Kathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I am glad to have an opportunity to raise this issue because it is very important to the people of Carlow and Kilkenny. The management of St Luke's General Hospital Kilkenny, which services counties Carlow and Kilkenny, has proposed to cut the number of maternity and gynaecology beds by up to 15%, which is the equivalent of four beds. I ask the Minister of State for clarification on the issue. I am sure he can understand it is causing a lot of distress and concern for patients, staff and anyone who expects to use the maternity unit in the near future. I have made several attempts to get clarification from management at St Luke's General Hospital but unfortunately to date I have not been able to receive a response.

I wrote to them about the issue and asked for a meeting with me and my Oireachtas colleagues but I have had no response and this is a concern.

There is a proposal to use beds from both maternity and gynaecology wards to facilitate the overflow from the current overcrowding situation. The two wards are on the one corridor and run into each other and such a move would see beds taken from this unit. It is unbelievable that anyone could think this was a possible solution to overcrowding because it would put patients, including newborn babies, at risk of infection. There would also be safety and privacy concerns for both women and their babies if an overflow was going to be allowed on these wards. I feel, and more importantly the staff, doctors and specialists at St. Luke’s believe that if this is to implemented it would be a reckless move and would show no regard for the health and well-being of female patients and newborn babies in the gynaecology and maternity wards.

The recent national maternity strategy and the recently published HIQA national standards for safer better maternity services set out clearly what needs to happen to deal with deficiencies in our services and how to improve maternity and neonatal care overall nationally. We need care that is safe, standardised, of high quality and offers a better experience and more choice to women and their families. Having general patients with varying conditions and illnesses located on the same corridor, sharing the same facilities as pregnant women, newborn babies and women who could be in a vulnerable condition, completely contravenes the standards which the national maternity strategy and national standards document set out.

The staff at St. Luke's have stated that if a 15% reduction in current bed capacity goes ahead, the quality and safety of care provided will be greatly compromised with women allocated to beds on corridors. This is ludicrous and I hope the Minister can intervene in this matter. There is an increased risk of cross-contamination from general patients, especially with higher-risk clientele such as premature or newborn babies and woman who are readmitted for various conditions. It will cause mayhem for them. If we are serious about protecting our women and their health we cannot allow a move like this to go ahead in our constituency. The hospital serves both counties of Carlow and Kilkenny so a huge amount of people use the wards

Finian McGrath (Dublin Bay North, Independent)
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I apologise on behalf of the Minister, Deputy Harris, who cannot be here. I thank Deputy Funchion for raising this matter and giving me the opportunity to update the House on the position in relation to maternity beds at St Luke’s Hospital Kilkenny. First, I assure the Deputy that over the past two years there have been significant improvements to the maternity services at St. Luke’s General Hospital. These include the appointment of additional midwives, a bereavement support midwife counsellor, a clinical practice facilitator, 24-7 shift leaders for the delivery suites, a lactation nurse specialist, an advanced midwife practitioner and a fourth consultant obstetrician. In line with the national trend, the number of births at the maternity unit at St Luke’s has decreased by 9% over the past four years.

We are all aware of the challenges for hospitals, including St Luke’s Hospital, in managing emergency demand and high trolley numbers during the first few weeks of January. These can be attributed to high demand for emergency care, bed capacity restraints and increased incidences of flu in the country. St. Luke’s Hospital in Kilkenny had a 6% increase in overall admissions for medicine and surgery to the hospital during 2016. It is a site of concern today with 29 patients waiting on trolleys this morning at 8 a.m. and 24 patients at 2 p.m. and I agree with the Deputy that this is totally unacceptable and we have to act on the matter.

The HSE escalation framework sets out the process and procedures which define how hospitals should react and deal with emergency department overcrowding. This can include the appropriate use of all other empty inpatient beds for a surge in emergency department capacity in order to ensure patients do not have to spend a night on a trolley when other hospital beds are available. I understand from the HSE that St. Luke’s Hospital is actively managing emergency department demand. This includes consideration of the use of part of the maternity service bed capacity as surge capacity when not being utilised for maternity patients. The layout of the hospital's maternity facilities ensures that any space used for emergency department referrals would be in an enclosed four-bed bay and not part of a larger maternity ward, thus ensuring the privacy, dignity and clinical well-being of all maternity and emergency department patients. The hospital is also focusing on discharging patients and maximising community supports to support discharges.

