Stephen Donnelly weighs into row over HSE policy on discharging elderly

Minister for Health Stephen Donnelly said: “We will try to accommodate patient preferences and patient wishes in terms of discharge to the greatest extent possible. But if we’ve got an 80-year-old on a trolley downstairs on a corridor, they need that bed.” 

The Health Minister has said it is “disappointing” to hear a new HSE policy on discharging elderly patients being criticised as ageist by a top gerontologist.

His intervention comes amid division among medical and social care communities over advice for hospitals that elderly patients who need a nursing home bed after their treatment will be offered the first available bed, even if this is not their first choice.

Stephen Donnelly insisted on Tuesday that the policy is about helping vulnerable patients waiting on hospital corridors due to overcrowding. Up to 160 hospital beds could be freed up in this way, the Department of Health has estimated.

“This is about patient safety," Mr Donnelly said.

“We will try to accommodate patient preferences and patient wishes in terms of discharge to the greatest extent possible. But if we’ve got an 80-year-old on a trolley downstairs on a corridor, they need that bed.” 

He rejected concerns older patients might be warehoused in inappropriate locations, telling the Irish Examiner: “No-one is suggesting that.

“What we said was once there is a clinically appropriate place for the patient to go then that needs to happen if you have a patient on a trolley downstairs.” 

Professor Des O’Neill, Irish Society of Physicians in Geriatric Medicine chair, has raised concerns around limited access to rehabilitation, describing the policy as “ageist”.

Mr Donnelly said: “I think it was a really, really disappointing comment to hear, I really do.”  Anyone waiting on homecare, for example, would not be discharged to a nursing home against their will, a spokesman added.

However, the minister said it is so far unclear what hospitals can do if offers are refused. “We are hoping that people will appreciate the reason why we are asking them to vacate the bed,” he said. 

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“At the moment there is good faith and encouragement.”  In a “small number of hospitals” this issue has already arisen, he said.

Irish Association of Emergency Medicine spokesman, Conor Deasy, has described the policy as “the least worst option”.

Mr Donnelly said hospitals have been supportive in general, noting a French study which found significant increased risk of dying from spending one night on a trolley in an ED.

Hospital data for Tuesday shows 457 patients waiting to be discharged. However, individual site data indicates various reasons behind this.

In the UL Hospital Group, out of nine delayed patients one was waiting for a nursing home. In Cork University Hospital, nine of 42 delayed patients were waiting for nursing homes.

Mr Donnelly also said better awareness of local injury units could help reduce emergency department attendances.

“Ennis Injury Unit is brilliant, their turnaround time for patients is really quick. They can do an awful lot of what people go into emergency departments for.

“And what they said to me is they know there are people literally driving by Ennis hospital, going to Limerick, waiting in Limerick for a long time to be seen and all they needed to do was turn right into Ennis hospital.”