David Cullinane (Waterford, Sinn Fein)
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Last Friday, at University Hospital Waterford, a number of cancer patients who were preparing for surgery were, unfortunately, sent home because critical care at the hospital had reached capacity and was at crisis point, according to those who work there. I am sure the Minister of State appreciates that when somebody has cancer, it is a traumatic event for the person and his or her family. When preparing for major surgery as a consequence of the illness, one has to build oneself up psychologically and physically. Stephen was one of five patients who turned up for surgery on the day. He was with his wife and was preparing for what he saw as major surgery. He was initially told he would be kept at the hospital for a minimum of six days but then that he would have to go home and have his appointment rescheduled. I contacted the hospital management the next day and was told it had happened because the hospital simply does not have enough critical beds. A high number of trauma cases at the time meant people in the critical beds because of their illness could not be stepped down into other beds at the hospital. As a result, not enough critical beds and surgeons were available to do the necessary surgery.

The problem happens frequently at the hospital but it is not good enough that patients are treated in this way. Stephen, whom I met last week, was complimentary of the staff and management and did not blame any individual, whether those who work in politics or at the hospital. Rather, he pointed out we need to treat people with dignity and respect and that hospitals should have the capacity they need. He did so because he does not want others to go through the trauma of what he and his wife went through, having built himself up emotionally, psychologically and physically, before going home and feeling - in his words - deflated because of what had happened. He will now have to experience all those feelings again whenever his appointment is rescheduled.

We all accept that such events can happen in hospitals and there is never certainty when one is scheduled for any surgery. Nevertheless, I am sure we would all accept that a cancer patient, who must go through the trauma associated with that illness, should be prioritised. That the problem is happening on a more frequent basis suggests that it is systemic and needs to be resolved. I have spoken with the Minister of State several times about the wonderful staff at the hospital, as well as about the lack of capacity throughout the health services. He is aware of the need for additional cardiac and neurological services, the high wait times for ear, nose and throat services and all the other issues that need to be sorted out. When not enough critical beds are available for older people who have cancer, and when people who need surgery do not receive it when needed, it is a poor state of affairs. The issue is not down to the wonderful staff at the hospital but rather to the lack of capacity.

Will the Minister of State raise the matter with the Minister for Health and revert to me to indicate when the appointments of the patients who were told to go home will be rescheduled? They should be notified quickly and prioritised. Will additional capacity be provided at the hospital to ensure that similar incidents do not occur in the future?

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Cullinane for raising this issue and for giving me the opportunity to provide an update to the House on the recent cancellation of surgical procedures at University Hospital Waterford. By way of context, it is of note that University Hospital Waterford is experiencing ongoing growth in demand for unscheduled care. Emergency department attendances over the past four years have increased by 11%. The HSE has advised that, as of 7 a.m. on Friday, 14 June last, there were 31 admitted patients in the emergency department and eight extra patients on trolleys at ward level at the hospital. The HSE has further advised that the demand for critical care beds already exceeded what was available on that day and, therefore, there was no critical care capacity available or likely to be available for patients who would require post-operative specialist critical care that day. As a result, and in line with the hospital's escalation policy, the HSE has advised that four scheduled surgeries were cancelled. The HSE has further advised that the patients will be contacted urgently to reschedule their appointments.

It is important to note that maintaining scheduled care access for all patients is a key priority for hospitals. I fully acknowledge the distress and inconvenience for patients and their families when elective procedures are cancelled, particularly for clinically urgent procedures. Furthermore, any decision to delay admission or treatment is not taken lightly, and where such decisions are made, they are done to ensure a safe environment, with safe delivery of care to all patients as the priority at all times.

In addition, the Deputy will be aware that increasing capacity across our hospitals is a priority for Government. An additional 241 acute hospital beds opened under the winter initiative 2017-2018, including 18 additional acute beds in University Hospital Waterford. Furthermore, the national service plan for 2019 provides for a comprehensive capacity programme and, as part of that programme, an additional six acute beds have opened this year in University Hospital Waterford under the 2018-2019 winter plan. The 2019 capacity programme also provides for 202 additional beds, including 24 beds in University Hospital Waterford during 2019, with a view to bringing this extra capacity into operation in quarter 1 of 2020.

My Department is also working to improve access for patients waiting for hospital operations and procedures. Budget 2019 announced that the Government had further increased investment in tackling waiting lists, with funding to the National Treatment Purchase Fund increasing to €75 million. The joint Department of Health, HSE, and NTPF scheduled care access plan for 2019 was published on 11 March. The NTPF is collaborating with University Hospital Waterford and, to date this year, initiatives have been put in place to arrange treatment for over 3,000 patients across inpatient, daycase and outpatient waiting lists.

David Cullinane (Waterford, Sinn Fein)
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I thank the Minister of State for his reply. I fully accept his point that any decision to delay admission for treatment is not taken lightly. I accept that hospital management do not take those decisions lightly because they recognise, as the Minister of State did in his response, there is an additional trauma for patients who are already traumatised because of the type of surgery they are in line for. The reply also states that these decisions are made to ensure a safe environment, with safe delivery of care for all patients. Again, I have no quarrel with that because, if it is the case that the critical beds are taken up and there is a higher demand than the capacity available, then, obviously, hospital management and staff have to make decisions, and decisions they probably do not want to make but are forced into making.

My main point, which was not addressed in the response, is that there is a shortage of critical care beds. I ask that the Minister of State takes this up with the Minister, Deputy Harris. This will happen over and over again unless we put more critical care beds into University Hospital Waterford. The Minister of State's response acknowledges there has been a massive 11% increase in demand because it is a university regional hospital, which services the south east. If the population grows, then demand will increase, and this means the capacity has to increase, which means more critical beds are needed.

I accept hospital management have a difficult job and that it has to make these decisions, and I have no quarrel with it whatsoever. As I said, the staff were very pleasant. They were excellent to the patients who had to be sent home and they were very conscious of the trauma patients were going through, to their credit. However, I have to press the Minister of State again on this point. We need more critical beds in the hospital in Waterford. I hope he will take that message directly to the Minister for Health.

Finian McGrath (Dublin Bay North, Independent)
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I acknowledge the stress caused to patients. The issue of critical beds is an essential one. We have to ensure these cancellation issues and postponements of planned procedures are dealt with in a proper, professional way. That is something I will bring back to the Minister, Deputy Harris.

While every effort is made to avoid cancellation or postponement of planned procedures, the HSE has advised that planned procedures and operations can be postponed or cancelled for a variety of reasons, including the capacity issues which the Deputy mentioned and due to increased unscheduled care demand, which is what occurred in University Hospital Waterford last Friday. The South-South West Hospital Group is committed to the ongoing development of services at University Hospital Waterford. The hospital group aims to ensure the experience of patients in the hospital is of the highest standard. It continues to work closely with the hospital management team and community and primary care partners as part of the integrated care model to realise this. Of course, I will bring the issues raised by the Deputy to the attention of the Minister, Deputy Harris.