Derek Keating (Dublin Mid West, Fine Gael)
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The next Topical Issue is in the names of Deputies Lawlor, Catherine Murphy and Heydon. The Deputies have two minutes each.

Anthony Lawlor (Kildare North, Fine Gael)
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I thank the Ceann Comhairle's office for allowing us to raise this issue. I also thank the Minister of State for attending. A positive aspect of my locality is Naas hospital. It has tremendous staff and management and is probably one of the most efficient hospitals in the country in terms of what it sets out to achieve. It is in the process of seeking planning permission for an endoscopic unit, which I hope will be up and running in the coming years.

We must consider the demographical pressure on the hospital. County Kildare has the second largest population in Leinster and has a large number of over 65 year olds. Both trends will continue growing. There are also 17 nursing homes in the immediate vicinity of Naas General Hospital, which automatically places pressure on the hospital. I understand that some agency staff have been replaced by full-time nursing staff, given the difficulty involved in finding nursing staff. In fairness to the hospital's management, 46 beds are open that, strictly speaking, should not be, but this has placed additional pressures on its budget.

A couple of issues are causing this problem. The fair deal scheme has been delayed in respect of a number of elderly patients who, despite wanting to go to nursing homes, are still occupying beds in the hospital. The staff are under extreme pressure because of their workload and their numbers have decreased considerably. I ask that the hospital be allowed to work within its budget to open a number of extra beds on a permanent basis instead of ad hocand without the HSE's approval.

Catherine Murphy (Kildare North, Independent)
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I will try not to go over the same territory. Approximately two weeks ago, nurses at Naas General Hospital took the unusual step of going out in protest during their lunch hours. Some of us joined them. The point they were trying to make was that they were presiding over an unsafe service. They took their decision with heavy hearts, as they are proud of their hospital. They were also concerned that working in the hospital's environment compromised their own registrations. I understand their point.

On average, 12 to 17 of the hospital's patients per week are on the fair deal scheme. In terms of size, this is the equivalent of 50 patients at Tallaght hospital. The large number of nursing homes creates pressure, particularly since many Dublin patients go to nursing homes in Kildare. There is pressure at both ends, given the area's young demographic.

Kildare has a population of 210,000 people. It is the fourth most populated county in the country. That its increasing population could lead to increased demands was never properly considered. The immediate recruitment of nurses is key. Some 24 nursing posts have been sanctioned. With 17 being filled on an agency basis, we are discussing seven or eight additional staff. Some of these posts have been funded by the hospital's management in an efficient way. The recruitment process has taken up to two years. There is a complicated system of recruitment. The staff are needed now.

Keeping a fair deal patient in a bed costs six to seven times what it does to keep someone in a nursing home bed. The latter would achieve a better outcome for the individual and an acute bed would be freed for people who actually needed it. The approach being taken does not make sense for the hospital financially or in terms of safety.

Martin Heydon (Kildare South, Fine Gael)
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I thank the Minister of State for taking this important issue. Like my colleagues, I stood outside Naas General Hospital a number of weeks ago on a wet, cold Monday. I saw members of its nursing staff doing something that was not natural for them, that was, to be out in front of the hospital. They did not want to scare patients, but they needed to highlight their frustrations.

The hospital has sought 24 full-time positions. Given the delay in filling a number of these by agency staff, it makes sense to go from agency staffing to full-time or full-time equivalent staffing. Approval for these positions needs to be fast-tracked, the red tape needs to be cut and the posts need to be advertised and filled as soon as possible.

The 12 delayed discharges have had a knock-on impact within the hospital. The figure was higher a couple of weeks ago, but it needs to be cleared. There are great step-down facilities in, for example, St. Vincent's Hospital in Athy.

However, it is necessary to have those cases processed in order that they can be moved out of the system in Naas and to ensure that everyone who is in a bed in Naas hospital needs to be there and that every available bed in Naas is open and used fully. I support fully the management and staff at Naas General Hospital. When my constituents in Kildare South get sick, they depend on Naas General Hospital for that great level of care, both at emergency level and for longer stays. Members must support the staff, must make sure their working conditions allow them to do their job to the very best of their ability and must ensure there is a sufficient number of staff. Moreover, where it makes sense the movement of those staff members from being agency staff to being full-time equivalents should be fast-tracked and should happen as soon as possible.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputies for raising this issue and for giving me the opportunity, on behalf of the Minister for Health, to outline to the House the current position on the matter. The HSE has advised that Naas General Hospital has experienced additional pressures this year with a 14% increase in emergency admissions in the year to date. Moreover, it has advised that there has been a 45% increase in the number of patients on trolleys since this time last year at the hospital. Naas General Hospital has also been obliged a number of times during the year to implement the full capacity protocol, which involves placing additional patients on trolleys to ward areas. I have been assured by the HSE that when Naas General Hospital experiences overcrowding in its emergency department, every effort is made to admit patients to inpatient beds based on clinical needs as soon as possible. The hospital has in place appropriate escalation policies and monitors its activities continuously. A number of measures have been taken to address the demand. The hospital currently has 30 additional beds open, which have remained open all year, and has additional beds open in the acute medical assessment unit and day ward to meet the demand from the emergency department. Moreover, from what the Deputies have indicated, this demand clearly exists.

