Topical Issues Debate Contribution following the publication of the HIQA Report on the A&E Department at the Mid-Western Regional Hospital in Limerick.

June 11th, 2014 - Pat Breen

Deputy Pat Breen: I welcome the presence of the Minister for Health to take the matter. I thank him for being here. It is obvious that all five Members who are raising the matter have the same goal, which is to make the accident and emergency unit in University Hospital, Limerick, a pleasant place for patients. We want to get rid of the overcrowding which has reduced privacy and bring dignity back to patients again. That is extremely important.
I welcome the HIQA report, which is timely. We all knew about it anyway, but it is time for us to work together to get a solution which takes us over the next two years. Colleagues have spoken about fast-tracking the emergency department at Limerick and I certainly agree that it is an option we should consider. We should be looking at further options to reduce the crowds coming into the accident and emergency unit in Limerick. It is quite obvious that the hospital is over capacity. We know there is a problem at University Hospital, Limerick, and that there is a problem trying to fill doctor positions. There is a real problem for staff who work in atrocious conditions. Morale is very low in the hospital.
This is about good management of the system and trying to make good what is in place. There must be a re-examination of the whole system to see if the HSE got it wrong in relation to reconfiguration. These are all issues we must examine. A meeting will take place at the hospital next Monday morning for the Oireachtas Members from the region. I welcome the opportunity to be at the meeting to raise my concerns about reconfiguration. I am also anxious to hear today what the Minister has to say on the current situation. That is important. It is also important that we all work together to ensure that the conditions patients are experiencing in the accident and emergency unit are alleviated. It is totally unacceptable. We are all here with the single goal of making the accident and emergency unit a better place.

Minister for Health (Deputy James Reilly): 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

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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. 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.
[Deputy James Reilly: ] 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.

Deputy Pat Breen: I want to focus on the issue of the absence of a model 3 hospital in the mid-western hospital group, which is a contributory factor in the overcrowding at University Hospital Limerick. I was delighted to hear the Minister’s comments in regard to exploring the idea of a possible model 3 hospital in the region. Ennis is well placed to become a model 3 hospital and such a hospital would help resolve the issues around overcrowding. If we look at the size of County Clare and the distances people have to travel from Blackhead or Loop Head to University Hospital Limerick, we see good reason to place a model 3 hospital there.
This could be done relatively cheaply. Doctors could be on a rotating roster between both hospitals and the infrastructure is already in place. All that is necessary is the will on the part of the HSE to put a model 3 hospital in place, similar to the models in place at Galway University Hospital and Cork University Hospital. I am glad to hear the Minister is exploring all options in this area and I thank him for his response. I hope we can work together on this to ensure we get the greatest benefits for the people of the mid-western region in the area of health services.

Deputy James Reilly: I thank the Deputies for their contributions.
I want to mention the model 2 hospitals. We need better use of these hospitals. This does not just mean using the beds in these hospitals, but that the staff working in these hospitals must co-operate and be part of the larger group and be prepared to work on different sites. We must not have a situation in which staff refuse to move from their own model 2 hospital. This is not acceptable.
We need to expedite the new accident and emergency unit and ensure it is opened as soon as possible. That is our goal.
[Deputy James Reilly: ] My understanding, having spoken to the manager, is that there is no delay. There will be a seamless passage through.
Deputy Breen made reference to “all five of us” but I would say “all six of us”. We are all here to improve the situation. There are issues around how things are managed but I wish to put it on the record of the House that we have a very good manager in Limerick University Hospital group and we will be sorry to see her go. Her departure will be Cork’s gain, or more specifically, Cork City Council.

I want to make sure that everybody understands what I am saying because I do not want a mixed message to go out from here. I am committing to exploring the lack of a model three hospital in the group.
Deputy James Reilly: I am not committing to putting one in or building one. There has been no mention of building a new hospital. There is no point—–
Deputy Billy Kelleher: Was that an election promise?
Deputy James Reilly: I do not believe Deputy Kelleher is involved in this discussion. He will have his opportunity shortly.
Deputy Billy Kelleher: I am involved.
Deputy James Reilly: Yes, he is involved in the sense that it was his Government that left the mess behind. It was his Government that reconfigured these hospitals and did not put in—–
Deputy Billy Kelleher: The Minister should address the Deputies who raised this Topical Issue.
Deputy James Reilly: Sorry, but seeing as the Deputy has raised his voice in this debate, let us be clear about this. It was Deputy Kelleher’s Government that reconfigured those hospitals and put the horse behind the cart instead of the other way around by closing facilities before new facilities were built. It left it to the next Government to clean up the mess.

Change is always challenging and difficult and people feel threatened by it occasionally but I believe the changes we are introducing vis-à-vis the hospital group will devolve more authority and autonomy locally, giving local people a much greater say in how their service is configured and delivered. I believe that is important. I will finish by assuring Deputies that we will expedite all of those issues that can be expedited, some of which were not raised today but are contained in this report - particularly the issue of the use of the model two hospitals and their staff. The aim is to ensure that we have a safe service. In that context, the report does not say that this is unsafe service but rather that there are risks that must be addressed. We will do everything we can to address those risks as quickly as possible. I, as a doctor and Minister for Health, do not want to see patients suffering.