Jimmy Deenihan (Kerry North, Fine Gael)

I raised this matter on the Adjournment on 24 November 2004. Back then, Dr. Sean O'Rourke was the consultant at the accident and emergency unit of Kerry General Hospital. He had major reservations about staffing in the hospital, and he eventually moved on. I refer to a letter from Dr. Pat Naidoo, a locum consultant in emergency medicine at Kerry General Hospital - who has also since moved on - to Pat Healy, regional director of operations at HSE South. He states:

There are some serious concerns regarding the staffing levels and the safety of emergency care provided at the Kerry General Hospital. In view of the Minister of Health's announcement in early 2004 to improve patients' experiences of emergency services and the more recent "Review of Emergency Departments and Pre-hospital Emergency Care in Cork and Kerry" published by the HSE South in which Prof. John Higgins (Director of Reconfiguration) said "these recommendations are totally focused on the needs of our patients in emergency situations, the Kerry General Hospital will retain its full Emergency Department and will be reorganised to best serve Kerry patients at their time of need and have access to better, safer emergency care", it is time that HSE South Board [reviewed] the staffing levels of the Emergency Department and the service provided.

The Emergency Department in Kerry General Hospital is experiencing an uncomfortable growth period of presentations and many of these presentations are becoming increasingly more complex. The population in this area is ageing, societal expectation of health care is rising and out of hours presentations are becoming more the "norm". These factors combined with staffing in Kerry General Hospital Emergency Department with only junior doctors poses a serious threat to the people of Kerry having access to better, safer emergency care.

The Emergency Department is the "front door" or point of entry of the Health Service and as such is open to all comers ... that is its strength in terms of training junior doctors, but it is also its weakness in terms of staffing needs. Managed well, a strong Emergency Department serves the region well ... with unnecessary admissions, prospective inpatients are worked up to save inpatient time, [and] procedures can be performed to avoid after hours theatre use saving time and resources.

While acknowledging the extraordinary dedication of nurses and doctors who are making every effort to keep the Department working, this service is now unable to cope with the demands of the increasing throughput as patients' safety and quality of care is being compromised. This results in reduced patient satisfaction, poorer processing of patients for admission and discharge, missed injuries, high rate of re-presenting, deferring care therefore threatening patient safety, patients leaving the department without being seen, overcrowding and congestion and finally exposure, intimidation and verbal abuse by patients.

The Emergency Department in Kerry General Hospital is without doubt the most understaffed department in the country. ... Comparatively Tullamore, Letterkenny and Mullingar who see fewer numbers of patients are better staffed (24,000 to 28,000 presentations compared to 34,000 at Kerry General Hospital).

The present staffing levels include a Locum Emergency Consultant [and] six Senior House Officers ... Five of these Senior House Officers work on a rota and there are no replacements by Locums when either of them are sick or on holidays. The result is that the department can be staffed by a single junior House [Officer] on various shifts during heightened activity translating to fatigue, stress and adverse outcomes for the patients. The patients are treated and discharged unchecked by a senior doctor. Junior doctors are being left unsupervised to deal with difficult and challenging patients and cannot reasonably be expected to deliver the same care that a highly trained and experienced doctor can deliver.

In conclusion, there is a major problem in Tralee. The problem is partly the present accommodation and accident and emergency department, but more especially staffing. I raised this matter five years ago, but the situation has not improved since. It is not fair on the people of Kerry that we should have to accept such conditions. I acknowledge the work of the nurses, the junior doctors and the locum consultant and their commitment and dedication to ensuring the service is maintained. However, these people are becoming frustrated. As I pointed out earlier, the original consultant, Dr. Sean O'Rourke, left, as did Dr. Pat Naidoo, who is now in a Dublin hospital. The current consultant is under considerable pressure due to staffing levels. It is just not acceptable.

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