Séamus Kirk (Louth, Fianna Fail)
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I thank the Ceann Comhairle for giving me an opportunity to raise this most important issue for the constituency of Louth and east Meath. Earlier today, there were 32 people on trolleys at Our Lady of Lourdes Hospital in Drogheda. That figure, which represents an increase of 25 on yesterday's figure, is almost double what it was last Friday. These figures are recorded and monitored by the Irish Nurses and Midwives Organisation. No other hospital in the country has as many people on trolleys today as Our Lady of Lourdes Hospital. University Hospital Limerick was in second place with 22. Given that there are 210 patients on trolleys across the country as a whole, it is clear that Our Lady of Lourdes Hospital accounts for one in seven patients on trolleys. The figures compiled by the Irish Nurses and Midwives Organisation indicate that 1,855 people spent time on trolleys between January and April of this year. This compares to a figure of 1,397 for the same period in 2013.

Last week, this House debated the overcrowding and the cramped conditions at University Hospital Limerick. I am pleased this week to have an opportunity to raise the very serious problems at Our Lady of Lourdes Hospital in Drogheda. We are continually receiving complaints from our constituents in counties Louth and Meath, and from people further afield, about the serious problems with accident and emergency facilities at the hospital. The Irish Association for Emergency Medicine has mentioned the possibility of accident and emergency department closures this summer, as budgetary measures aimed at making savings in the general health area take effect. The association has warned that accident and emergency units will face a perfect storm if staffing meltdown is accompanied by the possibility of closures. This is extremely serious.

I am glad the Minister for Health is present to respond to what I have to say. He is quite familiar with Our Lady of Lourdes Hospital, which is just down the road from his own constituency in Fingal. I am sure a few of his constituents have had cause to use the accident and emergency facilities at the hospital. As he will be aware, the hospital's huge catchment area extends not only across counties Louth and Meath, but also to the north of County Dublin and the south of County Monaghan. Perhaps some people have to come from further afield to Our Lady of Lourdes Hospital in Drogheda. The reality is that the accident and emergency facilities at the hospital are overcrowded and the level of staff cover is seriously inadequate. I predict that a very serious crisis will arise at the hospital sooner or later when it proves impossible to admit patients to the hospital in emergency situations because an adequate level of staff to cater for their immediate needs is not available.

Our Lady of Lourdes Hospital is one of the busiest hospitals in the country. While people who ring my constituency office accept that the hospital is fine or excellent when they get into mainstream treatment there, they are concerned that it has become a huge challenge to get through the accident and emergency department. The whole concept of requiring people who are more than 80 years of age to lie on trolleys for ten or 12 hours at a time is simply unacceptable in this day and age. We all accept that savings and curtailments are necessary, but certain areas need to be prioritised in that context. I suggest that the area of accident and emergency should be a clear priority within the health service. People receive excellent care in the mainstream hospital service after they have finally overcome the huge challenge of coming through the accident and emergency unit. As I said earlier, I am pleased that the Minister is here to take this Topical Issue matter because he is quite familiar with the problems at Our Lady of Lourdes Hospital in Drogheda. I appeal to him to ask the HSE immediately to examine the adequacy of staff cover at the hospital. We know that measures are clearly needed to address this problem immediately.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy. In common with many hospitals, Our Lady of Lourdes Hospital in Drogheda has experienced an increase in attendances at its emergency department in the current year. For hospitals like Our Lady of Lourdes Hospital that serve populations with significant numbers of high acuity elderly patients presenting with complex co-morbidities, the requirement to admit patients is similarly high. The nature of these patients' needs may require longer than average lengths of stay. Patient experience times at Our Lady of Lourdes Hospital are roughly in line with national patient experience times. Approximately 70% of patients are discharged home or admitted within six hours. Some 81.4% of patients are discharged home or admitted within nine hours. Despite the increases I mentioned at the outset, the number of patients waiting for ward bed accommodation has decreased by 15.4% in the last three years. The Deputy quite rightly pointed out that it is unacceptable to have patients on trolleys for eight to ten hours. While I agree with him, he should acknowledge that such waiting times represent a huge improvement on the waiting times of three or four days that were experienced when he was in government.