Notwithstanding current pressures, when compared with the baseline year of 2011, there have been 1,717 fewer patients on trolleys in the year to date in Naas in 2014. As for resources, the hospital's budget allocation for 2014 is €53.196 million with a staff of 637 whole-time equivalents. The hospital has appointed 26 staff nurses this year, 14 of whom were appointed as replacement posts and 12 as new posts. Furthermore, the HSE's national recruitment service currently is in the process of appointing a further eight nursing posts, of which six are replacement posts and two are new posts. I am assured by the HSE that the hospital will continue to engage with the HSE's national acute services and social care divisions to take advantage of additional capacity initiatives to relieve pressure on the hospital throughout the winter season.

The Deputies also will be aware that Naas General Hospital is part of the Dublin Midlands Hospital Group, which includes St. James's Hospital, Tallaght hospital, Midland Regional Hospital, Tullamore, Midlands Regional Hospital, Portlaoise and the Coombe Women & Infants University Hospital. I am confident there will be a structured integration of Naas hospital into the Dublin Midlands Hospital Group in 2015 and this will provide support for Naas hospital in managing demand and delivering high-quality and safe patient care in a cost-effective manner. However, I accept fully that when one has such numbers of replacement posts and additional posts as I read out, it is clear there has been great demand on this hospital and it did not have the requisite number of posts it needed to manage that demand. I hope the additional posts, both replacement and new, will alleviate some of this pressure because I know how beneficial it is to have a hospital within one's own area.

Anthony Lawlor (Kildare North, Fine Gael)
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I think the Minister of State and welcome her response. As far as most people in Kildare are concerned, the point is to have a safe hospital and while this is the case, the members of staff there are under extreme pressure. One thing that can be degrading for those staff members is to hear each morning on the local radio station the number of people on trolleys. I am aware of how hard they are working and I understand what they are going through at present. While I welcome the additional staff, I note many of them are replacement staff and additional staff are needed. As I already pointed out, the area's demographics are changing as its population increases and there is additional pressure on the hospital itself. While the additional staff members are welcome, I will push constantly for additional funding and staff for the hospital because, as stated earlier, it is a focal point for the entire county. Naas General Hospital is associated with the entire county because it is situated right in the centre and I reiterate that the staff, who are working under considerable pressure at present, consider that additional staff members are required there.

Catherine Murphy (Kildare North, Independent)
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One thing one never used to encounter was the direction of people from the Leixlip-Celbridge area towards Naas as heretofore, they always were directed towards Blanchardstown and Tallaght hospitals. To an increasing extent, Naas is absorbing that major conurbation and consequently this is a kind of pressure the hospital had never experienced previously. I wish to echo the point about the staff and the kind of stress under which they operate. When one has replacement staff, obviously there is a training-in period and so on and part of the reason that staff members are being replaced is they are burned out, as one can only deal with stress for so long. It is useful to have the figure of a 14% increase in emergency admissions but unfortunately, it is historical and one must get to that point to prove there is pressure on the hospital. However, the very fact that such an increase is showing up demonstrates that demand is increasing because of the size of the county and the increased pressure from places that heretofore never depended on the hospital. In addition, the 2,000 people who are queueing to gain access to the fair deal scheme are putting enormous pressure on both Naas General Hospital and the Dublin and midlands hospitals to which it is connected. Consequently, there needs to be more than just the consideration of an historical model. Consideration must be given to planning to make sure this situation does not arise when there is clear and demonstrated demand that is an increased demand all of the time.

Martin Heydon (Kildare South, Fine Gael)
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I thank the Minister of State for her response. The figures she has outlined of an increase of 14% in admissions and a 45% increase in the number of people on trolleys show the pressure under which Naas is at present and has the potential to be in the future. This is November, not January, and the peak time has not yet arrived. Absolute flexibility is needed in aiding the hospital to continue to provide safe care. Everything must be done to help the management and the staff of Naas General Hospital, in this time of increased pressure on demand on its services, to ensure it has the requisite flexibility. I welcome the Minister of State's comments on the new appointments this year, as well as the replacements, but I urge the Minister of State to go back to her officials, to cut through the red tape and to ensure that those agency nurses can be turned into full-time equivalents and that the additional positions can be put in place as soon as possible.

Kathleen Lynch (Cork North Central, Labour)
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I take on board the point about that area and how that population base is increasing once again. This is a significant issue and although Naas General Hospital will become part of a bigger group, I do not believe this will deliver the type of solution that is needed. Perhaps consideration should be given to a broader solution in terms of extending the hospital. I always find that once a building comes in and begins to be developed, additional staff always follow. Clearly, however, there is a need to examine the population base and the rate of growth. This area always has been fast growing and while there was a little bit of a dip for a while, it is coming back. Perhaps this requires more than simply staff, even though staff members are of crucial importance. Perhaps it will be necessary to take a broader look at what is needed there.