I wish the Chair and colleagues a good afternoon. I thank them for the invitation to discuss the critical issue of providing safe and effective emergency medicine care for the people of the mid-west.
The provision of timely and high-quality urgent and emergency care is an absolute priority for this Government and the HSE. So far this year, presentations to our emergency departments are up 12%. For those aged 75 and over, presentations are up 16% on last year. Notwithstanding this, our healthcare workers are making important progress. In the first four months of this year, there were 4,600 fewer patients on trolleys than for the same period last year. That is a 12% reduction. This reduction of 4,600 patients was achieved despite 55,000 more people attending the emergency departments so far this year compared with last year. That includes an additional 10,000 elderly patients as well. The current drop in the number of patients on trolleys this year continues the reduction seen through the latter half of last year when compared with latter half of 2022.
During the lifetime of this Government, an additional 28,500 people have been appointed to work in our health service. We have added an extra 1,182 acute hospital beds, 73 critical care beds and hundreds of community beds. However, despite the investments and reforms that are ongoing, we still face challenges in emergency care in certain hospitals. As we all know, University Hospital Limerick, UHL, is the most challenged. The number of patients on trolleys this year in UHL is up 40% versus last year. This contrasts with a national reduction in trolleys of approximately 12%. This Government has invested more in UHL than in any other hospital. Staffing at the hospital has grown by over 1,200 during the lifetime of this Government. That is a 43% increase in the work force in just four years. It includes 162 more doctors, 53 more consultants and 447 more nurses and midwives as well as 119 more health and social care professionals.
Within the emergency department, since the beginning of last year, the number of emergency medicine consultants has increased by one half. It has gone from ten to 15, which is inclusive of three paediatric emergency consultants where previously there were none. The number of non-consultant hospital doctors, NCHDs, in the emergency department has more than doubled from 21 to 47. The nursing work force in the emergency department has also grown considerably from 114 to 150.
Following a meeting I had with nurses in UHL recently, I asked the chief nursing officer to visit the hospital to ensure that the safe staffing framework is being rolled out. She went to the hospital with her team and met with nursing staff and management. She confirmed with the hospital team that sufficient funding has been allocated to and, indeed, received by UHL to fully implement the safe staffing framework. However, the nurses I met told me directly that they are not all experiencing it as they should be on their wards. There is still a great deal of work to be done to ensure that while the money has been allocated, safe staffing is implemented in a meaningful way in all of the wards.
In 2019, UHL had a budget of €265 million. This year, the budget is €382 million. That is a 44% increase. This is the biggest increase in a hospital budget in the country both in cash terms and percentage increase terms. We are also investing in additional bed capacity; 150 new beds have opened in the University of Limerick Hospitals Group in the region and 108 of these, including ten critical care beds, have been in UHL. Critically, there is a strong line of further beds to come. The first new 96-bed block will be finished next year, and 71 of these 96 beds will be net additional beds, with 25 being replacement beds. The enabling works for the second 96-bed block are under way and these will all be new beds. Some 16 additional fast-build beds are being commissioned on site this year. Overall then, between the beds that have been opened by this Government and the ones that are coming, UHL will have an additional 291 beds. In order to provide extra capacity as quickly as possible, I also recently announced 70 step-down beds for UHL and these will become available over the summer. These will revert to their intended purposes as community nursing units when the first 96-bed block is opened next year.
Reformed work practices, which have proven successful in other hospitals, have also been agreed as part of this additional capacity. This includes: that senior decision-makers are rostered on site, both in the emergency department and throughout the hospital, after hours and at weekends; an all-of-hospital approach to treating emergency department patients, including presence of non-emergency department consultants to support their emergency department colleagues; a strong patient flow team in place seven days per week; weekend access to scheduled diagnostics for the emergency department; all non-long-stay beds, that is, hospital and community, will now come under one bed management system; and senior management are to have a presence on the floor early morning.
In addition, a senior expert support team was announced on 30 April. This was put in place to provide support to UHL in addressing the current pressures on health services in the mid-west and most critically, patients on trolleys in UHL. The team is made up of Ms Grace Rothwell, national director, Ms Orla Kavanagh, director of nursing and integration at Waterford University Hospital, and retired consultant in emergency medicine, Dr. Fergal Hickey. It is also worth saying that Ms Rothwell, who is now the national director, was the hospital manager in Waterford and was front and centre in turning Waterford around from being one of the most under pressure emergency departments to having had no patient on a trolley now for several years.
There has also been much-needed investment in the region’s model 2 hospitals. Overall staffing in Ennis, Nenagh and St. John’s has increased 22%. An investment last year supported the medical assessment units in the three hospitals to open 12 hours per day, seven days per week. As colleagues will be aware, we invested more money recently. These units are now moving to 24-7 opening on a phased basis. A new injury unit was opened in Ennis in 2022. I visited that injury unit and it is very effective. The staff there were hugely impressive.
There have also been numerous community measures implemented in the region to ensure integrated care. This includes the recruitment of nearly 250 additional staff into the enhanced community care programme. All eight community healthcare networks are operational in HSE mid-west and all four planned specialist teams are now operational. In normal language, this means that there are eight new primary care teams and four teams specialising in chronic disease management and supporting older people.
As colleagues will be aware, as well as all the investment that has gone in and that is committed to and in the pipeline, I also recently commissioned a review by HIQA into urgent and emergency care capacity in the mid-west. This includes examining the case for a second emergency department, which would need to be underpinned by a model 3 hospital. While this review has been welcomed, we must remain focused on the need to fix the emergency department challenges at UHL in the near term. It is essential that people in the mid-west have access to timely and high-quality urgent and emergency care. The answer to this lies in a dual approach, namely an unprecedented increase in healthcare capacity together with urgent reforms in how that care is delivered. Some of that capacity has now been delivered and there is a lot more to come. Similarly, some of the reforms have now started and there is a lot more needed. A partnership approach between Government, the HSE and the administrative and clinical leadership at UHL can and must succeed.
