Seán Crowe (Dublin South West, Sinn Fein)
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I am not sure how up to date the Minister of State, Deputy Catherine Byrne, is with the dialysis situation in Tallaght Hospital. It is the regional centre of excellence for the Dublin Midlands hospital group and provides regional services such as 24-hour acute kidney dialysis care and home dialysis therapies. The demand for haemodialysis continues to grow as predicted by the national renal office and Tallaght Hospital's in-house assessments.

Dialysis activity at Tallaght Hospital has increased to more than 30,000 dialysis treatments per year. It has a designed capacity for 9,000 treatments a year. However, it has to deal with 30,000 treatments. The remainder were delivered in satellite dialysis units. That is basically private and costly. That is double the national average. Satellite dialysis units cannot cover complex medical diseases. Tallaght Hospital provides end-stage kidney disease management for St. James's Hospital. International best practice has mandated specific guidelines in regard to isolation facilities, patient segregation and wash facilities etc. to prevent hospital-acquired infections and blood-borne virus infections in haemodialysis units. These guidelines were adopted in 2006. New dialysis units have been commissioned and opened in other areas but the problem with Tallaght is that it is clearly not suitable. Tallaght Hospital's in-centre haemodialysis unit is not compliant with these 2006 guidelines. There is insufficient space around each dialysis station.

The heart of the matter is that there was an agreement to go ahead with the new unit. It was agreed in 2017 and then cancelled in January 2018. It is impacting on patients. The strategy behind it does not make sense. The unit in Tallaght has insufficient capacity to meet requirements and is not compliant with the Department of Health. There is also a shortage of capacity to deliver high dependency dialysis in the region. It does not make sense that the Health Service Executive, HSE, in its wisdom decided not to go ahead with this. I hope in her answer that the Minister of State will have some reasons why this is the case. Deferring this project will reverse the effect of the care provided to patients from south Dublin, Wicklow, Kildare, Laois and Offaly with end stage kidney disease.

All new patients who enter dialysis will have to receive haemodialysis in contracted satellite services. I asked how much we were paying for these private dialysis services. I got a response from the Minister of State's Department and the answer for 2017 was €4.056 million. That does not include transport costs for dialysis patients, which was €1.2 million. It impacts on patients but it also impacts on the costs and the staff within the hospital. I cannot understand why the project has not gone ahead. We need answers. The space is there. It is ready to go. I talked to the local authority and there are no difficulties with planning permission. It is up to the HSE and, more importantly, the Minister to explain why the project has not gone ahead and when it will.

Catherine Byrne (Dublin South Central, Fine Gael)
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I am sorry that the Minister, Deputy Simon Harris, cannot be here. I will take the opportunity to read the statement I have been given and then come back on some of the points that Deputy Crowe has raised.

The Minister, Deputy Harris, is aware that the Deputy has some concerns about the dialysis services in the Tallaght region. However, he can be assured that this is a matter the Department of Health, the HSE and the Dublin Midlands hospital group are working to address. Demand for haemodialysis nationally has been increasing in recent years. There was an average 5.6 % increase in dialysis treatments delivered by Tallaght Hospital over the past five years. There are currently approximately 220 patients receiving haemodialysis treatment and a further 40 patients receiving home dialysis therapy under the care of Trinity Health Kidney Centre and Tallaght Hospital.

I understand from the HSE that in 2017 there were 27,686 in-centre haemodialysis treatments. Those provided in Tallaght Hospital numbered 12,545, and those outsourced to satellite units under the governance of Tallaght Hospital numbered 15,141. In addition to this, there is an acute dialysis service in St James's Hospital that operates under the common governance model and common policies of the Trinity Health Kidney Centre. Tallaght Hospital is currently the second largest provider of haemodialysis in the country. The unit, with dialysis beds, is open seven days a week and almost all the growth in dialysis activity over the past few years has occurred in the satellite units. The requirement for additional capacity for dialysis at Tallaght is acknowledged.

The proposed new renal dialysis project to double the capacity at Tallaght Hospital is included in the national development plan. The new unit will not solely focus on increased capacity but also on enhancing the model of care, with particular emphasis on home and self-care. It will build on the existing status as a national home therapies centre. On the development of renal services overall, the Deputy may be aware that the HSE national renal office was established on World Kidney Day 2009 to provide governance, integration and leadership in developing a national framework for delivering renal services in Ireland.

The service planning and decision-making processes for allocation of resources are informed by the work of the renal office and its recommendations on future national renal priorities, based on clinical need and ongoing collection of epidemiological practice and outcome data. The overall aim is to develop networks of appropriately designed and maintained hospital dialysis facilities, with adequate inpatient, outpatient, laboratory and radiology facilities to support patient care in a fully integrated manner.

The Minister for Health is aware of the current demands on the renal services at Tallaght hospital and the requirement for expansion of dialysis capacity to accommodate the growth in demand. The Department of Health and the HSE are working to address the capacity necessary to meet this demand.

Seán Crowe (Dublin South West, Sinn Fein)
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I have read the reply but it does not outline why the decision was made to go ahead and then cancel. The information I have suggests there is insufficient capacity to cope with clinical requirements. The service is not compliant with Department of Health infection guidelines. There is a shortage of capacity to deliver high-dependency dialysis in the region. I could go on. This represents an unacceptable clinical risk to patients and increases costs, with funding being diverted to the private sector. The contents of the reply do not add up. The situation is resulting in an increase of inappropriate use of intensive care unit beds.

We need to get our act together. I know the Minister for Health has been to the hospital and has looked at the dialysis unit. Anyone who has visited the hospital would argue that the service is insufficient and not up to standard. The staff are doing great work but it is clear that this unit has seen its day. I am concerned about cross-infection. If the unit is not compliant with Department of Health infection guidelines, then there is a responsibility on us to move ahead.

I accept that the Minister of State does not have the answer to when this will proceed. She referred to plans for the future. Does that mean next year or this year? Will it be in ten or 20 years? The Department plan for the future is mapped out over a long period of decades. When is this plan going ahead for a new dialysis unit, one clearly needed in Tallaght and the regional health area, which covers Laois, the midlands, Wicklow and so on. I trust the Minister of State has some sort of reply for me. This matter needs to be addressed. This is an ongoing difficulty which impacts on patients, their families and the staff of the hospital and it needs to be resolved now rather than later.

Catherine Byrne (Dublin South Central, Fine Gael)
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I do not have the actual answers to the questions posed by Deputy Crowe. However, I assure him that I am well aware of the renal dialysis services in Tallaght because a member of my family is there on a daily basis. I do not have a date and time. I have only been given what I have been given by the Department and the Minister's office. Having said that, I will relay some of Deputy Crowe's concerns to the Minister and ask him to reply to the Deputy directly because I do not have the relevant time and date. There is a need for this. It has been acknowledged that there are some concerns. I do not have the exact answers to the Deputy's questions but I will pursue the matter for him through the Minister's office. I will ask the Minister to get in touch with him directly.