Dáil debates
Tuesday, 12 July 2022
Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions
Emergency Departments
11:00 pm
David Cullinane (Waterford, Sinn Fein)
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83. To ask the Minister for Health his plans to tackle the crisis in emergency departments; and if he will make a statement on the matter. [37352/22]
David Cullinane (Waterford, Sinn Fein)
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This question relates to the Minister's plans to tackle the crisis in emergency departments. As he knows, waiting times in emergency departments are unacceptably high. I accept that Covid-19 is in part responsible for that but there are also issues in respect of the lack of capacity in some hospitals. Part of the problem is patients are not getting sufficiently good care in the community or through a GP. I also wish to ask the Minister specifically about the mid-west region and the particular problems we have at University Hospital Limerick.
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy. I agree that the time patients are having to wait in emergency departments is not acceptable. Much of that is due to Covid and it is frustrating for everyone, including the patients, our healthcare professionals and all of us, because there is a level of capacity in the system now that has never been there before. There are more hospital beds, doctors, nurses and healthcare assistants than ever before. There is more community-based care than there has ever been. There are more home care hours and there is more preventative community care. One would expect the emergency departments not to be under the pressure they are.
A big part of the problem is the unprecedented level of presentations. May of this year saw the highest monthly national emergency department attendance on record. That was May, not December or January. Not only was that number the highest on record, the people coming in are older and more frail as a result of many of them having been at home for two years during the pandemic. I know the Deputy has acknowledged that.
What are we doing about it? I am working with the Department and the HSE to put together a short-term plan for all 29 emergency departments. There is now a draft plan in place and being worked out. More and more detail is being added to it. That plan is for all 29 emergency departments. It is considering how we keep people out of the emergency departments unless they really need to be there. Injury units, access to GPs on call, community-based care, older person intervention teams, home supports and other measures are the alternatives. When people need to come to emergency departments, we must consider whether the hospitals have the resources they need in the emergency departments and elsewhere in the hospital. Something that is critical, and the closer we look at this issue the more we realise this problem must be resolved, is the discharge option. For example, one of the big issues in Limerick is that patients are not being discharged as quickly as they should be. It would help with patient flow in the emergency department if they were.
David Cullinane (Waterford, Sinn Fein)
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We need a comprehensive review of healthcare services in the mid-west. I would, in fact, argue that one of the first regional health areas should be established in that area. We need to properly align community care, primary care and acute care. We must also consider capacity in Nenagh Hospital, Ennis Hospital and St. John's Hospital. I know the hospital group has advocated for an elective hospital in the mid-west. There is possibly merit in that. I know that representatives of the group have met the Minister on that issue. That might be one of the solutions. I certainly believe we need to consider increasing capacity in Nenagh and Ennis. The question of whether that is emergency department capacity is something that would have to be clinically assessed but elective capacity can certainly be considered to take the pressure off.
It is not difficult to understand what is happening in our emergency departments. It is partly a result of Covid but if people cannot get access to out-of-hours GP care, they will go to their local emergency department. If they cannot get access to an injury unit quickly enough, they will go to an emergency department. Far too many people are attending emergency departments. Admission avoidance is necessary and we need a plan to make it happen.
Stephen Donnelly (Wicklow, Fianna Fail)
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In the short term, one of the issues we are looking at is exactly the point the Deputy has raised. The injury units are superb. Many people who are walking into emergency departments could be seen quicker in an injury unit. We are considering whether the injury units can be opened for longer. Can they see more people? There are age limits on many of the injury units. Is everybody in the community aware of exactly the kind of injuries for which one would attend an injury unit? For example, there is a brilliant injury unit in Smithfield in Dublin but not that many people know about it. We need to have much more comprehensive engagement and communication. We are also looking, in the medium and long term, to build out the permanent capacity in the step-down facilities in the community.
David Cullinane (Waterford, Sinn Fein)
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All of that is necessary. However, I would like to see what is in the short-term plan about which the Minister is talking. I have visited a number of hospitals, as the Minister knows. I have attended 15 in total in the past year. I know the Minister has attended some as well. Some hospitals have taken a zero-tolerance approach to patients on hospital trolleys. In fact, in my own constituency of Waterford, there have been no patients on trolleys for the whole year. It does not mean that people are not waiting too long in emergency departments but very clear action was taken. I know that a hospital in Drogheda, for example, has got to grips with what was happening in its emergency department and the trolley situation involved. The last thing it wants is more pressure and that is why there is controversy around closing the emergency department in Navan. We need short-term plans but without medium- to long-term structural changes that will bed in community care, provide alternative care pathways and increase admission avoidance, we are going to see more pressure on our emergency departments.
Stephen Donnelly (Wicklow, Fianna Fail)
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The Deputy raised the example of Waterford, which is a great example of what can be done. A specialist team was sent into Waterford a few years ago. I stand to be corrected but from memory, I was told that it went from being one of the worst performing in respect of patient waiting times to the best. They have done things differently in Waterford.
David Cullinane (Waterford, Sinn Fein)
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They have good Deputies there, for a start.
Stephen Donnelly (Wicklow, Fianna Fail)
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There are, for example, overflow beds. The hospital is doing incredibly well. We have taken the same approach, for example, in Kerry and Limerick, where we have sent in specialist teams. There is a plan. It is a living document and as we learn more, the plan changes. I would be very happy to share the draft we have now with the Deputy. There are at least ten specific items that are being actioned for Limerick. The team is down there right now working with management to try to achieve in Limerick exactly what was achieved in Waterford.