Charlie McConalogue (Donegal, Fianna Fail)
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I hope the debate this evening provides clarity as to when funding will be approved for Letterkenny University Hospital to provide nurses and support staff to facilitate the opening of the 20-bed short-stay ward as an addition to the hospital. Currently, the short-stay ward is being used temporarily for rehabilitation service patients while refurbishments are carried out in the rehab unit in St. Conal's hospital campus. Previously, the short-stay ward was operating as a full ward of the hospital pending the reopening of the haematology-oncology ward, in which there were 11 beds, as well as the coronary care unit, which had eight beds. Those two wards opened in summer, following the flooding, and the beds and staff from the short-stay ward transferred to the two newly-opened wards. That meant the short-stay ward was vacant. Since then, it has been used for rehabilitation patients who are due to return to St. Conal's by the end of December when the ward will, once again, be vacant and available for use.

To bring the short-stay ward into use to provide the 20 beds requires staffing. In June 2017, hospital management in Letterkenny submitted a request to the HSE for approval for the staff required to open the short-stay ward and provide the additional 20 beds. If open, the ward would enhance the hospital's capacity from 330 patients to 350. To bring that about, funding of €1.8 million was sought to hire 17 additional nurses, six health care assistants and four other staff. As the Minister of State knows from his work in the Department of Health, it takes time to put staff in place. Once approval is secured, it takes weeks or months to get to a situation where beds can be reopened. It usually takes at least four months. Nevertheless, Letterkenny has still not received approval from the HSE or, in particular, from the Government, which is responsible for providing the funding to the HSE to enable that to happen. As a result, 23 patients are waiting on trolleys for admission to Letterkenny University Hospital today. Yesterday, there were 25 such patients.

Since January 2017, 4,000 patients have had to wait on trolleys for access to a hospital bed. They were admitted by accident and emergency department consultants but no beds were available on 4,000 occasions so far this year. That is an increase from 2016, when just over 1,200 patients were obliged to wait on trolleys. As such, the numbers increased almost two and a half times between 2016 and 2017. The hospital's assessment shows that, on average, approximately 20 additional beds are required at a given time. The proposal put forward would deal with that and provide the additional beds. However, that will only happen if the Government gets its act together and provides the required funding. Why has the Minister of State sat on this for the last number of months? Even if the funding is given now, we will have to wait a further period because of the inaction of the Government regarding the approval. Can the Minister of State inform the House today whether the funding will be provided immediately and state that every effort will be made to ensure the additional 20 beds will be available at Letterkenny University Hospital after Christmas for Donegal patients?

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy McConalogue for raising this important matter. First, I am delighted that as part of the budget 2018 announcements, €40 million in additional finding was provided for winter pressures in 2017 and a further €90 million for measures to improve access to scheduled and unscheduled care in 2018. As such, we are planning for these particular issues. This is a signal of the commitment of the Government to invest in hospital services, provide additional supports during the winter period, increase hospital capacity and reduce waiting times for hospital procedures.

The additional funding for winter preparedness will be allocated to a range of measures. I confirm that €5 million of the funding for 2017 will be focused on supporting patients to return home, or to an appropriate community setting where clinically appropriate, by providing 45 additional home-care packages and 20 additional transitional care beds per week over the winter period. These measures have already been rolled out to targeted hospitals nationally, thus helping to alleviate some of the pressures hospitals are experiencing at present. Funding will also be provided to increase bed capacity this winter and, moving forward, as part of service planning for 2018. The Department of Health is also undertaking a health service capacity review in line with the programme for a partnership Government commitment. The review's findings, which are due to be published before the end of the year, will provide an evidence base regarding future capacity. In addition, I confirm to the Deputy that all hospital groups and community health organisations have developed and put in place integrated winter preparedness plans for their localities with a focus on planning for periods of escalation, maintaining patient-flow processes and ensuring public health preparedness.

