Pearse Doherty (Donegal South West, Sinn Fein)
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On the afternoon of 14 October management at Letterkenny General Hospital issued a statement to the general public in which it asked people to avoid the hospital's emergency department owing to what it described as high activity levels. It also advised those seeking medical attention to visit their GPs instead of presenting at the emergency department.

In addition - reminding us just how understaffed and under-resourced that hospital is - the statement went on to explain that all those who were due for a planned admission as an inpatient at the hospital were being asked to phone the hospital beforehand so that staff could confirm the availability of a bed in advance of their arrival. If ever one needed further evidence that Letterkenny General Hospital is struggling to cope with the demands placed on it, this latest crisis should provide all the necessary proof.

Deputy Pádraig Mac Lochlainn and I have repeatedly raised the issue at the heart of the hospital's crisis. It is not surprising when one takes into account that management was forced to release a statement regarding the provisions afforded to the hospital compared with other major hospitals in the State.

Every year the hospital has on average 21,000 inpatient discharges, that is, patients who pass through its doors seeking treatment. To put that in context, LGH is the seventh largest hospital in the State, yet, despite this, it has still not been given regional hospital status nor has the facility been given the additional resources it desperately needs to appropriately serve the people of the north west. Based on the inpatient discharge numbers, LGH not only has the lowest budget allocation in comparison to other hospitals with a similar case mix, it also has the lowest allocation of medical staff. As a consequence, the hospital is forced every year - sometimes a number of times a year due to the failure to provide it with the necessary staff - to appoint an unnecessarily high volume of agency staff to deal with demand, something which is extremely costly for an institution with an overstretched budget. When HSE officials appeared before the Committee of Public Accounts, there was a discussion on the five vacant consultant posts in LGH. The hospital pays €110,000 through the HSE for those posts on a locum basis every 13 weeks. The cost of recruiting a full-time consultant would be approximately €110,000, yet the hospital is forced to pay €444,000 for the same post. We understand that five of these positions are filled in this way and not just one. In addition, agency staff fill other positions in the hospital.

It is clear from the national employment monitoring unit, which publishes health statistics, that the hospital is being disadvantaged in the context of the number of medical dental staff, nursing staff and agency staff per 1,000 inpatient discharges and in the allocation of funding. Given the resources available, how can the Minister ensure that next week, next month and next year patients who need to access the accident and emergency department are not asked to tune into Highland Radio, Radio na Gaeltachta or Ocean FM to be told by management not to attend and to visit their general practitioner and to be told that if they have a scheduled appointment, for which they may have had to wait for a long time, they may not have a bed for them? This is not suitable for patients in Donegal. This is the most important element of public infrastructure in the county and we are proud of it. It is close to our hearts, given it is where many of us have spent our first hours and will spend our final hours. We want to ensure the hospital is resourced in order that it can meet the needs of our communities.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy for raising the issue. Letterkenny General Hospital has an average of 98 presentations to its accident and emergency department on a daily basis. I have been advised by the HSE that over a period of several days last week the hospital encountered a spike in demand, where there were more than 120 presentations on each of the three days involved. Coupled with this was the acuity or degree of complexity in sickness of the patients. Sicker patients typically require more complex care and for longer periods. A series of measures was undertaken to manage this surge in volume, including a message to the public to avoid the accident and emergency department if possible and for people to contact their GP to see if their emergency merited them attending the department. This is a usual response for hospitals to pursue in the event of unusually high demand and this is not unique to LGH. All acute general hospitals are faced with these challenges when it comes to a spike in demand.

LGH has taken a range of measures to deal with increased demand and is working closely with the special delivery unit, SDU, on an almost daily basis to manage and identify strategies to expedite patients' journeys through the hospital. An additional 19 beds were opened in the hospital in July this year while the SDU funded a further 11 beds in primary and community care to expedite discharges from the hospital by creating additional capacity for patients who require step-down care before they return home. The navigational hub bed management unit was set up to improve the efficacy of management of inpatient beds in the hospital.

Further measures include prioritising patients who require diagnostics, other interventions for patients who can be discharged on same day and working closely with colleagues in primary and community care to minimise the impact of delayed discharges in the hospital. Letterkenny General Hospital has one of the lowest levels of delayed discharges in the country. Last week, there were no delayed discharges compared with more than 300 in the Dublin hospitals. Today at 8 a.m. only one patient was waiting on a trolley and by 2 p.m., there was none.

A consultant physician has been appointed to lead on the acute medical assessment unit, AMAU. All medical referrals to the accident and emergency department are directed to the AMAU where a senior decision maker can assess and treat patients, thus avoiding admission. There also has been a reorganisation of work practices of the consultant and non-consultant hospital doctor staff in order that those who are on-call to the accident and emergency department have no other commitments elsewhere in the hospital. For instance, the surgeon on-call does not do any scheduled care in theatre that day. This has led to a much more timely response in seeing emergency presentations.

The hospital's patient flow policy was also recently reviewed and updated. The outcome was the adoption of a range of measures to expedite patient flow throughout the hospital such as improved discharge planning with the aim of discharging patients by 11 a.m., meaning the bed is freed up for another patient earlier in the day. The measures include nurse-led discharge and the identification of estimated date of discharge for each patient. The patient flow escalation policy has been also updated.

