Jimmy Deenihan (Kerry North, Fine Gael)
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I raised this matter on the Adjournment on 24 November 2004. Back then, Dr. Sean O'Rourke was the consultant at the accident and emergency unit of Kerry General Hospital. He had major reservations about staffing in the hospital, and he eventually moved on. I refer to a letter from Dr. Pat Naidoo, a locum consultant in emergency medicine at Kerry General Hospital - who has also since moved on - to Pat Healy, regional director of operations at HSE South. He states:

There are some serious concerns regarding the staffing levels and the safety of emergency care provided at the Kerry General Hospital. In view of the Minister of Health's announcement in early 2004 to improve patients' experiences of emergency services and the more recent "Review of Emergency Departments and Pre-hospital Emergency Care in Cork and Kerry" published by the HSE South in which Prof. John Higgins (Director of Reconfiguration) said "these recommendations are totally focused on the needs of our patients in emergency situations, the Kerry General Hospital will retain its full Emergency Department and will be reorganised to best serve Kerry patients at their time of need and have access to better, safer emergency care", it is time that HSE South Board [reviewed] the staffing levels of the Emergency Department and the service provided.

The Emergency Department in Kerry General Hospital is experiencing an uncomfortable growth period of presentations and many of these presentations are becoming increasingly more complex. The population in this area is ageing, societal expectation of health care is rising and out of hours presentations are becoming more the "norm". These factors combined with staffing in Kerry General Hospital Emergency Department with only junior doctors poses a serious threat to the people of Kerry having access to better, safer emergency care.

The Emergency Department is the "front door" or point of entry of the Health Service and as such is open to all comers ... that is its strength in terms of training junior doctors, but it is also its weakness in terms of staffing needs. Managed well, a strong Emergency Department serves the region well ... with unnecessary admissions, prospective inpatients are worked up to save inpatient time, [and] procedures can be performed to avoid after hours theatre use saving time and resources.

While acknowledging the extraordinary dedication of nurses and doctors who are making every effort to keep the Department working, this service is now unable to cope with the demands of the increasing throughput as patients' safety and quality of care is being compromised. This results in reduced patient satisfaction, poorer processing of patients for admission and discharge, missed injuries, high rate of re-presenting, deferring care therefore threatening patient safety, patients leaving the department without being seen, overcrowding and congestion and finally exposure, intimidation and verbal abuse by patients.

The Emergency Department in Kerry General Hospital is without doubt the most understaffed department in the country. ... Comparatively Tullamore, Letterkenny and Mullingar who see fewer numbers of patients are better staffed (24,000 to 28,000 presentations compared to 34,000 at Kerry General Hospital).

The present staffing levels include a Locum Emergency Consultant [and] six Senior House Officers ... Five of these Senior House Officers work on a rota and there are no replacements by Locums when either of them are sick or on holidays. The result is that the department can be staffed by a single junior House [Officer] on various shifts during heightened activity translating to fatigue, stress and adverse outcomes for the patients. The patients are treated and discharged unchecked by a senior doctor. Junior doctors are being left unsupervised to deal with difficult and challenging patients and cannot reasonably be expected to deliver the same care that a highly trained and experienced doctor can deliver.

In conclusion, there is a major problem in Tralee. The problem is partly the present accommodation and accident and emergency department, but more especially staffing. I raised this matter five years ago, but the situation has not improved since. It is not fair on the people of Kerry that we should have to accept such conditions. I acknowledge the work of the nurses, the junior doctors and the locum consultant and their commitment and dedication to ensuring the service is maintained. However, these people are becoming frustrated. As I pointed out earlier, the original consultant, Dr. Sean O'Rourke, left, as did Dr. Pat Naidoo, who is now in a Dublin hospital. The current consultant is under considerable pressure due to staffing levels. It is just not acceptable.

Martin Mansergh (Tipperary South, Fianna Fail)
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I am replying on behalf of the Minister for Health and Children, Deputy Mary Harney.

The HSE has accepted the key recommendations of the Horwath-Teamwork review of acute services in Cork and Kerry, which proposed a single health care system for the region. A key principle is that, while no hospital in the region will close, all hospitals will fundamentally change the services delivered to their communities and how those services are provided as part of the region-wide delivery of health care.

Professor John Higgins was appointed earlier this year as clinical director for the reconfiguration of services in the south and is addressing this task on a consultative basis. As part of the reconfiguration process, the HSE reviewed the organisation of regional emergency services. The review, published in November, was carried out by clinical staff and chaired by the director of emergency medicine for Cork and Kerry. Its recommendations, by clearly defining a regional emergency service, will allow for development of an integrated system with better response times, improved medical outcomes and patient experiences, and a resource base focused on need.

Due to the specific demographic and geographic challenges in Kerry, the review recommends that the emergency department in Kerry General Hospital should continue to provide full-time emergency care as part of the Cork and Kerry network, connected by common procedures and practices, guided by the regional consultant team and with ICT links to the regional level 1 trauma centre at Cork University Hospital.

Kerry General Hospital is the second largest acute hospital in the southern hospitals group. The emergency department had 34,230 patient attendances in 2008 and has had approximately 30,650 attendances so far this year. Approximately 70% of inpatients are admitted through the emergency department. Attendances are second only to Cork University Hospital, and there are no significant trolley waits. The emergency department currently comprises a locum emergency medicine consultant, six non-consultant hospital doctors, five clinical nurse managers and 19.1 whole-time equivalent staff nurses, as well as 24-hour clerical support and other non-nursing supports.

A key policy objective of Government is to move from a consultant-led to a consultant-delivered service, with increased availability of senior clinical decision makers to treat and discharge patients. In this context the HSE is currently considering the filling of the vacant emergency consultant post in Kerry General Hospital on a permanent basis.

I assure the House that the Executive is addressing the issue raised by the Deputy. It is confident, pending completion of the wider regional reorganisation to which I have referred, that it will be in a position to put in place the clinical resources to ensure that the emergency department at the hospital continues to meet the needs of the population.

Jimmy Deenihan (Kerry North, Fine Gael)
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Chairman, with all due respect, I received a nearly identical reply this time five years ago. It is quite ridiculous.

Charlie O'Connor (Dublin South West, Fianna Fail)
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The Deputy will understand that the Chairman can only chair the proceedings. However, I thank him for his contribution.

Jimmy Deenihan (Kerry North, Fine Gael)
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Absolutely.