Topical Issues Debate – Accident & Emergency Departments Waiting Times at the University Hospital in Limerick

October 9th, 2014 - Pat Breen

Deputy Pat Breen: I welcome this opportunity to raise the issue of overcrowding in the emergency department at University Hospital Limerick, especially the incident that happened last week. The concern is not only about what happened last week but the cart before the horse approach that has been taken to the reconfiguration of health services in the mid-west. I thank the Minister for being present to reply to this matter that I and my colleague, Deputy O’Donnell, are raising.

Last June, the Health Information and Quality Authority, HIQA, warned that the emergency department at Limerick regional hospital was not fit for purpose as overcrowding there had reached critical proportions. According to the INMO trolley figures, 561 patients were on trolleys in the hospital in September. That is the highest figure recorded since statistics on this were first gathered back in 2007. A comparison of the figures for September 2014 and 2013 shows a 60% increase, which is an alarming increase.

I visited the emergency department at the hospital last Tuesday to see at first hand the numbers there. Before I describe what I saw, I pay tribute to the dedicated and hard-working staff who have to work in such an appalling and stressful environment having regard to what they have to endure, day in, day out. What I saw was disturbing. It was not a pretty sight. When I arrived, 23 patients were being treated on trolleys. It was almost a nightmare. Trolleys were lined up in the narrow corridors with family members gathered around their loved ones and many other patients were on their own wondering when a bed would become available. There was no dignity afforded to patients and little room for staff to treat them. It was bordering on unsafe. My thoughts turned immediately to the previous day when 50 patients were being treated on trolleys. I saw the emergency department when there were 23 patients on trolleys and it was a nightmare. At 7.30 a.m. on the previous Monday, 50 patients being treated on trolleys in the emergency department and they were waiting to be admitted.
The alarm bells are ringing on this issue. That is the reason Deputy O’Donnell and I are raising this issue. The trolley figures are a concern. Having regard to what happened throughout the summer with high trolley figures and with the influx of patients coming through in the winter period, the situation in the accident and emergency department will be unsafe. It will have to be closely monitored.

What would have happened if an emergency had occurred in the region on that morning where such a large number of patients were being treated on trolleys? It would have led to a serious situation in the region. I hope an interim solution can be found to the overcrowding in the department between now and when the new emergency department opens. We have been told some spare beds are available in the hospital. Will the Minister clarify the position with regard to the availability of spare beds? When I was there I was told that there were no spare beds as those beds were being used.

Minister for Health (Deputy Leo Varadkar): I thank Deputies Breen and O’Donnell for raising this issue and for giving me an opportunity to outline in the House the current position on this matter. In regard to trolleys, it is important to recognise that while there has been a deterioration in recent months in the number of patients on trolleys waiting to be seen, the situation throughout the country remains much better than it was in 2012, 2011 or during any period under the previous Government.
There are significant pressures on the University Hospital Limerick emergency department which arise from the restrictions of the physical infrastructure of the department. Many of these pressures were noted in the recent review by HIQA of the University of Limerick hospitals group. To address this situation, an extensive capital project is under way for a new emergency department for Limerick which will open in 2016. I understand from the HSE that there is no scope for speeding up this development without introducing significant risks for procurement, cost, health and safety.

In the meantime, pending completion of the new emergency department, a number of initiatives are in place to help address the limitations for patients and staff in the emergency department. In particular, a dedicated paediatric emergency area is now open. This means children are seen separately in a child-friendly space. In a major step for acute hospital services in the region, a new critical care unit has opened which allows for better patient flow for seriously ill or injured patients presenting to the emergency department. The acute medical and surgical assessment units are open, and these take direct referrals from GPs and the emergency department.

A 17-bed short stay unit opened in April 2014. This unit is managed by the acute medicine physicians and aims to complete treatment or assessment of patients within 48 hours of admission. Three patient flow managers are in place who co-ordinate the transfer of lower acuity patients from University Hospital Limerick to Ennis, Nenagh and St John’s hospitals to release capacity for emergency department admissions in the main hospital.

All hospitals within the University Limerick hospitals group take part in a daily teleconference, chaired by an executive management team member, to discuss the bed situation across the group. The group is raising awareness among GPs and the public about the local injury units in the other hospitals in order that patients can make better use of these. They will be seen much quicker if they have minor injury and they go to Nenagh or Ennis hospital.

