Thursday, 10 May 2018
Topical Issue Debate
Emergency Departments Services
I raise the need for investment and expansion in the emergency department of Cavan General Hospital and the minor injury unit in Monaghan General Hospital. Cavan's emergency department is attended by approximately 32,000 patients each year. It is a busy and highly utilised service that is under huge pressure with its current layout and facilities. It has ten examination cubicles, which is clearly inadequate to deal with 32,000 patients. Admitted patients who do not get a bed on a ward are kept in the examination cubicles, further reducing the availability of examination beds and causing further delays in the assessment of new patients in the emergency department.
The resuscitation room is inadequate. There is one trolley space and no room to accommodate another trolley. It is not lead-lined and the radiology department is reluctant to do portable X-rays in that room for that reason. It is difficult for staff to manoeuvre around the room during cardiac resuscitations or when dealing with trauma patients. There is only one small triage room in a hospital and emergency department that has a throughput of 32,000 patients. It needs at least four triage cubicles. We need a minor operation theatre in the emergency department and we have no designated paediatric area in the emergency department which means, as the Minister of State knows, that children are currently assessed and treated alongside adults.
We have inadequate facilities for women who are pregnant or gynaecological patients. We have no appropriate isolation facilities in the emergency department. Our reception area is small and cramped and there is no privacy for patients. We have only three public toilets in the emergency department, which is insufficient for 32,000 patients annually. This is against a backdrop of staff working night and day, above and beyond the call of duty to take care of their patients. The Taoiseach said he wishes more people would use the minor injury units, such as in Monaghan, to help to cut back on waiting times in emergency departments, such as in Cavan General Hospital, but in 2011, the HSE cut the opening hours of Monaghan's minor injuries unit back from a good service from 9 a.m. to 9 p.m. seven days a week to a 9 a.m. to 5 p.m. service from Monday to Friday. It is a ridiculous move when our local emergency department in Cavan General Hospital is overcrowded and working with inadequate facilities.
All of this is against a backdrop of appalling ambulance response times, particularly in Monaghan, where people are losing their lives. In recent times, a young father of two suffered a cardiac arrest in Ballybay, County Monaghan. He waited almost an hour and a half until the ambulance arrived. The doctor on call arrived after the ambulance. Tragically, that man lost his life before the ambulance made its journey to the nearest hospital. His family truly believes that he could still be here today if the ambulance response had been prompt on the night in question.
The RCSI hospital group has submitted an application for funding to the Department. Will the Minister approve that request? Will he extend the opening hours at the Monaghan minor injury unit and broaden the facilities that are available? Will the Minister and Minister of State meet with the family who lost their son that night because it took the ambulance so long to arrive at the scene of a dying man?
Unfortunately, the Minister cannot be here so he has asked me to convey his apologies. I will read the reply and then come back to the Deputy regarding some of the issues she raised. On behalf of the Minister, I thank the Deputy for the opportunity to update the House on this matter.
We are all aware that this winter was particularly difficult for our health service. The most recent verified figures show emergency department, ED, demand continuing to rise through March 2018. Nationally, ED attendances have grown by 3.7% by the end of the first quarter, with subsequent ED admissions up 3.3% when compared to the same period in 2017. Of course, any increased demand was further exacerbated by the severe weather associated with Storm Emma in early March. ED attendances at Cavan General Hospital have increased marginally by 0.2% and there has been a 3% decrease in attendances by patients 75 years or older as compared to this time last year.
While there has been an increase nationally in patients on trolleys, I assure the Deputy that the Minister is committed to breaking the cycle of overcrowding in our health service. As part of budget 2018, €40 million was provided to respond to winter pressures, of which 60% - €25 million - was allocated this year for social care measures. This includes €3.5 million for 480 additional transitional care beds and €18 million for 1,080 additional home support packages during winter. The Minister is fully aware of the need for additional capacity during periods of peak demand. The Deputy may wish to note that over 200 additional beds have been opened this winter.
As the Deputy may be aware, the hospitals in Cavan and Monaghan operate as one hospital serving the local population, with the ED located in Cavan and the facilities in Monaghan focusing on elective care and the streaming of appropriate patients to the minor injury clinic. In recent years, Cavan General Hospital has seen a number of investments in its services, in particular a new waiting area and additional treatment space in the emergency department in 2009, an acute medical assessment unit, AMAU, and a new cystic fibrosis outpatient suite. The AMAU officially opened in 2014 and consists of a ten-trolley treatment area, including two single rooms. It provides urgent assessment and care for patients with medical conditions and facilitates more capacity for patients presenting direct to the AMAU and medical patients who previously were being assessed in the ED.
I appreciate that this is a scripted answer but I must point out that there is very little relating to the issues I raised today. The one small token concerns what I am talking about, which is the ED and in respect of which we are given figures for 2009, which is nearly ten years ago. I know the Minister for Health visited the hospital recently to open the fantastic new cystic fibrosis outpatient unit. However, somebody standing in the ED in Cavan General Hospital would see that all of the issues I have outlined to the Minister of State are accurate and in no way exaggerated. People walk in the door and are straight into reception. They must give their personal details right across the counter and the entire room is obliged to listen to them. We are talking about personal details about their family, age and date of birth, all of the information that someone would never discuss with a total stranger, least of all in an ED.
Apart from all that, we are talking about 32,000 patients in terms of the footfall for the accident and emergency department in Cavan General Hospital. This department services a huge region, not just County Cavan. As the Minister of State clearly outlined, Monaghan Hospital lost its ED. Since then, the minor injury unit, which is a fantastic facility, has had its hours reduced. Therefore, Cavan General Hospital, particularly in the context of the ED, is crying out for investment and expansion. These are not my words. They are the words of the staff and patients who attend the ED. It is my understanding that the RCSI group has submitted an application. It was hoping for capital funding investment from the Government. I also understand that there is no mention of Cavan General Hospital in the national development plan, which does not bode well for people living in the Border region who depend on the ED in Cavan General Hospital to service a huge area. I accept that it works hand in hand with the minor injury unit but the latter also has very limited opening hours. In general, who as a fall or breaks his or her arm between the hours of 9 a.m. and 5 p.m.? Those kind of things generally happen after hours or at weekends. I ask the Minister of State to respond to the specific questions I asked. Will the Department grant the application that has been made by the RCSI hospital group? Will it extend the opening hours in the minor injury unit in Monaghan General Hospital? Will the Minister and Minister of State meet with the Dempsey family, which had such a horrific experience based on the ambulance response times in Monaghan?
Unfortunately, I cannot answer some of the specific questions because I am not familiar with Cavan General Hospital. I take the Deputy's concerns on board, particularly those relating to the minor injury unit and the fact that the opening hours have been cut. I see that as a very real issue so I will relay that. I do not have any information about the application. All I can tell the Deputy is that further investment in Cavan General Hospital will be considered within the overall acute hospital infrastructure programme. I do not have a timeframe. In saying that, I will ask the Minister whether he would consider meeting the Dempsey family. I have taken some notes on the other issues raised by the Deputy and will refine them when I go back up to my office.
I assure the Deputy that any time I take a Topical Issue, the first thing I do afterwards is go back to the Minister's office. The second thing I do is send on emails outlining all the questions that were asked. I cannot be responsible for whether people reply but I complete matters on my end in order to ensure that people's concerns are raised. I expect the Minister to respond to the individuals. If that does not happen, I would appreciate it if the Deputy would come back to me because I will continue to pursue the matter on her behalf.