Martin Ferris (Kerry, Sinn Fein)
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On Tuesday, between 12.30 p.m. and 2.30 p.m., nurses in the accident and emergency department in Tralee University Hospital found it necessary to protest against conditions patients in the department have been experiencing over a long period. The problems in the accident and emergency department in Tralee are overcrowding and a shortage of beds. Patients are admitted and are not transferred to appropriate hospital beds because beds are not available. That is the sad situation. I stood in protest with the nurses and there was a huge level of support and appreciation from the general public who passed in cars, buses, lorries and so forth. Almost every person gave a thumbs up or beeped the car horn to show support for the nurses. The staff are fantastic. They do a tremendous job in very difficult conditions. Every day, between 17 and 20 people wait on trolleys in the accident and emergency department in Tralee University Hospital. That is a serious indictment on the provision of a health service that is vital for patients.

I understand the hospital has a bed complement of approximately 350, with an additional 16 to 18 beds available to complement that. Some wards have been closed for a number of years and are lying idle. I understand also that the number of people lying on trolleys waiting for a bed in the hospital has increased by 67% since 2016.

The hospital has sought an extra 43 beds and the appropriate number of staff to provide the necessary service in the accident and emergency department in Kerry University Hospital.

So far, nothing has been forthcoming and that is the reason the nurses found it necessary to leave their posts and go outside the hospital to protest. It is a shameful state of affairs that they found it necessary to do so. They are highly appreciated by the people of Kerry, by patients and their families for the tremendous work they do. The Government must make the extra 43 beds available as well as the staff necessary to service them. It should be done immediately. It is not right that every day there are 17, 18, 19 or 20 people lying on trollies. Some of them are very elderly; I was there myself and there were 93 and 94 year olds in the height of the winter lying on trolleys, some of them for three or four days. I know of one person who passed away shortly after being moved to a bed. That is how they spent the last 72 hours of their life. It is not right.

I am not blaming the Minister of State personally but I do believe the Government has a responsibility to look after patients and provide the resources necessary to deliver a facility in this day and age. Is the Government prepared to make the extra 43 beds available? Is it prepared to create the staffing levels to service those beds and alleviate the terrible pressures and stressful conditions that nurses in the accident and emergency department of University Hospital Kerry work under? The nurses' commitment to patient care is tremendous. Is the Government going to match it?

Jim Daly (Cork South West, Fine Gael)
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I thank the Deputy for raising this issue. I am aware that nursing staff working in University Hospital Kerry emergency department engaged in a lunchtime protest on Monday. I understand that this was to highlight their concerns about overcrowding in the emergency department and its impact on patient care. I want to assure these staff that the Government is fully aware of the difficulties and challenges that are currently faced by all hospital staff, including nurses and midwives, in delivering care in the hospital setting. The emergency department of every hospital is at the front line when it comes to treating and caring for the public. There is a real focus within our health service on addressing overcrowding issues and ensuring continued recruitment and retention of staff.

University Hospital Kerry is experiencing a prolonged period of increased demand for its services. This is most evident in the older age group of over 75 years of age with a 10.7% increase in attendances year to date. Overall, attendances year to date are up 2.6%. However, the hospital is progressing a number of initiatives to support the patient pathway and improve the patient experience. Some of the examples include the implementation of a frailty intervention team, providing a second geriatrician post to provide specialist experience to care effectively for older people in the area, providing a consultant cardiologist and an additional bed capacity proposal. Recent staffing improvements at this location include the appointment of an assistant director of nursing for patient flow. Since 2017, two additional staff nurse posts have been put in place for night duty and two additional healthcare assistant posts for day duty. Seven staff nurse posts have also been upgraded to clinical nurse manager I grade. A further clinical nurse manager post is in the process of being sought by the hospital to assist patients being admitted. This is in line with the emergency department protocol. In addition to this, four new staff nurses recently joined.

Unfortunately, even with these appointments, there remains a nursing deficit of 1.3 whole-time equivalent posts due to maternity leave and sick leave. I understand that the hospital is currently recruiting for this shortfall in staff. In addition, the emergency department is also supported by 2.8 advanced nurse practitioners. I am confident that these measures will improve the situation in University Hospital Kerry.

At a national level, there is an agreement in place in respect of emergency departments, which was brokered through the Workplace Relations Commission, WRC. Indeed, only last week HSE management and officials from my Department engaged in a conciliation session with the INMO on implementation of this agreement. The outcome of this conciliation was that the HSE reaffirmed its commitment to comply fully with all aspects of the agreement. Engagement with the INMO at hospital group level has been re-established. Management agreed to promote and communicate the job advertisements to fill the vacancies in emergency departments and provide updates to staff on progress.

As part of the emergency departments WRC agreement there is a plan in place to address overcrowding. This plan was developed by the emergency department task force and is being implemented. That is why I was disappointed to see this protest proceed, despite this very recent commitment to renew efforts to progress implementation. The focus must be on working together to implement the plan, rather than engaging in industrial action. I urge the parties at local level to attempt to put aside their differences and engage with the agreement that is in place.

Martin Ferris (Kerry, Sinn Fein)
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It is evident from the Minister of State's reply that there does not appear to be any plan to put in place additional beds within the hospital. That is the crux of the problem. We have 17 to 20 sick patients on a daily basis lying on trolleys waiting for a bed to become available. Those beds should be available. It is not that the physical facilities do not exist within the hospital to provide them. Is there a political commitment to making them available?

The Minister of State said he is disappointed that industrial action was taken. I thought what they did was very mild. It was very principled and it was done in the interests of patients. The nurses came out in a peaceful protest to highlight the conditions they are working under. They wanted to highlight the 17 to 20 patients on trolleys and the fact that there are not enough beds available in the hospital and not enough front-line staff. The Government is not prepared to address those issues. It is stalling and dragging its heels and has been doing so for a long period. It is a very mild but a very principled position that the nurses have taken in the interests of patient safety.

The Minister of State says the task force is being implemented. Will it take another protest to implement whatever proposals the task force is going to make? Will it take another protest to get adequate beds in the hospital for patients in need? I hope the nurses' actions this week will accelerate whatever decisions the Government is going to take to provide patient care and safety to the people of our county.

Jim Daly (Cork South West, Fine Gael)
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I appreciate what Deputy Ferris is saying and the support he is showing to the situation there. I take no issue with that or indeed with what happened. It is just disappointing all round that we end up in a situation where it has to come to that and we cannot get agreement and get everybody playing their part. Everybody has a part to play in this.

If I may make an academic, broader point, every time I hear a debate on trolleys I am minded that we sometimes focus on the number of trolleys. I am not talking about Kerry at all in this instance, just general debate around trolleys. What is far more important is the length of time people wait on trolleys. Trolleys will always be a feature. If we had eight empty beds in a hospital waiting for eight people to arrive, there would be something wrong with the hospital that had those eight empty beds at any given time, especially with the challenges we are facing at the moment. We need to move our debate on a bit. That is just an academic point and not in respect of Kerry. It is the length of time people wait on trolleys that we really have to focus on. That is the bigger challenge.

There is a national plan to increase bed capacity ahead of the coming winter. A submission has been made by the South/South West Hospital Group on behalf of University Hospital Kerry for additional beds to be opened there for next winter. That is being progressed by the HSE and the Department at the moment and hopefully it will deliver some additional capacity in the hospital. I cannot put a number on those beds and do not want to do so until the process is complete. This is a national process and a number of hospitals are making submissions ahead of the winter.