Patrick Nulty (Dublin West, Labour)
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I wish to address the urgent matter of Connolly Hospital in Blanchardstown which serves 331,000 people. There are some 35,000 attendances at the emergency department each year and I welcome the commitments given a couple of weeks ago by the Minister for Health, Deputy James Reilly, that the Government will retain a 24 hour full service at the accident and emergency department.

However, services in the hospital are under pressure and I call for a resolution of this issue. Last January, 32 beds were closed in Connolly Hospital and that number has now risen to 44. The total number of closed beds in our health service has spiralled and on 11 October last there were over 2,000 hospital beds closed throughout the Republic. A recent review conducted by the Irish Nurses and Midwives Organisation, INMO, revealed high levels of overcrowding in our emergency departments. The record numbers of people waiting on trolleys is the result of cuts in services, reducing the number of long-term care beds and increasing the volume of acute bed closures.

The Health Service Executive has implemented a number of measures to achieve so-called savings in Connolly Hospital. First, there has been a reduction in the use of agency staff and overtime hours. Second, the surgical day ward was temporarily closed and re-opened with eight places rather than 24. This ward will close fully again for three weeks from 19 December. The result of these reductions and bed and ward closures is increased waiting lists, growing numbers of patients on trolleys and an increased risk of the spread of infectious diseases.

The implementation of crude cuts and financial controls by HSE management is pushing services in Connolly Hospital and other hospitals to the brink. The decision to implement these cuts as we head into winter, when demand for hospital beds and services is at its highest, undermines the capacity of our health care professionals to deliver a fair, safe and efficient service. A recent report published by the Think Tank for Action on Social Change, TASC, showed that access to health care and life expectancy is determined by class and social background. An immediate and urgent strategy is required to eliminate the inequalities in life expectancy that exist in Ireland today. The first part of such a strategy must be to halt the implementation of crude cuts and closures in our health care system.

On behalf of the people who loaned me their vote and sent me to Leinster House, I call for the lifting of the recruitment embargo by the HSE. In Connolly Hospital, for example, 50 nurses have been taken off the roster, with the gaps being filled by agency work and overtime. This is not providing value for money. We must review that policy if savings are not being made, as well as the impact on patients. I also call for the opening of closed beds and hospital wards and for emergency funding for Connolly Hospital through the winter. A guarantee must be provided that full accident and emergency services will be retained in the future. I welcome the previous assurances and I hope to receive them again today.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this important issue on which I am responding on behalf of the Minister for Health, Deputy James Reilly.

Connolly Hospital is an academic teaching hospital which provides a full range of acute services, including a 24 hour accident and emergency department. It serves a catchment population of 331,000. Multidisciplinary teams of medical, nursing and allied health professionals, as well as management and general support staff, play a pivotal role in the development, delivery, monitoring and evaluation of these services.

The efficiency of all services is being reviewed by the HSE in view of the current budgetary and financial position. The Minister for Health has emphasised to the HSE that budgetary compliance must be maintained with the delivery of service levels set out in the national service plan. Activity and expenditure at Connolly hospital are ahead of the levels approved in the 2011 national service plan. A comprehensive review of services at the hospital has been undertaken by the HSE and hospital management, and certain measures have been taken as a consequence of this review. These include a reduction in the use of agency staff and overtime hours and some limited bed closures. The latter measures include the temporary closure in the latter quarter of the year, for two short periods, of the surgical day ward. There will also be a limited reduction from 24 to eight places in the surgical day ward from early November. In addition, there are currently 24 acute inpatient beds closed in Connolly Hospital, although it is planned to open these beds where feasible to relieve specific pressures during peak times over the winter period. Two of the 11 critical care beds at the hospital are also closed but are being utilised when they are clinically required.

Deputy Nulty, being a new Member, might not know this but usually the ministerial reply on a topical issue debate is circulated when the Minister stands to speak. The copies of my reply have not yet arrived but the Deputy will receive one.

I congratulate the Deputy on his recent victory in the election.

Michael Kitt (Galway East, Fianna Fail)
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I do likewise. The copies of the reply are on the way to the House.

Kathleen Lynch (Cork North Central, Labour)
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Good. I was anxious to let the Deputy know.

