John Halligan (Waterford, Independent)
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3. To ask the Minister for Health his plans to address the overcrowding in the emergency Department and wards of University Hospital Waterford during the busy winter months; the number of the recently announced 440 additional beds that will be allocated to the hospital to increase its capacity; when these beds will open; the other measures, specific to the hospital, he has planned, to address regular overcrowding therein; his plans to address the number of delayed discharges at the hospital, particularly at weekends; his views that the shortage of residential follow-on aftercare placements for elderly patients deemed by the hospital medical staff to be medically well is adding to discharges being delayed, as many of these patients cannot be looked after at home by family members, and this is having an adverse effect on the bed shortages; his further plans to address this issue; if he will provide an update in relation to the promise to provide an additional 50-bed unit in Saint Patrick's Hospital in County Waterford; when planning permission will be sought; when building work will be carried out; his views on using the private sector to ease overcrowding at University Hospital Waterford during the particularly busy times; and if he will make a statement on the matter. [36667/15]

John Halligan (Waterford, Independent)
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What are the Minister's plans to address the overcrowding in the emergency department and wards of University Hospital Waterford during the busy winter months? How many of the recently announced 440 additional beds will be allocated to University Hospital Waterford to increase capacity and when will these beds will open? What measures specific to University Hospital Waterford has he planned to address regular overcrowding at the hospital? Could he provide an update relating to the promise to provide an additional 100-bed unit at St. Patrick's Hospital in County Waterford? Could he confirm when planning permission is to be sought and when building work is expected to be carried out?

Leo Varadkar (Dublin West, Fine Gael)
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Along with other acute hospitals, University Hospital Waterford has prepared a capacity plan to help address the expected increased demand for services this winter. Measures include opening additional beds as required, managing patient flow, appropriate discharges, internal surge capacity both in terms of beds and staff and prioritising diagnostics for inpatients to facilitate earlier discharge.

In addition, University Hospital Waterford and HSE community services will put a community intervention team in place by December for the Waterford region. This is a nurse-led team which works with other health professionals and services in an effort to provide a rapid response for certain patients with an acute illness episode. Such patients require short interventions, usually under 72 hours, in the community or at home such as blood monitoring, fluids or IV. The availability of the specialist team will, I expect, reduce hospital attendance and enable some patients to be discharged earlier.

University Hospital Waterford has an average of 15 delayed discharges. The hospital works closely with HSE community services so that patients are discharged as quickly as possible to appropriate accommodation. Suitable patients on the delayed discharge list are prioritised for home care packages. The hospital also works with community and ambulance services to ensure that weekend discharges are facilitated. While the additional supports provided to University Hospital Waterford do not include additional acute beds under recent proposals, 48 extra beds will be available across the South-South West Hospital Group.

The community nursing unit project at St. Patrick's Hospital is a priority project. A design review was completely recently. At this stage, it is expected that the planning application could be submitted before the end of the year.

John Halligan (Waterford, Independent)
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I try not to be critical but the Government is failing to deal with the most basic need of a human being when he or she reports ill to a hospital. This is giving them the dignity of a bed in which to receive treatment. As the main hospital in the south-east region, University Hospital Waterford serves a population of about 500,000. Going on figures from the Irish Nurses and Midwives Organisation's trolley watch, its emergency department is frequently one of the most overcrowded hospitals in the country. The figures are reaching new highs. The most recent data shows a massive 278% increase in the number of patients waiting on trolleys in September. Over one weekend alone last month, the accident and emergency department reached full capacity and ambulances had to be diverted to Wexford and Kilkenny, a journey of one hour from Waterford city. I do not need to impress on the Minister the difference an hour can make when somebody is ill, be they critically ill or otherwise.

In recent weeks, the Irish Nurses and Midwives Organisation has made claims that due to the recruitment ban, patient care at Waterford has been severely compromised. I want to hear the Minister's view about what the Irish Nurses and Midwives Organisation has said and trolley watch. Does he accept that there has been a 278% increase in the number of patients waiting on beds and that patient care at the hospital is being severely compromised?

