Imelda Munster (Louth, Sinn Fein)
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The closure of the medical assessment unit at Our Lady of Lourdes Hospital in Drogheda is a regular occurrence. It is common practice. It happened last week and the unit could very well be closed right now, as I speak. Perhaps the Minister can understand this but I cannot. The unit was opened to alleviate pressure on the very busy emergency department in the hospital. The HSE says that the hospital is very busy so it closes the medical assessment unit and sends patients back into the emergency department. One could not make it up.

Last Tuesday there were 217 patients in the emergency department in Our Lady of Lourdes Hospital. This was an unprecedented number but the medical assessment unit was closed. I contacted the HSE by e-mail on the Monday before last. My email was very straightforward - I asked the HSE to confirm that the medical assessment unit had been closed and to give me a reassurance that it would reopen on the following day. I got no response. I emailed the HSE again on Tuesday and Wednesday but got no response. I emailed again on Thursday but, to date, nobody has bother his or her backside to respond. That is a very serious issue and raises a number of questions. First, it raises the question of a lack of accountability within the HSE. It also raises the question of mismanagement in the context of the closure of a medical assessment unit which was opened in the first instance to alleviate pressure on the emergency department. The fact that the HSE did not respond to my emails leads me to believe that it did not want the public to know what is going on in the hospital.

First, there is the issue of the medical assessment unit. Second, there is the fact that the HSE did not respond to an elected representative on four different occasions. HSE senior managers seem to believe that they are answerable to nobody and are a law unto themselves. I ask the Minister to give his opinion on that. Will the Minister be holding them to account? I want to find out who made the decision not to respond to four separate emails on a matter of great concern to patients at Our Lady of Lourdes Hospital. I also want to know why the medical assessment unit was closed given that the reason it was opened in the first place was to alleviate the pressure on the emergency department. Why is it that droves of patients are now being sent back to the emergency department?

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Munster for raising this issue and assure her that I will be taking it up with the HSE directly. I received an email from the Deputy earlier this week regarding the lack of a response to her queries, which is not acceptable for any public representative or citizen of this country. I will get back to the Deputy directly regarding that matter.

I wish to take this opportunity to address the performance of the emergency department and the medical assessment unit in Our Lady of Lourdes Hospital in Drogheda. While recognising the pressures our emergency departments face, it is worth pointing out that recent data from the HSE indicates that, despite an increase of over 3% in attendances for the first quarter of 2017, the situation at the Our Lady of Lourdes Hospital has been improving, with 42% fewer patients waiting on a trolley compared to the same period this year. It is easy to get lost in percentages but that equates to 850 fewer patients on trolleys so far this year in Our Lady of Lourdes Hospital in County Louth. While there are still too many patients on trolleys, I want to acknowledge the Trojan work being undertaken by staff. Despite the fact that additional patients have attended the emergency department, 850 fewer people in that hospital have experienced being on a trolley this year as compared with last year. We need to build on that progress and I am confident that the staff there will do that.

The emergency department has also seen a sustained improvement in patient experience times during this period. I am sure Deputy Munster will join me in acknowledging the great work of front-line staff and managers in driving this improved performance. I want to thank everybody at Our Lady of Lourdes Hospital for that.

Notwithstanding this, under the framework of the HSE's full capacity protocol, Our Lady of Lourdes Hospital has an agreed escalation plan in place in line with national practice. This plan comes into operation during periods of emergency department overcrowding. I think this is the issue the Deputy is getting to. The plan sets out a range of special measures which can be activated through the escalation process as a last resort. These measures aim to improve the flow of admitted patients through unscheduled care pathways. As part of this, a medical assessment unit may temporarily be used to accommodate a locally agreed number of extra patients to address overcrowding. This is often referred to as surge capacity. At these times, patients are seen in the medical assessment unit rather than in the emergency department. While this temporary change of use may not be ideal in terms of the utilisation of medical assessment units, it enables hospitals to alleviate overcrowding in emergency departments and, most importantly, affords patients a greater degree of dignity. When patients are in a very overcrowded emergency department, it is important to afford them a little more dignity and privacy where possible. That is why decisions of this nature are taken. I accept that it might not always be ideal to use such additional space for these purposes. I have been advised that management in Our Lady of Lourdes Hospital has used the medical assessment unit facility in full accordance with the standard operating procedures as set out in the HSE's full capacity framework.

