the first five months in 2019.
After his visit to UHL, the Minister requested that a HSE expert team review the day-to-day functioning of the ED in a leadership, management, operational and clinical context. Following this intervention and the recent HIQA report, the HSE’s performance management improvement unit has been directed by the chief operations officer to lead a process, in partnership with UHL team members, supporting the hospital and community services in driving a programme of work to respond more effectively to the current pressures. The performance management improvement unit will ensure that all necessary immediate steps are taken to address the safety issues identified. A detailed plan will be developed as a matter of urgency in order to ensure that they do not reoccur. The plan will cover issues including admission avoidance, pre-admissions, community interventions and alternative pathways, as well as issues relating to patient flow through the hospital and its ED. There will be a strong focus on pathways for the over-75s.
The Minister also welcomes the recent publication of HIQA's report and is concerned about the significant risk to service users identified in it. The inspection focused particularly on the important issues of patient flow and inpatient bed capacity in the hospital, staffing levels, respect, and dignity and privacy for people receiving care in the ED. The HSE has been requested to prepare comprehensive short- and longer-term improvement plans for all 29 EDs, including that at UHL, in order to ensure sustainable improvements in emergency care performance. The Minister met with senior HSE management yesterday and received an update on progress in the development of those plans.
There continues to be substantial investment in UHL to address capacity issues, including a 28% increase in UHL’s workforce since the end of 2019 and the opening of an additional 98 non-ICU acute beds. This includes the 60-bed modular ward block that was established to provide a rapid-build interim solution to begin to address the bed capacity issue at UHL and improve patient flow.
In order to deal with the increased level of presentations this year, reform of service delivery as outlined in Sláintecare is vital. This includes the expansion of community care and other measures to provide people with the care they need outside of the ED and improve patient flow and egress from hospital by providing more home care packages and nursing home supports. Investment of €1.1 billion was allocated in budget 2021 to expand capacity, increase services and support reform, and this level of investment has been maintained in budget 2022.
I do not have a date for the publication of the action plan. We will come back to the Deputy with that.
I thank the Minister of State very much. I welcome that the HSE, at a national level, and the Minister requested that the performance management improvement unit move to assist and to work in partnership with the management, the nurses and medical staff at the hospital. We must see results for the people and patients of Limerick. We cannot have a situation where we have people on trolleys for an inordinate length of time. It is very distressing for them and their families. UHL provides a very good service, but we are at the point now where we have to see the numbers on trolleys coming down. I welcome the fact that they are down to 63. That is still way too high but it is moving in the right direction.
We must also, as part of the work being done by the performance management improvement unit, ensure that the capacity of the other hospitals in the group is being used to the optimum. I refer here to St. John's Hospital, Ennis Hospital, Nenagh Hospital and Croom Orthopaedic Hospital. The hospitals in the group must work very much in the context of a partnership model. We must also see that diagnostics are used properly and ensure that if people are coming to the hospital, they will be seen within a reasonable timeframe. We must also ensure that if people need to be admitted to inpatient beds, they will be admitted within a reasonable timeframe.
These are short-term measures, and that is why officials from the performance management improvement unit needed to be deployed to the hospital. The assistance that is needed at corporate level in the hospital is also there and is working with local management, medical, nursing and other staff.
In the medium term, planning permission has been obtained for the 96-bed acute block and a preferred bidder has been selected. That project should proceed to construction immediately. This 96-bed acute block will be located on the existing site. We then need to look at an elective hospital for our city and the region in general. Cork and Galway have already got such facilities. This matter was covered in the original Sláintecare proposal. It now needs to be looked at by the Government in the context of consistency and equality.
The people I represent in Limerick, the mid-west and north Tipperary deserve the same level of service as is available elsewhere in the country. This is not the case and it needs to be corrected.
I agree wholeheartedly with the Deputy's closing remark. I mentioned in my opening statement that the Minister met senior officials from the HSE yesterday to discuss the issues in University Hospital Limerick and the immediate responses required to address the pressures being faced by all 29 emergency departments. The Minister was updated on the progress of the University Hospital Limerick expert team review and the response to the HIQA report. He was also informed that the HSE's performance management improvement unit is to engage urgently with the hospital group and the CHO to provide intensive support to the hospital and community teams to ensure the issues identified in the expert team's assessment and the HIQA report are addressed as a matter of urgency. The HIQA report provides an important opportunity for a renewed focus on the capacity, capability, quality and safety of emergency care services delivered to the people of the mid-west region by University Hospital Limerick.
As I mentioned, significant resources have been invested in University Hospital Limerick in recent years. This has seen an increase in University Hospital Limerick’s workforce of 28% since the end of 2019. It is accepted that a key part of the solution for Limerick is additional beds, as the Deputy mentioned. A total of 150 additional beds have been opened in the University Limerick Hospitals Group since 1 Jan 2020. Of these, 98 have been in University Hospital Limerick. Further plans for Limerick include the provision of a 96-bed ward block at University Hospital Limerick, of which approximately half will replace older stock.
As with the Deputy, I welcome the reduction in trolley numbers but it is still too high. The matter of performance in hospital emergency departments is under constant review by the Department, including seeking assurance regarding the appropriate escalation measures for emergency department overcrowding through ongoing engagement with the HSE. I assure Members that the Minister, Deputy Stephen Donnelly, and the Government are committed to driving an improvement in emergency department performance in Limerick.