Leo Varadkar (Dublin West, Fine Gael)
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Like all emergency departments or certainly all major emergency departments, the emergency department at University Hospital Waterford experiences overcrowding and this has increased this year. Nobody is denying that. It is worth pointing out that of all the major city hospitals, Waterford performs the best in terms of overcrowding. There are eight people on trolleys in the hospital this morning, four of whom have been on trolleys for more than nine hours. This is the lowest of all the major hospitals. St. James's Hospital and St. Vincent's University Hospital are next on ten but there are other hospitals with 20 and 30. Waterford is actually a good performer in that regard. This is down to very competent and excellent staff in the emergency department, a good consultant team and good management at the hospital. This should be recognised. We are always beating people up in the health service. Where a hospital performs relatively well, it should be recognised.

There is no recruitment embargo. Obviously, hospitals cannot hire willy-nilly but the recruitment embargo was lifted quite some time ago. This is why we have nearly 4,000 more staff in the health service than we had this time last year.

10 o’clock

The hospital group is open to any proposals to provide additional beds. It seems that what would work most effectively and quickly for Waterford hospital is the establishment of the community intervention team, which I hope the Deputy will welcome, which is a team of nurses who visit people's homes to check their bloods, give medicines and fluids, including intravenously, thereby enabling people to leave hospital sooner or avoid going there in the first instance.

John Halligan (Waterford, Independent)
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The Minister's response is interesting. The nurses I met at University Hospital Waterford the day before yesterday told me that the biggest stumbling block to the opening of additional beds to ease the chronic overcrowding is the ongoing staffing crisis. According to those nurses wards are understaffed and they are unable to meet the total needs of their patients. The INMO estimates that Waterford hospital is operating at approximately 120% capacity without the appropriate nursing staff in place. Will the Minister sanction a special needs incentive to recruit nursing staff at Waterford hospital immediately? Will he sanction, as previously requested, the appointment of an additional community discharge nurse at weekends for University Hospital Waterford?

The Minister has referred to the possibility of the private sector being utilised to cope with overcrowding. Is this planned for Waterford in the winter, particularly for elderly people in the community who are frightened and need reassurance that if they present at the hospital over the winter they will not be left on a trolley or chair, in some cases for up to 16 or 17 hours, which, as I said, is undignified and unacceptable in a western country in 2015-2016?

Leo Varadkar (Dublin West, Fine Gael)
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As the Deputy well knows the sanction of staff recruitment at individual hospitals or services is not in the remit of the Minister for Health. Sanction of staff recruitment is a matter for the hospital manager, hospital group and the HSE.

John Halligan (Waterford, Independent)
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They cannot recruit unless they are given additional funding.

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy is well aware that I do not have the authority to hire, fire, promote or demote staff. I know there is an election coming but standing up in the Dáil Chamber and asking me to-----

John Halligan (Waterford, Independent)
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That is not fair. The Minister knows as well as I do that additional funding is required for the health services. This is not an election issue.

Michael Kitt (Galway East, Fianna Fail)
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The Minister has the floor.

John Halligan (Waterford, Independent)
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I do not like cutting across the Minister.

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy seems to do so quite regularly none the less.

John Halligan (Waterford, Independent)
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The Minister should not be making inaccurate statements. He is out of touch with what is happening.

Michael Kitt (Galway East, Fianna Fail)
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Deputy Halligan, please, the Minister has the floor.

Leo Varadkar (Dublin West, Fine Gael)
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There clearly is an election coming given the Deputy is standing up-----

John Halligan (Waterford, Independent)
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The Minister is out of touch with what is happening at Waterford hospital. That is not an election issue, it is a fact.

Michael Kitt (Galway East, Fianna Fail)
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We are moving on to the next question.