Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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Letterkenny University Hospital, which was recently renamed, is the seventh largest hospital in the State. Inpatient numbers exceed 20,000 every year. It is, therefore, a substantial hospital, serving a population of 160,000 across the county.

Over the years, based on inpatient numbers, Letterkenny University Hospital has been allocated the lowest budget of any hospital in the State and the lowest number of medical staff. It has been discriminated against by Government after Government. There are serious concerns throughout the hospital about the numbers of staff, the budget and the impact it has on waiting lists and trolley numbers. As the Minister is probably aware, the number on trolleys in Letterkenny University Hospital continues to increase and in 2015 almost reached the peak of 2006-2007. Management of the hospital, acting on behalf of the Saolta hospital group, has instructed consultant surgeons to scale back on elective surgeries during the month of January and early February to make beds available for additional people who present in accident and emergency. The most recent figures on waiting lists at Letterkenny Hospital show there are 13,950 outpatients, 3,338 of which have been waiting for more than a year. Those are citizens in Donegal who have been waiting more than a year for surgical procedures or appointments with consultants. There are an additional 1,742 inpatients on the waiting list, which is a shocking waiting list. It is well known in the hospital that this instruction will lead to the growth of those waiting lists. It is my view, and that of my party, that the Minister will focus on not having patients on trolleys this winter because it will not look good in the mouth of an election and to achieve this he will sacrifice patients on the waiting list. That belief was confirmed by comments made today by Liam Doran of the INMO. What choices has the Minister made? Will he intervene and send a clear message to the management of the Saolta hospital group asking why this instruction, which will result in the growth of the already shocking waiting lists in Donegal, has been issued? Why can it not address the issues in accident and emergency departments without growing the waiting list even further?

I also want to bring to the Minister's attention the profound concerns of senior staff in the hospital about this instruction. They have outlined those concerns to the management of the hospital which in my view is carrying out the instructions of its masters in the Saolta hospital group which in turn is carrying out the Minister's instructions. It is a political imperative to sacrifice patients in order to have as few people on trolleys this winter as possible. The Minister cannot rob Peter to pay Paul. Will he intervene on this issue and reassure the patients on waiting lists in Donegal that he will not allow this to happen in January and February?

Leo Varadkar (Dublin West, Fine Gael)
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I thank Deputy Mac Lochlainn for the opportunity to speak to the House on this issue. In preparation for the 2015-2016 winter period, hospital groups have provided comprehensive winter resilience plans to the HSE, outlining how they will implement an integrated approach across primary, community, social and acute services to manage winter pressures. This approach is intended both to avoid unnecessary admissions to acute hospitals and expedite discharges from hospital. If emergency department overcrowding occurs, all hospitals have escalation plans to manage patient flow and patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimal patient care. In November, a national emergency department congestion escalation directive was issued on foot of discussions between the director general of the HSE and me on how best to reduce emergency department congestion with all of the available resources, both within and outside of acute hospitals. This directive requires hospitals to implement their escalation plan whenever their emergency department experiences overcrowding. As part of this, acute hospitals are now required to take specific steps to reduce overcrowding such as the postponement of non-urgent elective procedures. During winter planning, Letterkenny University Hospital made a decision to scale back the number of scheduled inpatient admissions for approximately six weeks from 4 January to mid-February 2016. This is primarily to manage the predicted increased number of patients who normally attend and are admitted to the hospital via the emergency department at this time of year. This is already done in many other hospitals around the country and is considered to be good planning. In the past, in January, procedures were often cancelled or deferred at short notice. Rather than scheduling and then potentially deferring patients, the hospital has decided to reduce the number of inpatient procedures scheduled during this period to ensure that in so far as possible, patients who are scheduled are admitted and cancellations are therefore less frequent.

This temporary reduction will ensure that each surgeon has a dedicated amount of theatre time in January and that emergency surgery, including cancer surgery, is prioritised. The hospital regrets any inconvenience this situation may cause to patients and their families and I wish to echo that. However, I have been assured by the HSE and Saolta that the effect of these arrangements will be kept under constant review and urgent patients, including cancer patients, will continue to be seen. The hospital's overall aim is to avoid unnecessary deferrals or cancellations of planned surgery and ensure that hospital resources are targeted at emergency work during this period of the year when the pressure on the emergency department is greatest.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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A consultant urologist resigned in dramatic circumstances earlier in 2015. Neither Letterkenny University Hospital nor the Saolta hospital group has advertised for a replacement consultant urologist. As a result, urology is in real crisis in the hospital. I commend the Minister's officials for organising a meeting in February 2015. It was a good meeting at which solutions were tabled to address another crisis that had emerged in breast cancer care which was raised by the consultant there, Michael Sugrue. The meeting was attended by public representatives in Donegal and cancer campaign groups. We understood these solutions had been implemented but as we see from correspondence from the consultant breast surgeon there, Michael Sugrue to the Minister's officials, they have not been implemented. Letterkenny University Hospital is a hospital in crisis in Donegal. The management of Saolta is in denial and is telling us it has the resources it needs, everything is hunky-dory, there is nothing to see here and to move along. There are only two permanent consultant surgeons in the seventh largest hospital in the State serving 160,000 people. The rest are locums. Those surgeons are being told to pull back on elective surgeries to avoid the embarrassing spectacle of people on trolleys in winter. It is not good enough. The Minister is aware of the comments of the director general of the HSE, Tony O'Brien. We have a real crisis in our health service and we need solutions, not commentary. Will the Minister intervene in respect of the concerns of patients on the waiting lists in Donegal, which will continue to grow? Will he confront the management of Letterkenny University Hospital and the Saolta hospital group about their denials in terms of the resources they have when the problems are staring us in the face?

Leo Varadkar (Dublin West, Fine Gael)
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The major action being taken to reduce overcrowding in Letterkenny over the winter period is the provision of ten additional beds in the hospital, which are being funded and provided. I am told they will be made available from this week. This is a real action, not commentary or window dressing; it is ten additional beds for the hospital which represents a significant increase in capacity. It is normal for hospitals around the country to flex up and down their elective surgical activity - to do less in January and February when the emergency department is very busy and many people are coming through it and do more in the summer period when the emergency departments are relatively quiet. That makes sense and I hope the Deputy understands why that is. It is not intended to apply to urgent and cancer surgeries, which it is unsafe to defer. Budgets are not allocated based on inpatient numbers because hospitals do a lot more than treat inpatients - they have outpatients, day-cases, laboratories and, in some cases, specialties. Where a hospital has very expensive specialties, such as cancer or spinal surgery, it will need a higher budget, so it is incorrect to compare budgets based solely on inpatient numbers.

The conversion year for activity based funding is 2016. For the first time, hospitals will achieve a chunk of their budget based on their activity, which will benefit hospitals that are more efficient than others. All hospitals will claim they are more efficient than others. Activity based funding will show whether that is the case.

I am told efforts to restore the urology services are currently in hand.

As regards intervention in the management of individual hospitals or hospital groups, that is not practical. Every hospital has its own management which, in turn, has my support. It is important they are allowed to do their job. It would not practical or possible for any Minister to try to manage every hospital or health care institution in the country. Were that to occur, the management of those institutions would be undermined.