Dáil Éireann díospóireacht -
Thursday, 7 Mar 2002

Vol. 550 No. 2

Adjournment Debate. - Accident and Emergency Services.

Mr. Deenihan:

More than 30,000 people are treated every year in the accident and emergency department at Tralee hospital. This figure amounts to about 50 patients every day. Today ten patients were accommodated on trolleys in the corridor adjacent to the unit. There are only four cubicles in the unit. There are toilet facilities for men and women, but no toilet facilities for people in wheelchairs. It is often the case that people who attend the unit are incapacitated, perhaps due to injuries sustained in car accidents or other circumstances. There are no toilet facilities for such people. The trolleys in the unit are old and antiquated and need to be replaced. There are also problems with bed linen. Overall the situation is unacceptable.

Some of those admitted to the hospital have a referral note from their GPs. These patients expect to be treated properly and to be provided with a bed immediately. Such people have to be admitted through the accident and emergency unit and are left waiting on trolleys to be seen by a junior doctor or a nurse. In some cases these people go home because they feel degraded by being left on a trolley for hours or an entire day with people passing by. This can lead to serious consequences in some cases.

There is no accident and emergency consultant in the department. A part-time, temporary Australian consultant will be appointed on 18 March for three months and will be present in the hospital for three and a half days per week. He will spend the other day in Cork University Hospital which already has three consultants. Castlebar hospital, which deals with a similar number of people to Tralee General Hospital, has a full-time consultant. The same is the case in Sligo hospital which deals with about 22,000 people. Tullamore hospital deals with 25,000 people and has a full-time consultant, yet Tralee hospital does not have such a consultant.

Tralee has suffered considerably due to the fact that it is tied to Cork in the Southern Health Board region. Kerry is on the hind tit of services in the health board region whether regarding orthodontic or cancer services, care of the elderly or whatever. That is not right and the fact that we are lumped in with Cork has not been good for Kerry.

There are nine nurses and junior doctors in the accident and emergency department at Tralee hospital. These people are overworked and under considerable pressure. They work in pressurised conditions and are very stressed. These are great people who do their best, but they are becoming disillusioned and frustrated and they need help. The staff feel for themselves, but also for their patients.

It is time the health board and the Minister addressed the situation at Tralee General Hospital. The unit has no consultant, registrar or senior medical staff. The Minister visited the hospital recently and made an announcement for which he received a standing ovation. However, after he left nurses and others at the hospital asked why he had received such an ovation in light of the fact that he had given nothing. It is time something was done for Tralee General Hospital. After five years we expect some announcement.

Dr. Moffatt:

I thank the Deputy for raising this issue. He will be aware that responsibility for the provision of accident and emergency services at Tralee General Hospital rests with the Southern Health Board in the first instance. Tralee General Hospital is the second largest acute hospital in the Southern Health Board region. The hospital provides acute general hospital services to the population of County Kerry and to a proportion of the population of west Limerick and north Cork. The accident and emergency department provides medical treatment for cases on a 24 hour, seven days a week basis and caters for up to 30,000 patients each year.

According to the Southern Health Board the weekend of 22 to 25 February was particularly busy in the accident and emergency department at Tralee General Hospital. On the night of Saturday, 23 February, a number of patients were detained in the department awaiting transfer to beds on the medical floor at Tralee General Hospital. These patients were facilitated on Sunday and over the period from Sunday to Monday night 11 patients were detained in the department. Of these 11 patients, one was transferred to Cork University Hospital on Monday morning and a second was discharged at 8 a.m. The remaining nine patients were all admitted on Monday 25 February. In total, 253 patients attended the A&E department between 9 a.m. on Friday, 22 February and midnight on Monday, 25 February. Of that number, 69 patients were admitted to Tralee General Hospital via the A&E department. All medical admissions via the A&E department on the following Tuesday and Wednesday were accommodated in the hospital. The Deputy will appreciate that decisions on admissions of patients through A&E departments are taken by the relevant casualty officers on duty in the hospital. A new consultant in emergency medicine is due to take up duty with the Southern Health Board shortly. This consultant will have a shared occasional commitment between Cork and Tralee. This new appointment, together with appropriate support staff, will have a positive impact on the provision of services in the A&E department of Tralee General Hospital.

The Department of Health and Children, in conjunction with the Department of Finance and in consultation with the social partners, recently conducted a comprehensive review of acute hospital bed capacity needs. On foot of that review, entitled Acute Hospital Bed Capacity – A National Review, which was published in early January, the Government decided to provide an additional 3,000 beds in acute hospitals over the next ten years. On 16 January 2002, the Minister for Health and Children announced a €65 million investment package in the current year for the commissioning of 709 of these 3,000 beds in acute hospitals and these will come on stream before the end of this year. In Tralee General Hospital an additional 16 beds are included in this investment package. This represents an additional investment for the hospital of €1.7 million in both capital and revenue costs.

The 16 new beds at Tralee General Hospital will be allocated as follows: six additional beds for gynaecological services, five beds for the day surgery unit, four additional beds in the medical assessment unit and one additional bed in the intensive care unit. The increase in bed capacity at the hospital will help to continue the tremendous work which has been done over the last number of years in reducing public inpatient waiting lists at the hospital.

The development of A&E services nationally will be informed by a major review incorporating the operation and staffing of A&E services and departments with a view to improving the provision of patient care. The review is being undertaken by Comhairle na nOspidéal and has involved extensive consultation with the Eastern Regional Health Authority, the health boards, relevant voluntary hospitals, appropriate professional bodies and other interested parties. It has also involved an extensive examination of literature regarding A&E services in Britain, Europe, the US, Canada and Australia. This work is at an advanced stage and the report is due in the near future.

The measures I have outlined and the additional investment in Tralee General Hospital are clear evidence of this Government's commitment to the further development of acute hospital facilities for the people of Kerry and throughout the country. I agree with the Deputy, however, that a full-time accident and emergency physician is needed in the hospital.