A PRESCRIPTION FOR CHANGE

4. Hospital Reform

Hospital Reform

Current Expenditure: €1.6 billion

Overcrowding and Capacity

Overcrowding is not a new phenomenon and nor are the solutions: bed capacity, better hospital management and efficiency, and enhanced primary and community care. Sinn Féin would expand hospital capacity, reform waiting list management, and hold public hospitals and management to account to reduce pressure on emergency departments, reduce patient waiting times, speed up the return home, and reduce re-admission rates. Our comprehensive health plan would deliver earlier intervention and reduced waiting times, reducing the complexity of care needed and improving quality of life. Investment now will pay off for decades to come.

The health service is shifting the burden of overcrowded emergency departments onto waiting lists by cancelling scans and procedures on a regular basis. The consequences are longer waiting times and delays to patient care, driving a vicious cycle of long waits, overcrowding, and cancellations. This has severe consequences for waiting lists and is preventing any significant reduction in the totality of hospital waiting lists. This is exacerbated by delays on the other end of hospital stays which result in people staying in hospital longer than is necessary.

Sinn Féin would deliver 5,000 new hospital beds out to 2031, including replacements for 1,000 unsafe beds. Our bed plan would aim to eliminate hospital overcrowding by 2032. It would be supported by 2,000 community beds. We would continually develop capacity to meet expanding need on the basis of expected population increases and demographic shifts, ranging from 300 to 500 additional beds every year. We would make full use of existing planning mechanisms to fast track the delivery of beds, including emergency planning powers as has been done for other infrastructure projects in the past. The situation in hospitals is an emergency and needs to be treated as one, and planning priorities must be aligned across the HSE and local authorities.

Sinn Féin would champion common sense and quality-of-life enhancing innovations to provide hospital care at home. As part of our investment in a modern and digital health service, we would fund extensive use of technology-assisted “Hospital Care at Home” beds, known as virtual wards, to provide more options for care at home where it is clinically appropriate. This is about delivering better, more appropriate, higher quality care closer to home and ensuring that people are not in hospital when they do not need to be. This is not a replacement for physical space in hospitals. Hospital care at home has the important added benefit of reducing exposure to hospital-acquired illnesses, particularly among older people.

* = Includes specialist rehabilitation beds and a total of 1,000 replacement beds and 100 critical care beds.

Sinn Féin’s capital plan would bring the health service into the 21st century. We would invest in a dynamic and innovative digital health service. We would make full use of technological solutions to prevent hospital admission and manage a person’s care in their home or local community. We would ensure that remote monitoring is properly supported by local community-based teams.

Sinn Féin would take a zero-tolerance approach to hospital trolleys. We would mandate best practice across emergency departments and hold regional executives and hospital managers to account for improvements in EDs and waiting lists. Hospital occupancy levels should not exceed 85% during routine hours and outside of surges or emergencies. EDs need more senior decision makers on site to improve discharge rates, but those decisions need to be supported and implemented by management. We would ensure that the totality of healthcare resources in hospitals and in the community are being used efficiently and effectively to improve patient flow and tackle hospital mismanagement and overcrowding. We support the delegation of appropriate discharge decisions to senior nurses. It must be the responsibility of a designated person to ensure a discharge plan is in place for every patient.

Delayed access to diagnostics is a major issue for people in emergency departments and on waiting lists. Understaffing of radiology departments and laboratories are major problems that have not received the political attention they deserve. Past attempts at extending radiology operating hours fell through because of understaffing and the lack of a proper workforce plan. Medical scientists have been exploited for years. Insufficient or outdated equipment have also been cited as hindering the performance of the health service. Sinn Féin’s capital plan would fund an upgrade of equipment to improve productivity.

The biggest barrier to improving access to care and diagnostics is staffing. MRIs need radiographers, and radiation therapy needs radiation therapists, which is why Sinn Féin would implement a strategic workforce plan to train, recruit, re-activate, and retain health care workers. We would fund a major workforce plan and a doubling of undergraduate places to ensure a sustainable supply of workers to safely staff the health service. We would legislate for safe staffing levels to place a legal obligation on the State to deliver on minimum staffing levels. We would work to achieve a 7-day health service to make full use of available capacity.

Sinn Féin would deliver more urgent care through local primary care networks and local hospitals. Both have a major role to play in reducing ED admissions, delays, and improving discharge rates. There are thousands of delayed discharges from hospital every year due to a failure to plan and align community services with hospital need. This is a significant contributor to the trolley crisis. Along with increasing hospital capacity, we must also ensure optimal use of bed space.

We would develop adequate home support and step-down capacity in each region to reduce delayed discharges. Regional management will be expected to improve the availability of discharge-aligned home and community supports. We would provide time-limited funding for hospitals and local managers to access step-down care, such as in nursing homes, where it is available and appropriate from community and voluntary sector and private providers. We would immediately fund the construction of 1,200 community step-down and nursing beds to build public capacity and reduce reliance on non-public providers. Our local health services plan details the investments we would make across rehabilitation, transitional care, and home-based care, supported by links to GPs and wider primary and community services.

Local communities have been let down by the stripping of services from county hospitals. Not every hospital can provide a safe emergency care service, but far more services – such as routine appointments, outpatient or day case appointments, urgent care, diagnostics and testing, elective care, and step-down care – can be provided closer to home. As part of our commitment to population-based planning, we would review the role of model 1, 2, and 3 community, district, and general hospitals to improve the availability of services in local communities.