In parallel with these measures, the special delivery unit will support the University of Limerick hospitals group, with interim and long-term sustainable solutions to deal with bed capacity, excessive trolley waits and overcrowding in the emergency department.

[Deputy Leo Varadkar: Analysis by the SDU indicates a requirement for additional bed capacity at UHL. The hospital and the HSE are in discussions about increasing capacity on the hospital site, with a range of measures being considered in the 2015 service plan process. This process must take account of the financial constraints facing the hospital and the HSE’s budgetary limitations next year.

At a national level, the HSE is establishing a winter planning group, with representation from social care and acute hospitals. The group will identify immediate actions to address winter pressures in acute care. It will also examine medium term plans for delivering sustainable solutions. The SDU will also participate in this exercise. I look forward to the ongoing development of emergency services in the Limerick group, both in terms of the new facilities and modernising the way in which these services are provided. These will be of significant and lasting benefit to patients in the region and to UHL staff.

While there is a serious problem, as referred to by Deputy Breen, with 47 patients on trolleys on Monday, 29 September, requiring emergency action, yesterday morning at 8 a.m. there were six people on trolleys in the entire hospital, only one of whom had been waiting longer than nine hours. This morning there were ten people on trolleys, only six of whom had been waiting for nine hours. For whatever reason, the situation is the best it has been in several weeks, which is encouraging. It is of concern that UL hospital group is 16% over budget.

It is more over budget than any hospital group in the country. Spending is up, not down, and while one might be able to justify higher spending if we were seeing shorter waiting lists and fewer people on trolleys, it is very disturbing to see a hospital group with an increasing budget overrunning its budget but not achieving the goals that patients would expect.

Deputy Pat Breen: I thank the Minister for his reply and am glad to hear the hospital and HSE are in discussions about increased bed capacity. The primary issue is the care of patients, and while money is an issue, it should not be an issue in the care of patients. I spoke to staff in the emergency department last Tuesday, and this is about an interim solution. The Minister said a winter planning group is being established. I hoped this group would have met before this winter and have an interim plan in place. Some of the staff’s suggestions on the day I visited the hospital included using the spare capacity in St. John’s Hospital to establish a temporary geriatric accident and emergency unit or the provision of a prefabricated building adjoining the accident and emergency department in Limerick.
The Minister visited a hospital in Dublin some time ago and I suggest he visit UHL at some stage. The number of medical assessment beds in Ennis and Nenagh hospitals should be increased by two in each hospital. It is important the Minister listens to the staff, who are enduring the problems and who are stressed. They were very stressed that morning because they could not move in the hospital. I hope the winter planning group is meeting as we speak and that an interim solution will be put in place because we have heard the alarm bells over the summer. The trolley numbers over the summer indicate that we will have a major influx of patients over the winter period.

Deputy Leo Varadkar: The 20 beds that were closed due to a virus in St. John’s Hospital have been reopened and this may explain the considerable improvement in the numbers waiting on trolleys in the past few days. As Deputy O’Donnell said, a new emergency department is being built in Limerick, which will provide additional bed capacity. While the HSE will consider interim solutions in the meantime, interim beds cost interim money and a hospital group that is running so far over budget will be further down the list for receiving additional funding and capital than those that are running on budget. Increasingly we will pursue a policy of rewarding those who come in on budget, not those who overrun.

I have worked in three emergency departments and have visited two since I became Minister, so I know a fair bit about them. When I visited Tallaght Hospital, I was pleased to see how much better it was than when I worked there. When I worked there, trolleys were strewn down the corridors and, thankfully, it is no longer the case. This is not to say there are no problems. Based on public commentary, one would not think things are so much better than they were three or four years ago, but they are. I have received approximately 50 invitations to visit 50 different acute hospitals. If I visit one per week we will be well into the election campaign. While I will do my best to get around to as many hospitals as possible, it would be very naïve to think that my walking around an emergency department looking at people on trolleys is going to solve the problem. All these hospitals have CEOs, management teams and clinicians. Throughout the country, better patient flow and management can considerably improve the situation.

The responsibility ultimately lies with the CEOs, clinicians and management to make best use of the resources they have before they seek more.