PMB – Hospital overcrowding


Dáil Éireann 11 November 2015

Thank you for the opportunity to speak on this Bill

I intend to confine my contribution to three elements relating to our hospitals, the first is how people end up there and alternative treatment routes, the second is the need for change in how immune suppressed patients are treated once they present at A&E and the third is the need for better communication between hospitals and nursing homes with vacant step-down beds.

What’s wrong with our A&E departments was recently brought home to me by a GP who outlined his everyday experience in his doctor’s surgery. On the day I contacted him, he had earlier treated a young man who required seven sutures in his leg. This took 12 minutes in the doctor’s surgery. It was a bad laceration and he also required an anti-tetanus injection.

For this, the doctor will receive €28 from the government. The materials in this case cost €19, giving the doctor an after-tax income for this work of €3.90. I also understand that for many GPs operating in rural areas, making house calls to elderly patients is no longer an option because of the time such calls take and the remuneration involved and instead those patients are being referred to A&E which involve ambulance calls, trips all across the country and long waits on trolleys in already overcrowded A&Es.

It’s glaringly obvious that we have to ensure that such patients are kept out of A&E if at all possible, but unless GPs, including rural GPs, are properly resourced and remunerated this simply will not happen and chaos will continue in our emergency departments.

The second part of my contribution relates to a large cohort of the patients that make up presentations at any A&E in the country and that is cancer patients. Cancer patients undergoing treatment have suppressed immune systems and must be protected from an A&E setting if at all possible as they are so susceptible to infection.

These patients usually present at the A&E of the hospital where they are being treated, which is or should be a centre of excellence. It is imperative that all such centres of excellence, including UHG, have a streaming system in A&E whereby cancer patients presenting with infections or suspected infections are streamed away from the A&E setting to a dedicated facility.

I intend to visit St. Luke’s hospital in Kilkenny in coming weeks where I believe excellent new systems are being put in place in the A&E which will be of great benefit to cancer patients in the south east, and I believe that this must be replicated in UHG, which treats cancer patients from all over the west of Ireland.

I have taken this issue up with the Minister and the Chairs of the Emergency Department Taskforce, but I believe that cancer patients in the west need this issue addressed as a matter of urgency.

I know that staff in A&Es, including Galway, do Trojan work to ensure that immune suppressed cancer patients are accommodated as well as the facilities allow, but the facilities need complete overhauling and not just in the long term. We cannot have cancer patients lying on trolleys in cramped A&E settings, alternative strategies have to be put in place.

A third element is the need for better communication between hospitals and nursing homes with vacant step-down beds. Many nursing home owners spoken to me of having beds available and hospitals enduring overcrowding, but the lines of communication are almost non-existent. Better communications would greatly help alleviate discharge systems from major hospital.
I believe that there are a number of common-sense measures that need to be taken in the short term to tackle our hospital systems and change on this front will really benefit hospital patients throughout the country.