Dáil Éireann Debate, Wednesday - 3 May 2017
9. Deputy Éamon Ó Cuív asked the Minister for Health the action being taken to assist University Hospital Galway improve ambulance turnaround performance, in view of the fact that just 7.7% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20757/17]
View answer13. Deputy Lisa Chambers asked the Minister for Health the action being taken to assist Mayo University Hospital improve ambulance turnaround performance, in view of the fact that just 9.5% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20760/17]
View answer29. Deputy Jackie Cahill asked the Minister for Health the action being taken to assist South Tipperary General Hospital improve ambulance turnaround performance in view of the fact that just 8.9% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20776/17]
View answer44. Deputy Mary Butler asked the Minister for Health the action being taken to assist Waterford University Hospital to improve ambulance turnaround performance in view of the fact that almost 15% of ambulance calls at the hospital were not cleared within an hour during February 2017 [20751/17]
View answer46. Deputy Michael McGrath asked the Minister for Health the action being taken to assist Cork University Hospital improve ambulance turnaround performance, in view of the fact that just 11.8% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20762/17]
View answer76. Deputy Anne Rabbitte asked the Minister for Health the action being taken to assist Portiuncula Hospital improve ambulance turnaround performance, in view of the fact that just 11.5% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20753/17]
View answerThe Minister is probably aware of the fact that 92% of turnaround times in University Hospital Galway exceeded 20 minutes. Only 7.7% were less than 20 minutes. This is to do with trolley back-up and so on and the crazy situation that has not been dealt with in the emergency department at University Hospital Galway. What is the Minister going to do, in a holistic fashion, to deal with this issue and reduce the logjams that are there so that we can get the ambulances back out on the road to actually do what they are supposed to do, which is bring the patients into the hospital?
I propose to take Questions Nos. 9, 13, 29, 44, 46 and 76 together.
Ambulance turnaround times measure the time interval from ambulance arrival at a hospital, to when the crew is ready to accept another call. When the emergency care system is under pressure, there is the potential for delay in the transfer of care of patients from ambulance to emergency department personnel. I accept that in a number of hospitals, including those highlighted in the individual questions, the emergency departments are particularly busy and this can contribute significantly to delays in ambulance turnaround.
A framework has been developed to create a standardised approach between the national ambulance service and acute hospital emergency departments which allows all parties to understand their role in the timely release of ambulance resources from acute hospitals.
In addition, the framework sets out the escalation process to alert management, both within the national ambulance service and acute hospitals, to significant increases in emergency demand and activity, and occurrences of delayed turnarounds. Hospital management is tasked to enable the release of all ambulance resources in a safe manner.
In regard to emergency department overcrowding, my Department and the HSE are developing a plan focused on working with hospitals to improve performance, and overall patient experience which should also assist in improving ambulance turnaround times. I have been assured that the HSE is committed to ensuring that patients are clinically handed over in a safe, professional and timely manner, with the safety and dignity of the patient being of paramount importance.
If we are serious about reducing the turnaround times it means that we need to reduce the length of time people are spending in our emergency departments. It is with that in mind that I very much welcome the INMO's figures this morning which show a 12% decrease in the number of people on hospital trolleys awaiting admission in April of this year compared to April of last year. We still have a long way to go in this regard, and I look forward to talking to the INMO about recruitment of more nurses. We have ambitious plans in place to hire 1,208 new nurses this year and have a number of incentives to try and assist in that regard, because it is very much interlinked with the ability of an ambulance to get in, safely hand over the patient, and get back to doing exactly what we want them to do.
The Minister recently met a delegation from Connemara to discuss the ambulance service. I was surprised to get a reply from him yesterday telling me that the solution to the rural areas ambulance problem is a do-it-yourself job of voluntary responders. The letter says that the capacity review indicated that the only practical way to improve first response times in rural areas is through voluntary community first responders. I find this rather shocking. I accept that there are challenges in rural Ireland and that we cannot expect to achieve the same turnaround times as urban areas, but they could be vastly improved. Can the Minister tell me if that is really his policy or is that just what was written in the answer for me? It seems to me to be a shocking response. I am not against volunteerism, but I do not see why rural people are always expected to do the DIY job when urban people rightly expect it to be done properly. What is the policy on ensuring that rural people get good and comprehensive ambulance services in a timely manner?
