Michelle Mulherin (Mayo, Fine Gael)
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I raise this matter on account of the serious ongoing trolley problem at Mayo General Hospital, which is in the red zone as it has between ten and 12 patients, on average, on hospital trolleys day after day. The problem has been intensifying over the past year and is getting worse. It affects elderly people, who are not fit to be left lying on trolleys.

This is of grave concern to the Minister for Health. I compliment him on his nationwide campaign to eliminate the problem and his initiative in setting up and funding the special delivery unit to tackle the problem of people on trolleys. The state of affairs at Mayo General Hospital is even more disturbing given that the hospital got on top of the trolley problem in 2011 with a 64% reduction in the number of people on trolleys. This is a considerably greater achievement than the national average, a reduction of 20%. There is evidence that the management knows its stuff and has a track record of thinking outside the box to tackle the issue. This is exactly the challenge the Minister has laid down.

However the problems and blockages at Mayo General Hospital are caused by external factors and the problems are twofold. There was a significant increase of 8% in people presenting at the accident and emergency unit in 2012, together with an 8% increase in the number of medical patients being treated in the hospital. One of the reasons for this is that 5% of patients are from Roscommon. This is a knock-on effect of the closure of the accident and emergency unit at Roscommon hospital, which leads to an increase in the number of people presenting from Roscommon. Anecdotally, it seems that changes to the way GPs are paid means they are doing fewer house calls. Consequently, more people are being referred to accident and emergency units. There is an increased dependence on the public health system, with fewer people able to afford private health care.

The greatest problem causing overcrowding at Mayo General Hospital is delayed discharge, which is a major problem in the hospital. This week, the average delayed discharge daily figure is 16 patients. Last week it was 12. Over the previous weeks a similar pattern has emerged. These patients are passing their time in an acute hospital bed and should be transferred into stepdown facilities. The problem is a lack of stepdown facilities available in the county.

A startling statistic is that following the closure of 12 stepdown beds in Ballina District Hospital since the end of 2011, the number of delayed discharges at Mayo General Hospital has increased by 400%. The blockage at Mayo General Hospital is chronic and needs urgent intervention, which is what I seek. I acknowledge the €105,000 allocated from the special delivery unit this year and the €300,000 last year to support the acute medical assessment unit. These moneys were spent to good effect.

The money allocated for this year is insufficient to address the problem. We need more stepdown facilities. I request that the HSE is directed and funded to open 12 beds in Ballina District Hospital. It makes economic sense. A patient in a medical bed in Mayo General Hospital costs the State €900 per day, compared to €1,000 per week at Ballina District Hospital. Stepdown beds at Swinford and Belmullet district hospitals could also be part of the solution. It is imperative funding is made available for two intermediate care teams in County Mayo. This will allow patients, where appropriate, to receive hospital-style treatment in their homes. In many cases, it would prevent these people being admitted to hospital in the first place and allow for early discharge. I seek funding and urgent intervention. Management has a proven ability to tackle the trolley issue but external factors are having an impact and the hospital needs the support of the Minister and the Department.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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I thank the Deputy for raising this issue. The Government is committed to ensuring that patients receive the highest standards of care in the appropriate settings, be they acute, community, primary or residential. The traditional focus on the institution rather than the patient must be changed. To this end, we support older people to live at home and in their communities for as long as possible. This is realised through a range of community-based services such as mainstream home help, enhanced home care packages, or via other supports such as meals-on-wheels and respite or day care. The services are designed to be as flexible as possible to best meet the needs of individual recipients, their families and their carers.

In order to meet increasing population needs and to deliver sustainable services within available resources, innovative models of care are required to further advance the development of equitable integrated care for older people across community-based services, intermediate care options and quality long-term residential care services supported by a robust and well-funded scheme. The provision of intermediate care options and the provision of clear pathways of care for older persons accessing the health care systems will continue to be developed in 2013, with specific emphasis on the provision of transitional intermediate type care to address the issue of unnecessary admissions to acute hospitals and the requirements for long-term care. This will build on the work commenced in 2012, which saw an investment of €11 million in these types of services.

The HSE service plan 2013 was published on 10 January 2013 and the HSE west service plan was published on 28 February. Budgets have now been allocated for each local area within HSE west. New developments for 2013 are identified across a number of services, including funding of €35 million nationally for mental health, €620 million for primary care and €90 million demographic funding to include services such as screening, expansion of the ambulance service and a specific €10 million for pressures arising in hospitals.

Decisions will be taken shortly on prioritising need for this funding. They will be taken on the basis of current productivity and performance in managing existing resources. The needs and issues highlighted by the acute services in Mayo to which the Deputy referred will be taken into consideration in the process of allocating the funding.

I am happy to note the Deputy's acknowledgement that the provision of care in other settings could facilitate the better use of acute hospital resources. I assure the House that decisions relating to the funding of all services seek to address efficiently the needs of individuals and their carers. I thank the Deputy for raising this matter. I will bring it to the attention of the Minister for Health.

Michelle Mulherin (Mayo, Fine Gael)
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I thank the Minister for her response. I welcome the fact that it spoke to the concern regarding the trolley numbers in Mayo General Hospital that owe to blockages and a lack of step-down facilities. An urgent case has been made for some of the €10 million in funding to relieve hospital pressures to be released to Mayo General Hospital. Better value for money would be achieved if patients who were more suitable for step-down facilities were not in expensive medical beds. Re-opening 12 beds in Ballina District Hospital would make a considerable contribution to solving this problem. In light of the fact that decisions on prioritisation are imminent, I ask that this view be taken and that real support be given to the district hospital's management. From my regular dealings with it, its management is trying its best to stick to the Minister's intention, that is, to solve the problem creatively.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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I will bring the Deputy's points to the attention of the Minister for Health, Deputy Reilly.