Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I appreciate the Ceann Comhairle giving me the opportunity to raise this issue. I am also appreciative of the Minister's attendance to deal with it.

A new accident and emergency department is needed at Cavan General Hospital. I understand HSE officials have assessed the department's facilities and that they have been deemed inadequate, lacking the appropriate accommodation for the patient numbers currently attending, as well as to meet the requirements of patients and staff. Next month marks the 25th anniversary of the opening of Cavan General Hospital and at the time the numbers of patients presenting at the emergency department were considerably lower. The importance of the facility to the people of Cavan and Monaghan is evident when one considers that in 2013, 40,000 patients were checked in at reception in the emergency department, with just over 30,000 being treated in the department. The remaining patients were treated at the paediatric assessment unit and the acute medical assessment unit. These units were developed in the past five to six years. I am sure the range of new facilities required has been well documented to the HSE and the Department. I sought this Topical Issue debate in the hope some urgency would be afforded to these discussions.

I understand the areas requiring attention include the provision of appropriate resuscitation and isolation facilities and more examination cubicles. The layout of the emergency department is not suitable, which naturally imposes additional burdens on staff and patients. I understand a minor operating theatre and three to four cubicles in which minor injury patients could be seen by advanced nurse practitioners and junior doctors would enhance considerably the workings of the emergency department. The information technology system requires updating and triage cubicles of appropriate dimensions are also required. I am sure we all wish to see specific waiting accommodation and treatment facilities for children.

I outline these requirements in the context of the success of Cavan General Hospital and take the opportunity to compliment the staff in all disciplines in the hospital for their commitment, diligence and professionalism. I know that the manager of the hospital, Ms Bridget Clarke, works extremely hard and diligently, giving great leadership in challenging times. As the Minister knows, Cavan Monaghan Hospital operates as a single acute hospital, based on two hospital sites, catering for a population of 133,566 people. These figures from the 2011 census represent a population increase of 11.31% on the 2006 census figure, with Cavan seeing the third highest population increase recorded in the 2011 census, closely behind Fingal and County Laois. This welcome increase in population creates an extra demand on health facilities and, in the context of health service delivery, the 2011 census indicated that there were 15,847 persons aged over 65 years and 4,157 aged over 80 in Cavan and Monaghan. This age profile is much higher than the national average for these age cohorts, which imposes additional demands on local hospitals and in the delivery of health services in general.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy for raising this important issue. As he knows, I visited Cavan General Hospital not long ago as we met at the time. From January to the start of April this year there were just 195 patients waiting on trolleys at the hospital, whereas in 2011, during the same period, there were 1,825 patients waiting on trolleys. This is a decrease of almost 89.3% on the number who must endure long waits on trolleys at the hospital. I congratulate the staff for their great efforts in achieving this improvement.

An acute medical assessment unit, AMAU, was officially opened at Cavan General Hospital on 11 April. The introduction of this unit, alongside the emergency department, benefits patients by allowing for their assessment in a much more timely fashion. From the patients' perspective, attending the AMAU reduces their waiting time and means a senior doctor can make a prompt clinical decision on whether a patient needs to be admitted. A decision on discharge or admission is facilitated by radiology, laboratory and other dedicated services, including nursing, therapy professionals and medical social workers. If admission is required, the patient will be admitted to the most appropriate area of the hospital. If admission can be avoided, the patient will have access to appropriate and timely outpatient follow-up care.

As well as the AMAU, a separate paediatric assessment unit, as mentioned by the Deputy, was introduced in the hospital in July 2011. An outpatient facility for paediatric cystic fibrosis patients opened in April and I was pleased to attend at the time. Development work has been undertaken in respect of the short stay and day wards and the minor injuries unit in Monaghan also assists in ensuring only cases which genuinely require emergency care are directed to the emergency department in Cavan. The Deputy knows that the hospital in Cavan is not just a single hospital operating on two sites.

It is now part of the Dublin North East group and has a very bright future within that.