The special delivery unit has worked intensively with management and staff at the hospital. A variety of initiatives which address many of the needs of the local population have been introduced. A cross-sectoral group that will focus on frail and vulnerable elderly patients, with representatives from the community, private nursing homes, the acute sector and groups such as Alzheimer's disease carers, has been established. The HSE is seeking to expedite the recruitment of nurses, particularly for the emergency department and for critical care. Internal medicine services have been reconfigured to enable acute medicine assessment unit physicians to manage all acute medicine assessment unit and short-stay medical unit patients. An additional acute medicine physician has been recruited to further extend these services. Twice-weekly medical census meetings and once-weekly surgical and orthopaedic census meetings, led by the clinical director, have been introduced. At these meetings, an overview of each inpatient's care takes place and potential impediments to their discharge are discussed. Ten private nursing home beds have been purchased for the provision of orthopaedic rehabilitation following hip fractures. This service also utilises a physiotherapist. It has significantly reduced orthopaedic patients' length of stay at the hospital.

Our Lady of Lourdes Hospital is making progress in implementing all elements of the emergency medicine programme. Practice changes and patient pathways that have been put in place for acute medicine remain very effective. A recent audit undertaken by the quality and patient safety audit validated the hospital's full compliance with the acute medicine programme. The overall length of stay in medicine, surgery and orthopaedics is well within the targets set nationally and by the clinical care programmes. Our Lady of Lourdes Hospital recently got planning permission for the second phase of its planned expansion, which will provide an enlarged emergency department and 60 en suite single accommodation rooms which are fully compliant with the strategy for the control of antimicrobial resistance in Ireland. The hospital is actively bringing NCHD rosters into compliance with the requirements of the European working time directive. Medical on-call rotas have been reduced from 24 hours to 12 hours.

The hospital, supported by the special delivery unit, is continuing to actively seek improvements in the provision of patient care. Current priorities include the improvement of patient clinical pathways, the optimisation of the use of the acute medicine unit and the movement of patients to lower acuity beds at other facilities, such as Louth County Hospital, when his or her condition is sufficiently stable to do so.

Consideration is also being given to nurse staffing of the day ward and transition lounge.

Special delivery unit liaison officers continue to engage with the hospital on these operational issues, as a result of which I expect to see further improvements in access to appropriate care in a timely manner. The Department of Health and the Health Service Executive are focused on implementing the Government's reform programme for acute hospitals, including the organisation of these hospitals into a small number of groups, each with its own governance and management, to provide an optimum configuration for the delivery of high-quality, safe patient care in a cost effective manner.

Séamus Kirk (Louth, Fianna Fail)
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I find it very difficult to accept the Minister's assertion that patient experience timelines at Our Lady of Lourdes Hospital are broadly in line with national timelines. That is not what I am hearing in my constituency office, where people are complaining about the extraordinary length of time they are spending on trolleys there. I am appealing to the Minister to give special attention to the hospital's accident and emergency unit to see whether he and his Department, working with the HSE, can improve patient waiting times and remove as many people as possible, as quickly as possible, from trolley accommodation.

James Reilly (Dublin North, Fine Gael)
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I assure the Deputy that his desire is my desire. I do not want people spending any longer on trolleys than they must. I do not want to see the numbers of patients on trolleys increasing. We are moving to the use of patient experience times because those figures can highlight where people do have to wait prolonged periods on trolleys, which is unsatisfactory.

The newly appointed director of hospitals at the HSE, Dr. Tony O'Connell, comes to us from Australia, where he worked in New South Wales and Queensland. In both instances, he made a huge impact in improving quality of care and waiting times for patients. I am meeting with him and Mr. Tony O'Brien tomorrow. The Dublin north east hospitals group, which includes Our Lady of Lourdes Hospital, will be part of the focus at that meeting. The Deputy may be aware that Dr. O'Connell was chief executive officer of the Dublin north east hospitals group before being promoted to director of hospitals.

Everything will be done to improve the situation in Drogheda and identify the reasons for the increase in the numbers of patients on trolleys. The SDU has visited the hospital in the past and listened to suggestions from staff for service improvements, taking on board those which made immediate sense, asking for a better price on the provision of certain services and dismissing proposals that did not make any sense financially. That review encompassed such issues as community nursing facilities, home help provision, home care packages and even community intervention teams to deliver intravenous antibiotics to patients at home so they would not have to stay in hospital for long periods, thereby freeing up beds to allow for more admissions from the emergency department. I assure the Deputy and the people of Drogheda and the Dublin north-east region that everything will be done to ensure they have a safe, efficient and effective service and that patients do not spend any longer on trolleys than is absolutely essential.