Dinny McGinley (Donegal South West, Fine Gael)
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I thank the Ceann Comhairle for allowing me to raise this important matter on the Adjournment.

The situation in Letterkenny General Hospital is chaotic. Since last January, upwards of 15 patients a night are being accommodated on trolleys in the day services unit and the accident and emergency department at the hospital, resulting in the cancellation of day service procedures, elective procedures and leading to gross overcrowding in the accident and emergency department. Last Tuesday there were 26 patients on trolleys waiting for beds. Today, the situation has improved somewhat, in that the total number on trolleys is 13, nine in the day services unit and four in casualty.

This week, all elective surgery has been cancelled, along with day services procedures, and this has been the pattern almost continually since last July. Patients awaiting hip replacements, knee replacements, hernia operations and such procedures are being left to suffer without knowing when they will be treated. All of this mayhem is caused by a chronic shortage of beds in the hospital.

Letterkenny General Hospital caters for a population in excess of 130,000 with only 286 beds to accommodate in-patients. It is probably one of the lowest per capita bed ratios in the country. Doctors, nurses and staff in general are doing their utmost under impossible working conditions. As a regular visitor to the hospital I have seen for myself the turmoil that is a regular feature in casualty. One could justifiably say that it is more like what one would expect in a Third World country than in the so-called richest country in the EU.

The situation has been allowed to continue to deteriorate because Letterkenny General Hospital has been starved of resources. While the medical and nursing staff are among the best in the country, the facilities they have to work with are woefully inadequate. The requirements of the hospital have been identified and generally accepted. Top priority must be given to the provision of a new accident and emergency department as the present unit is woefully inadequate. It treats some 30,000 cases per annum and it is only about one quarter of the size required for treating so many patients. It is cramped, confined, overcrowded and completely inadequate to meet its demands.

An approval to proceed to planning for a new accident and emergency unit was given by the Department of Health and Children in July 2003. Plans were submitted to the Department in October 2004. Since then, nothing has happened. We are now awaiting approval to proceed to the next stage, the appointment of an architectural team. I cannot over-emphasise the importance of that approval and I am asking that it should be granted without further delay.

It is also accepted that Letterkenny General Hospital requires an extra 70 beds and until these beds are provided, the hospital will continue to career from crisis to crisis, with the ultimate victims being the citizens of County Donegal. Provision for the extra beds could be made by providing an extra storey or two on the proposed new accident and emergency unit which is envisaged to be an independent block. We have listened long enough to daily bulletins about conditions in the hospital. We want to hear the decision to proceed to the next stage of planning for the proposed accident and emergency unit followed by the provision of the 70 extra beds.

There are a number of other critical services that must also be provided in Letterkenny. Donegal cancer patients have to travel the long distance to Dublin to obtain radiation oncology treatment. This has resulted in some cancer sufferers in the county taking the drastic decision to have breast removal operations rather than face the gruelling journey to Dublin for radiation treatment. While there is an excellent day patient oncology unit in the hospital, there is no dedicated cancer unit for in-patients. This is unacceptable when one considers that in the most peripheral county in Ireland, there are 50 new breast cancer cases, 70 new bowel cancer cases and 80 new prostate cancer cases annually. Cancer treatment facilities need to be upgraded and the BreastCheck service made available immediately. We are not asking for special treatment for the people of Donegal, just equal treatment. I ask the Government to meet the needs of the county without further delay.

Seán Power (Kildare South, Fianna Fail)
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I thank Deputy McGinley for raising this issue and 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.

The Deputy 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 HSE that the increasing capacity pressures at Letterkenny have arisen both from the recruitment of additional consultants in recent years and as a consequence of advances in modern 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 access more services locally. These developments are welcome 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 the HSE north-western area to proceed with the planning of an extension to the emergency medicine department at Letterkenny. The HSE north-western area appointed a design team to carry out an option appraisal-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 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 take a whole-system approach involving primary care, acute care, and sub-acute and community care in tackling the problems in emergency medicine 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 Health Service Executive and the Department is working closely with the HSE to ensure early implementation of these measures.