I assure Deputy Ó Cuív that the way we are going to make sure that people throughout this country, regardless of whether they live in rural or urban areas, get better access to ambulances in a more timely manner is by investing in the national ambulance service. That is what we are doing. The €7.2 million of extra funding in 2016 for the service will be supplemented by a further €3.6 million, including another €1 million for new developments. The first report I received when I came to office was the Lightfoot report. It was the first external international look at our ambulance service. The piece of my response which the Deputy has put on the record of the Dáil referencing the report says three things. It says that we need significantly more ambulances and paramedics, but it also says that even if we increase ambulances and paramedics - we are committed to doing that, hence the extra investment - in order to meet HIQA response times, because of the demographic layout of this country we are going to need to continue to see additional contributions from our community first responders. They are doing a superb job around this country, as the Deputy has acknowledged, but with the best will in the world, even as we continue to increase ambulances, as we are going to do, and continue to increase the number of paramedics, which we are doing, we still require community first responders to help support rural Ireland. It is not just rural Ireland but urban Ireland as well. There are three pieces to this - more ambulances, more paramedics and the community first responders working hand in hand. I had a very good meeting with the group from Connemara on this issue.
I want to raise directly with the Minister the issue pertaining to the constituency of Mayo. Back in 2014, one of the ambulance bases there was determined by HIQA to be an ambulance black spot. Since then we have had a crew appointed to that base in Mulranny, but unfortunately what we have seen happening is that that crew very often does not make it to the Mulranny base. It is pulled back into Castlebar, Ballina or Belmullet, and so the area is not getting the service that we think we are getting. This was back in 2014, three years ago. The situation has not improved.
The Minister has touched on the HIQA response times. We should have a first responder on the scene in just under eight minutes, and for a vehicle carrying a patient they should be there within 20 minutes, or just under 20 minutes. Geographically the Minister is correct. It is not physically possible, with Belmullet, Castlebar and Ballina, and including Mulranny, to reach parts of our county in those times even if one leaves within minutes.
On the turnaround time at the hospital, from speaking to staff locally at Mayo University Hospital the feedback I am getting is that when an ambulance arrives at the hospital they very often have nowhere to put the patient. There is no trolley or bed to transfer the patient to, so they cannot actually get the patient off the bed that has to go back into the ambulance, which is remarkable. These are ambulances that could be deployed to another area.
I have raised the issue of the massaging of figures relating to response times for many years. If something happens in Galway a Castlebar ambulance will often be called when a Galway ambulance is not available in the knowledge that that ambulance will never make it to Galway. It was, however, dispatched on time. The ambulance may get half way there and is then sent back when the Galway ambulance becomes available, thereby massaging the figures that the Minister is supposed to use to develop policy. These are very serious, ongoing issues. It is happening all over the country.
I thank Deputy Chambers. I will follow up on the figures and how authoritative they are and revert to the Deputy directly.
On a general point, before dealing with the Mayo-specific issue, the national ambulance service received 859 calls per day on average in March. That is 26,629 calls over the full month of March. Of all of those calls we saw 1,668 ambulances delayed for greater than an hour. It is not acceptable that ambulances are delayed for that long, but it gives a sense of the volume of calls that our ambulance service is dealing with, and shows that the overwhelming amount of them are very successful.
However, we do need to do more about this.
I thank the Deputy for acknowledging the difficulty of meeting HIQA response times in certain parts of the country. This is not due to a lack of willingness on the part of the national ambulance service but because of particular geographical challenges which we have to work in innovative ways to overcome.
Staff reports from Mayo University Hospital are accurate and it is true that when an emergency department is congested it results in additionality in terms of time. I thank the staff in the hospital because we have seen an improvement in trolley numbers and on one day this week there was a 46% decrease in patients on trolleys as compared with the same day last year. Ultimately, the issue is bed capacity and we need more beds in our health service. Class sizes have increased as the population has increased but bed capacity has not, and this has been the case over periods of successive Governments. We need to do this collectively and that is why the bed capacity review is under way. I need to have a clear figure for the number of extra beds we need for the health service in time for the mid-term capital review.
