Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 45: To ask the Minister for Health if he will put in place an emergency plan for hospitals to accommodate the predictable surge in activity that occurs every winter; and if he will make a statement on the matter. [32717/11]

Willie O'Dea (Limerick City, Fianna Fail)
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Question 46: To ask the Minister for Health when the recommendations of the special delivery unit in the accident and emergency department in the Midwestern Regional Hospital, Limerick, will be implemented; and if he will make a statement on the matter. [32979/11]

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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Question 59: To ask the Minister for Health the steps he is taking to address the overcrowding crisis at Galway University Hospital; and if he will make a statement on the matter. [32713/11]

Luke Flanagan (Roscommon-South Leitrim, Independent)
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Question 71: To ask the Minister for Health if his attention has been drawn to the overcrowding which occurred at the accident and emergency department of National University of Ireland Galway Hospital on the 24 September; if his further attention has been drawn to the fact that the hospital was forced to appeal to the public, via local radio stations' news bulletins, not to bring emergency cases to the accident and emergency department of NUIG hospital on 24 of September; his views that this overcrowding is unacceptable and a danger to health and that the extra burden placed on the accident and emergency at NUIG hospital is in part due to its vastly increased catchment area due to the closure of Roscommon County Hospital accident and emergency ward; and if he will make a statement on the matter. [32712/11]

Gerry Adams (Louth, Sinn Fein)
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Question 85: To ask the Minister for Health if he will urgently address the critical situation in hospitals in the North-East region, including record numbers of patients on trolleys in Our Lady of Lourdes Hospital, Drogheda, this autumn; and if he will make a statement on the matter. [32962/11]

James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 45, 46, 59, 71 and 85 together.

I have said clearly on many occasions that the situation in our hospital emergency departments, where people must wait for unacceptably long periods on trolleys, will not be allowed to continue. For this reason, as I have already outlined to the House, one of my first actions as Minister for Health was to set about establishing the special delivery unit.

The problems in our emergency departments are complex and did not arise overnight. The issues vary from hospital to hospital and some of the solutions will depend on local factors. Delayed discharge, for example, is an issue in some parts of the country but not in others. A common factor is the need for reliable real time information, agreed standards for safe care and relentless performance management against those standards.

Following considerable analysis of the problems in individual hospitals, I recently approved an initiative whereby funding will be made available to ease pressures in certain emergency departments. The supports being funded are dependent on certain conditions and the money will be released based on specific performance. The supports may involve providing funding for smaller hospitals in the group to ease pressures on the major centre. As I have frequently said, I want to ensure that as many services as possible can be provided safely in smaller local hospitals.

In the case of Our Lady Of Lourdes hospital, Drogheda, the hospital has requested a range of supports and the special delivery unit has agreed to a set of proposals which will cost more than €700,000 between now and the end of this year. More than €300,000 is being made available to Galway University Hospital. The special delivery unit has indicated to me that considerable improvements can be made at Limerick hospital within existing budgets and I have requested the HSE to implement these changes. These include some reallocation of existing staffing resources, a better bed management system and the shifting of day case capacity to other hospitals in the group. The issue of further support for Limerick is under consideration by the special delivery unit.

The HSE has indicated that the impact of the emergency department changes introduced at Roscommon County Hospital in July 2011 has been marginal. The figures for the three month period to the end of October indicate an increase of 127 patients at Galway during this period, which is equivalent to ten additional patients per week or less than two per day.

Peaks and troughs are a feature of attendances at emergency departments. The special delivery unit is working with hospitals to use the data on attendance patterns to plan for the variations which will inevitably occur. At my behest, the unit is driving this approach to radically reduce the overcrowding in our emergency departments which has been tolerated for far too long.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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During the course of the general election last February, the Minister stated that his party would put in place an emergency plan to accommodate the predictable surge in activity that occurs every winter. According to the figures for Our Lady of Lourdes hospital in Drogheda, 842 patients spent time on trolleys in that hospital in September. The figure for the previous September was 331 which, unacceptable as the situation was under the stewardship of Fianna Fáil, implies an increase of 154% in the utilisation of trolleys in the hospital. How will the Minister address an impending winter crisis against the backdrop of that serious increase in trolley usage without lifting the moratorium on front line service provider and addressing the crisis resulting from the closure of public hospital beds, an issue he once raised with regularity but has been in denial about since being appointed to office? The two issues are directly related to the crisis that I fear will reach unprecedented proportions this winter.

James Reilly (Dublin North, Fine Gael)
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The Deputy is correct to note that I raised these issues while in Opposition. I guarantee him that the special delivery unit is keeping a close eye on all these hospitals and it is reporting to me on a weekly and, sometimes, a daily basis. The provisions we are putting in place have been recommended by the hospital itself. We have priced them and they are only being made available under strict conditions. Certain other arrangements, including weekend discharges and diagnostics, will also have to be put in place. We are getting to the point where we can see what is happening on a daily basis and we can institute reforms in a more rapid and targeted way than in the past. The matter remains under review and, if the initiatives we have undertaken to date do not deliver the results we desire we shall look to initiate other processes to help address the situation.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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The Minister suggested that the changes which took place at Roscommon hospital have not caused a problem for Galway University Hospital. If that is the case, why was a bulletin broadcast on local radio stations on 24 September to warn people against going to the emergency department? If the replacement cover is so good why did one of my constituents discover after calling an ambulance that the paramedics could not even put in a line? If not for the fact that the patient's mother could perform that task, her child might not be with us.