The Minister has made it a priority to unblock access to acute services in our hospitals by improving the patient flow through the system. Access to services is not about bed numbers per se but is about how the bed capacity in a hospital is managed to maximise throughput and provide safe and quality care to patients. This can be seen in the variations in performance in hospitals across the country.

The special delivery unit, SDU, which was established by the Minister in June this year, is focusing on these issues. The SDU is in the process of establishing an infrastructure based on information collection and analysis, hospital by hospital, in order to ascertain what is happening in real time. It provides information tools for hospital managers, including clinical managers, to map and measure bed capacity in their hospitals depending on variations in, for example, the average length of stay of patients. This will allow the Department to begin to embed performance management in the system, to manage bed capacity and to sustain shorter waiting times.

In principle, opening additional beds is not a panacea to resolve the difficulties in the hospitals.

Michael Kitt (Galway East, Fianna Fail)
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The Minister of State should conclude shortly as we must move on.

Kathleen Lynch (Cork North Central, Labour)
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I will conclude. The entire reply will be included in the Official Report and will be supplied to Deputy Nulty. I again congratulate the Deputy on his election.

Additional information not given on the floor of the House.

In the absence of real and sustained change in how the existing capacity is managed, additional beds will be quickly absorbed without any net gain for patients. The aim of the SDU is to unblock access to acute services by improving the flow of patients through the system. The SDU's initial focus is on emergency departments and it will work to support hospitals in addressing excessive waiting times for admission to hospital.

As part of the process of forming the overall picture of the emergency departments situation nationally, the SDU has identified 15 hospitals, which between them account for 80% of the trolley wait problem in the hospital system and of which Connolly Hospital is one. Liaison officers from the SDU are working proactively to support these sites including Connolly Hospital.

The Minister also has agreed that some additional funding may be provided, on a strictly once-off basis, based on specific proposals from the hospitals to reduce waiting times. Adherence to the agreed criteria will be closely monitored by the SDU. The SDU is currently examining a plan for some additional funding for Connolly Hospital. Where this type of support has been provided elsewhere it has been on the strict understanding that it will only be released to hospitals where the specific performance measures and specified conditions have been met.

The conditions and performance measures which hospitals must meet are as follows: for the remainder of the year and throughout January 2012, no patient will wait more than 23 hours in the hospital's emergency department. In addition, the trolley wait target must be maintained at least 70% below the maximum daily trolley count since January 2010. Other conditions or performance measures include seven-day ward discharge rounds, achievement of all acute medicine programme milestones and implementation of approved measures to stream elderly patients effectively. For the plan from Connolly Hospital to be seriously considered, it must convince the SDU that hospital management, by which I also mean clinical management, is fully signed up to the kind of performance measures needed to deliver real change.

Patrick Nulty (Dublin West, Labour)
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I commend the Minister of State on the fantastic work she is doing in the areas of disability and mental health. She is dealing with serious issues under difficult circumstances. To return to the issue under discussion, the manner in which the moratorium is being operated must be examined. The argument is that the moratorium will provide savings. However, as front-line staff are being replaced with agency workers and through overtime, I do not believe it provides savings to the Exchequer. Therefore, a pragmatic approach should be taken, particularly in respect of front-line services such as health, whereby front-line staff who need to be replaced should be replaced in the conventional way.

In addition, while I agree beds constitute just one aspect of the delivery of quality health care, it is an important aspect. In the health sector, both patient care and value for money are crucial but ensuring an adequate throughput of patients requires staff and requires beds to be open and operational, particularly in winter. Consequently, I ask that funding to ensure the operation of Connolly Hospital at an appropriate and high quality level be assured over the winter and that the accident and emergency unit, which serves 330,000 people, will be secured. I thank the Minister of State for her response.

Kathleen Lynch (Cork North Central, Labour)
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Briefly, I concur fully with the Deputy's comments. In addition, I note the Minister is not averse to providing additional once-off funding to ensure the waiting times in Connolly Hospital are reduced. Moreover, he is committed to ensuring the lengthy stays on trolleys seen in the past of people who are ill will be greatly reduced. However, as the Deputy is aware, it is not always about care but sometimes relates to something more fundamental, namely, structure and management. This is a longer-term goal even though I do not believe we have the time to wait and must act more urgently.