Dáil debates

Wednesday, 16 November 2022

Saincheisteanna Tráthúla - Topical Issue Debate

Hospital Overcrowding

9:12 am

Photo of Maurice QuinlivanMaurice Quinlivan (Limerick City, Sinn Fein)
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Before I begin, I acknowledge the passing earlier this week of Vicky Phelan. Although she was born in Kilkenny, Vicky was a Limerick woman and a tremendous advocate for women's health. Her honourable request was that action be taken immediately on cervical checks. We are all obliged to do so as parliamentarians.

Last month, University Hospital Limerick asked members of the public not to attend the emergency department unless absolutely necessary. Nobody would attend the emergency department in Limerick unless it was absolutely necessary because people could end up staying there for 30 to 60 hours before being seen. Last month, University Hospital Limerick was under huge pressure. We are now in the winter months and the number of people being treated on trolleys at University Hospital Limerick remains high. By autumn, we had already seen the total number of people treated on trolleys exceed the number in the entirety of 2021. Halfway through November, 767 people have been treated on trolleys. As I am sure the Minister of State is aware, Covid-19 and seasonal flu presentations will put additional pressure on staff at UHL. Record numbers are being treated on trolleys, and high numbers are presenting to the emergency department. None of this is new to the Minister, Deputy Donnelly, or to previous Ministers. I have outlined this situation to them for seven years, since I was elected, but it seems to get worse rather than better each month.

One would have thought the HIQA report, following its visit to the emergency department of UHL on 15 March, would have spurred the Minister, Deputy Donnelly, into reacting. He is well aware that in three of four categories in which it was measured, the hospital was found to be non-compliant. Despite this damning report, the issues continue. The emergency department continues to see high numbers of presentations. The University Limerick Hospitals Group advised that, in 2021, there were 76,473 presentations, and projects that the number will increase by 4% by the end of 2022. This is a huge stress on the functioning of the hospital. Of those 76,473 presentations in 2021, 8,720 waited for more than 12 hours to be treated. Not only is that a significant inconvenience for these people, it is also unsafe. It is worth reminding the Dáil, as I have said on numerous occasions, that the Royal College of Emergency Medicine in the UK notes there is, on average, one excess death per every 67 patients waiting in an emergency department for eight to 12 hours.

The vast majority of staff, including porters, kitchen staff, ambulance paramedics, doctors and consultants do an exceptional job in this impossible situation. However, staff cannot continue to work this way. Patients need to have more dignity when, unfortunately, they need assistance at a hospital. I am concerned that if the situation continues, we will have avoidable deaths and accidents. I have been contacted almost daily, as I am sure have other public representatives in the mid-west, by patients and their families about the treatment of their loved ones at the hospital. We have all had reports of dementia patients being able to leave the hospital and go missing. We have had feedback from others that they simply cannot get a response from the hospital when they try to call for updates on their loved ones.

The hospital is short by at least 68 non-consultant doctors, as the Minister confirmed to me in a parliamentary question, and by at least 200 beds, as the report states. Filling in these gaps would only bring the hospital on par a with hospitals of a similar size in the State. The Deloitte report went further and found that an additional 302 inpatient beds and 63 daycare beds are needed by 2026. It also outlined the demand for additional staff in the emergency department, with 83% of beds allocated to those who presented through the emergency department. A new 96-bed unit is under construction but it will only offer 48 additional beds, with half of the stock replacing old beds. Will the Minister of State outline what contingency plans are in place for the coming months so that seasonal presentations can be managed and staff have the opportunity to work in decent conditions? Will the Minister of State confirm if the Minister has planned for it all?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this important issue. I am taking it on behalf of the Minister, Deputy Donnelly, so I will keep to the script.

I recognise the long-standing interest of the Deputy in the development of healthcare at University Hospital Limerick and the entire mid-west. We are all familiar with the difficulties faced by UHL. It was in consideration of those difficulties that the Minister visited the hospital in February this year. Following that visit, he requested a HSE expert team to review the day-to-day functioning of the emergency department in UHL. The HSE's performance management and improvement unit, PMIU, led an intensive engagement with the hospital group and mid-west community healthcare organisation, CHO, throughout the summer in response to the Minister's concerns and the findings of the HIQA report published in June this year. The PMIU worked with UHL to support and oversee the implementation of rapid improvements in services in the region. These measures include a renewed focus on hospital avoidance, patient flow and discharge planning, and regular and frequent assessment of patients with long stays in hospital.

