Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
Link to this: Individually | In context

As the first two items are being taken together, the Deputies will have five minutes each to speak and the Minister of State will have ten minutes to reply.

Cecilia Keaveney (Donegal North East, Fianna Fail)
Link to this: Individually | In context

It is with great disappointment that I rise to speak about the need to provide extra beds at Letterkenny General Hospital. Although the matter was discussed when I was a member of the former North Eastern Health Board, neither side ever made progress for a number of reasons.

I would like to outline why it is sad that I have to raise this issue tonight. Letterkenny General Hospital is one of the best staffed and managed hospitals in the country. There is a great feeling among its staff and its patients receive great care and attention. The hospital's problems are not caused by the type of bed blocking we hear about in other parts of the country. The population of County Donegal is increasing significantly — Letterkenny's population has increased by 42%, for example — and the population of the region is aging.

I would like to discuss two issues which are causing great difficulty, the first of which is the state of Letterkenny General Hospital's accident and emergency department, where a new 12-bay medical assessment unit is needed. The Tánaiste said in January, in response to a question from me, that the unit has been identified as a priority for attention. Since then, she has announced a ten-point action plan, the progress of which will be implemented by the Health Service Executive. The executive told me in February that an application has been made and that it is awaiting approval to proceed to the design stage.

It is important for progress to be made. Accident and emergency patients are being moved into areas where day services should be carried out, as a consequence of the lack of space in the accident and emergency unit. Day services are under pressure — they cannot absorb the number of people currently availing of such services.

It is not right that just six bays are available in an accident and emergency department that is accessed by 30,000 patients each year. There is a need to develop the hospital's accident and emergency service because 8,000 of the 30,000 people who avail of it every year are deemed to be GP referrals. Therefore, 90% of them will be looking for an inpatient bed. The 8,000 patients who are sent to accident and emergency units by their GPs are causing problems for inpatient elective surgery and day services, through no fault of their own.

In recent months, hundreds of people have been prevented from accessing such services as a consequence of the problems I have mentioned, some for the third or fourth time. There were over 100 such cases in a single week recently. In some cases, a patient who has been prepared for his or her operation has been informed that it will not take place. It is an unacceptable set of circumstances for patients, staff and onlookers. The vast majority of people in County Donegal have either used the hospital directly or are related to somebody who has done so. Of the 100 day cases which were deferred over a single week recently, 20 were serious inpatient cases which were scheduled for elective surgery. As a doctor, the Ceann Comhairle knows the difficulties such postponements cause for everybody.

A proposal has been submitted to the Department of Health and Children for the construction of an additional two storeys, providing 70 additional beds, over the new accident and emergency department. That development is as important as the extension of the accident and emergency unit, but it falls under a separate application. It is important that both plans are considered.

There have been difficulties in deciding which of the two options to pursue. Some people who were on one side are now on the other side. It is important, however, that the entire project is advanced. I asked for some information about the first option, which is to transfer the acute psychiatric unit to St. Conal's Hospital and to convert the vacated psychiatric unit to provide a maximum of 30 beds for medical patients. That would cost approximately €10.5 million. The preferred option is to refurbish the acute psychiatric unit, while providing temporary accommodation, and to build the two additional floors over the proposed new accident and emergency unit. That option would cost approximately €16 million.

There is a timeframe of 18 months for the acute psychiatry service and a 36-month lead-in for the medical beds. It seems that no plans have been submitted yet. Therefore, I understand that the Tánaiste might be in a position to say that there are no plans. I would like the problems in Letterkenny General Hospital's accident and emergency department to be relieved immediately.

I am sorry that the Tánaiste is not here tonight to respond to the important issue being raised by Deputy Blaney and me. It affects every family in our constituency. I ask her to meet the Deputies who represent the area and those who are capable of moving this process forward. The HSE, the Department, the hospital and the different partners can blame each other, in one sense. I would like all those involved in progressing the two related but separate applications to come to a single table to thrash out the issues, take a decision and make progress on the basis of that decision. It is simply unacceptable that people who are ready for surgery have been denied it on three of four occasions.

The population of County Donegal is increasing and aging. A high-dependency unit needs to be opened. I appreciate that we are doing the best we can with the resources available to us. I hope a renal dialysis unit will open in October. We need the support and help of the Department of Health and Children and the Health Service Executive. They cannot be separated — they must work together, for example by talking to those involved at the coalface. They must decide that Letterkenny General Hospital is a priority. The hospital has not yet benefited from many services, such as BreastCheck. We are working in co-operation with those on the other side of the Border, such as the authorities at Altnagelvin Hospital. We need more beds and we need them now.

Niall Blaney (Donegal North East, IND-FF)
Link to this: Individually | In context

I join my colleague, Deputy Keaveney, in speaking about the concern caused by the serious problems faced by Letterkenny General Hospital, which is unable to handle the current level of patient intake. It would be an understatement to say that the circumstances at the hospital, which I visited on Monday, are chronic. I have never witnessed anything like it. The day-services ward has six beds and can, therefore, accommodate six patients, but on Monday it dealt with 16 seriously ill people who were waiting for elective surgery and other surgical procedures. Those present were male and female and ranged from children to pensioners. No washing or showering facilities of any kind were available. I spoke to a consultant, Dr. Keating, who was tearing her hair out.

I support Deputy Keaveney's comments. I would like to analyse this matter from three perspectives. I will outline the causes and effects and then offer some solutions which, I hope, the Minister for the Environment, Heritage and Local Government, will pass on to the Minister for Health and Children.

