Willie Penrose (Longford-Westmeath, Labour)
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I thank the Ceann Comhairle for selecting this important matter for the Adjournment tonight. It is very important for the people of Westmeath, whom I represent. I am forced to speak here again because of the disgraceful, arrogant and dismissive actions of the HSE regarding the disproportionate cutbacks being foisted on the regional hospital in Mullingar. These caused the accident and emergency department to close for a number of days last weekend due to the unsafe levels of overcrowding which arose as patients waited to be treated. The upshot of this decision, which was reluctantly taken and motivated by the safety and well-being of patients, was that people requiring urgent treatment had to be brought to other hospitals in the region.

I raised the plight of this important and centrally-located hospital in Mullingar in the Dáil on 12 November. I pointed out that, in light of the fact that 41 acute beds - or 20% of the total acute beds complement of the hospital - were to be closed, the outcome we witnessed at the weekend was inevitable. Like all hospitals across the country, one might anticipate some reduction in acute beds because of savings being sought. Mullingar is not any different. Nevertheless, the 20% reduction of the total acute beds complement at Mullingar hospital was excessive and clearly disproportionate. It had the potential to render the hospital potentially unsafe for acute admissions over the winter.

It is reported that the number of people lying on trolleys has escalated dramatically over the past two years. At one stage last Thursday, 22 patients were waiting to be admitted, with all trolleys in use. That is normal, as 15 to 25 patients could be there at various times. The union representatives involved, who were putting the patient interests first, indicated that the accident and emergency department at Mullingar was unable to cope with the level of overcrowding; this will get worse as we progress into the depths of winter, when the number of acute admissions significantly increase.

The level of overcrowding last weekend did not arise from an unusual peak or a surge in activity. What will happen when there is a significant spike in the level of activity in admissions? The whole system will creak and break down unless immediate action is taken to reopen most of the recently closed beds at the hospital.

Lest anybody be misled, plenty of beds are available. Four wards are closed and worse still, a new ward of 26 beds in the west wing of the new part of the hospital remains closed. What sort of a system of management allows such a scandalous state of affairs to exist? It is outrageous behaviour on behalf of the HSE and the Government, along with the HSE, is treating the citizens of Longford and Westmeath as second-class citizens.

I have lost all faith in the HSE. Mullingar is one of the most efficient hospitals in the country from a case mix perspective and is in the top three of the 52 hospitals in this country on a continuous basis. What thanks does it get only to be left with an ongoing deficiency in bed numbers which seriously impacts on the emergency capacity? Furthermore, the hospital is down approximately 35 nurses over the past 12 months due to non-replacements and retirements. In whole-time equivalent terms, it is well below the average staffing levels in Irish hospitals.

The people of Longford and Westmeath, whom I represent, feel this is part of an ongoing strategy to cripple and downgrade the status of a top-performing hospital. In light of recent events, it is hard to quibble with that assessment. As I have said before, the Government has failed the people of Longford and Westmeath in the delivery of health services. There is a significant gap between the many promises made on the electoral stump and the reality which has been delivered.

I call upon HSE management, whom I understand met with consultants and other personnel at Mullingar hospital this evening, to tackle this serious and pressing problem with extreme urgency. The Government and the HSE think nothing of riding roughshod over the people of Longford and Westmeath. Let me retort on their behalf - the Government and HSE will not get away with it.

On 30 November 2009, I communicated with the HSE, asking that the 26 beds in the west wing be opened and staffed so as to alleviate difficulties. It was a positive proposal to reduce the impact of the loss of these acute beds. I did not even get the courtesy of a reply, so need I say more?

John Moloney (Laois-Offaly, Fianna Fail)
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I apologise to Deputy Penrose as the Minister for Health and Children, Deputy Mary Harney, cannot be here this evening to respond herself.

Willie Penrose (Longford-Westmeath, Labour)
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I am glad the Minister of State is here as he is decent.

John Moloney (Laois-Offaly, Fianna Fail)
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I thank the Deputy. I will be taking this matter on the Minister's behalf. The HSE accepts that there was a problem in the emergency department at Mullingar hospital on Thursday last week. However, since then all patients in the emergency department were either admitted or discharged within the target of six hours set by the HSE this year.

The hospital's budget for 2009 is in excess of €64 million, increased from €54.8 million in 2006. As Deputy Penrose rightly points out, the hospital has been recognised as being one of the most efficient in the country in the context of the annual case mix adjustment. Last year, the hospital was the highest in the country with a positive case mix adjustment of €1.977 million. It should be noted that inpatient activity at Mullingar to the end of September was 0.2% ahead of last year, whereas day case activity was up by 6.2% year on year. There have been 24,636 emergency attendances to the end of September this year, a reduction of 5.7% on the same period last year.

Mullingar hospital, in common with all other agencies, is required to manage its services within the approved allocation and to run its services within the approved employment ceiling. It is envisaged that the hospital will break even this year and will be within its employment ceiling by end of year. There are no plans to increase the number of nurses employed in the hospital. At the end of October, there were 289.5 whole-time equivalents on the nursing staff, an increase of one whole-time equivalent on the same month last year.

In November, patients were transferred from old accommodation in Mullingar hospital to state-of-the-art accommodation in the newly upgraded wards at the hospital. The new wards are a major improvement in terms of standard of care that can be afforded to patients. Under the new arrangements, the number of inpatient beds has been reduced from 220 to 199, and the number of day beds has increased by 13 from 11 to 24. In addition, there are five extra observation beds.

These changes are very much in line with international practice, which aims to encourage a greater emphasis on the practice of day care medicine. This is a well-established part of the HSE's transformation programme and it will lead to an increase in the overall number of patients treated in the hospital in 2010. The adjustment in beds taking place will help to improve the position, thus making the hospital even more effective in providing care and treatment in the future.

The revised bed complement in place as a result of the move to the new hospital has been fully endorsed by the consultant surgeons and consultant obstetricians at the hospital. In addition, many discussions led by the clinical director have taken place with all relevant consultant staff at the hospital to increase the throughput of surgical and gynaecology work at the hospital. The provision of additional day ward beds as detailed will facilitate this increase in workload.

The hospital is arranging to carry out a bed utilisation study with a view to establishing that all beds within the hospital are being utilised to maximum effect and that all admission and discharge processes are being fully and effectively managed. It is important to note that the current usage of day beds in Mullingar hospital is still behind the international norms for such bed utilisation.

As previously noted, there has also been an increase in the number of observation unit beds from six to 11. These beds are strategically located next to the emergency department to cater for the overflow of patients from that department, which can occur from time to time. The hospital also intends to increase the throughput of patients through the medical assessment unit, which will also alleviate pressure in the emergency department. I am confident that the hospital will continue to provide the best possible quality of care for all its patients.