Tuesday, 11 February 2014
Health Services Staff Issues
I welcome the Minister of State to the House and thank him for taking this matter on the Adjournment on overcrowding in the accident and emergency department at University Hospital Galway and the potential for nurse prescribing to be used as a means of alleviating the ongoing crisis.
The Minister of State may be aware it was reported on 20 January that 44 people were waiting on trolleys at University Hospital Galway, but this figure was accurate only if one counted the trolleys visible in and around the accident and emergency department. I am led to believe a further 38 trolleys were spread among a number of wards, which meant the real figure was 82. I am also informed it took up to three days for some of these sick and elderly patients to get beds. Now is the time to examine viable solutions for these figures, which are quite regrettable.
As the accident and emergency department crisis continues throughout Ireland the practice of nurse prescribing is a resource which is not utilised to its fullest extent. Last year approximately 7,000 patients spent time waiting on trolleys in accident and emergency facilities, as reported by the Irish Nurses and Midwives Organisation. Nurse prescribing is considered a forward-thinking development in the health care sector and would help reduce the overcrowding we face in hospitals throughout the country, in particular in Galway.
The nurse prescriber qualification permits nurses to examine, diagnose and prescribe for residents in nursing homes and residential health care facilities when the patient's general practitioner signs an agreement to this arrangement. Health care professionals find many elderly patients are sent from private nursing homes and residential health care facilities to accident and emergency facilities to receive IV fluids, antibiotics and other such drugs which may need administering because nurses employed at such operations are unable to prescribe them. This further exacerbates the overcrowding crisis at accident and emergency departments throughout the country.
Nurse prescribers are able to provide services to private sector patients but a problem arises with medical card patients. The HSE will not issue a GMS prescription pad to nurses employed at non-HSE facilities, therefore effectively barring this practice. Utilising nurse prescribing would not only be of great benefit to the residents of such facilities who would have timely access to medical treatment and would not have to wait for a house call from already under pressure general practitioners, but there would also be benefits for taxpayers who would not have to pay for accident and emergency department visits where patients can be treated at a private facility. The HSE policy does not encourage competition in the health care industry as a result of what I have stated. To provide an equal level of care to patients residing in private nursing homes and care facilities it is important this practice be abolished and nurse prescribing be embraced. I look forward to hearing the thoughts of the Minister of State on this matter. I apologise for gasping; I had to run upstairs to get here on time.
I thank the Senator for raising this issue. Between 2012 and 2013, a 14% reduction was achieved nationally in the number of emergency department patients waiting for ward bed accommodation. When compared to the baseline year of 2011, there was a 33.8% reduction in 2013. This is equivalent to 29,200 fewer patients waiting on trolleys, a reflection of the willingness and ability of the system to manage each temporary crisis that occurs. A total of 4,015 fewer patients have had to face trolley waits since we began to actively address this problem in 2011, quite an achievement in the face of the ongoing crisis referred to by the Senator.
The trolley counts for the first few weeks of 2014 in some hospitals are disappointing for the Department, the INMO, the HSE and the special delivery unit, but much more so for the patients and their families for whom these delays add discomfort and further distress. However, as Minister Reilly has stated regularly in recent weeks, these pressures are anticipated in the early part of the year and time and again the system has proved it can come through these peaks, stabilise and continue to improve.
One of the elements which assists in all areas of acute hospital practice, including emergency and acute medicine, is the introduction of medicinal product prescribing by trained and registered nurses and midwives, as the Senator correctly outlined. Nurse and midwife medicinal product prescribing has been in place in Ireland since 2007, underpinned by legislation and the Nursing and Midwifery Board of Ireland, NMBI, regulatory framework, whereby nurses and midwives must be registered as nurse prescribers. There are currently 650 registered nurse prescribers. Professional guidance is in place with regard to the scope of nursing and practice, and specifically on nurse and midwife medicinal product prescribing. There is, therefore, no barrier to advanced nurse practitioners who are registered as nurse or midwife prescribers with the NMBI prescribing to patients in the accident and emergency department at University Hospital Galway or in any other acute hospital.
No single trend or factor is wholly accountable for the peak pressure encountered at this time of year and no single action will address these pressures. However, University Hospital Galway has made steady improvement using a combination of actions, such as prioritising diagnostics of inpatients over outpatients to enhance patient flow; the transfer of patients to other hospitals within the west and north west hospital group; increased ward rounding; the use of a surgical day ward; the use of a medical assessment unit in tandem with the emergency department; and a focus on the use of nursing home and long-stay beds with colleagues in primary care.
These actions aid progress, with numbers awaiting admission reducing from 29 on Monday, 27 January to 22 on Monday, 3 February and 17 yesterday, Monday, 10 February. While these numbers are still unacceptably high, I am confident that with sustained effort, supported by senior management, Galway can achieve the type of reductions it has shown it is capable of, namely, a 34.1 % reduction, or 266 fewer patients on trolleys, between 2011 and the end of 2013.
I thank the Minister of State and appreciate the very detailed response he has given. I wish to clarify one issue. Is it the case the HSE will not issue a GMS prescription pad to nurses employed at non-HSE facilities? This is where my issue arises.
I heard the Senator raise this issue in the course of her contribution, but I did not have notice of this specific issue when I came to the House. I will ensure the Senator obtains an answer to this particular question.