The target waiting time from presentation at the accident and emergency department to discharge or admission is six hours. LGH meets this target 87% of the time. The hospital experienced an unexpected spike in demand over the usual demand, therefore, additional special measures were taken to respond. All patients who presented to the accident and emergency department last week were assessed and treated as required.

As well as the exceptional measures outlined, the modern facilities created through the rebuilding necessitated by the flooding events in 2013 will ensure patients have improved access to safe, sustainable services for the long term. This is a direct reflection of the commitment and hard work of staff and management of Letterkenny General Hospital, the rebuild steering group and Saolta University Health Care Group.

Pearse Doherty (Donegal South West, Sinn Fein)
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I thank the Minister for his response. I am not sure he appreciates that the hospital is in crisis. This is not just my view; it is a view I have heard from senior levels within the hospital. The crisis presents itself at different times in different areas with the issue in the accident and emergency department last week an example of that. The hospital is kept going and meeting demand only because of the diligent efforts of its nursing staff, doctors, consultants and non-medical staff. This is where the problem arises. Many people are going beyond the call of duty.

I have statistics for 2012 and we need the updated statistics. However, LGH had 6.8 staff per 1,000 inpatient discharges that year compared with Kerry General Hospital, 7.2; South Infirmary Victoria University Hospital, 7.4; Mayo General Hospital, 7.8; St. Luke's General Hospital, Kilkenny, 7.8; Midland Regional Hospital, Tullamore, 9.9; and Sligo Regional Hospital, ten. I do not compare the hospital to the Mater Hospital and so on. LGH had 24.7 nursing staff per 1,000 inpatient discharges; Kerry General Hospital, more than 30; South Infirmary Victoria University Hospital, 31.9; Mayo General Hospital, 25; St. Luke's General Hospital, Kilkenny, 29; and so on. The number of agency staff in LGH was 0.7 per 1,000 inpatient discharges; Kerry General Hospital, zero; South Infirmary Victoria University Hospital, zero; Mayo General Hospital, zero; St. Luke's General Hospital, Kilkenny, 0.6; and so on. LGH, therefore, has the highest number of agency staff and lowest number of medical and nursing staff.

If LGH were compared to Mayo General Hospital, it would need 22 additional medical staff to meet demand while it would need 105 additional nursing staff when compared to St. Luke's General Hospital, Kilkenny. Consultants would not take up a position in the hospital if it was offered today. There is only one consultant who cannot take holidays because the consultant knows patients will not be treated.

The hospital is being run down because it does not have sufficient resources and staff. I do not except the Minister to respond to the statistics I have outlined.

6 o’clock

What I would like is if, as previously requested of the former Minister, Deputy Reilly, Deputy Varadkar as the new Minister for Health would look at the comparative data of Letterkenny General Hospital versus other hospitals with similar case mix and explain why in terms of all of these indicators Letterkenny General Hospital again comes at the bottom of the league in terms of resources.

The Minister referred in his reply to efficiency.

Brian Walsh (Galway West, Independent)
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The Deputy must conclude.

Pearse Doherty (Donegal South West, Sinn Fein)
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Letterkenny General Hospital has proven year on year that if is one of, if not the, most efficient hospitals. It has done everything it can but there are still major structural challenges within that hospital that cannot be met without the required resources.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Deputy Doherty for his comments. I have no doubt the Deputy is sincere in his concerns for Letterkenny General Hospital. We all need to be careful, however, when dealing with health issues, not to do down good hospitals or services in the belief that somehow that will generate more resources because, first, it does not and, second, it undermines public confidence in the health service, unnecessarily and unfairly in my view.

During my time working as a doctor I worked at eight different hospitals, all of which had spikes in activity from time to time. There are two ways of dealing with this. One can either have huge latent capacity staff waiting around in case a hospital gets busy, which is very wasteful, or one can have mechanisms in place to deal with spikes in demand, including, for example, going off-call. It would not, for example, be unusual in the city of Dublin for one of the accident and emergency departments to go off-call for a short time during busy periods. The work is then moved to other hospitals. Also, during a busy day at an emergency department when many people have to be admitted, it is not unusual for elective surgery to be cancelled. That is always the case. The only way around that is to have a huge number of unused staff and so on, which is very inefficient.

When it comes to agency staff, Letterkenny General Hospital spent €4.9 million in this area. As the public sector embargo is being relaxed, it will have much more flexibility next year to hire people on temporary contracts or as full-time employees instead of hiring them through agencies. Significant savings can be made through the hiring of people on temporary contracts rather than through agencies, which is very expensive.

I am not familiar with the statistics and data mentioned today by the Deputy. They were not given to me in advance. I am happy to receive them and have them examined. It is not my role as Minister for Health to decide the staffing levels or budgets of the 47 acute hospitals in the State. That is a decision for the HSE and the national director of hospitals and, in time, the south hospital group when fully up and running. I am happy to commit to having the statistics referred to by the Deputy examined to see if they stack up. I must clarify, however, that I do not make decisions in regard hospital staff or budgets.