Dinny McGinley (Donegal South West, Fine Gael)
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I thank the Leas-Cheann Comhairle for again allowing me to raise this important matter, namely, the continuing crisis in Letterkenny General Hospital, where patients on trolleys are a regular feature of hospital life and operations and appointments are cancelled on a daily basis. What has precipitated tonight's debate is the report carried out by a United Kingdom health care consultancy firm, Tribal Secta, into the situation in Letterkenny General Hospital. The report has not been published and is not available yet, but some of the findings are reported in today's media. The report is an indication of the way the hospital has been more or less abandoned in recent years.

Let me be clear on one issue, however. The report does not negatively reflect on the staff in Letterkenny General Hospital. On the contrary, they are complimented for their dedication to duty while working in almost impossible conditions. Any person who has been treated in Letterkenny General Hospital as an inpatient or an outpatient will vouch for the commitment, dedication, professionalism and sincerity of the staff who try their best to put up with the current conditions at the hospital.

The report details a litany of problems, difficulties, infrastructural deficiencies and shortcomings at the hospital, concluding that the accident and emergency department is "not fit for delivering emergency care in the twenty-first century". What an indictment that is. The report also finds that during the first six months of 2005, more than 1,100 admissions to the hospital had to be cancelled. Since then, the situation has deteriorated and is almost out of control. Patients on trolleys are the rule rather than the exception.

The report focuses on the accident and emergency unit and finds that it is incapable of meeting the demands on its services. The hospital's day-case ward is regularly used as a holding area for accident and emergency patients, resulting in the cancellation of elective procedures. Emergency and urgent admissions are given priority over elective work and cancellations are now routine, due to the rising number of patients requiring admission. The report also states that patients have had operations cancelled up to three or four times. I am aware of a patient who has had to endure five cancellations in four months.

It is not simply an accident and emergency crisis, but a whole hospital crisis that stems from the core problem of a chronic shortage of beds in Letterkenny. This shortage initiates a chain reaction of over-crowded wards leading to overcrowding in the accident and emergency unit, which spills over into the day-case ward and eventually even into the coffee dock. This chain reaction and its knock-on effects is the everyday situation in Letterkenny.

In truth, what has been found by the consultants is nothing that we have not been aware of for many years. While we did not need consultants to tell us what is happening in Letterkenny General Hospital, their report nevertheless highlights the crisis and might provoke the Government into seriously addressing the situation. While the hospital has been given approval to go to tender for the construction of a new accident and emergency department, this will not become available for at least three or four years. The report strongly recommends interim improvements, such as the provision of a temporary building to expand the treatment space now available to the accident and emergency department. I strongly support the adoption of that recommendation, which would relieve difficulties in the short term. The provision of the new accident and emergency block and 60 or 70 additional beds is the only long-term solution.

We need to plan for the future, given the age profile of the population of Donegal, which has a higher than average percentage of people over 65. Elderly people have recurrent illnesses and need continuous treatment. There will be increased and more incessant demands on the facilities in Letterkenny General Hospital in the next ten to 15 years. This is not the first, second or even the third time I have raised this issue this year. I will keep raising the matter until I get an acceptable response that will give some hope to the people who have to depend on the services, often unavailable for many, in Letterkenny General Hospital. I seek an immediate response and definite news from the Minister of State.

Tim O'Malley (Limerick East, Progressive Democrats)
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I am taking the adjournment on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney.

Tackling the current difficulties with accident and emergency departments is the Government's top priority in health. The service being provided to some patients in accident and emergency departments is unacceptable and must be improved.

The objectives are to reduce the numbers waiting for admission, the time spent waiting for admission and the turnaround time for those who can be treated in accident and emergency departments and do not require admission.

The HSE is continuing to implement the ten point action plan. In addition, it has been agreed with the HSE that a number of additional measures will be implemented by the executive. These include the setting of performance targets for individual hospitals. In terms of implementation, the HSE is tackling the issue on a hospital-by-hospital basis and is developing hospital-specific, time-based targets related to accident and emergency units and delayed discharges. The executive is also engaged in the development of financial incentives linked to performance in these areas and the development of additional targeted initiatives aimed at delivering an immediate and sustained impact.

In the immediate term, the HSE is introducing a series of measures to improve facilities for patients and staff in accident and emergency departments. Long-term care beds are being secured from within the private sector to facilitate the discharge of patients who have completed the acute phase of their care. The acute beds that become available as a result of this initiative will be ring fenced for those patients awaiting admission in accident and emergency departments. Funding is being made available within the capital programme to develop admissions lounges to ensure that patient privacy, dignity and comfort are preserved while awaiting admission to an acute bed.

The HSE has established a dedicated task force to oversee the implementation of the framework for improving the efficiency and effectiveness of services in our accident and emergency departments. The task force will support individual hospitals, including Letterkenny General Hospital, in identifying specific problems and addressing them. It will work with hospitals to introduce a system of whole hospital performance measures to improve the patient's journey, not alone through the accident and emergency department but through the hospital system, from admission to discharge.

Letterkenny General Hospital serves an estimated catchment population of more than 137,000 and employs almost 1,300 whole time equivalent staff. The Government is committed to the development of acute hospital services at Letterkenny General Hospital. Since 1997, the Hospital's annual allocation has increased by €60 million. In 2005, the hospital treated nearly 20,000 more in-patients and day cases than in 1997. There are now 550 more staff at the hospital and 70 more beds than in 1997.

With regard to accident and emergency facilities at Letterkenny General Hospital, the Tribal Secta report found that the hospital needs a larger, purpose-built, accident and emergency department to allow proper triage, streaming and care of accident and emergency patients. The HSE intends to provide a new accident and emergency department and medical admissions unit at the hospital. The medical admissions unit will streamline the processing of acute medical emergency patient referrals, ensuring that patients are prioritised on the basis of need and, where necessary, admitted to an acute in-patient bed. This project is currently at design and planning stage.

In the interim, the HSE has approved capital funding for the provision of 30 beds for Letterkenny General Hospital. These beds will be provided by way of a modern modular building to be erected on the campus of the hospital. A planning application has been submitted and tender documents are in the process of being completed. It is intended that this modular building will be procured through an accelerated tender process, with a view to having the beds available for use before the end of 2006. This development, which is in addition to 11 new beds already opened this year, will increase capacity at the hospital from 313 to 343, an increase of almost 14% from the start of the year. It is expected that current capacity pressures at the hospital, including pressures in the accident and emergency department, will be greatly alleviated under this initiative.

The HSE has also had detailed discussions with the hospital with regard to implementing interim measures to improve the facilities at the accident and emergency department, as recommended in the Tribal Secta report. A number of proposals are being examined, including the options for increasing the space and providing additional facilities for the accident and emergency department by relocating other departments at the hospital.