Joe Costello (Dublin Central, Labour)
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I wish to a raise an issue of considerable importance, namely, the death of a young woman of 39 in tragic circumstances in the accident and emergency unit of the Mater Hospital two weeks ago. The woman, Ms Seville-Doyle, arrived at the hospital, was assigned a chair and was put on a drip while awaiting medical assistance. At 6 a.m., 19 hours after she had arrived, she walked into a toilet unaccompanied where she was later found in a collapsed state by the nurses. Medics telephoned her family at 6.20 a.m. but, due to a lack of parking space in the hospital grounds, the family were not able to arrive before she had passed away.

Let me quote the statement of Mr. Colm Seville, the lady's brother, in the Irish Independent on 26 January:

"When we reached the hospital, they brought us through another route so that we wouldn't have to see the place where she died," Mr. Seville said. "But at one point we ended up in the middle of Accident and Emergency and I just said to a nurse: 'Please tell me my sister wasn't here'. People were sitting on chairs and in corners. The doctors literally had to step over the patients. It was like something out of the Third World." Last night Mr. Seville said: "I felt sorry for the ordinary doctors and nurses on the ground, who are dealing with this on a daily basis."

I am well aware of these dreadful conditions because I go to the hospital every Saturday and spend an hour there between 1 p.m. and 2 p.m. I inspect the conditions almost on a weekly basis and note that they are dreadful. There is a prefabricated building which is totally unsuited to interaction between the patients and hospital staff. The nurses and doctors do their best but there are long waiting lists. The accident and emergency department is like a railway station or even a cattle mart. People are coming and going and patients are in chairs and on trolleys in passageways and every other nook and cranny. The situation deteriorates even further every winter. I have gone there almost every week for four and a half years and the situation has not improved substantially in that time.

The Minister speaks constantly about her ten-point plan and how community care services are being put in place. In this way, she assures us, all this so-called bed-blocking, that dreadful phrase she uses, will be dealt with. The reality, however, is that waiting lists persist and accident and emergency departments remain overcrowded. Hygiene standards are atrocious. It is simply not good enough that people who are seriously ill find themselves in the frightening situation of not knowing how long they must wait in such unacceptable conditions. The Minister has been sitting on her hands on this issue, making promises but delivering nothing. It is the most vulnerable section of the population, the elderly and seriously ill, who are most affected by the situation.

I received a letter on 26 November from Phil O'Neill, head of operations and clinical support in the Health Service Executive. It stated:

I am writing to express the hospital's concerns regarding your unauthorised contact with patients in the emergency department of the Mater Misericordiae University Hospital and respectfully request that you discontinue this practice.

I have been calling into the hospital for four and a half years but now it seems I am not authorised to do so. The letter continues:

Hospital staff members in the emergency department work in an extremely challenging and stressful environment and must be permitted to fulfil their responsibilities without additional disruption from unwarranted personnel.

There has been a failure of management and leadership at the highest level in the HSE and the Department of Health and Children to deal with the matter. I am not even sure whether the HSE is conducting an internal inquiry. Such an inquiry is inadequate in any case. There must be an independent external inquiry into the death of this young woman.

Pat Carey (Dublin North West, Fianna Fail)
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I will take this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

I extend my sincere sympathies to the family of the deceased at this most difficult time. The Department of Health and Children has been in contact with the Health Service Executive about this case. The HSE has advised that when it became aware of the death of the person concerned, it sought and received an immediate briefing from the hospital on the circumstances of her death and the management of her care in the accident and emergency department. It is understood that she died while awaiting admission from the accident and emergency department.

The HSE has advised that the medical staff who attended to the deceased, along with the hospital's patient representative, met her next of kin to discuss the circumstances of her death. In accordance with the Coroners Act, the hospital reported the matter to the coroner whose findings are awaited. A coroner's post mortem was undertaken to establish the cause of death.

The Department is advised that the HSE and the hospital concerned will be guided by the coroner's deliberations and any recommendations made. This will inform the HSE's decision on any requirement for further action. In the interim, the hospital is carrying out a risk assessment in line with normal procedures. The hospital has assured the HSE it is anxious to provide whatever support the family considers appropriate in dealing with this difficult loss. The Deputy will appreciate it would be inappropriate to comment on the specific circumstances of the case at this time.

Fergus O'Dowd (Louth, Fine Gael)
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I thank the Ceann Comhairle for allowing me to raise this issue which, like that raised by Deputy Costello, relates to the appalling conditions in which hospital staff must work, particularly in accident and emergency wards. A report in today's edition of The Irish Times states that patients on trolleys yesterday in Our Lady of Lourdes Hospital in Drogheda were asked to give up those trolleys to accommodate more seriously ill patients admitted following a traffic accident. Patients had no problem doing so but it is an indication of the appalling pressure on patients and staff. It is unacceptable and disgraceful.

