Finian McGrath (Dublin North Central, Independent)
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3. To ask the Minister for Health to resolve the crisis at the accident and emergency department in Beaumont Hospital in Dublin 9 and to deal with the lack of beds; and if he will make a statement on the matter. [43046/15]

Finian McGrath (Dublin North Central, Independent)
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I thank the Ceann Comhairle for the opportunity to ask the Minister this question. I raise this matter because I was invited a few months ago by staff, in particular those working in the accident and emergency department, to walk the corridors and meet the people who were on trolleys and chairs. I was astounded by what I saw. For the doctors, nurses and all other staff, the bottom line of the issue was bed capacity.

Leo Varadkar (Dublin West, Fine Gael)
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Last December, I convened the emergency department task force to assist in dealing with the challenges presented by emergency department overcrowding. Significant progress has been made to date. The Special Delivery Unit, SDU, figures showed an 8% decrease in the number of patients on trolleys in November 2015 compared with November 2014. While the Irish Nurses and Midwives Organisation, INMO, figures for the month of November showed a 4% rise, it is significant that the nursing union's own figures also showed an 8% decrease in the second half of that month. This indicates that we are headed in the right direction. The numbers for November, whichever are used, are a considerable change from August when overcrowding was 20% to 40% worse than in August 2014. It is clear that the situation is not as bad as it was in the early new year when there were 500 to 600 people on trolleys every day. This morning, the number of people recorded as being on trolleys in the TrolleyGar report was 244, with 110 people having waited for longer than nine hours. This represents a 23% reduction on this day last year.

The improved results that we are starting to see are the result of the implementation of the emergency task force plan, the investment of further funding of €117 million, the employment of more nurses and the opening of approximately 200 additional and previously closed beds, with a further 250 due to open in the next few weeks. In April, €74 million was provided to reduce delayed discharges, lower the waiting time for fair deal funding and provide additional transitional care beds and home care packages. In July, €18 million was allocated to support the acute hospital system over the winter period by providing additional bed capacity and other initiatives to support access to care. This included additional funding for Beaumont Hospital to enable St. Joseph's day hospital in Raheny to provide a five-day service, thus reducing presentations at the emergency department and the need for elderly people to be admitted.

Six of the beds at Beaumont that had been closed for refurbishment or infection control purposes during 2015 have re-opened and a further 21 beds are to re-open in December. Beaumont Hospital is one of the sites that has been the subject of particular focus, with the SDU supporting it to implement solutions. For example, the number of delayed discharges at Beaumont has decreased from 95 in November 2014 to 70 last month, thus freeing up 25 beds everyday for acutely ill patients.

All hospitals, including Beaumont, have escalation plans to manage not only patient flow, but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care. Last week, I co-signed the emergency department congestion escalation directive to ensure that the progress made to date on overcrowding was improved upon. The directive requires hospitals to implement their escalation plans whenever their emergency departments experience overcrowding. It is expected that this will add to the progress made to date.

Finian McGrath (Dublin North Central, Independent)
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I welcome the fact that beds will be opened in Beaumont but we must focus on resolving the real issue. We all receive regular complaints from families, in particular those of senior citizens who find themselves on trolleys. This is especially the case at Beaumont Hospital. This situation is not acceptable. The Minister mentioned that 21 beds would be re-opened in Beaumont and six had been re-opened, amounting to 27 beds, but the staff on the ground have told me that they need approximately 80 long-term beds to resolve this regular crisis. I hope that the Minister pays attention. The professionals were objective and clinical about this issue. They told me that they needed approximately 80 beds, but the Minister has stated that they will only get 27. We must focus on this because we cannot have patients on trolleys this Christmas.

Leo Varadkar (Dublin West, Fine Gael)
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Beaumont is an overcrowded hospital. There is no denying that. All efforts are being made to improve the situation. That the number of delayed discharges has been reduced from 95 to 70 has freed up 25 beds. This decrease needs to be sustained and we need to reduce delayed discharges further. That will involve more nursing home places and more home care, but not necessarily more acute hospital beds.

The ward that was closed for refurbishment has now partially reopened. Six beds are open and a further 21 beds are yet to open.

While I do not have the statistics for the special delivery units before me, I have the numbers from the Irish Nurses and Midwives Organisation. According to those numbers, some 586 people spent time on a trolley at Beaumont Hospital at some point in November. That can range from one or two hours to a very long period of time. The figure for November 2014 was 729. This means that based on the numbers from the nurses' union, there was a 20% reduction from November 2014 to November 2015. Clearly, we need to do even better than that. I remind Deputy McGrath that there are plenty of examples of hospitals where we have put in lots of extra beds but it has not worked. Additional bed capacity is not the only factor that gives rise to hospital overcrowding - if only it were that easy - because there are many other factors at play.

Finian McGrath (Dublin North Central, Independent)
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If what the Minister is saying is the case, I want to know why the doctors and nurses in Beaumont Hospital are telling me that the reality is otherwise. I would like to mention two appalling cases in my constituency that recently highlighted the need to deal with this issue. A 90 year old woman ended up on a trolley after arriving at the accident and emergency department. Her family was treated appallingly. I am sending the details of that case to the Minister. I would appreciate it if he could look at them. The family in question does not want to go public. The second case relates to a 20 year old man with cerebral palsy who is peg-fed, non-verbal and 5 stone in weight. There was nobody in the radiology department to deal with his needs at 6 o'clock on Saturday, 31 October last. His family members were so distressed that they had to take him home. When they came back on Sunday, 1 November, there was nobody in the radiology department again. They had to take him home again on the second day. When they came in on the Monday, they eventually got to see a doctor in the radiology department. It is not acceptable for a young man with cerebral palsy to be treated in such a way in any hospital in 2015. I ask the Minister to focus on the provision of proper services to people at Beaumont Hospital.

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy will appreciate that I cannot comment on individual cases. I do not have all the information on them. I might never have all the details, for reasons of patient confidentiality and for other reasons. If the Deputy wants to make those details available to the chief executive officer of the hospital, I will make sure the matter is looked into appropriately. He is not the only person who knows doctors and nurses in Beaumont Hospital. I do too. I have visited the hospital on two occasions and the emergency department on one occasion. The doctors and nurses there acknowledge that many factors give rise to overcrowding. It is not just about bed capacity; it is also about delayed discharges, length of stay and other issues. In theory, a hospital in which the average patient spends eight days needs twice as many beds as a hospital in which the average patient spends four days. In practice, it needs to reduce its average length of stay per patient. A reduction of half a day in the average length of stay in a hospital can free up a huge number of beds. Many factors other than bed capacity contribute to overcrowding. On a bad day, there can be 30 or 40 people on trolleys at Beaumont Hospital. If it were as simple as providing extra beds, this problem should be solved by a reduction of 25 in the number of delayed discharges and the opening of 25 beds. That will not happen, however. There are many other factors at play. All of them need to be worked on as well.