Gerald Nash (Louth, Labour)
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The situation in the accident and emergency department at Our Lady of Lourdes Hospital in Drogheda requires the immediate attention of the HSE and the Department of Health. The Minister will know from our various conversations over the past three years that I am proud of my local hospital. I am proud of its staff and I know the staff quite rightly take great pride in the service they provide to the people of Drogheda and for the people across the north east and north County Dublin.

The hospital has evolved considerably in recent years from being a local acute hospital and maternity service to a major regional centre of excellence, the major trauma centre for the north east with a busy, newly built emergency department dealing with more patients than ever. The Minister will be aware of the longer-term plan for the further expansion of the emergency department with €22 million allocated to the project which will double the capacity. Full planning permission was recently granted for this expansion and the project is ready to go.

This does not deal, however, with the problem facing nurses, doctors, hospital management and, most important, the patients and their families. Yesterday morning, a total of 45 patients who had been technically admitted to the hospital, were waiting for beds, with nine patients in a queue in the accident and emergency department. Management and staff did their utmost to respond as best they could to the situation by reassigning staff and opening some new beds in other facilities in the region. However, the major problem is that since the reconfiguration of hospital services in the north east under the previous Government, the Lourdes hospital has never had the full complement of beds which a region with this size of population merits. It did not have a full complement under Fianna Fáil when the country was awash with money and I take the view that neither does it now. Older patients who are medically discharged need their home care packages fast-tracked.

The Minister for Health and the HSE need to provide the necessary resources for the development of 100 beds in a long-term residential nursing home, a proposal promoted by me and by my colleague, the Minister of State, Deputy Fergus O'Dowd. The HSE has applied to the Department of Health for capital funding to allow this project to come to fruition. This is my aim and that of the Minister of State, Deputy O'Dowd. It is now the policy of the HSE region of Dublin and the north east which made an application in recent months.

The Cottage Hospital in Drogheda has been kept open and it is a facility in which the Minister has an interest. The hospital cares for those who are no longer acutely ill and are waiting until they are well enough to go home or until their longer-term care needs are addressed. It is vital to see the new extra transitional care beds which the HSE is committed to delivering and which are much needed. The HSE is working with the staff in the hospital to fulfil that goal.

James Reilly (Dublin North, Fine Gael)
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I thank Deputy Nash for raising this issue. Our Lady of Lourdes Hospital, Drogheda, experienced an unusually high level of presentations at its emergency department on Monday and Tuesday of this week, which placed services under severe pressure. The situation was exacerbated this week by the fact that over 57% of the inpatient beds in the hospital have been occupied by elderly patients who generally require more complex care or who may be waiting for community or nursing home services to facilitate their discharge from acute hospital care. In this regard, all available private nursing home capacity is being utilised and it is intended that a further 15 beds will be opened in Louth County Hospital. In response to the pressures experienced earlier this week, a full escalation protocol was engaged within the hospital, and other hospitals within the area were notified and assistance requested.

The overall aim of an escalation protocol is to ensure each hospital with an emergency department has a fit for purpose operational framework to respond to surge pressures. The hospitals must manage admissions, discharges and escalation - surge capacity - procedures in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care. It is important that escalation measures are undertaken across the full health system, including primary, community and continuing care services, to ensure all available capacity and options are utilised and brought to bear on the situation.

In response to the surge experienced in Drogheda, all non-urgent meetings and training sessions were cancelled to ensure availability of staff, including diagnostic teams - for example, radiology and laboratory - and allied health professionals such as physiotherapists, to focus on managing that surge. All emergency department requests were expedited to allow everyone to focus on the emergency department response. Elective endoscopy was cancelled or diverted, thus making six beds available to emergency department admissions. This will remain the case for the rest of this week and next. Cancelled procedures are being redirected to Louth County Hospital to ensure patients are accommodated. Non-urgent and non-cancer related elective activity is also cancelled at present. In addition, use of the minor injuries unit and GP services are being actively promoted for appropriate patients.

