Transfer of patients who are fit for discharge out of hospital ramped up as demand for beds increases

Moves to hasten the transfer of patients who are occupying hospital beds and are fit for discharge are to be stepped up, HSE chief Bernard Gloster said today.

He said the number of these patients was at 600 at the beginning of the year and they are now down to 474 but he wants to bring the figure to 400 at the end of this year and reduce it to 300 a month in early 2024.

He told the Oireachtas health committee today that it was important for hospital staff to flag if someone is going to be ready for discharge soon and arrange stepdown care for them.

Around 40 patients a day who present at emergency departments need to be provided with a hospital bed.

He was speaking after some criticism of the decision to request patients approved for a nursing home or transitional care to move to a facility which may not be their first choice temporarily to free up hospital beds.

“I am aware of recent commentary in respect of communications regarding discharge and options for people for whom it has already been decided that alternative care is a requirement,” said Mr Gloster.

“It is regrettable that some of the narrative has emerged particularly for older people and their families, when it is abundantly clear that the measures are appropriate, sensitive and most importantly a response to patient safety issues.

“There is a clear and unambiguous connection between DTOC and the pressures in the emergency department in several hospitals. It is of course accepted there are also other contributory factors.

“I have made it a clear priority of this year’s focus that older and more frail people are to be the most urgent focus of all of our services, including where necessary their care experience while in emergency department awaiting admission. There is no doubt we can do better and recent indications are proof of this.”

Mr Gloster is already on record as saying the health budget for 2024 falls short of what he believes is needed and he told the committee next year will be “exceptionally challenging”.

It will mean that a target to hire around 5,000 more health staff in the next eighteen months will have to be reduced to around 2,268.

He said the bailout of €1bn which the HSE got this week for 2023 will cover its cash requirements for this year but a deficit of around €500m will be carried over to 2024.

The whole year deficit in 2024 will again be in the region of €1.4bn to €1.5bn.

He reiterated that he believes the HSE is too top-heavy with central management and he will be working on reducing this further in the coming year.

He told the committee: “There is little doubt that as we face this coming period, trolley waits and pressures will be a feature of our services and the focus of the HSE is to ensure that these are not only to the minimum extent possible but also that there is a pathway to continuous improvement.”

He added: “I particularly want to recognise older people and those who find themselves in vulnerable situations and to restate our commitment that their care and comfort will be a priority even when some waiting is unavoidable.”

He said that “year on year trolley wait have dropped by an average of 21 per day or 6.5pc and while recognising some individual site variations and challenges this is to be welcomed. More focused counting methodologies will assist in a detailed understanding of the position.”

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