Charlie McConalogue (Donegal, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Ceann Comhairle for selecting this very important matter for answer by the Minister of State, Deputy Marcella Corcoran Kennedy. I am raising it so there can be no doubt that the Minister of State and the Minister, Deputy Simon Harris, are entirely aware of the very acute overcrowding in Letterkenny University Hospital and to allow the Minister of State the opportunity to explain the reasons for this unacceptable overcrowding uncovered by the investigations in the Department of Health. Most crucially, what is the Government doing to ensure the issues are addressed and to ensure this is not something we continue to see over the coming weeks and months as we go into the winter?

Yesterday, Letterkenny University Hospital had the joint highest number of people in the country, alongside Cork University Hospital, on trolleys in A&E and waiting for admission. That was a record number in the experience of Letterkenny but it comes on the back of similar experiences over the last number of days and weeks where the maximum capacity protocol has been initiated in the hospital. Each day for the past couple of weeks, with very few exceptions, the A&E has been overcrowded and there have not been beds available in the hospital to take in new inpatients. I hope the Minister is able to give an explanation of the dynamic of the problem and what the Government proposes to do about it. It is not a result of significant respiratory illness, which is very often an issue at particular times in winter and leads to particular pinch points in hospitals. That is not part of the dynamic here. We are only at the start of winter and there is no identifiable cause, for example a particular illnesses causing a spike. It comes back to something which is much more structural about the management of our hospitals and our health service in Letterkenny and other hospitals across the country. This is an ongoing issue. Families of patients have been ringing me over the last number of weeks looking to get their family member moved from Letterkenny hospital either to a hospital in Galway, where they need to go for specialist treatment, or for an operation in a hospital in Dublin, one of the acute hospitals or one of the children's hospitals. They cannot get away because there are problems in those hospitals and they are then blocking beds in Letterkenny. The problem is we are seeing a domino effect where one issue in the health service has a knock-on effect on a number of patients right down along the track. For example, if a person in Galway cannot get in to have an operation, they are blocking a bed that somebody in Letterkenny wants to take up.

They, then, are blocking a bed in the main hospital in Letterkenny from someone who cannot get out of the accident and emergency department. Then, as a result of maximum capacity protocols being launched, inpatient and day cases are being delayed. In turn, this means those patients are being inconvenienced and not getting the treatment they need.

I hope there is clarity from the Government today in respect of exactly what the structural management issues are in the health service that are causing this capacity shortage and lack of beds. If the Government cannot clarify what exactly is at issue, then there is not much hope that the problems can be addressed. I hope the Minister of State can at least do that much and then outline what action the Government will take to ensure that the resources and assistance are put in place to address the problem in Letterkenny so that we do not see it continue on an ongoing basis over the coming weeks.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank Deputy McConalogue for raising this issue and for giving me an opportunity to update the House on the serious matter he has raised relating to Letterkenny General Hospital. The Minister for Health, Deputy Harris, has asked me to convey his apologies to Deputy McConalogue as he is unavoidably detained elsewhere. He has asked me to address this matter for Deputy McConalogue.

I appreciate that the number of people on trolleys is too high and this leads to a very difficult environment for patients and frontline staff. The HSE and the Department of Health are working hard on measures to try to reduce these numbers, especially as we head into the busy winter period. The Minister, Deputy Harris, has been meeting regularly with the HSE because of his concern at the high trolley numbers and particularly today’s unacceptably high numbers. I am pleased to say that the numbers have reduced dramatically by over 200 as of this afternoon but this is going to take a relentless management focus from the HSE in the coming winter period to sustain the improvement.

Patient attendances at emergency departments to the end of September have been 5% higher this year when compared with the same period last year. Notwithstanding this increased demand, there has been a decrease of approximately 3% in the number of patients who have had to wait on trolleys in comparison with the same period last year. Trolley numbers have been higher in recent days due to consistently higher emergency department attendances and increased incidence of infection, which has resulted in bed closures in many hospitals. In addition, hospitals are currently carrying out a high rate of elective procedures to address waiting lists and this is contributing to pressures on the emergency departments.

I realise Deputy McConalogue is more interested in what is happening in Letterkenny University Hospital but it is important to set the general context. The HSE TrolleyGAR system shows that Letterkenny University Hospital with 33 patients waiting on trolleys 8 a.m. yesterday morning. This reduced to 14 by 8 a.m. this morning. I am advised by the HSE special delivery unit that Letterkenny emergency department has been under pressure this week, due to high attendances, a high number of delayed discharges and a suspected winter vomiting bug outbreak. The hospital is working hard with the local community health organisation to resolve its delayed discharges.

