Change in patient care under way at CUH as waiting list reduction remains target

While patients on trolleys are a visible sign of overcrowding at CUH, the less visible but no less urgent cases are people on waiting lists for elective care and consultant appointments.

The CEO is from Limerick originally and came to Cork after 27 years in health and government jobs in the UK.

He took up his role in August last year as the after-effects of the pandemic took hold, following a 27-year career with the NHS and British government including over three years being responsible to ministers for London’s counter-terrorist, security and emergency planning arrangements in the UK.

He told the  Irish Examiner that reducing these waiting lists has been a major focus.

“The waits that we have still are far longer than I’m comfortable with. I’m a clinician by background,” he said.

“Every single one of those patients on that waiting list is a patient we are very much focused on, but we have seen a significant step-change in improved performance – in emergency care, in elective care, in cancer care - that are the early signs that CUH is starting to turn a corner.” 

He predicted these are signs that: “Within two to three years we have a real shot at delivering services that Cork deserves.” 

The National Treatment Purchase Fund data for June shows 31,124 waiting for their first appointment with a consultant, having been referred in by a GP or other primary care specialist.

Another 1,459 are waiting on specific in-patient operations or procedures at the hospital.

Mr Donegan is also head of the CUH Group which includes sites in Mallow, Bantry and Wilton, Cork City. He highlighted reforms which some patients have experienced since the pandemic eased.

“Our waiting lists for surgery have reduced, over just the last 12 months, from over six years to just over three and a half. Now that’s three and half years too long, but that is a significant improvement in a relatively short period of time,” he said.

Patients needing an urgent endoscopy no longer wait longer than the HSE target of 28 days, he said.

“We have almost eliminated out-patient waits of over four years, which we hope to achieve by the end of the year,” he said.

“Many, not all, of our cancer access performance has also dramatically improved in the last 12 months. Those with symptomatic breast concerns were only treated within the correct period of time 13% of the time last May; in May 23 they’re being treated 78% of the time in the right treatment period.” 

While overcrowding still impacts the emergency department, recent changes saw ambulance turnaround times reduced from an average of 95 minutes to 45 minutes by June which they expect to sustain through the winter.

Clinical director for emergency and acute care Dr Conor Deasy said: “Before this quality improvement initiative we would regularly have ambulances waiting for hours to find space to offload their patient at CUH.” 

He noted the countywide impact of this, saying: “This was time they were then not available to respond to 999 calls in our community.” 

The CEO keeps a colourful model of the hospital campus in his office, with moveable pieces to help with planning.

Parents of young children will be relieved to hear that blocks representing expansion of paediatric care remain in place despite the construction crisis.

This regional paediatric centre will also house a new school. A five-storey extension will provide 82 paediatric in-patient bedrooms, high dependency units, palliative care suites, haematology bed spaces, procedure rooms, operating theatres and diagnostic facilities.

It is expected 98% of children’s care in the region, essentially covering one-third of Ireland will be done at CUH.

The remaining 2% are children with complex conditions who can be treated at the new National Children’s Hospital in Dublin, when it opens.

“It’s really exciting,” he said of the developments.

“We are in the process of completing a new dedicated paediatric emergency department, which we hope to open by the end of the year. That will allow the centralisation of all paediatric emergency care in Cork, with the transfer of emergency care from the Mercy so all paediatric emergency care takes place in CUH.” 

Discussing the timetable for the overall construction, he said enabling works have started.

“We hope to start full construction of the new paediatric in-patient wing in the summer of 2024, and I am very much hoping that will be open by 2026 or 2027,” he said.

He would not be drawn into discussion of the new Dublin hospital, but said: “It is absolutely right that given that we will be caring for the southern third of Ireland, that the facilities for Cork, Munster and the south of Ireland are just as good as the care that is going to be delivered from Children’s Health Ireland.” 

Further on-site construction is linked to the announcement of Cork as one of two major trauma centres nationally.

“We have building projects including a CT scanner in ED with trauma bays, bed capacity, theatres, helipad all in various stages of development,” Dr Deasy said.

The helipad is expected to be in operation from December.

Mr Donegan linked many changes to working with external management consultancy firm PWC. This work has been the subject of much criticism due to the money spent on it, which was over €2m by the end of May.

He said they are tracking over 200 projects personally involved as project managers in eight larger areas.

“Our overall staff for CUH Wilton is about 4,500, and our management and administrative staff is about 460 although a comparable organisation in Dublin would be about 600,” he said.

Dr Gerry Wise, CUH clinical director of diagnostics and therapeutics said of developing a new outpatients unit: “There is an urgency to this."

“A lot of people in Cork with be familiar with the dark, dated and overcrowded outpatients waiting areas in CUH,” he said.

“PWC project managers supported me to lead a piece of work which will ensure that by late spring of 2024, patients will be seen in a new state-of-the-art offsite outpatient centre on the Curraheen Road. More patients than ever will be seen quickly in the new facility.”

Among less visible changes are closer links to community services, to ensure patients are discharged to the best place around the region.

Sinead Brosnan, head of speech and language therapy and health and social care professional lead said they are working to “dramatically improve our rehabilitation services across Cork”.

As he talks, Mr Donegan circles back again and again to capacity and to beds in particular, noting the deficit grows every year and could reach 288 beds by 2037.

“The plans we are putting in place, if successful, will address all of those needs within the next five to 10 years, but you’ll appreciate that is a sizeable piece of work,” he said.