Dáil Éireann díospóireacht -
Thursday, 5 Mar 2015

Vol. 870 No. 3

Topical Issue Debate (Resumed)

Deputy Derek Nolan

I thank the Minister for Health for his response. I am trying to read between the lines.

I welcome some of the positive investment in Galway University Hospital. It is the case that construction on a new 75 bed ward block will start next year which will have a big effect on the number of people on trolleys. However, we are still left with a completely inadequate, underdeveloped and unsafe emergency department. The Minister said he asked the HSE to ensure some funding is available. The term "some funding" is vague. Will some funding allow what I have asked to happen to take place? Will it allow the HSE in Galway to engage people to design an emergency department, go to planning and move it along the line? The capital plan is a number of years away. There is no point being in a capital plan if we do not have a project ready to go.

Will the Minister be clear with me, because this is extremely important to me, as a public representative, and to the people of Galway? Will he ensure the funding, for which he has asked the HSE, will allow the emergency department to be redesigned, to go to planning and to be brought along to a stage where it can be capital-funded in the future? There is no point applying some funding, which only goes halfway. We are either going to do something right or not do it at all. Will the Minister clarify that, because it is particularly important? As he will have seen, the situation is getting worse as time goes on.

Deputy Leo Varadkar

I do not necessarily want to make promises that I might not be able to deliver but, I suppose, reading between the lines what I am saying is that I acknowledge there is a serious problem with overcrowding in the emergency department in UHG, about which I want to do something. It is better than it was in 2011 but it is starting to get worse again. It is certainly worse than it was this time last year. It is a very busy emergency department with 57,000 attendances in 2006, increasing to 65,000 attendances last year. Daily attendances can be as high as 258 patients so it is certainly one of the busiest departments in the country.

Much development is under way in UHG. It is certainly not being neglected but is being developed and improved all the time as a major regional centre and university teaching hospital at the heart of the Saolta group. What I am indicating is that I want to have it included in the next capital plan, if funding can be secured for it. I am indicating to the HSE to see if it can find funding within its existing budget to begin planning and design for a new emergency department as soon as possible because it takes time to design, plan, get planning permission and so on. If funding is available in the post-2016 envelope, I would like us to be able to prioritise that project.

Hospital Accommodation Provision

Deputy Bernard J. Durkan

I thank the Ceann Comhairle's office for allowing me to raise this issue and I especially thank the Minister for coming to the House to reply. I raise this issue for a number of reasons. I do not propose to name the patient concerned, even though that patient has already been named in the media. There are serious issues which need to be dealt with. The more we find that we must respond to each issue raised in the public arena, the worse the reputation of all of us seems to get.

There are three aspects to this issue, the first of which is patient health, safety and well-being. The second aspect is damage to the hospital's reputation and the third aspect is the remedy. In a previous incarnation, I spent many years on the visiting committee of Naas hospital, so I have a reasonable idea of what can and cannot be done.

The hospital has had 100% bed occupancy for the past number of weeks. If anything happened which over-extended that further, there would be an overspill. This can be resolved in the case of Naas hospital. There are at least two decommissioned wards which do not meet health and safety standards and fire prevention requirements. They could be recommissioned, if necessary.

The Minister is a caring and compassionate man and is mindful of the need to address the concerns of patients. We should look at the availability of this space with a view to bringing it up to standard, which could be done at a reasonable cost, and making it available so that overspill in the future can be dealt with and that we do not have a situation where the unfortunate patient must remain on a trolley for three days awaiting attention. It is far better to get ahead of a problem and to resolve it in a meaning way before it becomes a potential tragedy.

Every patient in hospital feels vulnerable. People going into a hospital at any age are dependent on their surroundings and the care and attention they get. Naas hospital has a very dedicated staff who have done tremendous work in very trying and testing circumstances which become more trying and testing as time goes on. However, in order to preserve and protect their reputations, that of the hospital and the health service, it is important we focus on how best to deal with the problem.

While I do not claim to be an expert in this area, I know a little bit about it, as I am sure the Acting Chairman, Deputy Wall, does. The situation I see emerging needs to be dealt with as a matter of urgency because if we do not deal with it now, something may happen which could be hugely damaging to everybody's reputations, including hospital services in general, and it could put patients at risk. There is no need for it to happen because we have, in theory, a good service and dedicated staff. We need to allay the fears and concerns of patients who might find themselves in hospital awaiting attention. Older people, in particular, are very vulnerable and they expect things to happen more quickly than would ordinarily be the case because of their vulnerable situation and their age.

I thank the Minister for coming to the House to reply to this issue, about which I know he is concerned. I deliberately did not name the patient because this is an issue we should not have to visit again and again.

Deputy Leo Varadkar

I thank Deputy Durkan for raising this issue and giving me an opportunity to outline the current position on this matter. As the House will know, I cannot comment on individual cases for reasons of privacy and confidentiality. Moreover, I do not have access to any individual's patient files or patient information, so I cannot speak authoritatively on any individual case. I appreciate that the Deputy did not name any individual in the House. However, I can address the matter in general.

