Is Reilly's delivery unit delivering?

Health Minister James Reilly's Special Delivery Unit (SDU) says it is taking steps to address long trolley waits in the eight hospitals suffering from the worst emergency department overcrowding.

In addition, the SDU says it is addressing the issue of patients waiting over 12 months for hospital treatment, although overall, waiting list numbers are continuing to grow.

According to a briefing document from the Department of Health, eight hospitals are currently responsible for 60% of the trolley figures. These are - Beaumont; Cork University; Galway University; the Mater; Our Lady of Lourdes in Drogheda; St Columcille's, Loughlinstown; St Vincent's; and Tallaght.

The Department says the SDU has recently been involved in a 'major interaction' with these hospitals. It says each of the eight has been invited to seek supports under certain headings and these requests were being analysed in consultation with the HSE.

In the case of Our Lady of Lourdes in Drogheda, which has suffered from some of the worst ED overcrowding, a number of measures are being put in place to ease pressure on the ED and on hospital capacity.

These include extending the opening hours of its acute medical admissions unit, opening eight previously closed medical beds, and re-opening 'step-down' beds in other locations, to which inpatients can be discharged.

The Drogheda hospital has been given a special allocation of just over €725,000 for this initiative. However, the hospital has been warned that getting the money is contingent on consultants organising seven-day ward discharge rounds and that the initiative is not offset by capacity reductions elsewhere in the hospital.

Today's (November 2) 'trolley watch' figures from the Irish Nurses and Midwives Organisation (INMO) show that there were 45 A&E patients on trolleys in Drogheda this morning, compared to 42 on the equivalent day last month.

Trolley numbers are still high at some hospitals, with 37 patients on trolleys at Beaumont today and 50 at Galway University Hospital.

Nationally, patient trolley numbers today totalled 375, compared to 463 on the equivalent day last month. However, it is too early yet to predict whether the ED crisis is easing.

We will get a better picture of whether Dr Reilly's initiative will work as the winter progresses and pressure grows on hospital ED services.

Tallaght Hospital, which is currently the subject of an emergency services patient safety probe by HIQA, has recently succeeded in reducing its trolley numbers.

Health Minister James Reilly has pledged that the record trolley numbers seen in EDs nationally will not be repeated this winter.

However, the SDU said recently that while this cannot be absolutely guaranteed this winter, the real improvements in ED overcrowding would come about in 2012.

The SDU also says its plan to have nobody waiting more than a year for planned inpatient or day case treatment is on target to be implemented by the end of the year.

It says a further 4,000 people will be treated before the end of the year as part of this initiative.

Once that goal is achieved, it says a new shorter waiting list target will be set.

The SDU is working with the National Treatment Purchase Fund (NTPF) and is using the fund's allocated budget to act on trolley numbers and waiting lists.

However, as part of this arrangement, the NTPF, since July, has no longer been routinely arranging treatment for those waiting more than three months on public hospital lists for treatment. Instead, the longer waiters- those waiting over 12 months for procedures - are currently being targeted.

In the meantime, waiting lists  for those waiting between three and 12 months for care have been steadily increasing.

Recent figures show that the number of adults waiting between three and 12 months for hospital procedures increased from 19,996 to 23,398 between April and August - a rise of 17%.

The number of waiters in this category is likely to grow further, as the ending of automatic referral to the NTPF after a three-month wait kicks in. This could create a 'bottleneck' effect which could potentially scupper the current waiting list initiative.

As more and more people people coming onto waiting lists continue to wait for longer periods, this could put pressure on the initiative to implement a maximum 12-month wait target by the end of this year, followed by a lower wait target next year.

A spokesman for the Minister said the initial focus was to deal with the issue of long waiters. This initiative was working and the plan was on track to have no-one waiting longer than 12 months by the end of the year.

Admitting that there had been some increases in the numbers waiting for shorter periods - between three and nine months for example, the spokesman said the intention was to concentrate first on the 12 months-plus waiters and 'work our way back.' with waiting lists.

The intention is that a new maximum waiting list target of nine months will be set next year, once the 12 month- plus waiting list has been cleared.

The SDU says it now has the type of detailed information on waiting lists from individual hospitals and consultants that was not available before. This made it easier to target specific long waiters and find the capacity to get treatment for them.

Recent signs that Dr Reilly's Special Delivery Unit is starting to deliver are certainly welcome.

However, against a background of yet more harsh health cuts next year and increasing demand on services, the jury is out on whether it will provide a lasting solution to the seemingly never-ending hospital capacity crisis.

[Posted: Wed 02/11/2011]