Séamus Kirk (Louth, Fianna Fail)
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I thank the Ceann Comhairle for allowing me to raise this important issue for the population of the north east. Will the Minister clarify the situation at Our Lady of Lourdes Hospital in Drogheda in light of the recent announcement by Government backbenchers in the constituency that an additional €700,000 will be made available to alleviate conditions in the accident and emergency department? That announcement suggests a political motivation behind some of the decisions being taken. Are we focusing on spin or are we addressing the significant problems at this and other hospitals?

Unfortunately, the sum mentioned will not go far given the scale of the crisis at Our Lady of Lourdes Hospital. Today, 53 patients are on trolleys there, the highest number in the country. It is consistently the worst-performing hospital in the State in terms of overcrowding. This poses a major risk to patient safety and must be addressed immediately. The proposed funding of €700,000 is a short-term provision. We must know what will be done in the medium term and whether there is a long-term plan in place.

I expect that the Minister will refer in his reply to my party's tenure in government. The unit at Our Lady of Lourdes Hospital is the main accident and emergency department for the Louth-Meath hospital group. A new facility was opened in June 2010. It is three times the size of the old unit and was built at a cost of €11.5 million. The department is supported by an interim medical assessment unit, an on-site short-stay unit, a medical assessment unit at Louth County Hospital in Dundalk and a minor injuries unit at Our Lady's Hospital in Navan. The north-east regional colonoscopy screening service opened in Louth County Hospital in December 2010. In September 2010, 331 patients spent time on trolleys in Our Lady of Lourdes, which I accept is too many. However, in September 2011, under the auspices of the new Health Service Executive board which the Minister filled with civil servants from his Department, 842 patients were on trolleys, an increase of 154%.

The accident and emergency department at Navan remains open, yet there has been a leap in the number of patients on trolleys at Our Lady of Lourdes Hospital. The situation will deteriorate even further in the coming months as the winter period is traditionally the worst in emergency departments nationwide. The Irish Nurses and Midwives Organisation has described the situation as a meltdown. It is clearly causing untold human suffering for patients. The INMO has called on the Health Information and Quality Authority immediately to inspect the unsafe conditions that exists in the emergency department at Our Lady of Lourdes Hospital in Drogheda.

I appeal to the Minister to clarify the position. Will he indicate whether the funding which has been referred to by Government backbenchers in the constituency is being made available? What is the medium and longer-term plan to alleviate the State's worst pressure point in the health service?

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy for raising this issue. To tackle unacceptably long waiting times in emergency departments on a sustainable basis, immediately following my appointment I set about establishing the special delivery unit, SDU. It will not have escaped the Deputy's notice that this problem is the legacy of his Government, although, as the former Ceann Comhairle, he may claim not to have played any part. The aim of the SDU is to unblock access to acute services by improving the flow of patients through the system. The SDU is focusing initially on emergency departments and will work to support hospitals in addressing excessive waiting times for admission to hospital. Our Lady of Lourdes Hospital in Drogheda is working across several levels to reduce the time patients wait on trolleys in the emergency department. The clinical director and group general manager are fully engaged with the SDU in this regard.

As part of the process of forming an overall picture of the emergency departments situation nationally, the SDU has visited units throughout the State and conducted a data analysis. It has identified several hospitals providing unscheduled care that require support. Eight of these, including Our Lady of Lourdes Hospital in Drogheda, require a very high level of support. As part of the process of engagement with the SDU these hospitals have prepared plans setting out measures that could be taken quickly in the hospital and-or closely related community setting that would significantly relieve pressure on the emergency department by, for example, addressing delayed discharges.

This is a new approach. Staff at the SDU visit the hospital and undertake the analysis in co-operation with staff and management. Following that, the SDU asks management to set out what it considers to be required in order to addressed the hospital's difficulties. The SDU will discuss these proposals with the management, questioning particular costs, asking why particular actions are being taken and others not attempted. The bottom line is that we are seeking to identify how, for a limited expenditure, we can secure maximum results.

Following consideration, and as part of the overall process of SDU engagement, a package of short-term measures has been agreed for Our Lady of Lourdes Hospital in Drogheda. The supports being provided to it and other hospitals and associated community services are dependent on a range of conditions being met. These include a commitment on the part of the hospital to progress implementation of the HSE's acute medicine programme and ensure the hospital has seven-day ward discharge rounds in place. In particular, additional capacity, funded by the initiative, must not be offset by reductions elsewhere.

A sum of €725,710 is being made available in respect of proposals relating to Our Lady of Lourdes in Drogheda between now and the end of this year. The measures being taken, though aimed at easing the pressure on trolleys in Drogheda, involve Louth County Hospital in Dundalk and Our Lady's Hospital in Navan, as well as measures in the community. To reiterate what I said elsewhere, no part of the health service works in isolation.

The measures include additional assisted discharge packages including home help, home care and funding for aids and appliances, which will be implemented immediately; the extension of the hours of the acute medical assessment unit at Drogheda to 18 hours a day seven days a week, which will happen by the end of the month; the opening of eight medical beds in Drogheda by the end of the month; the opening of an additional 28 low-acuity beds in Louth and Navan; and the opening of an additional 27 low-acuity beds in the community.

The funding support is dependent on the hospital meeting the performance conditions set down. The SDU will be monitoring the position closely. Owing to its central position and the expertise that is available to the special delivery unit, it is able to develop and roll out solutions that will quickly resolve situations as they arise. I anticipate that the plans being implemented in Our Lady of Lourdes Hospital will quickly address the unacceptable levels of overcrowding in its emergency department.

Séamus Kirk (Louth, Fianna Fail)
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What will be the provision in late winter and early spring? Will there be a continuation of this support or will additional financial support be made available to ensure the winter months and the early spring months, which will represent a real pressure point for the hospital, will be addressed? Will that be borne in mind and will additional resources be allocated to it?

On the logistics of what is proposed, a number of beds in the Louth County Hospital, Dundalk were sold to a Libyan charity. Will they be replaced? Is there a capital provision in this arrangement to replace beds in the hospital? It will take additional people to staff the additional beds when they are provided in the Louth County Hospital. Will the issue of the moratorium be revisited to ensure there are adequate staff to cater for the patients to be accommodated in the hospital?

James Reilly (Dublin North, Fine Gael)
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Sufficient funds are in place to ensure appropriately staffed beds are available in the hospital mentioned. The Deputy should bear in mind that we are discussing low acuity and not high acuity.

An analysis was done by the SDU on the IT system that was installed at a cost of less than €250,000. Although it is not completely installed throughout the system yet, it is a fraction of the €10 million we were told it would cost and it was completed in 98 days rather than in 18 months. We now know that early January is the key crunch point. It is not as a result of increased numbers attending the emergency department, but as a result of work practices in hospitals throughout the country. The increase in activity comes as people come back from holidays and many elective procedures take place. Those need to be spread throughout the year to avoid creating the double crunch we get.

I can reassure the Deputy that there will be sufficient resources in my view to deal with the problems. However, this was never about more money but about the way we work. It is about more flexibility from consultants in giving us the Saturday and Sunday discharges we have discussed here. It is about diagnostics at the weekend so that X-rays, and ultrasound and CT scans can be read and patients discharged. It is about nurses working differently and not expecting to work the entire week in three days. It is about NCHDs, GPs and pharmacists working differently. It is about the core principle of treating the patient at the lowest level of complexity that is safe, timely, efficient and as near to home as possible. We do not want the wrong overqualified person dealing with a problem that could be dealt with by somebody at an entirely lower level much more conveniently to the patient and at much less cost to the State.