Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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I do not mean this as any reflection on the Minister of State, Deputy O'Dowd, but it is regrettable and disappointing that neither the Minister for Health nor one of the two Ministers of State from the Department is here to respond to this matter.

The front page of our local newspaper in south Tipperary, The Nationalist, carries the heading "Trolley case at South Tipperary General Hospital". The treating of patients on trolleys in the corridors of the hospital has been an ongoing feature. There were 13 patients on trolleys on Monday last, 18 June, 20 on Tuesday, 16 on Wednesday, 12 on Thursday and 16 on Friday. Patients on trolleys is an ongoing feature of the delivery of health services at South Tipperary General Hospital as a significant number of beds in the hospital, some 31, have been closed due to Government cutbacks.

There is no better way of outlining the current position at South Tipperary General Hospital than to record what a patient at the hospital said in recent days. He stressed that hospital nursing staff, doctors and other staff were outstanding and gave excellent care but he was shocked by the number of patients on trolleys, particularly the number of elderly people, and was angered at the lack of privacy and dignity they had. He said there was little changing facilities for them and they had to use the hospital public toilets. He said that patients had to share screens and it was very difficult for doctors to speak to patients privately about their illness. He said patients found it very difficult to sleep on trolleys due to the general noise of the hospital around them and people passing though staff tried to keep the corridors where there were trolleys free of traffic as much as possible.

That is a totally unacceptable situation, particularly when there are 31 beds closed at the hospital. I appeal to the Minister to ensure that some of those beds are open to deal with this situation.

Mattie McGrath (Tipperary South, Independent)
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I thank the Ceann Comhairle for allowing Deputy Healy and myself to raise this matter today. I do not mean any disrespect to Minister of State, Deputy O'Dowd either but it is downright shameful that neither the Minister nor a Minister of State is here to answer this matter. We will get the a standard answer that we always get and that is not good enough.

Deputy Healy referred to the more than 30 beds that are closed. We have never that this level of overcrowding in South Tipperary General Hospital with the patients being treated on trolleys last week numbering 13, 18, 16, 12 and 16, respectively, and this is an ongoing feature. It creates too much pressure. It affords patients no dignity. It is not good enough or acceptable.

I compliment the doctors, the medical people and all the staff at the hospital for operating on a daily basis under that pressure, keeping their sanity, having good manners, maintaining a good relationship with the patients and doing their best, as reported by patients in an article on the front page of our local newspaper. I hear those comments all the time. However, this situation is clearly unacceptable.

Where is HIQA when it comes to dealing with this situation? It is up and down the country closing nursing homes, two or three in my county. Its officials are looking for the carrying of name badges and other nonsensical requirements. Why are its officials not on the corridors when the treatment of patients on trolleys is clearly unsafe, unhealthy and undignified? What are HIQA officials not in this hospital? This sham must stop. They are attacking the running of private and public nursing homes and putting them under savage pressure. Where are they when trolleys are blocking up the place? Patients are on trolleys for up to a day and half. Where are the HIQA officials then? This farce must stop. The Minister promised he would eliminate the need to have patients on trolleys.

The Minister and the Minister of State, Deputy Lynch, closed St. Michael's unit at the hospital, which means that anybody with a psychotic attack in south Tipperary, other parts of Tipperary and parts of west Waterford must go to the accident and emergency department in St. Joseph's, adding to an already disastrous situation there. This is totally untenable, it cannot last and it will not last as something drastic will happen here.

It is beyond time that the Ministers came in and answered to the elected representatives of Tipperary South. I wonder what Deputy Tom Hayes and Senator Denis Landy are doing about this. It is not good enough for them to be merely rubbing their hands. We need action on this and at least the respect the Minister or one of his junior Ministers could show by coming in here to answer this matter.

Fergus O'Dowd (Louth, Fine Gael)
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I am replying to this matter on behalf of the Minister for Health. I can assure the Deputies that the comments they made will certainly be brought to his attention as soon as possible.

It is a very important issue and the HSE South Tipperary General Hospital regrets that because of increased activity some patients are experiencing delay in being transferred from the emergency department to a hospital bed. The HSE apologises for inconvenience caused and wishes to assure patients and the public that staff are working hard to minimise this inconvenience.

Mattie McGrath (Tipperary South, Independent)
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We know that.

Fergus O'Dowd (Louth, Fine Gael)
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Patient care is paramount in South Tipperary General Hospital. The situation is a priority for hospital management and is being continuously and actively reviewed. Additional staff are in the emergency department to ensure patient care and safety at all times. Hospital management wishes to acknowledge the hard work and dedication of all staff during this busy period to ensure that all those waiting for treatment and admission are accommodated in a manner that is in keeping with proper dignity and respect for all of the people in these trying circumstances.

