Hospital units had busiest year to date
HSE seeks €5.2m in additional resources
The Medical Assessment Units at Nenagh, Ennis and St John’s hospitals had their busiest year to date in 2022, with 12,737 patients being seen.
This represents a 19% increase on 2021. The HSE has submitted a bid to the HSE National Acute Division for €5.2m for additional resources.
Responding to questions from Cllr Séamie Morris at last week's meeting of the Regional Health Forum West, Joe Hoare, Assistant National Director, Capital & Estates, said additional staff would allow the HSE to extend the operating hours and open the MAUs in Nenagh and St John’s to seven days a week. Presently, patients can only be referred to Nenagh's MAU from Monday to Friday, 8am to 6pm.
Mr Hoare told Cllr Morris that additional funding would also enable the HSE to increase the number of slots currently available to GPs, ShannonDoc and ambulance paramedics. The bid also includes permanent funding for Ennis MAU to secure the extended hours and weekend service into the future.
The Nenagh councillor had queried the additional resources that would be put in place to support the extension of the recently-introduced ambulance protocol. He also wanted to know what plans are there to increase bed capacity and staffing at Nenagh, Ennis and St John's hospitals.
The new protocol saw the MAU pathway for 112/999 extended to Nenagh and Ennis hospitals earlier this year. The MAUs at both hospitals treat patients referred by GPs, ShannonDoc and now National Ambulance Service paramedics. It is envisaged that similar measures will be introduced at St John’s in the coming weeks.
“It is important to note that the introduction of the new ambulance pathway did not require an expansion in physical capacity at either site,” Mr Hoare stated in his formal response. “To support the roll-out of the pathway in Nenagh hospital, there has been a slight increase [0.5 Whole Time Equivalent] in nursing resources.”
Cllr Morris made the point that the new protocol would not change anything without additional resources. Dependence on the Emergency Department in Limerick would not be reduced without opening additional beds and providing additional staff for the smaller hospitals.
SHANNONDOC
Cllr Morris also sought a figure for the amount allocated in additional resources to the out-of-hours ShannonDoc GP service in preparation for the “Christmas/Winter surge”.
Colette Cowan, CEO of UL Hospitals Group, replied that an additional allocation of €193,000 was made available by HSE Mid West Community Healthcare for ShannonDoc through the Winter Plan to prepare for an increase in activity over the winter period (November 2022 – March 2023).
“The purpose of the additional funding was to support ShannonDoc in meeting the expected increase in demand and to enhance the ShannonDoc GP out-of-hours service across the Mid-West region over the winter months,” Ms Cowan stated.
“The additional funding was provided to enable ShannonDoc to roster additional doctors and triage nurses in out-of-hours treatment centres across the Mid-West region.
“The additional resources facilitated more patients to receive ‘in person’ consultations by the out-of-hours GP service with the objectives of reducing the number of referrals to Emergency Departments, and reducing the number of patients presenting directly to EDs without having first been seen (triaged) by an out-of-hours GP service.”
AFTER-HOURS MENTAL HEALTH SERVICES
Cllr Morris furthermore questioned the HSE executive on the services in place in North Tipperary for people having a mental health episode after hours or at weekends.
Maria Bridgeman, Chief Officer, HSE Mid-West Community Healthcare, replied that the out-of-hours mental health service in North Tipperary is operated by HSE Mid West Community Healthcare Mental Health Services. It is an extension of the Community Mental Health Teams based in Nenagh and Thurles.
“Out-of-hours staff liaise with both teams on an ongoing basis and will arrange follow-up care in the community, based on the needs of the person,” Ms Bridgeman stated in response to Cllr Morris.
“The out-of-hours service is staffed by nursing staff supported by an on-call consultant. The service is available from 4pm to 3am every day, including all weekends and holidays.
“Mental health service users who attend the Community Mental Health Teams can access the out-of-hours service. They may receive a home visit, appointment or phone support, depending on the situation.
“In addition, out-of-hours staff offer advice, support and sign-posting to people not known to mental health services, who are presenting to mental health services for the first time. If clinically determined that a person requires admission to the Acute Psychiatric Unit (APU) at Ennis General Hospital, the out-of-hours team may support the person in this process.
“In this situation, the out-of-hours team completes an initial assessment and determines the person’s level of need. If admission is indicated, the team makes contact with the consultant/NCHD on call and discuss the case.
“The team works with any family present to ensure the person has travel arrangements in place. If this isn’t the case, the out-of-hours team will identify appropriate transport, based on a risk assessment.
“On arrival to the APU, a mental health assessment will be undertaken by the consultant/NCHD on call to confirm whether admission is appropriate. Communication with the appropriate Community Mental Health Team will be undertaken and the service user will be followed up as an inpatient, or in the community as appropriate.”