Statement on Emergency Department Overcrowding Leo Varadkar T.D, Minister for Health

The current situation with Emergency Department overcrowding can’t go on. I acknowledge the difficulties which the current surge in activity is causing for patients, their families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances.

I convened the ED Taskforce last December. I am now bringing forward the next meeting of the ED Taskforce to next week to give urgent consideration to the following issues.

· Firstly I have been examining international evidence of what is effective in dealing with ED overcrowding. In particular, one of the most successful measures was the full capacity protocol originally developed in Stony Brook Hospital in New York. I want assurance that all the staff, unions and management are aligned behind a common view of the necessity to implement this as a key part of the escalation response in each hospital.

· Secondly, there are lots of different factors that contribute to overcrowding in emergency departments and some of the precise reasons will vary from hospital to hospital and therefore the precise measures to be taken will also vary. Therefore I am convinced that the only way that this can be addressed is through local leadership and management and effective local communication. I want to satisfy myself that this is happening.

I intend to shortly announce the appointment of a new Chair with sufficient expertise and experience to drive an effective national response to this issue of genuine public concern.

It is important to acknowledge the work that is already being undertaken to address overcrowding in emergency departments

· The HSE anticipates that the figures will continue to fluctuate, but the actions being taken by the HSE are already having an impact: trolley numbers this morning are down 15% from yesterday.

· The HSE has confirmed that all hospitals have escalation plans in place to manage not only patient flow but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care. These action plans include the opening of additional overflow areas, curtailing non-emergency surgery, providing additional diagnostics and strengthening discharge planning. Outside of the acute hospitals themselves, primary, acute and community care sectors are working together to ensure that all available capacity and options are utilised and brought to bear on the situation.
· I want to address the issue of opening closed beds. Firstly, hospitals do open additional beds regularly to cope with surges (recent examples in this regard include an additional 38 beds opened in the Mater Hospital, three five bed temporary wards opened in St. Vincents Hospital, 26 additional beds in St. Luke’s Hospital Kilkenny, and 24 beds in Our Lady’s Hospital Navan). Secondly, each bed that is opened has to be adequately and safely staffed and we know that there are many difficulties with recruiting staff. Finally, and importantly, if you consider that a substantial proportion of our acute beds are occupied by people who no longer require acute care, then you can understand why the focus on these ‘delayed discharges’ is key to efficient patient flow. Adding more facilities and more services is only effective if they are added where there is a genuine need – not as a sticking plaster for existing services which are not being managed effectively.
· The Government committed an additional €3m last December and an additional €25m in 2015 to address delayed discharges. This initiative, coupled with efficiencies which must continue to be sought within hospital services working with community and social care, will enable patients to move from acute or transitional care into long term care or to return home with appropriate supports. Thus far, this has allowed 109 patients to leave acute hospitals, which has had a beneficial effect on available bed capacity. I welcome recent efforts by the HSE to address administrative issues and cut red tape for Fair Deal applicants and I anticipate further progress in this regard in the coming weeks.
· The HSE has commenced a hospital redesign programme, startign with pilots in Tallaght Hospital and in Our Lady of Lourdes Hospital Drogheda and this programme of work will be informed by the work of the Taskforce. Following the initial meeting of the ED Taskforce on 22 December, the HSE is working on an action plan to be finalised by the end of January to specifically address ED issues with a view to a significant reduction in trolley waits over the course of 2015.