I assure the Deputy that there will continue to be a strong focus on reducing overcrowding. This should result in medical assessment units being used less frequently for surge capacity purposes. My Department and the HSE are already engaged in a process of commencing planning for next year's winter period. We are continuing to build on and improve trajectory in emergency department performance. In parallel with this process, the HSE's special delivery unit continues to work closely with hospitals, including Our Lady of Lourdes Hospital, to identify improvements that can be made to support patient flow, reduce trolley numbers and improve patients' emergency department experience. The programme for Government includes a commitment to build on the capacity for our emergency and acute services. This Government has agreed to review the management, operation and funding of medical assessment units with a view to extending their hours of opening and providing for weekend opening. My Department is in the scoping phase of this review. I hope hospitals like Our Lady of Lourdes Hospital can benefit from it. A number of major capital projects are under way to increase overall capacity in our hospitals. One such project at Our Lady of Lourdes Hospital will see the construction of a ward block to accommodate a clinical decision unit. This ward block is expected to be completed later this year. I expect that this increased capacity will further reduce the need to initiate the full capacity protocol.

Imelda Munster (Louth, Sinn Fein)
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The response from the HSE is not acceptable. First, it contradicts itself. As I said, the medical assessment unit was provided to alleviate the pressures on the emergency department. The HSE has pretty much said in its response that the medical assessment unit was closed because the hospital was so busy. What sort of chaos or mismanagement is that? If it was provided to alleviate pressure on the emergency department, but management is deciding to shut it as soon as the hospital is busy, common sense will dictate that this must lead to overcrowding in the accident and emergency department. Last Tuesday week, 217 patients had to wait all day and through the night. The medical assessment unit was closed. I cannot make up my mind about whether this is happening because of chaos, mismanagement, or both. I would be interested to know whether the Minister thinks it is either or both.

We have been discussing the crisis at Our Lady of Lourdes Hospital for many years. This problem has been further compounded by the decision of the previous Government to remove services from the minor injuries unit of Louth County Hospital, which currently has two registrars who cannot see children under the age of 14 to deal with minor ailments they might have. The Minister has previously given us a commitment to restore those services. Can he tell us when that will happen? All of these cutbacks are compounding the crisis at Our Lady of Lourdes Hospital. Will the Minister ask the HSE or the senior management at the hospital to give a commitment not to shut down the medical assessment unit again, as such a closure would result in a repeat of the crisis we have seen in the emergency department this week?

Simon Harris (Wicklow, Fine Gael)
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I am disappointed, if not unsurprised, that the Deputy has not acknowledged the significant progress that has been made by the staff of Our Lady of Lourdes Hospital to reduce the number of patients on trolleys in that hospital this year. These are not just figures; they are real people. Compared to last year, 850 fewer of Deputy Munster's constituents have had to experience a period of time on a trolley in the hospital this year. I want to make it clear that the number of people who have had such an experience this year is still too large, but it is worth noting that there has been a reduction of 850 in that number to date this year. The figures, which are there for all to see, show that people have been able to get in and out of the hospital more quickly because of an improvement in patient experience times. There are still many challenges in our health service. If we do not stop to acknowledge instances of significant progress being made by the staff of our hospitals, what are we actually at? We need to acknowledge it when people make progress. We are making progress in Our Lady of Lourdes Hospital, which is the Deputy's local hospital. I am going to acknowledge that even if she chooses not to do so.

Decisions on how best to utilise space in the medical assessment unit are best made by staff. We have a procedure in place to be followed by a clinical nurse manager, a clinical director, a doctor, a nurse or a manager who is running a hospital with a crowded emergency department. Under the procedure in question, which has been agreed with the INMO, if extra surge capacity is available to afford additional dignity and privacy to patients, that space should be used, even if it is not an ideal situation. We want to minimise the need for such arrangements by tackling overcrowding. We are going to do that by opening a new clinical decision unit. This is a tangible example of how capacity can be increased in hospitals. We are going to recruit more nurses. We have agreed with the INMO and SIPTU that an additional 1,208 nurses will be recruited this year. We will ensure there are more staff back in our hospitals. The bed capacity review will enable us to look at exactly how many beds we need. I am the first person to admit we need more beds in the Irish health service. However, beds are only good when personnel are available to staff them. I will ask the HSE to respond directly to the Deputy on the issue she raised with regard to Louth County Hospital, or else I will come back to her directly on the matter. I will follow up directly with the HSE to ensure the Deputy's correspondence is answered.