The hospital has experienced an 11% increase in activity from 2011. Of this increase, general medicine has increased by 32%. There has also been a 14% increase in patients from the north Tipperary area. On a normal day, about 108 people attend the emergency department and 21 of these patients, on average, are admitted. From time to time, a surge may occur in patients attending and this has been the case recently.

At 10 a.m. on 27 June 2012, there were 13 patients on trolleys. It is planned that at least four of these patients will be discharged today. In addition, four other patients will be discharged later today from wards to assessment beds or step down community hospitals. Further discharges may be made following ward rounds during the day.

The hospital escalation plan is in operation. The plan includes additional inpatient surge capacity, regular assessments of all emergency department patients by hospital consultants, evaluation of inpatients for discharge and management of elective activity. There are a number of meetings held throughout the day between the bed manager, the discharge planner, director of nursing, clinical director and hospital management to review and manage the situation.

Liaison officers in the special delivery unit, SDU, are in touch with management on a daily basis and the situation is monitored as part of the three times daily trolley count by staff in the SDU. The SDU high intensity support programme is working with senior management to resolve the issues of overcrowding and reduce the number of patients on trolleys.

The SDU is working closely with hospital management to implement integrated discharge planning and to further develop the acute medical assessment unit in an effort to decrease admissions and length of stay. In this context, it is noted that the hospital's average length of stay, at 3.5 days, is below the national average and the latest hospital bed capacity review identifies the appropriateness of admissions and care as well within the recommended national levels.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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That response is outrageous and shameful. It did not address the issues raised. There is an acceptance in it that the hospital activity level has increased significantly and substantially with an 11% increase in activity over 2011 and a 32% increase in general medicine. The reply states that the average length of stay at 3.5 bed days is below the national average and admissions are well within recommended limits. The thanks that the hospital staff get for that is that they have to operate in a situation where patients on trolleys in the corridors on a daily basis is an ongoing feature

The patient I mentioned who was in the hospital recently and made this matter public confirmed, for instance, that patients on trolleys in corridors are a fire hazard and also pose obvious infection control dangers. Trolleys also pose a difficulty for cleaning staff who had to physically move the trolleys from one side of the corridor to another.

It is past time that some of the beds that are currently closed at South Tipperary General Hospital be re-opened. The basis for doing that is outlined in the Minister of State's reply in terms of increased activity levels, a shorter length of stay than the national average and more than an appropriate admission policy.

Mattie McGrath (Tipperary South, Independent)
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I must agree with my colleague. This response is pathetic nonsense. All we get is jargon. The reply states that a number of meetings are held throughout the day between the bed manager, the discharge planner, the director of nursing, the clinical director and hospital management to review matters. When we had the sisters as matrons, there were none of these titles and we had good hospitals. As Deputy Healy said, we have worked very hard, kept within the guidelines, done everything we were asked to do and we are being punished. There are all these people in positions with titles and, no disrespect to those involved, they are pen pushers. There are all these new positions that carry fancy names. We need front line staff and the wards open. We do not need all these people in positions with fancy names, using all this jargon and going around carrying their folders. There is a bed manager, a discharge planner and a director of nursing. These positions were unheard of in the past. This is what is wrong with the HSE and there has been a complete system failure. We have all these people while the front line staff such as doctors, nurses and consultants, are working tirelessly. The next development will be a clamping of beds in corridors. It is a shame and a disgrace and it is untenable. Nenagh hospital has been closed, there is not enough space in Limerick and that is why people are coming to Clonmel. The situation is the same in Waterford. Ministers avoiding the issue will not do anything for us. It is time we got some honesty, decency and fair play in Tipperary.

Fergus O'Dowd (Louth, Fine Gael)
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I assure the two Deputies opposite who have articulated their strong views that the Minister will be made aware of their points of view. Either the staff are doing their best or they are not and it is clear that the two Deputies are commending the staff and the organisation of the hospital and its capacity to respond, given the difficult situation.

I refer to three significant achievements of the hospital. In 2010, South Tipperary General Hospital was chosen as one of the first implementation centres for the national colon cancer screening programme. It achieved second place in Ireland in the national audit of end of life care standards and it now receives postgraduate medical students from the University of Limerick and from Cork. This identifies the talents and capacity of the staff to deliver the best possible service, given the very trying circumstances under which they work. It is a national recognition of the significant work and the calibre of the staff of the hospital.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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They are now being punished.