I will turn to the question raised regarding Letterkenny University Hospital. I am aware that a proposal for additional beds in Letterkenny has been submitted to the HSE by the Saolta hospital group. This proposal will be assessed by the HSE in line with current financial and procurement processes and a decision will be made thereafter. In general, there is no doubt that too many patients continue to wait on trolleys for admission to hospital on a daily basis within our health service. I acknowledge the distress that long wait-times in emergency departments cause for patients and their families, including in Letterkenny. The public hospital system is seeing a growing demand for care and Letterkenny follows this trend. This year, accident and emergency attendances at Letterkenny had increased by more than 1% by the end of September, including an almost 5% increase in emergency department attendances by people over 75 years. Notwithstanding the pressure on Letterkenny emergency department, 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 compliment and thank the staff for that.

I conclude by noting the commitment of this Government to develop and improve services at Letterkenny University Hospital as evidenced by the significant level of investment in capital projects in recent years. These developments include multiple remedial works following flooding in 2013, a new state-of-the-art blood science laboratory in 2015 and a new medical academy and a clinical skills laboratory, both of which were opened last year.

Charlie McConalogue (Donegal, Fianna Fail)
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I thank the Minister of State for his response. It beggars belief, however, and is unacceptable. First, I emphasise the tremendous work the staff at Letterkenny University Hospital perform on a daily basis. It is completely unfair that their work and effort is met, as it has been in the Dáil this evening, by the absolute failure of the Government to get to grips with its responsibility to ensure the planning and support is in place so that they can do the job they do their best to perform every day.

The Minister of State said he is delighted that €40 million is available to ease the pressure on hospitals. He also said he is aware that a proposal for additional beds in Letterkenny had been submitted to the HSE and that this proposal would be assessed by the HSE in line with current financial and procurement processes, with a decision made thereafter. The HSE and the Government have had this proposal since June. We are in the middle of winter and the Minister says it will be assessed and considered as part of due process. He said he wishes to acknowledged the distress from long waiting times for patients in emergency departments. We do not want the Minister of State to tell us that he acknowledges people's distress. We want the Government to deal with the matter in order to ensure that people are not distressed.

The hospital in Letterkenny put forward a clear proposal to provide 20 additional beds which would greatly help deal with overcrowding and people having to wait on trolleys every day for admission. Fortunately, when the rehab patients return to St. Conal's after Christmas there will be the physical space in the hospital to provide those 20 beds. Not every other hospital in the country has that capacity. The Government, however, cannot get its act together - even after six months - to provide the funding required to put staff in place for this purpose. It is totally unacceptable.

Pat Gallagher (Donegal, Fianna Fail)
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The Minister of State has two minutes to reply.

Charlie McConalogue (Donegal, Fianna Fail)
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I ask the Minister of State and the Minister for Health, Deputy Harris, to recognise how they have failed in respect of this very viable proposal. I ask for an immediate answer and that, come the new year, we will have the 20 additional beds in Letterkenny and people will not have to continue to experience being on trolleys.

Pat Gallagher (Donegal, Fianna Fail)
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I realise this is a very important issue but we have gone over time by a minute and that cannot be allowed.

Finian McGrath (Dublin Bay North, Independent)
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I will bring the Deputy's strong message about Letterkenny University Hospital back to the Minister, Deputy Harris. I agree with the Deputy regarding the staff at the hospital and I compliment them. The patient experience at the hospital is above the national average and there are many examples of good practice. It is misleading to say that nothing is happening. A great deal is happening. The projects under way and planned include: a CCU haemotology-oncology ward restoration upgrade; a radiology and interventional suite restoration and upgrade; a mortuary restoration and upgrade; boiler-house maintenance; and an underground service duct with details at design stage.

Charlie McConalogue (Donegal, Fianna Fail)
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Nothing has happened in government. Everything is happening in the hospital. What is the Government doing?

Finian McGrath (Dublin Bay North, Independent)
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There is a restoration upgrade for the physiotherapy and occupational therapy departments and additional projects are planned. It is unacceptable to have people on trolleys and that will be the focus of our extra spending in 2018. There is €90 million extra to deal with these issues. I will raise with the Minister for Health the points made by the Deputy on the 20 beds and the €1.8 million. I will push this issue but a lot of work has been done. We will continue with that work.