Derek Nolan (Galway West, Labour)
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I welcome the increased ratio of red headed Deputies in the Chamber. It is a nice change.

I raise an important issue affecting my constituency, namely, the position at the accident and emergency department of University College Hospital, Galway, which I understand, with approximately 66,000 attendances per year, is the second busiest accident and emergency department in the country after the department in Tallaght hospital. It is also a hospital with a much wider remit. Tallaght hospital is not the only major hospital in Dublin, whereas University College Hospital, Galway serves the entire western region and is a major hub of medical activity. The experiences of constituents of mine who present at the accident and emergency department are severe and are very worrying. Approximately two weeks ago on 24 September matters got to the stage where HSE West had to issue a statement asking people not to present at the department, unless it was absolutely necessary to do so, as it simply could not cope with the number of patients presenting. That is a sign that the problem is reaching crisis point.

Yesterday morning there were 42 patients on trolleys in the hospital, which was almost a record. The problem was so bad that there was an overflow into other units. The ward space required is not available to deal with patients in the accident and emergency department and that issue needs to be tackled. It is often a gruesome and an horrific experience for patients waiting endlessly in an overcrowded department, not knowing how long they will have to wait to be seen. Conditions are often cramped. I have heard one story from a constituent who had a leg injury and who had to stand while waiting to be assessed as as there was no chair available. Those presenting are vulnerable, sick and worried because they are not used to being dealt with in such circumstances.

According to figures I received today, 356 patients spent time on a trolley in the hospital in September 2010, but this figure rose to 642 in September 2011, a huge increase of 286. Clearly, the trend is deteriorating. I have a 78 year old constituent who spent four nights on a trolley in the hospital. On the afternoon of 24 September every single patient on a trolley was over 75 years old.

I met the clinical director and the registrar in the accident and emergency department on 30 August to discuss the issues involved. They talked about some of their plans such as the movement of critical functions from the hospital to other satellite hospitals in the HSE West region, the use of the medical admissions unit and the medical assessment unit. However, these initiatives on their own are not capable of solving the problem. The fair deal scheme is part of the problem. There are persons in the acute hospital system who should be in elderly care settings, but they cannot receive such care because the funding is not available.

There are also other issues such as the effectiveness of the national ambulance service. Patients are spending time in hospital beds when they should have been transferred. Owing to a lack of resources, it can take two days to have them transferred by ambulance.

It will be interesting to hear the Minister of State's reply on any actions she proposes to take.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this issue. There is a slight flaw emerging in the topical issues debate format. The Deputy is speaking about something of which we are all aware. Perhaps we should be concentrating on plans to resolve the issues involved. That is what Members would really like to see, but that is not what we get. I am about to repeat virtually everything the Deputy said, although I must correct one of his figures. The throughput at Galway University Hospital's accident and emergency unit last year was 68,000 as opposed to 66,000.

We all know the reason for bottlenecks in acute hospitals is the lack of step-down facilities for people who should not be in hospital but are not able to go home. Primary care will be part of the solution to the bottlenecks in acute hospitals. For instance, the leg injury of the constituent to whom the Deputy referred could have been dealt with in an upskilled minor injuries clinic or a proper primary care unit. If such facilities were in place, the only people being assessed in accident and emergency departments would be those whom general practitioners considered to be in need of an assessment by a consultant or admission to hospital. We need to address the ancillary services required around acute hospitals rather than focusing solely on acute hospitals. The Minister of State, Deputy Shortall, is battling to have primary care units and multidisciplinary teams established in the community setting. These units and teams will also form part of mental health services, for which I am responsible, and care of the elderly. The social care needs of older people, persons with a disability and those with mental health issues are identical, and there is no reason this aspect of their care cannot be delivered in the community.

If we do not start thinking outside the box the chaos we have inherited, including in Galway University Hospital, will continue. The special delivery unit is gathering all the information we need to allow us to put in place mechanisms to ensure we can avoid the type of problems Deputy Nolan has observed in overflow wards and accident and emergency departments. The Deputy's most poignant comment concerned a 75 year old man who found himself facing the indignity of being placed on a trolley. While the rest of us may have a degree of dexterity and mobility, it must be disturbing for anyone of that age profile to find himself or herself in such a position.

Before coming to the House, I attended a meeting of the Cabinet sub-committee on health at which we discussed how we would address the issues Deputy Nolan raised. We must act urgently because a long-term response would be of little benefit to the 75 year old gentleman to whom the Deputy referred. I concur with the Deputy on this issue. The Government is working very hard to resolve the problem.

Derek Nolan (Galway West, Labour)
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I thank the Minister of State for her heartfelt response. As a member of a Government party, I support the strategy of diverting patients from acute hospitals, the most expensive facilities to treat patients, to primary care, which is more effective, efficient, local and trusted by members of the community. We are, however, a long way from achieving this objective. As such, I must raise the issue of 42 people on trolleys in Galway University Hospital who do not yet have access to the primary care service that is required.

The special delivery unit has been widely discussed. I understand from my discussions with representatives of Galway University Hospital that Dr. O'Connor visits the hospital every week and various changes are being made. What are the plans of the unit and what have been the results to date? The Minister took the initiative by asking the special delivery unit to write a report on the position in the Mid-Western Regional Hospital in Limerick. I ask the Minister of State to give a commitment on behalf of the Government that an investigation will be carried out and a report published into Galway University Hospital. Such an urgent response is warranted given that 42 patients were lying on trolleys in the hospital this morning.

I would be pleased to work with the Minister of State and Health Service Executive to facilitate the required shift from acute hospitals to primary care facilities. I will also discuss with her the local situation in Galway. This issue must be resolved urgently, especially given that the real blockage in accident and emergency departments starts in winter. It is not yet winter and already 42 people are on trolleys in Galway University Hospital. Will the Minister of State see to it that the special delivery unit produces a performance report for Galway University Hospital which will be presented to the Dáil?

Kathleen Lynch (Cork North Central, Labour)
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I will most definitely bring the Deputy's request to the Minister. One of the significant proposals made by the special delivery unit, and which appears to be common sense to anyone who has spent any time in hospital, is that consultants make two daily ward rounds rather than one. As we all know, people can be discharged later in the day once results come back from laboratories. In such circumstances, there is no point holding on to patients until the consultant does another round the following morning. Taking such a common sense approach will have an effect.

The special delivery unit has also informed us of a significant finding, that the number of people attending accident and emergency units does not increase in the winter months we associate with chaos. What changes is the type of patient presenting in winter, specifically people with chest infections and so forth who need to be admitted to hospital. This appears to be the reason for the backlog. Having this type of information will allow us to engage in planning. I will bring the Deputy's reasonable request to the Minister.