I regret that I only have four minutes in which to reply because many good points have been made and I need to inform the Deputies of several points. I thank them for raising this matter and affording me the opportunity to welcome publication of the HIQA report on the review of governance in the University of Limerick Hospitals Group. It is the first hospital group to be assessed against the national standards for safer and better health care which I approved in accordance with the Health Act 2007. The review is an independent assessment of services against explicit standards and it is important that the findings, good and bad, be made clear. This will help to drive improvements in the quality and safety of health services. I want to move away from reports being used to undermine and close services and use them to address the issues raised within them and fix them.
The report makes it clear that significant challenges remain, as outlined by the Deputies, particularly in emergency services. It also identifies the significant progress made in corporate and clinical governance and on the reorganisation of services within the group. Among the many positive developments are the establishment of a new management structure, including the board of management, the CEO and management team and the clinical directorate; the reconfiguration of surgical, critical care and paediatric services; and the establishment of an infection prevention and control team.
With regard to risks, the HSE has identified actions that have and will be taken to address the concerns raised and provide an improved and safer service for patients. The key risk area identified is unscheduled care. I fully acknowledge that there are ongoing pressures on the accident and emergency unit, which is why an extensive capital project is under way to build a new state-of-the-art unit.
It will be difficult to cover the issues raised in the short time I have available. I want to respond to Deputy Kieran O'Donnell by saying there has not been a delay. The tendering has been undertaken in parallel. When he meets Ms Ann Doherty, he will be told very clearly that there is no second fix. A huge amount of work remains to be done before the fit-out is undertaken. The tender will be complete and there should be a seamless progression towards the fit-out. There should not be a delay.
Since the report was published, a separate paediatric emergency area has been fully opened. It provides a separate, family-friendly area for children who require an emergency response. It clearly reduces overcrowding to some extent.
A 17 bed short stay unit opened on 25 April and is being managed by the acute medicine physicians. The unit admits short stay patients who can be discharged within 48 hours of admission.
A new €35 million critical care unit opened recently. This is a major step forward in the development of acute hospital services across the region.
The acute medical and surgical assessment units are open and accept direct referrals from GPs and the emergency unit. GPs can bypass the emergency unit. Further information campaigns will be undertaken locally to advise GPs and the public of the availability of three local injury units and medical assessment units in the region - in Ennis, Nenagh and St. John's hospitals. These are very good model 2 hospitals with a critical role in supporting people in the area.
In parallel with these measures, the special delivery unit will support the hospital and provide the expertise required to provide both interim and long-term sustainable solutions to deal with the issues of bed capacity, excessive trolley waits and overcrowding in the emergency unit. The establishment of the hospital groups has the potential to bring about significant improvements in the way we organise acute hospitals. In that regard, I am satisfied that group boards are capable of exercising authority assertively and constructively. Deputy Michael McNamara did not read further from the report which states: "Notwithstanding, the Authority welcomed the fact that the reporting relationship between the HSE’s National Director for Acute Hospitals and ULH was described as being both supportive and enabling, thereby allowing the Board of Directors, CEO and Executive Management Team flexibility in reorganising and restructuring their services as appropriate". The issue cannot be addressed until the legislation is enacted to create trusts. We made it clear that we would have a trial period for hospital groups to see how they worked and where there were deficits.
Deputies referred to the absence of a model 3 hospital in the group.
I believe this is something we need to examine closely.
I want to assure people that we will continue to work to make this hospital as safe as possible. Other issues in the report that have not been raised by the Deputies here are of equal concern to me and must be addressed - in particular, the length of time people with a broken hip must wait on trolleys. This is a critical issue and I have asked for information on this to be sent to me. Four hours is the gold standard, but I want to know how many people wait longer than six hours. Surgery for a fractured hip should never be cancelled because of theatre lists. I understand from speaking to management that they have issues around the figure in regard to this. Sometimes the cancellations have not been due to lack of theatre time but for medical reasons, where the patient is not fit for surgery or has developed complications that must be sorted out.
This is not to ignore what HIQA is doing here. It provides a great service and I welcome the fact that it is there. I wish the CEO of HIQA, the chairman and all its staff the best. HIQA exists to help us see where there are problems so we can fix them. That is what we intend to do.