This development has significantly improved patient experience and reduced wait times in both the acute medical assessment unit and the emergency department, ED, with a daily average of two patients waiting for admission, and these waits being less than nine hours. I am determined to see that this good practice and organisation, which has been put in place in Cavan and resulted in such great ED improvements in recent years, will be repeated in other hospitals and lead to further improvements in EDs across the country.

I am conscious that the infrastructure of the ED in Cavan General Hospital is now 25 years old, and that the number of presentations has grown by around 33% from 2011 to 2013, with an average of 80 presentations each day. In many of our hospitals, the physical structures which were acceptable at the time of construction were not future proofed. When judged against recently developed guidelines, such as the Children First guidelines or the standards defined in the emergency medicine programme, they cannot meet the more stringent standards that have developed in their lifetime. Despite constrained resources, we try to ensure that essential service developments are undertaken. Since 2011, Cavan has seen the expansion of its renal dialysis unit, the development of the paediatric assessment, short-stay and stroke units and the expansion in 2010 of the ED. As resources allow and service needs are determined and prioritised, such developments will continue in the future.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the Minister for his reply.

He rightly states that he officially opened the relocated medical assessment unit some weeks ago and the unit in its original location has been extremely successful. Similarly, the paediatric assessment unit eases the pressures on the ED. Between 2000 and 2011, Cavan General Hospital received major capital investment, which has resulted in new facilities and services. Some of the additional facilities provided during that period include a special care baby unit, additional bed capacity - more than 21 beds, I think - MRI units, a CT scanner, other diagnostic facilities, major expansion of the renal dialysis unit, an upgrade to a very high standard of the intensive care unit, the provision of oncology services linking with the Mater hospital which is very welcome, improved psychiatric services and resources for inpatients, and investment in other facilities. The hospital cares for substantially more patients with differing medical needs. Thankfully, today, patients can be treated in Cavan who in the past had to access those services in Dublin or outside our region. We sincerely appreciate those developments in oncology and nephrology, which have been spectacularly successful.

In general, where a hospital’s overall capacity expands, that indirectly places more demands on the ED. In layman’s terms, the hospital is busier and the need for additional new build facilities is an endorsement of the hospital’s work. I am realistic enough to know these facilities will not be developed overnight but we want them in the pipeline so that they will be put in place in a few years’ time.

I take this opportunity to thank the staff who work in EDs. I have had very little reason to attend an ED for care but the staff work under very difficult circumstances and I appreciate their commitment and diligence.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy. He has outlined the considerable improvements in Cavan General Hospital, including the expansion of the renal dialysis unit from ten to 18 stations in 2011, thus enabling patients to access dialysis locally instead of having to travel to Dublin three times a week. The paediatric assessment unit opened in July 2011, with 5,000 patients assessed and treated in a dedicated facility by a dedicated paediatric staff instead of being seen in the ED. The was also the infrastructural expansion of the ED in 2010, the genitourinary medicine clinic developed in Monaghan Hospital, supported by Co-operation and Working Together, CAWT, and the development of the stroke unit. The care of stroke in this country has been transformed in the past 18 months through the clinical programmes and I congratulate everybody involved. It now means that we are either saving a life or preventing somebody from going to into long-term care every single day. We have gone from the bottom of the league in Europe for use of thrombolysis, the clot-busting drug, to the very top in a short period. That is a real credit to all concerned.

I congratulate the staff in the ED too and I am not being smart when I say that I congratulate everybody in the hospital because the ED operates only if the whole hospital operates properly and people can be admitted quickly when they need to be admitted and not left languishing in the ED. That requires great co-operation from the staff up the house as well. It also requires proper integration with community services so that people can get into long-term care when they need it, or get the home care package they need. Nobody wants to go into long-term care before they really need to. The cystic fibrosis area developed in the outpatient suite is a huge boon too because it means that patients do not have to worry about cross-infection. Cavan General Hospital has done a fantastic job of delivering quality care across an increased range of services and while the fabric is 25 years old and we would like to modernise it, the most important point is that patients today receive a safe, efficient service from very dedicated professionals.