Dáil Éireann Debate, Thursday - 16 February 2023
85. Deputy David Cullinane asked the Minister for Health if he will publish a multi-annual capacity and wait time reduction plan to tackle overcrowding, cancellations, extreme patient experience times in emergency departments and hospital waiting lists; if he will include measures to expand primary and community care in such a plan to aid admission avoidance and rapid discharge; and if he will make a statement on the matter. [7553/23]
View answerThis question is on hospital overcrowding and waiting lists. For some time I have been asking for the publication of a multi-annual capacity and waiting list reduction plan. We need to tackle overcrowding in hospitals, cancellations and extreme patient wait times in accident and emergency departments. The figures for December, November and October were particularly high and I will get to that in a second. I ask the Minister to outline what measures will be put in place to expand primary and community care to aid admission avoidance and to speed up rapid discharges from hospitals into community settings.
This question goes to the heart of our priorities in healthcare. The goal is universal healthcare, which means affordable, accessible and high-quality care. A lot of good progress has been made in patient outcomes and clinical strategies being rolled out, including in women's healthcare, and there have been other positive initiatives. A lot of progress is being made on affordability as well. Progress is being made on access but that is the highest priority. To the Deputy's point, there are various initiatives in place, one of which is enhanced community care, which he asked about. That is going well and I have sanctioned 3,500 staff, about 2,500 of whom are in place. Some 92 of the 96 new primary care teams are in place and they are staffing up. Some 21 of the 30 chronic disease management teams and 21 of the 30 older persons teams are in place. All 21 community intervention teams are in place so enhanced community care is moving at pace.
We have an urgent care plan, which is being finalised. I am keen that we move away from winter planning to urgent care planning, access to injury units, access to out-of-hours GPs and access to accident and emergency departments where necessary. As we have discussed before, the numbers through the year are too high. This is not a winter issue but a systemic issue in terms of quicker access to urgent care right through the year. A plan is being finalised between the Department and the HSE and that will be a multi-year plan. There has been multi-year investment right through the first three budgets of this Government.
Second, a waiting list action plan is being finalised for this year. The plan for last year had some positive impacts. The overall target was not hit and I am not satisfied with that. However, the number of patients waiting beyond the Sláintecare targets, which essentially is our main focus, fell by 11% last year. It is encouraging to see that and we want to see that accelerate through this year and beyond.
Short-term waiting lists were never going to work and I have said for some time that winter plans are simply window dressing. They were also never going to work and the winter plan failed spectacularly this year. The Minister’s short-term waiting list plan for the year gone promised to take 132,000 people off waiting lists but it only took 10,000 people off waiting lists. The target that was set was modest but we came nowhere near that. The number of people waiting over 12 months and over 18 months decreased, and I welcome that, but there are still over 170,000 patients waiting over a year. However, the length of time that people are waiting in accident and emergency departments in some hospitals is crazy.
I got the following details from a response to a parliamentary question I put to the Minister. The average wait time for patients over 75 in Cork University Hospital in December of last year was 40 hours. Let that sink in; the average wait time for all patients over 75 in a major hospital in this State was over 40 hours. How can anybody stand over that? Why are there so many variations between hospitals such that in a major hospital like Cork University Hospital we can get it so wrong that this is the average wait time for patients over 75?
I am not satisfied, nor are any of us, with either the number of people waiting on trolleys or the amount of time people are waiting. There are two parts to how we will solve this. First, we need extra capacity, including more emergency medicine, consultants, nurses, healthcare assistants, beds in hospitals, home care packages and preventative measures. A lot of work is going on there and I accept, on behalf of the State, that more capacity is needed.
Second, we need significant reform in how hospitals are managing patient flow. We know that some hospitals are doing well and that other hospitals are not doing well. The Deputy will be aware that I intervened after the new year bank holiday to instruct that the clinical teams, both community and acute, were rostered for weekends and evenings. We saw the number of people waiting on trolleys fall by 60% in about four or five days after that. I fully agree that we need more capacity, and we are committed to that. At the same time, we must see reforms and better ways of working from some hospitals.
We need more capacity but the problem is that in the budget just gone, apart from beds that were not delivered from the previous budget, there were no additional inpatient beds provided. What additional beds will be put in this year to ensure that next year those hospitals will have the capacity? The reality is that beyond what was previously committed to, none will be added.
On hospitals and variations, in the same figures I got for December, in University Hospital Waterford the average time patients were waiting for admission to a bed was cut by four hours. Riddle me that. This was a massive drop, which is really positive but in other hospitals there are massive increases. Resources and capacity are problems but there is also the issue of how we are managing patients in hospitals, which the Minister has recognised. We have to deal with that issue, therefore. I go back to University Hospital Galway, Cork University Hospital, some of the major hospitals in Dublin, and University Hospital Limerick.
The waiting times are too high. It is the same hospitals over and over again. There are capacity issues in those hospitals and issues about how we are managing patients and patient flow. We must deal with it. Why is Waterford Hospital doing it so well and why are other hospitals not? No one has been able to answer that question for me.
We have some pretty clear ideas as to why not only Waterford Hospital, but also the hospitals in Portlaoise, Tullamore and others are doing better. Some of it comes down to rostering patterns, some of it to patient flow and advance triage in the emergency department, block booking of private beds and nursing home beds for discharge, strong leadership on patient flow through the hospitals and many other issues. At this stage we have a pretty good idea as to why some hospitals are doing better.
Why are the other hospitals not doing it?
That is exactly what we are focusing on. It is incumbent on the Members of the Oireachtas to keep the focus on both. I fully accept the position of clinicians who say they need more capacity. They do. As the Deputy will be aware, we have added more community and hospital capacity than at any time since the foundation of the HSE and we will continue to do that. At the same time, we must keep focusing on different ways of working. That is the core of the new consultant contract, which we will be offering later this month.
