LAST UPDATE | 26 May 2022

THE CHAIR OF the Public Accounts Committee (PAC) Brian Stanley has told the HSE boss Paul Reid to “knock heads together” in order to reduce the waiting times over 75s face in hospitals.

A recent parliamentary question by Sinn Féin’s David Cullinane revealed that the average waiting time for admission to hospital emergency departments last month was nearly 14 hours for people 75 years of age and over.

The data indicates that the waiting time was nearly twice that duration in two Cork hospitals.

Five hospitals – Naas General Hospital, St Vincent’s Hospital, Cork University Hospital, Mercy University Hospital and University Hospital Limerick – had an average wait time of more than 20 hours for patients aged over 75.

In 23 out of the 27 adult hospitals, this age cohort had a longer wait from registration to admission than those aged under 75.

The target for patient experience time (PET) – the time from Emergency Department registration to either admission to a hospital or discharge home -  for patients aged over 75 is 95% within six hours and 99% within nine hours.

The number of patients overall waiting more than 48 hours in an ED was 40% higher than April 2019, and for those aged 75 it was 70% higher.

One-third of patients overall had a wait time of less than six hours.

Commenting on the figures, Cullinane said it was “outrageous” that wait times in particular for those aged over 75 were so high.

“It should be a key priority for each hospital to reduce their ED wait times across the board but in particular for older people,” he said. 

He pointed out that the 20-hour average wait time for some hospitals meant that some people were waiting longer than that, in some cases for a number of days before they were admitted.

“These are people with acute needs, some in chronic pain, waiting for admission,” he said.

Cullinane said there is “no magic solution” to the issue, as it is due to a number of factors including inpatient bed capacity and a lack of resources in the community to facilitate discharges for older patients.

“Many find it difficult to get support packages in particular for older people who need a recovery bed or to go to a nursing home or to convalesce, the resources are not there,” he said.

“And while the funding is there for intensive home care packages, they don’t have enough staff to provide the service.

“To add to that we have a growing crisis in GP care, people are waiting to access GP services, out of hours services in many areas are patchy so in some areas people are left with no choice but to go to an ED.”

He said Emergency Departments are “picking up the slack for a failure to ensure” there is appropriate capacity in GP care, primary care and community care in general. 

In response to a query from The Journal, the HSE said reasons that result in longer wait times include volume of patients presenting to the Emergency Department and the requirement to prioritise, treat and care for the sickest and older cohort of patients and those with life threatening illnesses.

“This can mean that patients with less serious illnesses and conditions may need to wait longer for their treatment,” it said.

The HSE said a patient’s experience can include multiple steps and delays in any one of these events or services increase a patient’s wait time and can create bottlenecks in the ED. 

“Emergency Department wait times are also affected by what’s happening outside of the hospital Emergency Department, in both the hospital and the community,” the HSE said.

This includes such things as the availability of inpatient beds within acute hospitals for acute admissions, the availability of community beds and or home care support for those patients in acute settings who are medically for transfer or discharge to the community. These factors in turn slow down the transfer of patients from the ED.

‘Intolerable’

Committee members, including Stanley, said that substantial funding was going into the Irish health system, but it “seems we are not making any headway”, he said.

“What is HSE going to do to address that,” he asked. 

“Hopefully everyone in this room will see 75 years,” said Stanley, adding that “it is just an intolerable situation in a well-funded health system”.  

Reid said Irish hospitals were seeing increased levels in the presentation of over 75s to Accident and Emergency. He said the HSE is working with individual hospitals in a bid to get community healthcare networks in place to shift presentations away from the acute hospitals.

As the winter months approach, Reid said things will be done differently, stating that given the current situation with Covid, he would hope that dual pathways of access to hospital will reopen. 

Stanley urged the HSE to look at the work of Kilkenny Regional Hospital, whereby streaming has been introduced, which involves GPs directly referring people to A&E.

Reid said it was a “really good example”, stating that the HSE is aiming to “pick up the best practices”.

Sec Gen salary

Wexford Independent TD Verona Murphy robustly questioned the Secretary General of the Department of Health Robert Watt asking him: 

“Have you identified a problem and you don’t know what to do about it? Have you not identified the problem in which case it’s getting worse or are you paid a large salary which you get regardless and just don’t care?”

Secretary General of the Department of Health Robert Watt

‘Third world service’

Murphy said for the money that was being invested into the health service, the public are getting a third world service. This was subsequently denied by Reid.

She acknowledged that the health service is a massive area to manage, but said the fact that over 75s are waiting more than 14 hours in emergency departments shows that the home care supports – and the Government’s pledge to deliver an additional one million hours – is not being delivered upon.

Murphy said Watt was the new “top dog” in the department, and asked what he was doing to ensure funding was being translated into services. 

Watt said the department’s priority is to ensure we are getting value for money 

He said he was dedicated to the delivery of Sláintecare and the new Regional Health Areas, which he said will “reform the way in which we fund the health service including a pathway to implement population based funding and multi-annual budgeting”.

In addition, the committee was also told that the HSE is set to record a deficit of more than €250 million for the first three months of 2022.

Additional reporting by Christina Finn.