ED Challenges on Winter Planning
The Minister for Health acknowledges the distress overcrowded EDs cause to patients, their families, and frontline staff working in very challenging working conditions in hospitals throughout the country. Hospitals are increasingly operating at or above capacity, with year-round demand pressures that are further challenged over the winter months.
According to the latest information available, which is still provisional, as of 8am this morning (28 November), over 91,000 patients have been reported as waiting on trolleys across the acute hospital system to date in 2018. This reflects the increasing demand for unscheduled care so far this year, especially by patients in the 75 and over age group. Total attendances were up by 3.7% and admissions up by 2.5% at the end of October 2018, compared to the same period in 2017. For those aged 75 and over, attendances were up by 5.7% and admissions up by 5.4%.
As of the end of October 2018, compared to the same period in 2017, the cumulative daily count of patients waiting on trolleys increased by 3.1% to 83,096, according to validated figures from the HSE. Despite challenges in the earlier part of the year due to the severe weather associated with Storm Emma and the extended influenza season, the trolley numbers have stabilised considerably since March. The national daily average 8am trolley count decreased from 340 in March to 244 in October 2018, a 10.8% reduction on the same month in 2017.
The Department of Health has been working with the HSE throughout the year to ensure the most effective response to the pressures on our hospital system associated with the winter period. The main elements of the Winter Plan were presented to the Emergency Department Task Force (EDTF) earlier this week. The EDTF which is co-chaired by Anne O’Connor, Deputy Director General of the HSE, and Phil Ní Sheaghdha, General Secretary of the INMO, endorsed the Winter Plan, which has a major focus on supporting patients in the 75 and over age group. These patients are the highest users of most health and social care services, have more complex needs and longer stays in our Acute Hospitals. A major strength of the Winter Plan is the integrated nature of the plan and the involvement and ownership of management and staff in local hospitals and community health organisations in both the development and roll-out of the plan in the months ahead.
The HSE are now finalising the Plan , with the objective of putting it into effect from 1 December 2018. The Plan will run until 31 March 2019 and include a period of focused action from 17 December to 13 January on 9 key hospital sites of concern, identified on the basis of pressures experienced in previous winters. A key component of the Plan, which is already underway, is the provision of an additional 550 home care packages over the winter period to help patients return home from hospital with the supports they need.
However, given the increasing demand for acute hospital services and the capacity and financial parameters in which the system is operating, a significant number of patients will wait on trolleys for admission to a hospital ward. The recent patient experience survey found that 81% of people surveyed said that they were always treated with respect and dignity in the emergency department and ensuring the values of Patient Dignity and Respect are upheld at all times, is a key priority this Winter.
Increasing capacity is a priority for the Government to ensure that hospitals have available beds to meet the demand. The Health Service Capacity Review has recommended an increase in acute hospitals beds of over 2,600 by 2031 to support the projected increase in demand for services in the years ahead. The National Development Plan provides for the full complement of beds by 2028 – three years ahead of schedule. As many hospitals are running at over 95% bed occupancy rates, the Health Service Capacity Review indicates that an additional 1,260 beds in the system would be required to reduce occupancy rates to 85%.
Over the past 12 months, an additional 240 beds have been opened and a further 78 additional beds are planned for early 2019. This includes an additional 30-bed ward in Our Lady of Lourdes Drogheda, a 40-bed modular ward block in South Tipperary General Hospital, and four high dependency beds in the Mater and Cork University Hospital respectively. In addition, the new ED planned for Our Lady of Lourdes Drogheda is due to open early in 2019.
The Winter Plan will also seek to increase capacity and the Department of Health is currently in discussions with the HSE, in the context of the National Service Plan 2019, to identify the sites for investment and the associated number of beds, as part of an agree capacity programme for 2019.
Taken together, these initiatives will increase the number of available in-patient beds in the acute hospital system to over 11,000, a threshold last last seen in 2009.
Notes to the Editor
9 hospital sites of concern
The key sites are: Mater Hospital; St Vincent’s University Hospital; Tallaght University Hospital; Naas General Hospital; Midland Regional Hospital Tullamore; Galway University Hospital; University of Limerick Hospital; Cork University Hospital; University Hospital Waterford.
Methodology for TrolleyGar count
TrolleyGAR data is collected each day at 8AM, 2PM, and 8PM, including Saturdays, Sundays and bank holidays which are not included in the INMO count.
The INMO Ward Watch counts additional patients on beds, trolleys or chairs, on inpatient wards/units above the stated complement of that ward/unit. (This includes inpatient beds being used as surge beds at a given time or designated beds being used for patients that the INMO has staffing concerns about).
Collection of data in the Children’s Hospitals began in September 2013 by TrolleyGAR and January 2018 by the INMO. INMO started including the Children’s Hospitals in their monthly report totals from October 2018.