A total of 174 out of 823 calls took over an hour to clear in GUH. That is nearly three times as many as were cleared within 20 minutes. That is always a problem but it is a much bigger problem if the ambulance which is waiting outside has come from an area that only has one ambulance within 30 miles of its base. Are there proposals to ensure ambulances from stations with no back-up vehicle will be given priority and can disgorge patients so that it can get back out on the road? That is one simple thing that could be done. Is there a process to prevent an ambulance from Clifden or An Cheathrú Rua, where there is no other ambulance nearer than Westport, sitting in Galway for over an hour when somebody else needs an ambulance? Will the Minister give an instruction that areas where there is only one ambulance cannot be pulled into Galway as back-up, leaving a very extensive area without any ambulance cover within a reasonable distance? These issues can and must be dealt with immediately.
I had the honour of visiting Galway University Hospital recently to talk to staff, patients and management. The clear need is for a new emergency department, which has been much talked about for many years and which we will deliver. I have provided the funding for the design team which is being appointed and it is important that its work is completed as quickly as possible so that I can ensure the new emergency department for Galway University Hospital is included in the mid-term capital review. It is vital we get the emergency department under way because that will assist staff in the clinical handover of patients from ambulances to the emergency department and will provide them with more capacity, better working conditions and privacy for patients.
It is a clinical consideration for the national ambulance service to decide which ambulance to prioritise getting back out onto the road. The hospital must deal with the patient's needs and triage them when they arrive in the emergency department but I will raise the two matters the Deputy raises with the national ambulance service and come back with a response.
I welcome the fact the Minister will look into the issue of ambulances being called when they know they will not get there, which is happening all over the place. Crews from Castlebar and Ballina have been sent to Roscommon and to Galway and a crew that is meant to go to Mulranny on a daily basis often does not get there. They might be sent a small bit down the road but are then called back to man a base in Castlebar or Ballina because a crew from one of those places has been called out to a wild goose chase somewhere else. The staff do not have any choice but to do this.
The recruitment of nurses is a key issue to ease congestion in our emergency departments. The Minister will be well aware of the difficulties in attracting nurses back and we all know people working in other jurisdictions where they are treated far better and have a smaller workload. We need to do an awful lot more in terms of working conditions to attract highly skilled and qualified people back.
I welcome the reduction in trolley numbers at Mayo University Hospital this year as compared with last year. I have raised the movement of patients to other wards with the Minister in the past but I do not know if he has looked into it. They are often moved to the medical assessment and day service units in the hospital to remove them from the view of those who conduct the trolley watch. Staff tell me that there is pressure on hospital management to ensure patients are not counted on trolleys so that the numbers can be made public. They are human beings and it puts pressure on them and this incentivises some managers to do things which massage the figures, creating an inaccurate reflection of what is happening on the ground. The Minister needs to look behind the figures and talk to staff in the hospitals.
I always enjoy talking to staff in the health service and I have visited 48 of our hospitals in the past year. The Deputy makes an important point about trolley figures. The INMO produces its own trolley watch and its members have clear guidelines, as does the HSE, as to what constitutes a trolley as opposed to an additional bed. Its figures are published on a daily basis and the HSE publishes figures three times a day. The general secretary of the INMO is co-chair of the emergency department task force, where there is an exchange of information on this, so I believe the 12% decrease in April, according to the INMO's figures, is widely accepted among staff.
The Deputy is entirely correct to say we need to recruit more nurses and we need to do more to recruit nurses. The HSE has been at career fairs in London and, as part of our discussions with the INMO and SIPTU to avert industrial action, we agreed a number of measures including the doubling of the bring-them-home allowance from €1,500 to €3,000, and extending it beyond the UK. There is a number of pre-retirement allowances for people who want to work part-time rather than full-time, meaning we keep a part-time nurse in the system. I am looking forward to going to the INMO conference later this week, where I will have an opportunity to outline plans in this area.
