Dáil Éireann debate -
Wednesday, 15 Dec 1993

Vol. 437 No. 3

Adjournment Debate. - Overcrowding at Dublin Hospital.

Miss Flaherty

I am pleased and surprised to have the opportunity to raise this issue with the Minister tonight, perhaps it is due to the late hour. This morning a constituent telephoned me in a state of deep concern with regard to her father who had been admitted to the Mater Hospital 48 hours before suffering from emphysema. He was placed on a couch during the night and on a bench during the day while awaiting treatment and because he was in casualty and not a ward he was not receiving regular meals. This man was highly distressed by being moved around. We all know that emphysema affects one's breathing and can be serious.

I would have satisfied myself by making particular inquiries in regard to this case had it not been for the fact that on a Sunday in the past fortnight I was contacted by another constituent who had been approached by hospital staff to take her 90 year old mother, who was suffering from cancer, out of the hospital on the Sunday night and bring her back on the Monday morning at 8 o'clock simply because of lack of space. This woman lived in a flat in Ballymun and had no transport. The nursing staff, who were excellent and who were trying to do their best, explained to me that on that weekend they had 30 patients in casualty whom they could not accommodate in the hospital and which required them to open a day ward. They had to clear the day ward on the Sunday night to get ready for Monday and were required to ask anyone who was barely fit to go home for the night.

This seems to indicate substantial pressure on the facilities. I realise there is the normal rise in admissions to hospitals at this time of the year and I gather the problem is equally severe in other hospitals, but perhaps not quite as severe as in the Mater. All of those who complain about the problem have the highest regard for the nursing and medical staff, who are trying to do their best, but the accommodation is simply not adequate to meet the needs at this time of the year.

Is the Minister happy with this situation and does he believe the hospitals in Dublin are adequately resourced to meet these demands? Does he propose to take any action to ensure that people will not have to anticipate this type of problem in the accident and emergency departments of our hospitals?

Mr. Howlin

I am aware of the pressures under which the accident and emergency service in the Mater Hospital and the other major Dublin hospitals must operate, particularly at this time of year.

I would like, first, to outline to the House the nature and scale of the service provided by the Dublin hospital accident and emergency departments. There are six hospitals involved, three on the north side of the city and three on the south. These are, on the north side, Beaumont, the Mater and James Connolly Memorial Hospital, Blanchardstown, and on the south side the Meath, St. James's and St. Vincent's Hospitals. Altogether there are some 300,000 attendances at the accident and emergency departments of these hospitals every year. Of these, some 65,000 attend the accident and emergency department of the Mater Hospital and in 1992 over 8,500 of those attending required admission to the hospital.

It must be understood that because of the nature of the work of hospital accident and emergency departments it is not possible to predict what their workload will be at any particular time. At all times, however, priority is accorded to those patients most in need of immediate medical attention.

The situation in relation to the accident and emergency departments is exacerbated at times through, for instance, major accidents or epidemics such as 'flu. At this time of year, as Deputies will be aware, there is usually an increase in the number of people, many of them elderly, suffering from respiratory and other complaints and this results in increased pressure on the facilities, both in the accident and emergency departments and the medical wards of hospitals. A difficulty has arisen from time to time, not primarily in relation to the availability of acute hospital beds, but in that there have been insufficient step-down facilities for patients in need of a lower level of care. Therefore, such patients have had to be kept in hospital, even though they are no longer in need of care at the level provided in an acute hospital setting.

I understand that at present all of the Dublin accident and emergency hospitals are extremely busy. In the case of the Mater Hospital, an influx of seriously ill patients, some of them elderly, coupled with a number of road traffic accident cases, has meant that it has not been possible to provide beds immediately for all patients in need of admission. Every effort is being made to deal with this situation through the discharge of patients so as to release beds for further admissions. The position regarding the accident and emergency departments is monitored by my Department on an ongoing basis. In this regard, shortly after coming into office at the beginning of this year, I approved a sum of £500,000 to provide an immediate response to a problem regarding a shortage of step-down accommodation of this type.

I am glad to announce that following further discussions in recent weeks, I have allocated an additional £250,000 to the Eastern Health Board to enable the pressures on the accident and emergency departments to be eased further. This is being achieved through the placing of more than 100 patients from the six accident and emergency hospitals in Dublin, who are no longer in need of acute hospital care, in step-down accommodation more appropriate to their condition.

To date, the Eastern Health Board has placed 86 of these patients in step-down accommodation and a further 23 patients will be placed in the coming days. This action will, I am confident, greatly relieve the seasonal pressures on the hospitals.

I would like to assure the House of my continuing concern that the accident and emergency hospitals in Dublin are enabled to respond effectively to the demands placed upon them and that I will continue to monitor the situation with a view to taking further action if required.

The Dáil adjourned at 12.50 a.m. on 16 December 1993 until 10.30 a.m.