I am always very disappointed to hear about anyone who has had a bad experience of our health service, although most people tell me their experience is very good once they get access to the hospital. I also want to make it very clear to the House that I consider long trolley waits of more than nine hours to be indefensible. That is why the reduction of emergency department overcrowding and the provision of safe, quality care are key priority issues for the Government and me.

The Government acknowledges the difficulties that the recent surge in emergency department activity is causing for patients, families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances, in emergency departments and elsewhere in our hospitals.

Actions currently being taken to address emergency department overcrowding include accessing all suitable non-acute accommodation to the maximum extent possible to allow those who have been clinically discharged to leave acute hospitals; the provision of 900 additional transitional care beds in nursing homes, 500 in January and an additional 400 in February; 50 short stay public beds have been opened across the country for a three-month period; up to 300 overflow beds have been opened in acute hospitals; 400 additional home care packages have been provided; 300 additional fair deal places have been provided; and the community intervention teams, where nurses go into nursing homes and homes to give patients IVs, have been extended to Kildare this year.

Arrangements are in place in the HSE to allow for recruitment of staff where it has been established that there is an urgent service requirement and this year the number of general nurses directly employed by the public health service will increase by at least 500. Mental health nursing will be in addition to that.

I am happy to advise the Deputy that 39 posts have been agreed for Naas and recruitment of nursing staff is under way. It is also important to point out that individual hospitals also need to take local actions to improve patient flow and reduce length of stay, so patients who are admitted get their tests and treatment more quickly and get home quicker, thus freeing up beds.

As the Deputy will be aware, I convened an emergency department task force in December 2014 to provide focus and momentum in dealing with the challenges presented by the current trolley waits and emergency department overcrowding.

I am determined that an action plan be completed as soon as possible, taking the views of the task force into account, and then made operational without delay. The task force is due to meet again next Monday, 9 March.

I reassure the Deputy that we are working hard to find workable solutions to the management of emergency care, with optimum patient care and patient safety at all times remaining a Government priority. I will have the issue of the two decommissioned wards in Naas examined. If it is possible to reinstate them and have them opened as overflow wards, it would make sense, but I would need to have that examined in terms of capital costs, HIQA requirements and the ability to have them staffed. I would also like to recognise Portlaoise in particular, which helped out Naas during the week when Naas became very overcrowded. I appreciate that local solutions may be needed in Naas. Most overcrowding in our hospitals is caused by delayed discharges, people awaiting nursing home places and homecare packages. That is not a problem in Naas, which does not have a high number of delayed discharges. It seems that the overriding issue in Naas is the significant increase in population in that county in recent years. We have not been able to invest adequately in providing additional acute beds for the hospital in the past ten years because of the economic crash but perhaps we can right that in the next couple of years.

Deputy Bernard J. Durkan

I thank the Minister for his comprehensive reply, which clearly indicates his understanding of the situation. In particular, I compliment him on his recognition of the possibility of examining the decommissioned wards with a view to bringing them on stream for emergencies of this nature. I also wish to point out that the Acting Chair and I, and other elected Members, would be delighted to escort the Minister if he should wish to visit Naas hospital in the near future, where he can see for himself the situation as far as the patients are concerned in respect of overcrowding. It would also enable him to consider what is required in the future so that no one else has to raise an individual case in this House.

The reputation of Naas hospital is excellent and the staff there are very dedicated. All staff members show commitment that is above and beyond the call of duty. I have been visiting, as has the Acting Chair, at times when the place was so over-crowded that it was virtually impossible to know who was likely to be doing what and where at any time because staff were reaching over other patients and colleagues to attend on patients. It would be of great benefit, in terms of reassurance to the hospital itself and patients who will be referred to the hospital in the future, if it were possible for the Minister to make that visit, because he would see the situation for himself. Given his background in the medical profession, he would recognise that the situation can be resolved effectively in the short term and without a great deal of expense.

Deputy Leo Varadkar

I thank Deputy Durkan for the invitation. I would like to visit Naas and intend to do so in the coming months. It is a case of trying to fit it into the diary between everything else I am asked to do in addition to my commitments in the Dáil and Seanad. It is a visit I intend to make whenever it can be scheduled.

There are developments happening at the hospital. The phase 3C development is now being progressed. I am not sure whether planning permission has been awarded yet, but subject to its award the project will go ahead and there will be a two-storey building, which will provide for further development of the hospital, with endoscopy and day services. It is an important hospital in a county with a rapidly expanding population, to which the Government is very committed. If there is a workable solution around those two wards I will have it examined and see if it can provide us with a solution to those problems.

The Dáil adjourned at 5.35 p.m. until 10 a.m. on Friday, 6 March 2015.