It is important to state there are two major interrelated problems facing Letterkenny General Hospital. The emergency medicine department has six bays, as Deputy Keaveney said, and that is not sufficient to assess the 30,000 patients who attend each year. Six bays normally cater for only 10,000 patients. There are not enough beds to facilitate the annual number of admissions, which is just short of 10,000 per year.

As Deputy Keaveney outlined, the attendance level in the emergency department is rising. In 1992, approximately 15,000 people attended whereas now more than 30,000 attend each year. This is caused by changing demographics, urbanisation and growth. As Deputy Keaveney stated, the population of Letterkenny has grown by 42% in recent years.

There have been many consultant appointments in the hospital since 2000, including a haematologist, oncologist, cardiologist, respiratory consultant, nephrologist, geriatrician, breast care surgeon, two radiologists and two anaesthetists. There have been two appointments to the accident and emergency department. Although new consultants are being appointed, we feel we are not getting a fair crack of the whip. As the Ceann Comhairle will know, each consultant needs his or her own bed in turn. Only 17 beds have been added to Letterkenny General Hospital in the past 25 years.

The effects of all these problems include the cancellation of day service procedures, elective inpatient procedures and outpatient appointments. The morale of staff is at an all-time low despite that there are good staff at the hospital. Public confidence in the hospital is also at an all-time low. The effects are also such that patients admitted overnight are put in inappropriate accommodation. Some 340 patients were put in inappropriate accommodation so far this year. Already in 2005, 250 procedures have been postponed owing to the unavailability of beds. Twenty-two of the procedures were cancelled twice. This will increase the number of patients on the day case waiting list for next month by up to 10%. Waiting lists will get even longer if the problem persists.

On the cancellation of elective inpatient procedures, 52 procedures were cancelled during January 2005 owing to the lack of a recovery bed. Cancelled procedures included boil, bladder and breast cancer cases. Some patients' procedures were cancelled two, three or four times. The inpatient waiting list grew by 22% during 2004 and it is growing further as we speak. On the cancellation of outpatient appointments, 315 patients had their appointments cancelled between 5 January 2005 and 12 January 2005.

Deputy Keaveney outlined some solutions. In this regard, I refer to the ten-point plan announced by the Minister for Health and Children and the uniqueness of the problem faced by Letterkenny General Hospital. All the points in the plan that can be implemented in the hospital have already been. The others cannot be implemented until the two issues we have identified are addressed, namely, the need for approximately seventy extra beds and the need for an adequate extension to the emergency medicine department.

We already have a transit lounge to be employed in respect of the second consultant appointed to the emergency medicine department. A joint management consultant group has been in place since 1998 and there are additional nursing staff in the accident and emergency department. The triage service has been introduced and extended and there are additional non-consultant hospital doctors in the emergency department. There is an air tube system for the delivery of samples and a digital X-ray system has been introduced. A bed manager and discharge liaison nurse have been appointed to maximise bed turnover.

Among the medium-term to long-term solutions are additional accommodation to house 70 beds and an extension to the accident and emergency department. These are essential. The 11 oncology and haematology beds also comprise part of the solution and they will need to be fully funded if they are to be commissioned in 2005. I ask the Minister of State at the Department of Health and Children or the Minister, if she is available, to come to Donegal to see at first hand the severe circumstances that prevail at Letterkenny General Hospital and note how the hospital is different from those in Dublin to which the ten-point plan relates. Circumstances are different in Donegal.

Dick Roche (Wicklow, Fianna Fail)
Link to this: Individually | In context

I welcome the opportunity to clarify the position on the development of services at Letterkenny General Hospital on behalf of the Minister for Health and Children, Deputy Harney, who, unfortunately, cannot be present tonight. Deputies Keaveney and Blaney will be aware that the Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision and development of services at Letterkenny General Hospital.

The Department of Health and Children is advised by the executive that the increasing capacity pressure at Letterkenny General Hospital has arisen from the recruitment of additional consultants in recent years, as mentioned by Deputy Blaney, and as a consequence of demographic change and advances in modem medicine which have resulted in greater life expectancy. The most recent consultant appointments to the hospital, including a consultant cardiologist, haematologist, oncologist, geriatrician and a consultant in respiratory medicine, have meant that more patients now access more services locally. These developments are to be welcomed but it is acknowledged that they have led to an increase in the local demand for services.

To assist the hospital in addressing the issue of capacity, the Department gave approval in 2003 to what is now the HSE north-western area to proceed with the planning of an extension to the emergency medicine department at the hospital. The HSE north-western area appointed a design team to carry out an option appraisal or feasibility study to determine the preferred location for the facility on the hospital site. The study, which examined eight options, has been completed and is under consideration by the HSE. The proposal also includes the provision of two shelled-out floors over the emergency medicine department for the future provision of up to 70 beds. The Minister for Health and Children has identified the delivery of emergency services as a priority area for attention.

Many of the difficulties and delays experienced in emergency medicine departments reflect system-wide issues. It is therefore necessary to adopt a whole-system approach, involving primary, acute, sub-acute and community care in tackling the problems in such departments. In November 2004, the Minister announced additional funding of €70 million to implement a ten-point action plan to improve the delivery of emergency services. She has met senior management of the HSE, and the Department of Health and Children is working closely with the executive to ensure early implementation of these measures.

I thank Deputies Keaveney and Blaney. I understand their concerns and will certainly draw to the attention of the Minister for Health and Children the very cogent case they made for Letterkenny General Hospital.