Seanad debates
Tuesday, 17 December 2019
Nithe i dtosach suíonna - Commencement Matters
Hospital Overcrowding
1:30 pm
Kieran O'Donnell (Fine Gael)
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I thank the Minister of State, Deputy Daly, for coming before the House. This Commencement matter follows on from an issue I raised last week in the health committee with the Minister for Health and the HSE. It came to my notice that 15 beds in St. John's Hospital in Limerick were not in use for the past three months, which is unacceptable. I will qualify that by saying I fully understand the considerable difficulties faced by staff, including consultants, other medical staff and administrative staff, throughout the hospital but more particularly in University Hospital Limerick, UHL, in managing a situation whereby we are playing catch-up with reconfiguration. The 24-hour emergency departments, EDs, at Ennis Hospital, Nenagh Hospital and St. John's Hospital were closed, and 138 co-location beds were supposed to be built on the grounds of UHL before the reconfiguration went through. It should not have gone through. We are playing catch-up. What we now need is the 60-bed block under construction on the site of UHL. A 96-bed block will go into the planning phase early in the new year. This will provide more than 150 beds. That will take time. The 60 beds will be in place by next September, but we must all work together. No one, management or anyone else, told me these 15 beds were idle and not in use. Two long-standing consultants retired in St. John's Hospital over the past year. If we are operating in the dark and we do not know what is happening within the hospital group, it is impossible for someone like me, a public representative in Limerick, to assist fully at national level. If I were aware that 15 beds, for whatever lack of resources, could not be opened, I would have been at the desks of the Minister and the Minister of State and would have beaten down the door to get the funding in place. I will put Limerick ahead of everything else but I did not know about this.
I am glad funding is being provided under the National Treatment Purchase Fund, NTPF, to open the beds in St. John's. I want them open quickly. Furthermore, I want a comprehensive bed management plan put in place to ensure the beds are put to maximum use in UHL, St. John's, Ennis, Nenagh and Croom. It is important that everyone works together on this. This is not in any way a criticism on my part of anything to do with the medical profession - the consultants, the nurses or anyone else. I want to help but I do not know what the position in the hospitals is. There are 15 beds not in use. Why was this the case? How can I assist? I want to know now whether a comprehensive bed management plan is in place to provide the resources. If the university hospital group needs resources, the Department should ask for them and tell us it has done so. Funding for the second MRI scanner was provided when asked for, but when I asked for i tat the health committee, there were 15 beds at the same time not in use in St. John's. I did not know that at the time. If I had, I would have looked for funding there as well.The situation with the 15 beds does not concern me if they are not open but the Minister of State should tell me what is required to be done in terms of resources. I will go to the appropriate Minister and the Government to fight for those resources for Limerick. There has been a major capacity crisis in Limerick for a number of years.
I would like to see an audit of the nursing home beds in Limerick and its regions to ensure they are put to most efficient use. If funding is required, it should be provided. Funding will come through the NTPF for an additional ten nursing beds. That has been approved. The minor injury clinics in Ennis, Nenagh and St. John's Hospitals must have longer opening hours and we need to see the second MRI scanner for Limerick hospital in operation straight away. We all need to work together to ensure we deal with the crisis facing patients in Limerick. That includes Ministers, management in the hospital group, consultants, nurses and administrators. I will take whatever criticism put at our door but I am there to help. If I do not know beds are unoccupied, how in the name of God can I help?
Have detailed discussions taken place to ensure there is a comprehensive bed management strategy in place and we can all work together, including medical, ministerial, administrative and management staff? We must ensure we can get through this crisis and get the 150 extra beds that should have been put in place.
Jim Daly (Cork South West, Fine Gael)
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I welcome the opportunity to address the House on the matters raised by Senators Kieran O'Donnell and Maria Byrne, although she was not able to be here.
The Minister for Health wishes to acknowledge the distress overcrowded EDs cause to patients, their families, and front-line staff working in very challenging conditions in hospitals throughout the country. The number of patients attending EDs continues to increase year on year. For the first 11 months of 2019, the number of patients attending hospital EDs increased by 2.5%, and the number of admissions increased by 0.7% when compared with the same period last year.
According to HSE TrolleyGAR data, there was a 14.5% increase in the number of patients waiting on trolleys in UHL emergency department this year up to the end of November 2019 when compared to the same period last year. It is acknowledged that this is exceptionally high and the HSE is actively working with the University of Limerick Hospitals Group to ease congestion in the hospital, with a focus on facilitating transfers to level 2 hospitals, assistance from rehabilitation units and community health organisation services, as well as prioritisation of diagnostics to aid inpatient discharges.
