Seanad debates

Monday, 10 May 2021

Nithe i dtosach suíonna - Commencement Matters

Emergency Departments

10:30 am

Photo of Seán KyneSeán Kyne (Fine Gael)
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I thank the Cathaoirleach for choosing this Commencement matter and I welcome the Minister of State at the Department of Health, Deputy Feighan. Once again, I wish to discuss healthcare provision in Galway, this time in respect of overcrowding in the emergency department in University Hospital Galway, UHG.

We have had a strange year in healthcare provision. Obviously, there have been cancellations, Covid-19 and an array of issues. However, this is the month of May, not a month that is traditionally associated with overcrowding due to the winter flu, vomiting bugs and the like. Nonetheless, there is overcrowding in UHG. Today, according to the Irish Nurses and Midwives Organisation, INMO, there are 24 people on trolleys in the hospital. The figure was as high as 36 last week, and it has gone up and down from the low 20s to the mid-30s over the past month. One patient on a trolley is one patient too many when he or she should have the dignity of having a bed provided. The overcrowding is not the fault of the hard-working staff and management team in the hospital, who are doing their best under difficult circumstances to ensure patients get the best care possible, which they deserve.

It is worrying that people in Galway are being told not to attend the emergency department unless it is necessary. I hope that nobody presents unless it is necessary. That is the basis of an emergency. Clearly, there must be an assessment of why there is overcrowding in UHG at present. We know the emergency department is not fit for purpose.Former Taoiseach Enda Kenny said it in response to the then Leader of the Opposition, Deputy Micheál Martin. The then Minister for Health, Deputy Simon Harris, announced in February 2017 that funding for the design of a new emergency department was provided by the Department. In September 2018, Saolta University Health Care Group told the then Minister, Deputy Harris, that the planning permission for the new emergency department would be lodged before Christmas 2018. Here we are in May 2021 with no planning application lodged yet.

There is a lack of focus and direction from the Saolta hospital group in terms of the emergency department. The people and patients of Galway are suffering from having an emergency department that is still not fit for purpose. We have had continous overcrowding over the last month. Hopefully, this will resolve itself in the near future. Is the Department of Health taking an active interest and a proactive approach to overcrowding issues in the hospital? Is the Department interested in sending down a team to assess why there is overcrowding over the last month in UHG? Are there sufficient discharge managers? Is there a team that can go in to better manage the discharge of patients and the flow of patients through the system to ensure they get a bed as quickly as possible? That was done before. The then Minister, Deputy Harris, sent a team down from the HSE nationally to ensure the efficiency of the hospital was improved. I do not like using the words "efficiency" or "flow" but it is a situation of grave concern for patients, their families and the people of Galway. We have continuous overcrowding and no light at the end of the tunnel. If there was such light and we knew work would start next month or before Christmas on the new emergency department, we could tolerate it to a degree. However, we are putting up with this problem and we have no light at the end of the tunnel.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I welcome this opportunity to address the House on behalf of the Minister for Health, Deputy Stephen Donnelly, on the issues raised by the Senator. I acknowledge the distress overcrowded emergency departments cause patients, their families and front-line staff working in challenging conditions in hospitals throughout the country.

According to HSE TrolleyGAR data, there was a 79.9% reduction in the number of patients waiting on trolleys at 8 a.m. in the emergency department at University Hospital Galway in the period January to March 2021, compared to the same period last year. However, the number of patients waiting on trolleys at 8 a.m. increased by 51% in March 2021 compared to February 2021.

Several factors have affected the increased number of people waiting on trolleys in the past week, including a significantly higher level of attendances. Admissions for the over-75 age group with higher levels of acuity have returned to pre-pandemic levels. The management of Covid-19 and non-Covid-19 pathways presents an additional challenge to patient flow in UHG emergency department. The hospital is also experiencing capacity issues due to an increase in elective activity and bed closures for operational reasons.

The HSE is actively working with University Hospital Galway and Saolta hospital group to ease congestion with a focus on patient flow, facilitating transfers to level 2 hospitals, providing assistance from community health organisation services to support egress and prioritising diagnostics to aid inpatient discharges. UHG is particularly attuned to the need to manage infection prevention and control. We continue to invest in UHG to improve services to patients. The project for a new emergency department in University Hospital Galway, which is part of a larger development incorporating maternity and paediatric services, is included in the capital programme for 2021. Approval has been granted to complete a temporary extension to the emergency department to provide additional accommodation. This includes segregated waiting and treatment areas, isolation rooms, additional resuscitation spaces, additional support accommodation to take account of new requirements to treat Covid-19 patients and improved infection control and prevention requirements for the emergency department.Enabling works have commenced and construction on this temporary extension is expected to commence in early May. It is expected the project will be completed in early 2022.

Improvements continue to be made in the haematology oncology day ward to increase capacity. A new radiation oncology facility is expected to be fully open by quarter 3 of 2023. The main emergency department and women's and children's block development at UHG is a complex project and is in the early stages of design progression. In addition, UHG has introduced a combination of virtual clinics and actual attendances in its general outpatients department clinics and oncology clinics in line with national guidelines to address the challenges presented by Covid-19. Furthermore, as outlined in the national development plan, a new dedicated ambulatory elective-only hospital facility will be provided in Galway. This will provide high-volume, low-complexity procedures on a day and outpatient basis, together with a range of ambulatory diagnostic services. It will create capacity at acute hospital sites and help to reduce the numbers waiting on trolleys, assist in reducing cancellations and acute hospital footfall, and drive down waiting lists for outpatient and inpatient day cases. Work is ongoing on a draft preliminary business case. The Department and the HSE will continue working to improve the emergency department waiting times for all patients.

The Senator asked about the former Minister for Health, Deputy Harris, sending a team from the Department. I will bring that issue to the current Minister.

Photo of Seán KyneSeán Kyne (Fine Gael)
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I thank the Minister of State for his reply, but it is depressing to see written down that, "The main emergency department and women's and children's block development at UHG is a complex project and is in the early stages of design progression." When the former Minister, Deputy Harris, was in Galway in September 2018, we saw design plans for the emergency department. Yes, the situation may have changed. It was a shell and core fitting-out for the top two storeys of paediatrics and maternity services that then went to a full design project at fit-out, but how long does that take? Why do we have to wait for the temporary emergency department to be completed before we can lodge a planning application for the new emergency department? That application can be progressed. As I have said about numerous projects, nothing in this country can be built without planning permission and approvals. The application has not been lodged and we have no date for that.

While I appreciate the response, I would also appreciate it if the Minister of State brought to the Minister, Deputy Donnelly, what I have said about the possibility of bringing a team to Galway. I ask that the Department of Health engage with Saolta University Health Care Group and request it to progress the planning application for the emergency department.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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The Minister acknowledges the distress that overcrowded emergency departments cause patients, their families and front-line staff. He and I commend all the staff in our emergency departments on the tremendous work they have done to ensure emergency departments have remained open and available to provide a service throughout the pandemic.

The number of patients receiving care on trolleys recently in UHG is unacceptably high. The HSE is actively working with the Saolta group and hospital management to ease congestion there. Improving timely access for patients to unscheduled care is at the heart of Sláintecare. The Sláintecare Action Plan 2019 includes a specific workstream on access and waiting lists. Sláintecare emphasises the need to invest in increased capacity while shifting the balance of care from hospitals to community services for better health outcomes and more sustainable health services.

I will bring to the Minister's attention the Senator's desire that a team go to Galway and speak to Saolta and the hospital as soon as possible.