The Minister was notified of the problems in the hospital last June. Dr. Finbar Lennon, a senior consultant in the region, wrote a letter to the Health Service Executive at that time, which I understand was forwarded to the Department of Health and Children, expressing his concerns about the "failure of the management authorities at all levels to appreciate the impact and consequences of the current workload and throughput of cases in Our Lady of Lourdes Hospital". Mr. Lennon went on to state that, in his opinion, the situation was "very unsafe" and that he had called for a "fundamental reappraisal of the current strategy being pursued by management".

It is a shameful situation. The patients to whom I have spoken are very appreciative of the excellent treatment they receive from consultants, nurses and other hospital staff. However, they cannot understand why adequate provision is not made to improve conditions. Why does the HSE not provide the necessary services in Dundalk, Navan, Cavan and Monaghan to relieve the pressure on Our Lady of Lourdes Hospital? The current conditions are unsustainable and unsafe. Mr. Lennon's statement, which was brought to the attention of the HSE and the Department last June, is quite serious.

What is the Government doing to improve this unacceptable situation? The hospital is in chaos in terms of finding space for sick people. A friend of mine attended the accident and emergency department last Monday and had to wait on a trolley for almost 36 hours. The problem at that stage, before yesterday's crisis, was that there was only one bed for 30 possible patients. This is an ongoing crisis. While I fully acknowledge that there is a substantial difficulty in coping with the winter vomiting bug, the HSE has made an entirely inadequate provision for the care of patients in the hospital.

How is the Minister accountable for this situation? The Government has allowed the HSE to function in such a way that public representatives do not have a forum in which to raise such issues. The Minister absolves herself of any responsibility and everything goes back to the HSE. There must be accountability to the House. The Minister must be able to answer our questions on certain urgent matters. It is a shame that the wonderful staff of our Our Lady of Lourdes Hospital and the sick patients who receive tremendous care from them must endure these appalling, disgraceful and shameful conditions.

Pat Carey (Dublin North West, Fianna Fail)
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I will take this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

My understanding is that the issues raised by the clinician in question relate in the main to the capacity of Our Lady of Lourdes Hospital, Drogheda, to manage the regional emergency workload within existing resources. The issues raised were brought directly to the attention of the medical board of the hospital, the Health Service Executive and the Minister. The Department raised the issue with the National Hospitals Office of the HSE and asked that the matter be followed up as a matter of urgency with the HSE north east which has operational responsibility for the provision of hospital services in the region.

The number of patients reporting to the accident and emergency department of Our Lady of Lourdes Hospital has increased in recent days and this has placed additional pressure on its capacity. The HSE is working to ensure all possible measures are taken to alleviate the difficulty and to ensure the waiting time for patients is kept to a minimum. The measures being put in place include increased ward rounds by consultants, and liaison with other hospitals to effect transfers, where appropriate. Discussions are also taking place with a view to placing into more appropriate care settings patients whose acute phase of treatment has finished.

In line with a commitment to improve the overall capacity and resources at Our Lady of Lourdes Hospital, the HSE advises that construction of a new accident and emergency department and additional clinical facilities commenced at the end of January this year at a cost of more than €11 million. This project will provide for an accident and emergency unit on the ground floor encompassing some 1,300 sq. m of space with additional clinical facilities proposed for the upper floors. This project will result in an almost 300% increase in the existing space available for the Department. The HSE advises that the new emergency department is scheduled to be operational by the end of the year with 19 adult trolleys and six paediatric beds. The HSE is also working to ensure that the hospital has the required capacity in readiness for the overall reconfiguration in the north-east area.

The Teamwork Management Services Limited report entitled, Improving Safety and Achieving Better Standards, which was prepared for the HSE found that the present system in the north east, whereby five local hospitals deliver acute care to a relatively small population, is exposing patients to increased risks. The report recommended a three-strand action plan as follows: the development of a new regional acute hospital; the development of local services, with the existing five hospitals and primary and community care providers playing central roles; and the development of a series of clinical networks to bind local and regional services around the needs of patients, including networks for emergency care, surgery and critical care.

The hospital reconfiguration process is being overseen by the HSE steering group. Following a tendering process, the HSE appointed a firm of consultants to carry out an independent site location study for the new regional hospital. The Department has been advised by the HSE that it anticipates that the consultants' report will be completed in February. The report will then be considered by the board of the HSE.

The first priority in the development of a fully integrated regional health service is to ensure that the people of the north east have local access to both routine planned care and immediate life-saving emergency care. Over the next few years, in preparation for all acute emergency inpatient care and complex planned care being provided at a regional centre, the existing five hospitals will continue to provide services which meet the majority of health needs of the community.

The HSE has given an assurance that in progressing the implementation of the Teamwork report, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.