Notwithstanding the pressure on Letterkenny emergency department in recent days, it is worth noting that patient experience times in Letterkenny are above the national average, meaning that patients complete their episode of care more quickly in Letterkenny emergency department. I imagine Deputy McConalogue will be pleased to get that information. Letterkenny University Hospital has continued to receive capital funding in recent years to address the flood damage sustained in 2013. At present, work is ongoing to restore and upgrade the critical care, haematology and oncology units damaged in the 2013 floods.

The HSE has advised me that a number of measures are being followed to address congestion seen in emergency departments in recent days not only in Letterkenny but throughout the country. These include the use of escalation plans by all hospitals and a continued focus on diagnostics and enabling prioritised discharges. Hospitals and hospital groups are also working with the HSE social care and primary care areas to maximise discharges, through optimising the use of homecare packages, transitional care beds, as well as community intervention Teams.

The winter initiative plan 2016-17 has provided €40 million of additional funding for winter preparedness and is now operational. The initiative sets out a comprehensive range of actions across primary, community and hospital services to increase hospital avoidance measures, facilitate timely discharge from hospital and increase hospital capacity. As part of this process, the HSE special delivery unit has been visiting hospitals to review current practices and support those hospitals in implementing key process improvement changes. Under the winter initiative, additional home care, home help and transitional care bed allocations have been made available to hospital sites, including Letterkenny University Hospital to alleviate winter emergency department pressures.

Charlie McConalogue (Donegal, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for her response. It goes without saying that the experience that patients have had to endure in recent days in Letterkenny - the same applies to other hospitals - is unacceptable for them, their families and the staff, who have to try to manage what is an impossible situation.

I had hoped the Minister of State could have given me more detail on specifically why there has been overcrowding in Letterkenny in recent days and weeks as well as what specifically will be done. There was too much general comment in the response of the Minister of State. The Minister of State referred to what is being done at a national level, but there must be a specific response that recognises what exactly is causing the issue in Letterkenny and what exactly is required to address it. I call on the Minister of State and the Minister for Health, Deputy Harris, to engage further with the management in Letterkenny hospital to establish exactly what the issues are and to ensure that the response from the Government and the HSE in appropriate to address them. As I indicated earlier, there are no particular issues yet with respiratory illness or seasonal spikes. Undoubtedly, there are structural issues in the management of our health service and knock-on effects from one hospital to another as well as particular problems at local level.

Can the Minister of State give me more detail on what specifically the Government is going to do in Letterkenny? Will the Minister of State come back with a clear plan on what is going to be done there? Will she give a commitment that the resources and assistance required will be made available to ensure that home help is available for people being discharged from hospital and to ensure that every possible community hospital bed is opened? This particular experience of recent weeks – not that we needed reminding – emphasises the importance of ensuring that community hospital beds are available. We must work to ensure that the use of escalation plans, to which the Minister of State referred, is not the standard response. This is because that standard response means people who were due to come in for day operations and appointments are being told to say at home. Waiting lists get longer as a result.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I have been advised by the HSE that those responsible in Letterkenny have confirmed that the emergency department is under pressure. The reason provided – this is as specific as I can be – is that there are high attendances there and a number of delayed discharges and a suspected winter vomiting bug outbreak. That is as specific as I can be about the reasons around what is happening in the emergency department in Letterkenny. Those responsible are working hard to try to resolve this.

The hospital in Letterkenny, as in the case of many hospitals, will benefit from the winter initiative and will received the associated funding allocation. I hope that will be of help in future. I hear the concern expressed by Deputy McConalogue around what might happen and I realise influenza outbreaks and so on can cause many problems.

There is a more general point to be made about our health and well-being. It is important that people who should be availing of the flu jab avail of it to prevent themselves from becoming ill in the first place. I realise this is not specific to Letterkenny but it is a general comment in terms of what should be done to try to keep ourselves well and healthy so that we do not wind up having to go there. For those who do end up in hospital, we want them processed as quickly as possible. In fairness, those in Letterkenny are doing a great job in that regard.

I will bring Deputy McConalogue’s message back to the Minister, especially his point about escalation. I have no hesitation in doing so.