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Hospital Funding

Dáil Éireann Debate, Tuesday - 3 November 2020

Tuesday, 3 November 2020

Questions (92)

Pádraig MacLochlainn

Question:

92. Deputy Pádraig Mac Lochlainn asked the Minister for Health if his attention has been drawn to the fact that Letterkenny University Hospital had the sixth highest number of inpatients in hospitals across the State in 2019 but only received the 13th highest budget allocation of the hospitals across the State, just 36% of the highest budget allocation to a hospital, the 14th highest allocation of consultants in hospitals and the 12th highest allocation of nurses and midwives in hospitals; and if he will make a statement on the matter. [33172/20]

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Oral answers (6 contributions)

Letterkenny University Hospital is the sixth largest hospital in the State yet it only has the 13th largest budget allocation and the 13th to 14th greatest number of nurses and doctors. That is discrimination. I wish to engage with the Minister on that now.

Letterkenny University Hospital, LUH, is a model 3 hospital, operating as part of the Saolta University Health Care Group. There were 24,141 inpatients in LUH in 2019 and 9,731 inpatients in the first two quarters of this year. The budget allocation for Letterkenny University Hospital is €145.9 million. This is the 12th highest annual budget allocation for a public hospital in 2020. The Deputy will be happy to know that it is also the second highest budget for a model 3 hospital anywhere in Ireland. Data provided by the HSE on staffing levels indicate that 1,745 whole-time equivalent staff are working in Letterkenny University Hospital, which is the fourth highest number in a model 3 hospital nationally.

There have been significant investments in services in the hospital in recent years. These include the completion of the radiology rebuild, including a second CT and interventional radiology suite, and of a 20-bed short-stay ward; the construction of two new wards, Medical 6 and Medical 7; the commissioning of a new mammography machine in the symptomatic breast disease unit; and the appointment of consultants in paediatrics, gastroenterology and urology as well as advanced nurse practitioners. The HSE also advises that a new acute stroke unit will commence operation before the end of the year. I know this news will be very welcome to the local community.

Plans for further investment in Letterkenny University Hospital in 2021 include plans for the commissioning of a new maternity theatre, the commissioning of a second CT scanner, the expansion of the colposcopy service with additional clinic rooms, and the replacement of the haematology oncology day ward aseptic unit. I hope the Deputy agrees that the extent of recent and upcoming developments illustrates the Government's commitment to Letterkenny University Hospital and to patients in the north west.

No, I absolutely do not accept that. This is the first chance the Minister and I have had for an engagement about Letterkenny University Hospital but I assure him it will be the first of many. What the Minister's colleagues who wrote this response did not tell him is that the 24,141 inpatients seen in the hospital last year make it the sixth largest hospital in the State. They have admitted that it has the 12th highest budget. We have the sixth greatest number of inpatients but only the 12th largest budget. I love that somebody decided to change the hospital's name from Letterkenny General Hospital to Letterkenny University Hospital. It was given a big fancy name but, whenever anyone is challenged about the budget allocation given to it, we are told that it is a model 3 hospital and that it is doing great for a model 3. It is a university hospital and part of the Saolta University Health Care Group. I will provide the Minister with additional figures after tonight that show the hospital is heavily discriminated against, which cannot be allowed to continue.

I took a close look at this when I was going over the Deputy's question yesterday. I asked the very same question, which is if the hospital has the sixth highest level of inpatients but the 12th highest budget, what is the rationale? Is it that patients are being short-changed? The simple answer is "No".

The Deputy knows well that in comparing budgets for hospitals, we must look at many different elements. For example, we must consider case mix, complexity, average length of stay and many other factors. There is no easy way to do that but we can use the proxy of model 3 versus model 4. It is not a perfect comparison but it gives a reasonable adjustment to the complexity of cases. If the Deputy is of the view that it should be a level 4 hospital, I am happy to have that conversation. Doing a proxy for case mix adjusting, we can see the hospital has the second-highest budget for that level of hospital. That goes a long way to explaining the discrepancy pointed out by the Deputy.

Nobody in Donegal would argue that Letterkenny University Hospital should get the same allocation per inpatient as the likes of Beaumont, the Mater, St. James's or University Hospital Galway. That is accepted. Let us look at one comparison. In Letterkenny we had more inpatients in 2019 than St. James's Hospital, with Letterkenny having the sixth largest number and St. James's having the seventh largest number. Look at the budgets, with Letterkenny having €145.237 million and St. James's having €396 million. That is almost three times the budget of Letterkenny, despite having fewer inpatients. That cannot be explained other than to be labelled as discrimination. I can provide the Minister with the statistics. I assure him that when he looks at them, he will have to admit that this must change.

I thank the Deputy. We both know St. James's and nearly every other hospital are different. The work going on at St. James's per patient is highly complex and really expensive in all the ways we know. The right comparison would be activity-based costing. I am more than happy to discuss with the Deputy how much Letterkenny hospital is getting for the procedures it performs and the service it provides. Is it being short-changed, for example, and is it getting less money for a given procedure? That would be a concern and it should not be the case. Rather than comparing Letterkenny with highly specialised centres like St. James's, we could look at the volume of known procedures, and if there is a discrepancy, I would be more than happy to take a look with the Deputy. That is definitely something we could look at rectifying.

Sitting suspended at 9.13 p.m. and resumed at 9.33 p.m.
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