Does the Minister really think it a success or is it solely a matter of money? I acknowledge he is not responsible for the mess that the last Government made but is this just about money?

James Reilly (Dublin North, Fine Gael)
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I acknowledge the concerns expressed by the Deputy regarding Roscommon hospital. However, I have investigated with HIQA and the HSE every option for keeping the hospital. I was told it was not safe to keep the emergency department open and that is the long and the short of it.

I stated previously that I will be honest with the House in indicating whether a decision is based on safety or matters of money. I am willing to admit to Deputy Ó Caoláin that the issue in Monaghan is budgetary in nature rather than about safety. The issue in Roscommon involved safety, however. The situation in Roscommon is unlike the situation in Our Lady of Lourdes hospital. The situation is far worse than in Galway University Hospital.

We experience surges but it is interesting to note that the special delivery unit discovered that a major surge does not occur in January. The tremendous problems that have arisen in the month of January were caused by a combination of people returning from holidays and increased activity in elective surgery, allied with what is there already.

Specific initiatives are being taken in Galway and new management is being put in place. Recent appointments have included a new chief financial officer and chief operations, and a new CEO will also be appointed as part of a wider initiative including Limerick mid-west to allow for upskilling across HSE west hospitals.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister referred to continuing monitoring but has he a plan? We are well into November and there is already ample evidence that the situation is worse now than it was 12 months ago. We need a plan that includes a means of addressing the moratorium on front line service providers and a programme for lifting the closure orders on beds in a number of hospital sites around this state.

Can the Minister tell us that he has a plan and that he will be in a position to respond if the numbers grow exponentially in the coming weeks?

James Reilly (Dublin North, Fine Gael)
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I will take the contribution from the Deputy in the spirit in which it is offered. There is a plan and I have outlined some of it to the Deputy. It is being implemented and must be given time to work. If we are not achieving the desired effect when we review it a number of weeks hence, we will take further initiatives. The plan covers much of what the Deputy has mentioned. Beds have been opened in Louth County Hospital and Navan hospital to relieve the pressure in Drogheda. All these issues have been addressed. In addition, eight beds within the hospital have been opened. These things are happening and we must give them time to take effect. We will keep the matter under active and close review.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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The Minister mentioned patient safety at Roscommon County Hospital and HIQA. In fact, HIQA representatives did not visit the hospital and produce a specific report on it, although the impression is given that they did. Also, when the campaign to keep the accident and emergency department open was at its height, figures were produced to show that the hospital was somehow four times more dangerous for people having a heart attack and with other conditions, but nobody produced concrete evidence to show that this was the case. Many would deny that it was any more dangerous than the hospital in Galway.

James Reilly (Dublin North, Fine Gael)
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The figures will be made available. I understand the report is to be published in the next few weeks and the Deputy will then have an opportunity to scrutinise the figures. However, I must restate the decision of the HSE to close the emergency department, on foot of HIQA's recommendation, was based on its assessment of the position prior to any of those figures becoming available. The figures emerged in the course of the debate as further evidence that there was a problem, but that was not the basis on which HIQA made its decision that it was not safe to continue the emergency department in Roscommon in its form at the time.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Minister says the closures can be justified on safety grounds. On 19 April 2009, shortly after the accident and emergency department in Ennis was downgraded to providing an 8 a.m. to 8 p.m. service, Mr. Dan McConnell, a 59 year old father of three, died just minutes away from Limerick hospital. He had suffered a heart attack in Kilkee, 34 miles from Ennis-----

Tom Hayes (Tipperary South, Fine Gael)
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Is the Deputy putting a question to the Minister?

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Yes. It was 34 miles from Ennis but 59 from Limerick. In other words, he died because the hospital in Limerick was further away. The closure of local accident and emergency departments in hospitals costs lives. That is the health and safety issue. What is the Minister's response?

James Reilly (Dublin North, Fine Gael)
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It is very straightforward. As I do not wish to show any disrespect to an individual, I will not discuss the individual case mentioned. The supposition on the Deputy's part that somebody might have survived had they gone to the hospital in Ennis which did not have the backup support that was available in Limerick is erroneous and not factual by any means. All the evidence shows that survival is predicated on getting to the right type of hospital, even if it takes longer than one hour, which has the ability to assess the problem, thrombolyse the patient and insert a stent, if necessary.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Therefore, the response times mean nothing.

James Reilly (Dublin North, Fine Gael)
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The response times are always important, but they are not the be-all and end-all. For many years we talked about the golden hour, which originated from field medicine in a war, but it is now outmoded and long gone, as any expert emergency doctor or consultant in this country will confirm.