The HSE winter plan was launched on Thursday, 14 November, in preparation for the anticipated increase in demand over the winter period. The Government allocated an additional €26 million to fund the implementation of the winter plan. Each winter action team has set out a range of initiatives it will undertake within its area to implement the plan. The integrated winter plan for University Hospital Limerick will be delivered by winter action team, WAT, 3. The initiatives for WAT 3 include additional home support hours to facilitate early hospital to community transfers; additional aids and appliances to facilitate early hospital discharges and ED avoidance; mobile doctor service units to manage increase demand for home visits and facilitate ED avoidance; a low-level domiciliary rehab team in Limerick city to facilitate early discharge and ED avoidance; added triage nursing support in Shannondoc to support ED avoidance; an added registrar in UHL to assist in addressing workflow and improve patient experience times; and added healthcare assistants support in the hospital to provide staffing at ward level to support additional surge patients.
The NNTPF has agreed at my request to support the marginal costs of funding additional beds for three months to the end of March 2020. This initiative will support the commitment by the HSE and my Department to alleviate winter pressures in our hospital system. Hospitals have been invited to make submissions to the fund to utilise this funding. To date, the NTPF has approved in principle and subject to appropriate governance and oversight 172 additional beds. These beds will be funded from the fund's budget at a cost of approximately €4.6 million. This includes an additional 15 beds in St. John's Hospital and ten additional nursing home beds to facilitate egress and alleviate overcrowding in UHL emergency department.
The NTPF is currently assessing further proposals that are still being received. In this regard, given the challenges facing the EDs with the exceptionally high use of trolleys for patients, I urge all hospital groups and individual hospitals that have not done so to engage with the NTPF to identify proposals to provide additional bed capacity for the winter period. Furthermore, a capital budget of €19.5 million has been approved for the provision of a modular 60-bed inpatient ward block at UHL, with funding of €10 million allocated in 2019. The HSE has advised that the enabling works are complete, the main contractor has commenced work and it is anticipated that the construction will be completed in mid 2020.This important project will go some way towards addressing the acknowledged lack of bed capacity in the region.
Kieran O'Donnell (Fine Gael)
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I thank the Minister of State. I welcome the fact that 15 beds are coming into use in St. John's Hospital. They need to be up and running as quickly as possible, along with the additional nursing home beds. If management and consultants in Limerick and the mid-west region feel there are areas where there is a need for additional funding and resources, they should let us know. We are here to assist and work collectively as a group. I am aware of the difficulties of working in the hospital group for consultants, the medical team and nurses in Limerick and the mid-west. They work throughout the hospital group in UHL, Ennis, Nenagh, St. John's Hospital, Croom and the maternity hospital.
We all must work together to ensure we do not have a situation where there are 62 people on trolleys in UHL, as happened yesterday. It was the highest number in the country. There were 54 on trolleys in Cork. There is a continuing crisis because of the lack of bed capacity. The focus must be on addressing the short-term needs over the next number of months so everything is done to alleviate pressure in the ED. I admire the work the medical and nursing teams do with consultants in the University Limerick hospital group. The key issue is that people are made aware on time of whatever resources are required because my role as a public representative for Limerick is to go to the Government to ensure the resources are put in place.
Jim Daly (Cork South West, Fine Gael)
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As the Senator knows, I was in UHL last week. I acknowledge and commend the work of the team there, led by Professor Colette Cowan, and the community healthcare side as well. It is working with UHL on driving innovation in healthcare. That is an important aspect because it cannot always be about more beds and money.
Kieran O'Donnell (Fine Gael)
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There is a bed crisis in Limerick.
Jim Daly (Cork South West, Fine Gael)
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We have to look at new ways of doing old things. That must be acknowledged and it must be referenced in any conversation about healthcare and its future. We must recognise the good work that is being done in the clinical education and research centre, CERC, building and the many innovations. Most of them are led by clinicians. Many of these are superb initiatives. We were shown presentations on them. They are essentially about building capacity but by having better innovation and efficiencies driving through the system, as well as lessening people's reliance on hospital beds by being more creative in how we deal with them. That is an important part of this debate. I acknowledge the good work being done on that front by the UL hospital group. I was particularly impressed and it would be remiss of me not to point to that.
While we struggle to build the 60-bed modular unit, it is not all about funding. Sometimes staffing can be the difficulty in terms of trying to get the appropriately skilled staff. UHL has advised the NTPF that it expects to open the ten beds in the nursing home this Wednesday. The opening of the beds will be staggered for clinical safety reasons but they should all be fully operational by the end of the year, which is effectively two weeks away. It is usual practice to stagger the opening. One would not just open ten new beds on the day. Regarding the 15 beds in St. John's Hospital, UHL will revert later in the week with further information, as these beds require a consultant. That appears to be the difficulty. It is not funding alone, but the availability of a consultant.
Kieran O'Donnell (Fine Gael)
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My understanding from University Limerick hospital group is that it was being arranged.
Jim Daly (Cork South West, Fine Gael)
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The NTPF informed the unit that the ambulance initiative funded by the NTPF in Limerick is up and running, as is the extension of the medical assessment unit, MAU, opening hours in Ennis.