On 5 January 2017, the HSE announced a series of enhanced measures as part of the existing winter initiative plan. These measures focus particularly on augmenting the supports for primary and community care and targeting of acute capacity, and are designed to alleviate the current significant demands on emergency departments. The enhanced measures under the winter initiative include the opening of 63 new acute hospital beds nationally, in addition to the 35 beds already opened this winter. Approximately 40 of these beds have already opened and, under this funding, work is under way to open eight new emergency department beds in St. Luke’s as soon as possible. The money is there to open these new beds.

Under the winter initiative, St. Luke’s in Kilkenny was selected as a pilot site to develop an integrated case management approach, between acute hospitals and the community organisations, to the provision of health care services to our frail and elderly population. The Ireland East Hospital Group has advised that it is continuing to work closely with St. Luke’s Hospital Kilkenny to support it in managing the situation and to improve the experience for patients and staff attending the hospital.

Kathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I agree with some of what the Minister said on the excellent service in the maternity unit. I have been a patient there on two occasions so I know exactly how good the staff are and that is why the current system should not change. If one knew the layout of the hospital one would know that it is not possible to use four beds in isolation. The corridor, the maternity ward and the gynaecological ward run right next to each other and the people in those four beds would be sharing toilets and showering facilities with other patients so there is no way one can say there is no risk of cross-contamination and other general infection. It is ludicrous to put people from the general population of the hospital in with newborn babies, premature babies and women who are in hospital because of the loss of a pregnancy as this just puts them at greater risk of infection.

The Minister said there was a decrease in births but the 2016 census indicated an increase of 4.1% in the population of Carlow and 3.9% on Kilkenny. The projected requirement for maternity services for childbearing women aged 25-44 will increase the need for services for in the next number of years. The maternity ward is very good for women in a difficult situation, such as the loss of a baby or a pregnancy loss. The hospital gives them privacy and, often, their own room but that would be completely taken away and we have to look at that from the point of view of mental health. Using the maternity and gynaecology wards to deal with overcrowding and putting a woman who has had a pregnancy loss in the same place as somebody who has just had a baby will have negative repercussions from which we will not be able to row back. The ward runs really well at the moment even though, like all other hospitals, they are under pressure. I urge the Minister to get onto the management of St. Luke's Hospital Kilkenny and ask it not to go ahead with this as a solution for overcrowding. It will cause a lot of problems for women and newborn babies, which we do not want.

Finian McGrath (Dublin Bay North, Independent)
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I take the Deputy's point on the practical effects on patients of the conditions and will bring it back to the Minister, Deputy Harris. Eight new beds will be opened and that is an important step in the right direction. We must ensure that we are able to deal with the bed capacity issue. On 9 September last, when the Minister and the Government introduced the winter initiative plan 2016-17. we managed to get €40 million of additional funding. That is from where the funding for the eight beds in the hospital to which the Deputy refers came. The initiative has developed and has managed to deal with the winter surge, which gave rise to major difficulties. St. Luke's Hospital also announced a number of enhanced measures, particularly targeting acute capacity in primary and community care. These are designed to alleviate the significant demands involved.

According to the figures I have been given for the area, some 1,586 babies were born in 2015, while the figure for 2016 was 1,467. As Deputy Funchion said, however, there has been a recent increase in the population in Carlow-Kilkenny. We must adapt services for those changing circumstances. I take that point on board.

I will bring the issue raised by Deputy Funchion back to the Minister. I will also make representations to the hospital management to see exactly what is going on there. As we all know, health services have suffered from underfunding for many years. We also know, however, that we have started this year with a major investment of €500 million for services. That is a start and it is also part of a catching-up process. That reality must be faced, so I will be pushing that initiative. I will bring all the Deputy's concerns to the attention of the Minister.