Unusual pressures such as these are disappointing for the Department, the Irish Nurses and Midwives Organisation and the HSE's special delivery unit, but much more so for the patients and their families for whom these delays add discomfort and further distress. However, as a result of the efforts of the staff and management of Our Lady of Lourdes Hospital, the number of patients awaiting admission has reduced significantly, from 45 at 8 a.m. yesterday to 15 at 8 a.m. this morning. I take this opportunity to join Deputy Nash in commending the hospital staff on their efforts.

Gerald Nash (Louth, Labour)
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I thank the Minister for his detailed response. I am aware that the numbers awaiting admission have reduced dramatically in the past 24 hours. It is due to the work of nursing staff, doctors and hospital management that these serious inroads are being made. Earlier today I contacted the INMO to arrange a meeting to discuss this problem, which concerns the wider community in Drogheda, County Louth and the east Meath area. It is an issue we must address.

When the special delivery unit got stuck into this issue of trolley waits at Our Lady of Lourdes Hospital a couple of years ago, we began to see significant year-on-year reductions. In fact, the trolley figures have more than halved since the Government came into office, from 7,500 in 2011 to 3,212 in 2013. That dramatic reduction represents serious progress in addressing the problem. It is all well and good, however, for the Minister or me to point to that progress. The reality is that ill people being made to wait on trolleys for admission to a bed in this or any other hospital in the country is a situation people are not prepared to tolerate. It is time to tackle this issue in conjunction with the SDU. The response by the SDU to the crisis previously was excellent, progressive and effective.

In an ideal situation, nobody would be waiting on trolleys, and there is no doubt that some of the reforms led by hospital staff and the Department have worked. What it boils down to, however, is that where blockages arise in regard to the fair deal scheme and home care packages, they must be addressed without delay. The underlying problem is the high numbers of elderly patients stuck in acute beds when that is not necessarily the right place for them. The only way we can address this problem locally is by ensuring the HSE's proposal to develop a 100-bed unit at the site of St. Mary's Hospital on the Dublin Road in Drogheda is delivered. It is a proposal I support, as does the Minister of State, Deputy Fergus O'Dowd. I hope the Minister will take on board our representations in this regard.

James Reilly (Dublin North, Fine Gael)
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I am aware that this matter is of considerable concern to the Minister of State, Deputy Fergus O'Dowd, and to Deputy Nash and our colleague, Deputy Peter Fitzpatrick. We have major reforms under way which are yielding results. I thank the front-line staff and management for implementing those reforms with 10% fewer staff, a 20% reduction in budget and an 8% growth in the population. Despite these pressures, we are still managing to improve the service and will continue to do so. Ultimately, however, reforms of the current system can only go so far, which is why I will shortly be bringing forward a White Paper on universal health insurance.

Regarding the fair deal scheme, it is important to note that it operates in chronological order, with people in the community coming on stream first followed by people in hospital, or vice versa. Early last year we opened up a number of long-term care beds, many of which went to people in the community. As such, they did not alleviate the situation in hospitals. I am in ongoing discussions with the Minister of State, Deputy Kathleen Lynch on this issue. Patients who require long-term care are, by definition, very ill and, in many cases, elderly. As Minister for Health and as a doctor, my view is that those who are most acutely in need, namely, the people who are acutely ill in casualty, must be prioritised. If that means we sometimes have to break the chronological order under the fair deal scheme, then it will be done because it is the fair thing to do. I do not agree that we should dispense entirely with the chronological order, but when we experience surges such as we have seen at Our Lady of Lourdes Hospital, we must take action to protect those who are most vulnerable and most at risk. Those are the patients lying on trolleys in our emergency departments.

I thank the Deputy for raising this issue and the staff of Our Lady of Lourdes Hospital for the great work they are doing, as well as the staff right across the health system who have implemented major improvements despite the lack of resources they face.