Friday 6 December 2019

Patients waiting for nursing home beds are costing the health service €700k a day

An ambulance waits outside the Mater Hospital, in Dublin. Photo: Damien Eagers
An ambulance waits outside the Mater Hospital, in Dublin. Photo: Damien Eagers

Denis Naughten

Over the weekend, Waterford-based GP Dr David Janes, who worked in West Africa, told the Annual General Meeting of the general practitioners in Limerick that Accident and Emergency patients in The Gambia were treated quicker than they would be in Ireland.

Everybody within the health service again wrings their hands at such comments, yet nothing ever seems to happen to really tackle the problem, a problem that is straight in front of our noses.

Dr Tony O'Connell, the HSE's National Director of Acute Hospitals, recently pointed out that there were still "enormous efficiencies" to be made in Irish hospitals but that this was hampered because patients fit for discharge cannot access a nursing home bed.

What if we could release an extra quarter of a million bed nights across our hospitals, would this not help ease the chaos and congestion in our A&Es?

Consider the impact it would have on quality of care in hospitals or the other support services, such as ambulances. For example, it is not unusual for an ambulance to be held up for hours parked outside a busy A&E, waiting in line to hand over a patient to hospital staff who are run off their feet.

And still nothing happens.

Well that was until October 14 - Budget Day - when Brendan Howlin, Public Expenditure Minister, made what I believe is a very significant announcement. He specifically allocated €25m to delayed discharges from hospital. These are patients, mainly older people, who are too well to be in hospital but there is nowhere else for them to go.

While the vast majority are waiting on a long-term nursing home bed, other patients are "stuck" in hospital for other reasons. In total, we have 800 such patients, costing the health service about €700,000 every day.

The €25m announced by Mr Howlin has the potential to pilot major reform of our health service that can make a real difference to older people who do not want, or need, to be in hospital and for very ill people who need medical treatment in an actual hospital bed.

But this can only happen if this money is specifically ring-fenced for the right purpose. That is to treat older people before they need to go to hospital and, for those in hospital, to get them better and out as soon as possible.

We need to increase our long-term care capacity by about one-fifth to meet the needs of our older population. This requires capital investment in public long-stay hospitals and private nursing homes.

But also we need to develop new community care models that allow older people to remain at home longer.

For example, this should include extending the Fair Deal nursing home scheme to care at home. Some of the €25m must be used to develop this new model of funding care at home.

But some patients - regardless of age - who are in hospital beds, don't need long-term care but instead require short-term respite for two to three weeks until they are strong enough to go home.

At present, Fair Deal does not fund short-term care, and some of this €25m must be put into these types of support beds which in turn would free up acute hospital beds for those who need them.

For others, both young and old, they may be stuck in hospital waiting on approval from the local county council for a grant to carry out alterations to their home to make it accessible. It may be that they just need a walk-in shower, a ramp at their front door or a few grab rails, yet they continue to cost our hospitals €6,000 a week. This needs to be addressed, and addressed quickly.

While it's one thing to try to get 'fit' patients out of hospital, it is far more complex to stop them requiring hospital care in the first place.

This can only be achieved by supporting GPs and community health services in identifying and treating conditions earlier. There are some very successful pilots currently in operation, and funding should be set aside to expand these or support new, innovative projects.

But we must also utilise what we already have, including our existing medical assessment units and minor injury units in our smaller hospitals. These have the capacity to care for far more patients, in a more appropriate and timely manner. These units are usually based in communities with large older populations, such as Roscommon, and they are already being funded by the health service. But setting just a small amount of the Howlin reform fund aside to promote these units, both with GPs and the public, could divert patients away from our over-congested A&Es, giving everybody more appropriate and timely treatment.

The fact is that the current system is not working, not just in A&E but for planned hospital treatment as well. This is resulting in people being sicker when they eventually receive their treatment, leading to longer stays in hospital and thereby increasing the cost of each procedure.

In addition, some of those patients fall ill whilst waiting for treatment and have to be admitted to A&E, where they add to the existing trolley counts as they wait for a hospital bed to be released.

Mr Howlin's fund, if used wisely, can begin to make a real difference for everybody waiting within the health service.

If we can get these basic things right, then we can have an effective and efficiently run health service that meets the needs of patients.

Denis Naughten is an Independent TD for Roscommon-South Leitrim

Irish Independent

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