Beverley Flynn (Mayo, Independent)

I, too, welcome the opportunity to speak on the problems with accident and emergency services. When the Tánaiste outlined her ten-point plan last year, I stated it could not work throughout the country, particularly in the west. The majority of points in the plan were geared towards problems in hospitals in Dublin, yet the problem in accident and emergency units was and is countrywide. I am very conscious of this in County Mayo. Almost four weeks ago, there were 30 people on trolleys in Mayo General Hospital, which is the highest ever number recorded in that hospital.

I listened very carefully to the Tánaiste's contribution. In outlining what has been achieved to date under her plan, she referred to the minor injuries unit. This is inapplicable to Mayo General Hospital in that it did not benefit from it. The Tánaiste also referred to the MRI scanner for Beaumont Hospital. I am sure it is very welcome in that hospital but it does not help Mayo General Hospital. She referred to the acute medical assessment units but Mayo General Hospital has not benefited from these either.

The Minister mentioned contract beds, which is a real bone of contention for me. No contract beds, either medium or long-term, have been allocated to County Mayo and Mayo General Hospital. Three times in recent weeks people were sent from Mayo General Hospital to beds in nursing homes, without budget, as an emergency response to the problem in the accident and emergency unit. I mentioned this problem to Professor Drumm at the meeting of the Oireachtas Joint Committee on Health and Children and it needs to be addressed as a priority.

Last year the Tánaiste announced 500 home-care packages under the plan, of which five were allocated to Mayo General Hospital. The home-care package is an excellent scheme. How could this option be mentioned to an elderly person when only five are available in a county with 110,000 people, of whom 12% are over 65? In reality nobody is getting it and it is unfair to offer such an attractive option. In rural communities people are much more inclined to want to stay in their own home and community because very often nursing homes and hospitals necessitate travelling in excess of 50 miles across very bad roads. When I brought this issue to the attention of Professor Drumm I was delighted that he expressed horror and surprise at Mayo having got only five places. He reassured me that between 2,000 and 3,000 home-care packages will be announced and we will get a greater percentage of those in the west. I ask that the matter be dealt with as an absolute priority.

The out-of-hours GP service operates only in the east of County Mayo, which means that people on the west side need to go to accident and emergency units at all hours of the day and night. The one positive aspect of the plan is the direct GP access to diagnostic equipment, which is working quite well in Mayo General Hospital and has ensured that many more people do not need to go to accident and emergency units.

However, this is not just a Dublin problem. I do not always want to talk about Dublin versus the west. In reality we need a nationwide response. In this regard I congratulate Professor Drumm on a new initiative which could be successful in dealing with the accident and emergency problems. I refer to a new pilot scheme to apply to 15 accident and emergency units throughout the country, of which, I am pleased to say, Mayo General Hospital is one. For a change the HSE is now asking the local hospitals to give the solutions to the problem in their areas. It recognises for the first time that every area has different problems. It might be beds and capacity in one area and something completely different in another. Our hospital is seeking 20 contract beds, which is not an unrealistic request. We are seeking an increase in the home-care packages.

One of the step-down facilities catering for elderly people in County Mayo is the Sacred Heart Hospital in Castlebar. In the past five years the capacity of that hospital has been reduced from 300 to 160. Phase 2 of Mayo General Hospital, which cost €40 million — I signed the contract documents when I was chairperson of the Western Health Board — increased the capacity of the hospital by 100 beds. During the same time, a step-down facility has reduced its capacity by 140 beds, which is crazy. Part of the local scheme to address the problem in Mayo will be to increase the capacity of the Sacred Heart Hospital. Another aspect will be to carry out tests locally that are currently being carried out in Galway. People are staying in beds for three or four nights when they only need to stay for one night. At the Oireachtas Joint Committee on Health and Children, Professor Drumm accepted that this was a critical component in dealing with the accident and emergency problem.

I wish to refer to the performance appraisal indicators. Last year my local hospital received a penalty of €1.2 million based on the performance indicators adjudicated by the HSE, which deemed the hospital to be inefficient. I made the point that the hospital was not inefficient. It had a problem relating to the new orthopaedic unit which had been set up but was not operational. The indicators examined, the inpatient numbers in the hospital, gave an inaccurate reading for Mayo General Hospital and as a result we suffered this penalty of €1.2 million. How can a hospital be expected to improve its efficiency when that level of penalty is levied against it? When the new performance appraisal indicators are determined by the HSE, it should consider all hospital activity, not just inpatient activity. It must also consider outpatient activity, particularly for the smaller hospitals. Otherwise these performance indicators will favour the bigger hospitals and the smaller hospitals will suffer as a result. This was certainly the case last year with hospitals such as those in Letterkenny, Sligo and Mayo, which all suffered on the basis of the performance appraisal that took place. That will not be acceptable in future.

Between January and June last year, Mayo General Hospital had an average of between ten and 15 people on trolleys, reaching a high of 30 three and a half weeks ago and on occasions a low of absolutely nobody. Between June and December the average was between four and eight people on trolleys, which indicates a seasonal aspect to the problem. The accident and emergency unit in Mayo General Hospital has seen a year-on-year increase of 5% in the past three years. The number of people attending accident and emergency units in the county has increased substantially. While I was surprised this is not the case throughout the country, I believe that while the numbers of people attending accident and emergency units has declined, the number of admissions to hospitals has increased. We need to carefully consider this trend, which is obviously a direct result of the age profile of our population. In ten years' time 16% of our people will be more than 65 and the problem will continue to increase. While we may see a further reduction in the numbers in hospitals, particularly if we improve the out-of-hours GP services, the number of admissions will be greater.

I am seriously concerned about the mechanism for admitting a person through an accident and emergency unit. The Oireachtas Joint Committee on Health and Children was informed that up to five different people could attend to a patient presenting at an accident and emergency unit. The person deciding whether to admit a patient may ultimately be a junior doctor. In my county recently an elderly man, who had been admitted to hospital through the accident and emergency unit, was discharged from hospital at 2 a.m. and sent home in a taxi, which arrived at a rural part of the county at 4 a.m. He was readmitted the following day in an ambulance. What kind of decision is that? Surely a mechanism should exist to prevent an elderly person from being discharged after a certain time in the evening. This sad case in particular was outrageous.

I listened to Deputy Gregory talking about accident and emergency consultants at 6 a.m. Where are they? There are no accident and emergency consultants on duty at 6 a.m. In my county the service operates from 9 a.m. to 5 p.m. Today I asked my local hospital manager whether having an additional accident and emergency consultant would improve the situation. There is no point in recruiting an additional accident and emergency consultant if he will only work between 9 a.m. and 5 p.m. We need 24-hour cover and not to have junior doctors making the decision to admit patients. It is ludicrous to have a chain of events whereby a person is admitted, seen by a nurse, a junior doctor and a consultant, who should make the decision, and finally a few hours later seen by another junior doctor who second-guesses what the consultant should have decided a number of hours previously. A junior doctor under that type of pressure will err on the side of caution and will admit rather than discharge. Many of the problems in our accident and emergency units arise as a direct result of that process.

I am particularly concerned about this matter. For the first time I believe there will be a regional focus to the problem. However, only time will tell. The pilot scheme has not yet started and I urge the Government to put the resources into the regions as well as into the city of Dublin.

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