Seanad debates

Wednesday, 9 October 2019

Nithe i dtosach suíonna - Commencement Matters

Hospital Overcrowding

10:30 am

Photo of Kieran O'DonnellKieran O'Donnell (Fine Gael)
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The Cathaoirleach is fair and equitable in his role. I welcome the Minister of State, Deputy Jim Daly, to the House. On a personal note, I wish him well. Politics is a tough game and I very much respect what he is doing. I put on record that he has a phenomenal body of work to his name. I wish him well for the future and he might return at some point.

This matter concerns overcrowding at University Hospital Limerick. There is a sense of déjà vuas I raised it at a meeting of the Oireachtas Committee on Health last Wednesday, 2 October, when the Minister of State was present. There is persistent overcrowding and this is a human issue now, as opposed to a political matter. In September, University Hospital Limerick consistently had the highest number of people on trolleys and that has been the pattern for a long period. An average of 68 people per day were on trolleys this September, but in September 2018, there were an average of 44 people per day on trolleys. I have seen the daily figures since the start of October and over the past nine days, the average per day has been over 70. That figure is too high.

I put a number of suggestions to the Minister for Health, Deputy Harris, and the Minister of State, Deputy Daly, and I concluded by calling for a radical action plan to tackle the overcrowding. There is a 60-bed block under construction and it is expected that it will be completed next June and operational next September. There is also a 96-bed acute care bed block in the planning and design phase, and the HSE has assured me the planning process will start at the beginning of the coming year. I have pushed for both projects and I got €100,000 for preliminary design work by University Hospital Limerick and the HSE in getting it under way.

This is a legacy issue and there was a reconfiguration when facilities at Ennis, Nenagh and St. John's hospitals were closed in 2009. There were supposed to be 138 co-location beds on the grounds of University Hospital Limerick but that did not happen. Over the next number of years we will have 150 extra beds, but until that happens, we must have radical interim measures to deal with overcrowding, which every day is affecting people I deal with.

There should be a number of components in these measures. An additional MRI scanner should be provided, as was mentioned at the meeting of the Oireachtas health committee last week. The existing MRI scanner is old and under severe pressure. It is contributing to the fact that diagnostics are not being completed on time. Recently there were 47 people awaiting discharge but in the previous year this number was always approximately four. There should be funding for fair deal transitional care to allow people to move to step-down facilities quickly. There are many people occupying beds in University Hospital Limerick who could avail of step-down facilities if funding was available. Perhaps facilities at Ennis, Nenagh and St. John's hospitals could be used more efficiently to get non-acute patients out of beds at University Hospital Limerick.

We are at a crisis point and I have campaigned about this for a long period. We must overcome the problems that will arise over winter. A commitment was given by the Minister and the Minister of State at the Oireachtas committee to meet representatives of the HSE and the Department to discuss matters specific to University Hospital Limerick and the mid-west before reverting to us. This is such an urgent issue that I am asking where is the radical action plan and when will it be implemented. Will there be a new MRI scanner as I do not believe that the process could still take up to eight weeks? This is a crisis and if we need a new scanner, it should be found. A transition package for people to avail of fair deal would allow people to be discharged more quickly to step-down facilities. The facilities at Ennis, Nenagh and St. John's hospitals could also be used more efficiently.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I welcome the opportunity to address the House on the issues raised by Senator O'Donnell. According to provisional HSE TrolleyGAR data, there was a 17% increase in patients waiting on trolleys year to date in University Hospital Limerick accident and emergency department in September 2019 compared with the same period last year. In September 2019, there were 897 patients counted on trolleys in University Hospital Limerick, which was a 28% increase compared with the previous month. It is acknowledged that this is unacceptably high and the HSE is actively working with the University of Limerick Hospitals Group to ease congestion in University Hospital Limerick, with a focus on facilitating transfers to level 2 hospitals, as mentioned by the Senator, with regard to transitional care, assistance from rehabilitation units and community health organisation services, and prioritisation of diagnostics to aid inpatient discharges. Senator O'Donnell quite correctly and aptly referenced these.