Sinn Féin is committed to developing a second model 3 hospital with an emergency department in the Midwest. We recognise that there is a need for a second emergency department in the region, particularly given population changes and continuing population growth. There is significant evidence from 15 years of preventable tragedies that a single-point-of-failure can be devastating, and that a single emergency department for the region has not worked. We would mandate the ongoing HIQA review of urgent and emergency care services to determine the best location and resource need, based on clinical advice and population. We would ensure comprehensive urgent and out-of-hours primary and secondary care utilising public GPs and by upgrading Ennis, Nenagh and St John’s Hospitals to 24/7 urgent care centres. This is an opportunity for the Midwest to be a model of best practice, and no less is demanded by the legacy of those who have been failed at University Hospital Limerick.

Sinn Féin Will:

icon_check iconDeliver 5,000 hospital beds by 2031, including replacing 1,000 unsafe beds, to set the course for eliminating use of hospital trolleys

icon_check iconTake a zero-tolerance approach to hospital trolleys and mandate best practice across emergency departments

icon_check iconPublish a funded multi-annual health bed plan within 100 days

icon_check iconInvest in 100 more critical care beds

icon_check iconDeliver 400 Hospital Care at Home virtual ward beds

icon_check iconDeliver more 24/7 urgent care through local primary care networks linked with local hospitals

icon_check iconInvest in a model 3 hospital with a second emergency department for the Midwest

icon_check iconMake full use of existing emergency planning powers to accelerate infrastructure delivery

icon_check iconUse pre-ED assessments to triage appropriate care to timelier treatment options, and develop pilot schemes to improve triage at and before arrival

icon_check iconDeliver a digital health service that operates in the 21st century, with integrated care management, financial, and data systems

icon_check iconInvest in public community radiology services

icon_check iconInvest in community-based intermediate care to reduce re-admission to hospital and streamline discharge

icon_check iconWork with healthcare workers to deliver a 7-day health service

icon_check iconImplement multi-annual funding frameworks to accelerate delivery of essential service improvements such as the trauma strategy ‘A Trauma System for Ireland’

icon_check iconMandate adequate discharge planning for each patient, with discharge-aligned home support or step-down care where needed

icon_check iconHold regional executives and hospital managers to account for hospital performance

icon_check iconTime-limit funding for hospitals and local managers to access step-down care outside of the public sector

icon_check iconLegislate for safe staffing levels and engage with workers to improve retention

icon_check iconImplement the recommendations of the National Taskforce on the NCHD Workforce

icon_check iconPublish and implement the evaluation of emergency and urgent care services in the Midwest and future-proof access to urgent and emergency care in the region, including recommendations on extending emergency department capacity

icon_check iconReview the role of model 1, 2, and 3 community, district, and county hospitals to improve the availability of services in local communities

icon_check iconMandate each health region to develop a population-based care and capacity plan to inform strategic investment and workforce planning

icon_check iconConduct a root-and-branch review of emergency and urgent care provision on the basis of population and geographic spread in each region

icon_check iconUnderpin service expansion with strategic workforce planning and substantially increase training places

icon_check iconCommit €15 billion in capital investment to address infrastructure deficits across the health service, including digital systems, beds, clinic and theatre space, retrofitting, and equipment

Waiting List Reform

Sinn Féin’s strategy to reduce waiting lists is to fundamentally reform the State’s approach to scheduled care and put transparency at the fore.

We would reform the National Treatment Purchase Fund to play a larger role as a commissioner of care from the public sector to hold public hospitals to account for efficiency. This body would be responsible for implementing our Comhliosta policy (2017) on an integrated hospital waiting list system. It would work with regional referral offices to manage and cut waiting lists. Its mandate would include transparency and value-for-money. We would mandate this body to optimise use of public assets, leverage all available capacity in the State and across the island, and reduce reliance on outsourcing as public capacity is developed. We would work to implement multi-annual funding in this area to facilitate better medium-term strategic planning. This would assist in getting strategic and value for money use of existing private sector capacity while building public capacity.

This body would be fully accountable to the Oireachtas and responsible for the publication of all health and social care waiting lists. We have already published some legislation to underpin this reform, the Health (Waiting Lists) Bill 2023, which would also give legal effect to target waiting list times.

Our Comhliosta system would improve transparency around the performance of individual hospitals on different waiting lists. It would integrate lists on regional and national level. It would give an honest reflection of the state of hospital capacity across the State. Our system would give patients the choice to move, or not, from one hospital to another where their local or regional hospital breaches waiting times set by the Minister. Data on breaches of waiting time targets would be published annually for each hospital.

Sinn Féin supports the development of regional elective centres which can separate scheduled care from emergency care and tackle waiting lists. Sites have been identified for four centres, but plans are years behind schedule. We would prioritise the development of 6 rapid-build surgical hubs adjacent to major regional hospitals. Depending on regional need, surgical hubs could be retained or repurposed when the major elective centres are opened. Protected capacity for scheduled care is needed to reduce waiting lists and cut down our reliance on the private sector.

Sinn Féin Will:

icon_check iconImplement our Comhliosta policy on an integrated hospital waiting list system

icon_check iconIntegrate waiting lists on a regional and national level

icon_check iconLegally underpin waiting time targets

icon_check iconReform the National Treatment Purchase Fund to hold public hospitals to account for efficiency

icon_check iconGive patients the choice to move lists where their hospital breaches waiting time targets

icon_check iconPublish data on breaches of waiting time targets annually for each hospital

icon_check iconDevelop regional elective centres and surgical hubs

icon_check iconControl funding on the basis of reform delivery, rewarding best practice and progress against waiting time targets