The situation at University College Hospital Galway is critical for patients and the nurses and doctors who work there. It is critical for each member of the community of 355,800 who live in the area served by this hospital and for the 30,000 tourists who swell the local population throughout the year.
This hospital was built in the mid-1950s and despite the huge increase in population in the region since, no major improvements or additions have been undertaken. Some interim measures were undertaken and others are planned, but the major development plan submitted to the Department of Health in July 1982 has never been approved by any Minister for Health since.
To illustrate the enormity of the problem at University College Hospital Galway, I wish to give some relevant facts to the House. In 1971 there were 16,900 in-patients, which increased to 27,138 in 1994. Clinic attendances in 1971 totalled 32,000 which increased to 75,500 in 1994. Accident and emergency attendances in 1971 totalled 24,500, which increased to 45,000 in 1994. It must also be acknowledged that the western region served by this hospital has the highest dependency ratio in the country. Some 28 per cent of the population is under 14 years of age, 14 per cent is over 65 years and 45.29 per cent of the population are medical card holders.
The hospital authorities have listed their problems to the Department under the headings overcrowding and underfunding. Over the past few months the situation has become even more acute with patients on trolleys for long hours each night. On one occasion since Christmas a patient was 26 hours in the accident and emergency department awaiting admission and up to 26 trolleys had been occupied overnight filling all the physical space, clogging up the corridors and the surrounding area. Congestion has been so bad that doctors have difficulty making their way through the many trolleys to examine and attend to their patients. The pain and suffering of patients has been most distressing with the added embarrasment of being left for hours without normal privacy and restful care.
The neglect of University College Hospital Galway by successive Ministers is a scandal. It is so bad that junior hospital doctors have taken industrial action by withdrawing their services, except in cases which are determined to be acute. They are now refusing to work because of their concern about practices in the accident and emergency section, particularly at night. Their principal concern is that there is no casualty officer on duty between 3 a.m. and 9 a.m. This workload falls on the surgical senior house officer who must cover wards, acute emergency admissions, theatre operations and the casualty department between 3 a.m. and 9 a.m. The junior house doctors believe this is an inherently dangerous practice as during these hours, when the surgical senior house officer is scrubbed in theatre operating and, therefore, unavailable, there is effectively no casualty officer available in an emergency. This dangerous window in cover occurs frequently in this busy hospital. They believe it is only a matter of time before an untoward and potentially fatal event occurs.
The Post-Graduate Medical and Dental Board recommends a rate of one doctor per 6,000 patients in an accident and emergency department. The ratio at University College Hospital Galway is one per 12,200. It is clear that the accident and emergency department is critically understaffed and this is further illustrated when one makes comparisons with other hospitals. Staffing levels should reflect the requirement of an accident and emergency department providing 24-hour care, as recommended by the Faculty of Accident and Emergency Medicine, the Post-Graduate Medical and Dental Board, the Royal College of Surgeons and practices in hospitals caring for similar patient throughput.
The minimum level of cover recommended by the FAEM for non-consultant hospital doctors in an accident and emergency department is one per 5,000 new patients per year. In Galway 41,000 new patients are seen. The PGMDB recommends one non-consultant hospital doctor per 6,000 patients seen in an accident and emergency department. The total number of patients seen in the accident and emergency department in Galway was 49,000 last year.
The necessary level of cover should be two registrars and eight senior house officers, excluding locum cover. At present in the accident and emergency department in Galway there is only one registrar and three senior house officers. The long waiting time suffered by patients in the accident and emergency department is directly related to the staffing levels which are inadequate at the best of times and which, according to hospital doctors, are very dangerous between 3 a.m. and 9 a.m.
The hospital doctors state that they have repeatedly pointed out this critically dangerous situation to hospital management through the IMO and the surgical consultants. The industrial action taken by the junior hospital doctors today reflects their frustration at what they consider to be an inadequate response to their complaints from the hospital management and the Department of Health and to their concerns for the health and welfare of their patients.
I hope that by raising this matter the Minister will intervene directly. His Department supplies funds for the hospital in Galway and he has control over what will happen. I hope he will approve the additional staff required to deal with this critical situation. I emphasise that the doctor-patient ratio in Galway is too low. In the Dublin hospitals the ratio is one doctor to 5,000 patients being seen, while in Galway it is one doctor to 12,000. This is unacceptable.
