Cathal Crowe (Clare, Fianna Fail)
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757. To ask the Minister for Health the progress made in improving access to urgent and emergency care, including critical care, trauma services and the national ambulance service since 27 June 2020; the additional funding provided in successive budgets; his plans for 2024; and if he will make a statement on the matter. [29607/24]

Stephen Donnelly (Wicklow, Fianna Fail)
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Urgent and Emergency Care

A significant improvement in Urgent and Emergency Care Performance is being seen across Emergency Departments nationally. This is driven by the ongoing implementation of the Urgent and Emergency Care Operational Plan. In the first 5 months of the year, despite a 10% increase in ED attendances, the 8am Trolley count has reduced by 14% compared to the same period last year. In addition, there has been a 20% reduction of the number of patients aged 75 and over waiting more than 24 hours in EDs nationally, representing a total of 1,947 patients.

The 2024 UEC Operational Plan, presented to government this week, includes targeted actions and reform initiatives such as:

o The delivery of a 10-bedded Virtual Ward in University Hospital Limerick (UHL) and in St Vincent's University Hospital (SVUH), scaling to 25 virtual beds for each site by year end to deliver 50 virtual beds in total.o Providing additional and extended hours for senior decision makers and staff integral to supporting 7/7 operations.o Standardising the opening hours of all Injury Units (IUs) to provide a 7-day service, 8am to 8pm including Bank Holidays. o Working with GP Out of Hours Services to maintain and increase GP Out Of Hours contacts and reduce the level of GP Out of Hours referrals to EDs.o Delivering high levels of streaming in the emergency departments, e.g. to: Medical Assessment Units; Injury Units; and other appropriate services.o Ensuring all sites adhere to weekly long stay reviews of patients with a length of stay greater than 14 days, to ensure efficient patient flow.o Transferring all clinically appropriate non-acute patients in models 3 and 4 hospitals to appropriate alternative settings, including model 2 hospitals and transitional care beds.o Putting in place additional National Ambulance Service private capacity through voluntary and private ambulances to improve egress and patient flow.o Delivering national and local media communications campaigns to provide information on appropriate and alternative pathways of care and to encourage vaccine uptake.

Critical Care

The Strategic Plan for Critical Care that was brought to Government in 2020 is successfully addressing historical deficiencies in critical care capacity. Significant funding of €78.2 million has been provided by Government since 2021 under Phase 1 of the Strategic Plan. This funding provides for an additional 94 beds over the 2020 baseline figure of 258 beds and will bring capacity to 352.

Today, a total of 334 adult critical care beds in place, an increase of 76 beds, or 29.5% since 2021. To put the increase into perspective, there had been an increase of just 21 beds in the previous eight years (2013 -2020 inclusive). Where necessary, the number of critical care beds can surge beyond the baseline of 334 as part of an emergency response.

The development of critical care capacity involves much more than simply sourcing a bed and putting it in a hospital. It requires trained available nurses and doctors, who are in demand around the world, as well as appropriate equipment, such as ventilators, to deliver effective patient care. Since 2021, we have invested in education and training initiatives to increase the critical care workforce.

In addition to an increase in critical care beds, this investment has also increased workforce supply and resulted in other initiatives such as the NAS Critical Care Retrieval Service, work on the Critical Care Information System and Critical Care Outreach Teams.

Phase 2 of the Strategic Plan will provide a further 106 beds, increasing capacity to 458 beds. This will exceed the recommendation of the 2018 Health Service Capacity Review, which had recommended 430 beds by 2031.

Capital funding of €5m in the HSE Capital Plan 2021 was allocated to commence the planning for the five prioritised Phase 2 developments. These capital builds will be delivered over a number of years and this reflects the scale of these buildings, decant of existing accommodation, design, relevant approval processes, construction, equipping and commissioning.

Trauma Services

Implementation of the National Trauma Strategy continues to progress. The establishment of two Major Trauma Centres was one of the major commitments of the Trauma Strategy. In April 2021, the government approved the designation of the Mater Misericordiae Hospital in Dublin as the Major Trauma Centre (MTC) for the Central Trauma Network. Recruitment in 2021 enabled the commencement of phase one of the development of the MTC at the Mater and facilitated the development of Planned Trauma Care services at Cork University Hospital, the MTC for the South Trauma Network.

On 20th April 2023 the Minister and Taoiseach launched Major Trauma Services at the Mater Misericordiae University Hospital (the Central Trauma Network) and Cork University Hospital (the South Trauma Network). This event marked the successful completion of the first steps in the development of a trauma system for Ireland.

In addition to the development of major trauma services at the two MTCs, a number of key recommendations of the Trauma Strategy have been progressed, including:

• The establishment of the trauma desk at the National Emergency Operations Centre (NEOC) to streamline and coordinate inter-hospital referrals through the centralised system, 1800-Trauma. This service is available to hospitals in the Central Trauma Network to refer patients to the Major Trauma Centre at the Mater Hospital, and Beaumont Hospital for patients with Traumatic Brain Injury (TBI).

• The development of Pre-Hospital Trauma Triage Tool and Bypass Protocols to ensure patients are brought to the most appropriate place for treatment.

• The development of a standardised Rehabilitation Needs Assessment (RNA) and Rehabilitation Prescription (RP), which have been implemented at the two MTCs.

• The development of a Trauma Transfer of Care and Egress policy to provide a standardised process for referral and transfer of care for trauma patients.

• The development of a Clinical Guidance Document for the Management of Major Trauma in Older Adults, which aims to improve trauma care for older adults.

National Ambulance Service (NAS)

The NAS has been engaged in a continuous process of strategic reform to transform the service from a traditional emergency response and conveyance service to a clinically led and agile mobile medical service with an increasing capacity to treat patients at the most appropriate level of clinical need, including in home and community settings in line with the overall aims of Sláintecare.

Specifically, these reform measures include the development, roll-out and expansion of both "Hear and Treat" and "See and Treat" alternative care pathways, including the NEOC Clinical Hub and Pathfinder, which mean that circa 1,000 patients each week are now being treated in home and community settings of which approximately 40% avoid clinically unnecessary conveyance to a hospital ED leading to both a better care experience for the patient as well as significant acute hospital savings.

The NAS also continues to address identified front-line capacity requirements. The current staffing includes 196 Student Paramedics who were enrolled at the NAS college in 2023 and 144 newly qualified Paramedics who successfully graduated from the NAS college in 2023 to add additional front-line capacity. A total of 410 students are currently in training at the NAS College with further recruitment ongoing this year following recent campaigns.

The total NAS budget this year of over €230 million represents a rise of €63million or 37% from the 2019 allocation, and continuous year-on-year increases in government funding has allowed the NAS to grow its staff to 2,360 full time equivalent employees, of which well over 2,100 staff are deployed in the provision of direct patient care.