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Emergency Departments

Dáil Éireann Debate, Thursday - 26 May 2022

Thursday, 26 May 2022

Questions (1)

David Cullinane

Question:

1. Deputy David Cullinane asked the Minister for Health his plans to tackle emergency department overcrowding and long waiting times; the number of scheduled patient care appointments that were cancelled due to complications with unscheduled care in 2021 and to date in 2022; and if he will make a statement on the matter. [26375/22]

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Oral answers (6 contributions) (Question to Health)

I ask for an outline of the length of time people are waiting in emergency departments. Are the Government's targets for the maximum wait times being met? Yesterday I received a response to a parliamentary question which stated that the average time to admission for patients aged over 75 through emergency departments across the State was 13.75 hours. That is a long time. Unfortunately, the data across the board are not good.

It is too long and completely unacceptable. I have personally, as no doubt the Deputy has, seen the distress in overcrowded emergency departments - distress to patients, their families and our healthcare professionals across the country. I have visited some of the busiest sites including Limerick and Galway. Later today I will be in the Mercy Hospital in Cork and tomorrow I will be in Cork University Hospital, CUH. I will talk to senior management and clinicians about what is going on and what needs to change.

We invested an additional €1.1 billion in the budget for last year to expand capacity, increase services and support reform. We maintained this level of investment this year with an additional €77 million in the winter plan for the winter that has just gone by. The plan sought to address the causes of long waits in the emergency departments. It targeted attendances, patient flow and better egress or discharge.

The approach is to allow emergency department staff to focus on those most urgently in need of care or most in need of urgent care. We have provided 850 additional non-ICU hospitals beds since January 2020.

Despite this unprecedented investment and increase in capacity, patients still face unacceptably long waits. What patients face in some, not all, of our hospital emergency departments is simply not acceptable. It is mainly due to increased attendances and admittances especially of those aged over 75, as outlined in the response to the parliamentary question the Deputy received. Many are sicker than before, have comorbidities and stay longer. As the Deputy will be aware, Covid impacted bed availability and facilities in hospitals. It has also significantly affected discharge options, including taking out about two thirds of nursing homes in terms of being able to discharge patients to them.

In one of the hospitals the Minister will visit tomorrow, Cork University Hospital, the average wait time for over 75s in April was 28.8 hours which is staggering. These are people over the age of 75, who the Minister admits have comorbidity and other challenges. The average wait time in the Mercy Hospital was 26.8 hours and University Hospital Limerick was 22.2 hours. We have major problems in all our acute hospitals. The Minister is right in saying some hospitals are getting it right. I will get to the solutions in my next round of questions. Our Lady of Lourdes Hospital in Drogheda and Cavan hospital are two examples of hospitals that have put in place in a zero-tolerance approach to emergency department waits and it seems to be working. Why is this not being replicated across the State?

I fully agree that the operation in Our Lady of Lourdes Hospital in Drogheda is fantastic. I think it has five separate pathways when patients come in, including the use of advanced nurse practitioners who are doing a phenomenal job in being able to see, treat and discharge about 70% to 75% of the patients coming into that hospital. The challenge the Deputy posed is exactly the challenge I posed the HSE. What are we doing about it? We now have a group that is looking at every emergency department throughout the country and doing an analysis of what they have and do not have, versus what they must have. It is using an approach, called the five fundamentals, which is drawn from experience in Scotland and across the UK. Essentially it comes down to looking at pre-admission and reducing the numbers coming in, ensuring hospitals have the facilities and management they need, and ensuring patients can be discharged. We are carrying out an analysis for every emergency department. I am determined that the identified gaps will be addressed.

We obviously need more inpatient beds in some hospitals, but it is not all about beds. In some hospitals which got additional beds in recent years, we are not seeing the improvements we need. Of course, we need more inpatient bed capacity because if we have more beds, we can admit patients more quickly. We also need a discharge plan for each patient as soon as they go into the hospital. That needs to be multidisciplinary with all staff working together as a team. They also need to know that step-down beds are available in the community which very often is not the case. Many patients cannot get home care support packages. There is a clear linkage between what is happening in our acute hospitals and a lack of capacity in GP care and out-of-hours care, a matter I have raised with the Minister before. Unless we get the enhanced community care piece right, 40% of patients, who should be treated within the home or in the community, will continue to go to emergency departments. That is where the Minister's focus needs to be.

I agree with all of that. In Bray on Friday, I met the new chronic disease management team, the new older persons team and the new community healthcare network, including a pilot on mental health led by an advanced nurse practitioner in mental health. The level of prevention that is going on, including emergency presentation, is very impressive and fully in line with the Sláintecare vision, involving a massive investment in community-based care. We are beginning to see a reduction in referrals in the areas where that has been deployed.

There is no monopoly in wisdom for fixing this issue. If the Deputy, other colleagues or members of the health committee want to meet or make a submission, that would be very welcome. We are in the middle of a very intensive planning phase at the moment with the HSE. I have asked the HSE to work with the Department on a hospital-by-hospital basis because the solutions are different by hospital. Any insight or ideas the committee or colleagues may have would be a very welcome part of that planning work.

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