Catherine Connolly (Galway West, Independent)
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I tabled a written question on the cutbacks in home care packages in Galway. I addressed the question to the Minister and got a reply on 4 October which said "As this is a service matter it has been referred to the Health Service Executive for direct reply". I contacted the Health Service Executive before I tabled the question which I tabled in exasperation to the Minister and this is the response I received. New politics has been mentioned but at this point it is a cliché. How in God's name could I get a reply that this is a matter for the Health Service Executive when it has clearly pointed out that its money and funding have run out. I will put the consequence of that funding running out in context for the Minister of State. There are two oncology wards in the hospital in Galway which cannot discharge or admit patients. That is a centre of excellence that covers Donegal down to Clare. They cannot discharge patients who are ready for discharge and they cannot admit patients. Those they cannot discharge cannot be discharged because recently a patient, who I will not identify, with stage 4 cancer was discharged with six home care hours when 21 hours were recommended. In that week, a person suffering from leukaemia stayed in a B&B because they could not gain admission to the oncology ward. Yesterday there were 35 patients on trolleys in a centre of excellence. Two weeks ago, a woman in her mid-80s died on a trolley while waiting for admission. Full capacity protocol has been in operation in the hospital in Galway every day since last Thursday and sporadically before then. Code black, which is the top code, has been in operation every day this week and most of last week. Yesterday there were four people in a queue to gain admission to the resuscitation room in the accident and emergency department. That is four patients waiting for admission to a resuscitation room where there are two beds. There is a two-hour wait for a triage nurse in the accident and emergency department. Elective procedures have been cancelled. Oncology clinics have been cancelled without explanation.

There is a new ward - I might pre-empt the Minister of State's reply - that is almost finished and has 75 beds. Management has confirmed there is no funding for this hospital and that by January or February its intention is to close two wards in the hospital, reducing capacity further, and transfer the equivalent of one ward into an empty building which has the capacity for 75 beds and will be operating at one third capacity.

That is the position in Galway. I make no apology for raising this and I will raise it at every single opportunity I get. Two actions need to be taken. First, a commitment to a new hospital in Merlin Park is needed as a long-term measure. This has been called for not just by me, but by the hospital’s clinical director, who has said the state of the hospital is number one on the clinical risk register. Second, we need immediate extra funding for home care packages to relieve the pressure on the hospital. No Government can stand over a situation where four people are waiting to go into a resuscitation room, an 80 year-old woman dies on a trolley and there are any amount of other incidents in that hospital.

I know this is not the Minster of State’s area but I tried to table a question to the Minister. I received a circular answer so I am tabling it again and seeking an answer.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputy Catherine Connolly for raising this important issue which is close to all of our hearts. There but for the grace of God it could be any of us requiring services for our elderly relatives.

On the point about a couple of sentences in a reply to a parliamentary question, the Health Service Executive has the facts. Questions are often referred from the Department of Health to the HSE to get the information. It is not that there is an unwillingness to provide the information. There is a procedure as to how that information is obtained. I will follow up on that matter on the Deputy’s behalf.

Home care services are critical to support older people to stay in their own homes and communities, and maintain their independence for as long as possible. This is better for older people as they are happier in their own homes. It also makes sense because it helps avoid admissions to acute hospitals and many people can be supported at home at a far lower cost than in residential care. The HSE’s national service plan for 2016 provides for a target of 10.4 million home help hours to support about 47,800 people. It provides for 15,450 home care packages and 190 intensive home care packages for clients with complex needs, including dementia. This is less than we would like to have available, however. Services are being stretched by demands from more people, as well as for more hours at times outside of core hours, in the evenings and at weekends, all of which cost more.

The Government has made a start in responding to this demand by providing an extra €40 million for home care packages in 2016, allowing us to maintain services at a higher level than would otherwise have been the case. The Government will allocate €10 million to support discharges from acute hospitals as part of the next winter initiative. We will now provide an extra 115,000 home help hours and 528 additional home care packages in 2016.

On 9 September 2016, the HSE published its winter initiative plan for 2016-17. The plan will focus on specific measures required to address the anticipated surge in health service activity in hospitals and in the community nominally associated with this time of year. One of its key objectives is to reduce the numbers of people waiting to be discharged from hospitals by providing the specific supports and pathways to allow patients to move home or to a suitable community setting which meets their needs. Achieving this objective will free up beds in the acute hospital system which, in turn, will lead to less overcrowding in emergency departments.

We have several initiatives aimed at increasing capacity at Galway University Hospital. Earlier this year, 30 new beds were opened. In addition, a 75-bed ward block and acute adult mental health unit are under construction. They are expected to be operational by 2017. Further, the programme for a partnership Government contains a commitment for a new emergency department for Galway University Hospital. Community services are endeavouring to support the discharge of patients who have been deemed medically fit for discharge and require alternative supports, be that long-term care, home care and transitional care.

University Hospital Galway is within the community area of CHO, community healthcare organisations, area 2 which has received almost €5.5 million for home care as part of the €40 million additional funding to which I referred to earlier. In addition, as part of the winter initiative funding, CHO area 2 is receiving €1.8 million specifically for University Hospital Galway to provide six new home care packages each week from October to February.

Catherine Connolly (Galway West, Independent)
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I thank the Minister of State for her reply. However, the full capacity protocol is in operation in Galway. Code black is the one it is using. The hospital is in crisis, notwithstanding anything the Minister of State has told me in this reply. That is the position in Galway. The money for the home care packages has been used up and no money is available to provide the necessary home care packages for patients who cannot be discharged from the hospital. The manager in charge of home care packages must make cutbacks to save further money.

I am not here to scaremonger but to argue for a public health system in Galway. Will the Minister of State respond to the concerns I have raised about the full capacity protocol? Hospital management has said no funding is available for the 75-bed unit and it will remain empty, other than the 25 beds to be taken from the hospital which reduces its capacity. There is no quid pro quogain. No funding is available for the new ward. The home care packages cannot be delivered. Somebody on the oncology ward cannot go home because there is no home care package. It makes no sense on a human or health level. More importantly, it does not make sense on an economic level because it is costing more money to keep a patient in the general hospital. It makes more sense to put the money into home care packages.

What is the Minister of State’s response to my request for a new hospital for Galway? What is her response to the risk identified that the condition of the hospital places it number one on the risk register for Galway?

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I appreciate the Deputy’s concerns on this matter. She has addressed specific questions to me but I do not have a reply to them because they were not part of her original question to the Department. If her question had been more detailed, I would have been able to get a more specific response. I can only give her a response to what she submitted in her original question.

CHO area 2 is receiving €1.8 million specifically for University Hospital Galway to provide six new home care packages each week from October to February. This will provide for 114 new home care packages over the winter period. Intensive home care packages are being provided to 32 clients in that area who require considerable levels of resources and who would, in the absence of this support, be admitted to long-stay residential care or would have remained in an acute hospital.

University Hospital Galway is in receipt of transitional care beds throughout the course of the year and averages 16 approvals per week. Transitional care beds support patients who have been deemed fit for discharge but may be awaiting a specific bed in a long-term care facility, or some degree of convalescence prior to returning home. The hospital is also supported by the provision of short-stay public beds throughout the Galway and Mayo region.

Similar to all acute hospitals, we will keep the situation in Galway under constant review in line with the winter initiative plan.