The HSE has advised that University Hospital Limerick is experiencing high levels of occupancy combined with challenges from infection prevention and control measures. Ward rounds are ongoing in the hospital to identify patients for discharge and diagnostics are being prioritised to maximise egress. In addition, transfers to model 2 hospitals are being expedited and the surgical and acute medical assessment units are functioning to assist admission avoidance. The University of Limerick Hospitals Group has reported that indications for an MRI scan have greatly increased over the past 15 years and that an additional MRI scanner would have an immediate benefit in faster discharge of patients and reducing admissions. Proposals for funding of a second MRI machine and replacement of the existing scanner have been made by UHL. The HSE will have to consider the proposal in the context of the budget process.

Planning for the winter of 2019 and 2020 has commenced, and the Department of Health is working with the HSE to finalise the winter plan in the coming weeks. Individual community healthcare organisations and aligned hospital groups are preparing integrated winter plans that will focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients, and the provision of appropriate and timely egress from acute hospitals. The local integrated winter plans will be delivered by local winter action teams. The winter action teams will report to the HSE winter oversight group, consisting of senior HSE staff across the relevant divisions and chaired by the chief operations officer.

The integrated winter plans will support the development of a single overarching strategic level winter plan for the HSE. Additionally, the Department and the HSE have been considering a comprehensive approach to the current high level of delayed transfers of care. However, recognising the urgency of the situation, approval was provided to the HSE to begin actions immediately to the value of €5 million in 2019 with a view to bringing the waiting times for the release of the nursing home support scheme funding back to four weeks, providing additional home support and increasing transitional care.

The health service capacity review published last year highlighted the need for a major investment in additional capacity. Progress has been made on increasing capacity in University Hospital Limerick, and the average number of open inpatient beds has increased by 4% between 2017 and March 2019. Since 2017, an additional 25 beds have been opened in University Hospital Limerick, including eight as part of last year's winter plan. In addition, a capital budget of €19.5 million has been approved for the provision of a modular 60-bed inpatient ward block at University Hospital Limerick, with funding of €10 million allocated in 2019. The new modular ward will include three wards comprising 20 single-room occupancy with en suite facilities, two of which will be full isolation facilities and will provide care and treatment for patients from admission to discharge. The HSE has advised that the enabling works are complete and the main contractor is commencing work.

Photo of Kieran O'DonnellKieran O'Donnell (Fine Gael)
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I thank the Minister of State for the response. We need to see a specific radical action plan and I will hold the Minister, Deputy Harris, and the Minister of State to the commitment made at the Oireachtas health committee last week. They asked for two weeks and I will give that but it should take no longer. We need immediate action on the MRI scanner and I expect to see results on that over the next two weeks.

The Minister of State referenced bed capacity, which is clearly the fundamental issue at University Hospital Limerick, if not the only one. There are two aspects to this. When a second MRI scanner is in place, it may prevent the admission of people who may not need to be admitted because of the wait for an MRI. Additionally, people could be discharged much more quickly. Will the Minister of State confirm that there will be funding under the budget to allow people to transition to fair deal so they can move to a nursing home before the fair deal scheme kicks in formally? Will it be fast-tracked for University Hospital Limerick?The action plan must be radical and involve a new scanner with immediate effect, as well as transitional step down funding. The Minister of State made reference to the use of the hospital. I ask for confirmation of transitional funding for fair deal to nursing homes.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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The Senator made a comprehensive case at the committee last week, not just to me and the Minister for Health, Deputy Simon Harris, but, more importantly, to Mr. Paul Reid, CEO of the HSE, and Mr. Liam Woods, who, along with the senior team in the HSE, addressed the issue of the scanner. The hospital can do no more than put forward a proposal for funding. The HSE is currently examining the situation and I and the Minister for Health, Deputy Harris, will support the Senator in his endeavour to have that expedited as quickly as possible. We see it as a very practical solution which can help the situation.

Transitional care funding was released on 9 September nationally, which has had an impact. The weeks in the month of August were out of kilter for the fair deal scheme and there was a block on transitional care funding which made everything in the hospital system worse. Emergency funding was released on 9 September, which is playing out through the system and has brought everything back into kilter. The waiting time for the fair deal scheme has reduced to four weeks. The flow of transitional care funding has opened up again. That is why the peaks in September are particularly acute. We hope to see some improvement. Continuing funding will be made available over the winter plan to deal with that.