In addition to the review requested by the Minister, UHL commissioned Deloitte to review and advise on unscheduled care and patient flow in the hospital. This review was published in September. Its key recommendations include the opening and staffing of the acute medical assessment unit on a 24-7 basis and the recruitment of an additional 20 non-consultant hospital doctors, four emergency medicine consultants and dedicated paediatric nursing staff. They also include a review of health and social care professional staffing levels, an additional 202 acute beds and 63 day beds by 2036, and improved access to primary care through additional places for GP training schemes and expansion of GP access to diagnostics.

In addition to this work, the Minister launched the 2022 waiting list action plan, as the first year of a multi-annual approach to reducing waiting lists and waiting times. The €350 million funding allocated to the HSE and the National Treatment Purchase Fund, NTPF, this year has been primarily focused on providing additional public and private activity to reduce waiting lists, but also to lay the foundations of important multi-annual reforms that will deliver sustained reductions in waiting lists. This work will continue in 2023, with €443 million allocated to tackle waiting lists, including €123 million in funding for delivery of the HSE waiting list action plan, €150 million for the NTPF to procure additional capacity, and €90 million for additional short-term measures to address acute scheduled care waiting list backlogs.

There has been significant investment in infrastructure in UHL in recent times. Work has commenced on a new four-storey, 96 single bed acute inpatient ward block. In 2021, a new 60-bed modular ward block opened. This follows the completion of two separate rapid-build projects constructed in response to the Covid-19 emergency, which provided an additional 38 inpatient beds on site at UHL.

I would like to assure the Deputies that the work underway to address capacity issues at UHL will make a significant difference to patient experience at UHL. The Department of Health continues to work closely with the HSE to ensure UHL is fully supported and that the necessary improvements are actioned in a timely manner.

9:22 am

Photo of Maurice QuinlivanMaurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State. The reality is there has been a catastrophic failure of the hospital. The situation cannot continue in the current manner. Yesterday I spoke to a woman whose husband is in UHL. After days in the emergency department, ED, he was sent to the ward. The sheets on the bed he was given were filthy. His young son who visited him later left the room because he could not stand the smell. This is simply outrageous. We deserve much better than this. Under the current management, crisis has become normal. The perpetual crisis at the hospital demonstrates that the management team is not up to the task. A new approach and a new team are needed. Patients deserve much better than they are getting. Simple things do not work in the hospital. People do not have blankets when waiting in the emergency department. They are cold and hungry. The toilets quite often are not cleaned properly. These are simple things that can be fixed.

Pandemic bonuses were announced in January and still thousands of workers remain without them. These are people who took the risks in our hospitals when the rest of us were able to shelter at home. I would like to mention one positive note. That is the introduction at the hospital of the pathfinder programme. It is a welcome addition which it is to be hoped will deflect some of the elderly patients away from the ED without compromising their care. This should lead to improvements in waiting times at the emergency department while removing the possibility of infection for those elderly citizens who otherwise would have to sit in the ED waiting room. However, as is always the case in this hospital, it is too little too late when it comes to action and health.

The recent report I referred to earlier commissioned by the UHL group requires a proper Government response. It has detailed what we already knew, namely, that we have an overcrowding and capacity issue at UHL. It is time for the Minister for Health to step up and address the capacity in a much better way than he has been doing up to this. Staffing and management issues at the hospital need to be addressed as well. An additional 48 beds will not solve the problem. We need a minimum of 202 beds. There is no tackling the crisis at UHL unless we get to grips with this, the people of Limerick and the mid-west will continue to suffer in the emergency department due to Government inaction and a failure to act and invest with the proper money, resources and staffing we need.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I again state that the Government, along with the Department of Health, remains fully committed to improving services in Limerick and throughout the country. Significant efforts are being made to ensure the issues, such as overcrowding in the emergency department and delays for elective care at UHL, are being addressed as a matter of priority. As I noted, following the Minister, Deputy Donnelly's, intervention earlier this year, the performance management improvement unit of the HSE immediately engaged with the hospital group and the CEO under the HSE performance accountability framework. This is to provide the intensive support needed to ensure the necessary improvements in services for the region are achieved. These measures include a renewed focus on hospital avoidance, patient flow and discharge planning, and regular and frequent assessment of patients with long stays in hospital. This work, along with the broader efforts and the considerable funding made available through the waiting list action plan, will provide significant assistance in addressing capacity issues at UHL and across the hospital group.

The Government is fully aware of the impact overcrowding and hospital capacity issues have on patients and their families in the mid-west. I assure the House that intensive efforts are under way to address the difficulties currently facing UHL, and those efforts will proceed as long as required. The Department of Health will continue to work with the HSE to ensure support for the improvement of services for all patients attending the hospital.