Lisa Chambers (Mayo, Fianna Fail)
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My adjournment issue relates to Mayo University Hospital and the consistent overcrowding at its emergency department. It was only a number of weeks ago that the emergency department actually issued a public statement to the wider community surrounding Castlebar and County Mayo for people not to present unless it was absolutely necessary, because they were so overwhelmed with demand. It is a crazy situation for an emergency department to ask people not to attend. It is a recurring situation and is an issue I have been highlighting for many years in my community. I know staff who work in the hospital and on that day trolleys overflowed into the cafe beside the emergency department. That is how bad it was. It is getting to the stage when staff morale is at an all-time low. People are afraid to go into the emergency department. No patient should be left on a trolley for a considerable period but some elderly and extremely ill people are being left on trolleys for very long times. It is an issue that needs to be addressed forthwith.

The accident and emergency unit in Roscommon was closed a number of years ago and that has led to an increase in demand at Mayo University Hospital. It is not the only reason but it is a contributing factor. Patients are also presenting from Galway because, believe it or not, the hospital situation in Galway is actually worse. People are hedging their bets and presenting at Mayo University Hospital hoping that they will be seen more quickly.

We have an ageing population, which is the case throughout the country but is especially the case in the west, and this is leading to increased admissions too. Another very serious issue relating to this problem is that hospitals are now finding themselves under increased scrutiny, particularly by the Irish Nurses and Midwives Organisation, which runs the trolley watch service. This scrutiny puts increasing pressure on staff and hospital management to keep the figures as low as possible. It is my belief that there are patients being moved at night to the medical assessment unit and the day services unit, which are vacant at night because they operate for day procedures. Those patients are being moved from the corridors into those units to give the appearance of fewer trolleys in the corridors. It is my understanding that they are brought back during the day so that day services operations can resume. Those patients are not picked up by trolley watch as being there from the previous day and are counted as new figures. This is information the Minister can get if he so wishes.

This is not in any way a criticism of hospital management or the staff. They are under such severe pressure from the public and are doing everything they can to make the hospital work as well as possible but they cannot cope with the demand. Capacity is the key issue, a lack of beds and staff to man those beds, as well as a lack of step-down facilities for patients who do not need to take up hospital beds and could be moved on somewhere else.

There is also an issue regarding rheumatology services at Mayo University Hospital. A full service was promised to the hospital but there was a row-back on that promise. The consultant was actually appointed to Leitrim and the intention is that the consultant will service Mayo University Hospital on a visiting basis, with what will be 11 hours' service per week for the entire county. Rheumatology affects many thousands of people so 11 hours per week, while welcome as it is an increase on zero, is not close to being enough to look after the patients with such conditions. These conditions are quite debilitating and the people affected require disability payments but they are being asked to travel large distances to Merlin Park in Galway or Manorhamilton in Leitrim for services.

Mobility is an issue and finances are an issue in terms of getting around. Many patients cannot drive themselves to an appointment and rely on friends and family members to transport them to services that have a huge impact on their daily lives, so it is crucial that these patients are provided with services in the local community and I ask the Minister to review the 11 hours being provided to Mayo University Hospital with a view to increasing that service. I am sure there are huge demands on resources but, with a county the geographic size of Mayo and the number of patients with that illness, a full-time service is required.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Chambers for the opportunity to address the House on this important issue and for bringing these matters to my attention. I am very conscious of the impact that long wait times in emergency departments can have on patients and their families. Emergency department overcrowding is not just a problem for emergency departments to resolve. There has to be a system-wide health response and the programme for a partnership Government recognises this, as does Deputy Chambers.

Emergency department attendances have been significantly higher this year. The HSE has reported an average increase of 6.4% compared with the same period last year. This indicates the pressures that our hospital services are experiencing. Pressure on emergency departments has been rising as the population is growing and ageing and investment was constrained during the recessionary period. However, the 2015 and 2016 budgets have seen increases in the health budget, investments in capital expansion and the implementation of measures designed to tackle overcrowding in emergency departments, though, clearly, there is much more to do.

In June 2015, additional funding of €18 million was made available to the HSE under the winter additional capacity initiative to facilitate the opening of new hospital beds and the reopening of previously closed beds. With these beds, emergency department performance has remained steady, despite a sustained increase in patient attendances.

The performance of Mayo University Hospital emergency department has been improving in 2016. Despite a 12% increase in attendances in quarter one of 2016, fewer patients have waited on trolleys at the hospital compared to 2015. I take seriously the point Deputy Chambers has brought to my attention about trolleys and concerns about people being moved. I will ask the hospital group chief executive to respond directly to that point.

With regard to measures to tackle emergency department pressures, the programme for Government has committed to progressing a new emergency department facility for University Hospital Galway which will reduce pressure on emergency departments across the Saolta Group, including at Mayo University Hospital. A review of bed capacity in our health service, coupled with the review of the hours of service of medical assessment units, are key commitments in the programme that are intended to alleviate emergency department overcrowding. We must look at alternative options to emergency departments and examine whether medical assessment units and an extension of the opening hours of such units can assist. That is an issue I will prioritise. The review of bed capacity will be evidence-based and will inform decisions made regarding the bed complement of all our hospitals, including Mayo University Hospital.

In our first year of this Government, we will carry out a full review of the hours of service of medical assessment and similar units, with a view to extending their hours where justified by patient usage. Maximising the potential of these units, including the unit at Mayo hospital, will help alleviate emergency department pressures due to the growing demand for emergency care.

In January 2016 the primary care centre in Castlebar commenced participation in the primary care ultrasound project, which will increase access to diagnostic facilities in the Mayo region. These programme commitments will all contribute to reducing patient waiting times in our emergency departments.

As the Deputy will be aware, an emergency department task force implementation group has been set up. This group is co-chaired by the INMO and the director general of the HSE. The group continues to meet on a regular basis. I will meet the group by the end of this month to consider the actions it intends to take, bringing in all the relevant stakeholders to tackle issues in emergency departments and ensure co-ordination across acute hospitals and primary and social care to address emergency department overcrowding. I look forward to meeting the task force shortly.

Following on from this debate and the important issues Deputy Chambers has raised, I intend to send a transcript of this debate to the hospital group chief executive and ask for a direct response to Deputy Chambers and to me on the important matters she has raised. I will ask to have the issue of the rheumatology service examined and I will report back directly to the Deputy.