Bernard Durkan (Kildare North, Fine Gael)
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Late last night, I had occasion to visit Naas General Hospital in response to a call from a constituent whose child had been admitted at 5 a.m. yesterday. This child had previously been in the care of child and adolescent mental health services, CAMHS, and has difficulty getting a place. It is expected that there will be an announcement on an extension to the Lakeview mental health unit in Naas hospital shortly.

What I am about to describe applies to many other hospitals throughout the country. What I saw at almost midnight last night was chaotic. It was a sad reflection on all the work done by many people, including by the Minister and Minister of State, and by various people in this House who have raised this issue in respect of this and other hospitals. It was chaotic in the sense that patients who had been there for ten, 12, 14 hours or more - some were into their second day - were being manhandled on to trolleys in a narrow corridor.

Only one doctor, a registrar, was available. I do not know why that was. No bed was available, even though the parents of this child had made repeated interventions, all to no avail, with consequent stress on the patients. It is not possible to deliver an effective, efficient and workable service in the way the staff were trying to deliver last night. It was not fair to the staff, patients and the public who expect more. It was not fair on the Minister and Minister of State.

I make this suggestion. I do not care what the cause is; it is time to do something about it. We have all gone down this route previously and raised this issue. Every time we are told of some difficulty or snarl-up be it a lack of beds, space, accommodation or something else. We expect to deliver a reliable health service, and to deal with patients and emergencies. I do not know what would happen if an emergency occurred in a situation like that. However, it would not be possible to respond in the way that one would be expected to respond to an emergency.

I ask for an immediate review of the facilities at Naas hospital with a view to ensuring that day patients can get through the emergency department, ED, in a reasonably efficient, effective and reliable manner. There is nothing as bad as lack of confidence in a system. Without doubt there is a lack of confidence in the system. The staff are not able to resolve the problems. There is a requirement for an evaluation of the situation from above to put in place what is required to deliver the service. There is not much sense in telling me in a year or two that we will have the problem resolved. That will no longer work. I do not blame any of the Ministers personally, but the time is up and we cannot wait any longer. Something needs to be done about it now.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputy for raising this important issue. I know that for many years he has been a strong advocate for health issues, particularly for developing and supporting the services at Naas General Hospital.

The Minister for Health acknowledges the difficulties overcrowded EDs cause to patients, their families and front-line staff working in very challenging working conditions in hospitals throughout the country. For the first ten months of 2019, the number of patients attending hospital EDs nationally increased by 2.7% and the number of ED admissions increased by 1% compared with the same period last year.

In October 2019, the number of patients subject to a delayed transfer of care was 16% higher than the same month last year. The Deputy is, therefore, correct. Between January and October 2019, the number of patients recorded as waiting on trolleys at 8 a.m. in Naas General Hospital ED was 3,733, a decrease of 0.2% compared with the same period last year. As of last week, there were 21 patients with delayed transfers of care in the hospital compared with ten for the same week last year.

The HSE winter plan for 2019-20, launched by the HSE on 14 November, seeks to address the challenges of overcrowded EDs and the current high numbers of delayed transfers of care in our acute hospitals. The aim of the winter plan is to ensure that service providers are prepared for the additional external pressures associated with the winter period. The increased pressures include a prolonged holiday period, severe winter weather, seasonal influenza, the spread of norovirus and other healthcare associated infections.

Nine winter action teams, WATs, each aligned to a community healthcare organisation, CHO, and associated acute hospital and hospital group, have prepared integrated winter plans that will focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients, and appropriate timely discharge from acute hospitals. These integrated winter plans have supported the development of a single overarching strategic-level winter plan for the HSE. The integrated winter plan for Naas General Hospital will be delivered by WAT 7, whose membership includes the CEO of the Dublin Midlands Hospital Group, the chief officer of CHO 7, and the CEO of Naas General Hospital.

The winter plan is supported by an additional €26 million in winter funding nationally. This funding will support social care measures and local WAT initiatives to improve patient experience times in EDs. Funding for social care will support access to the fair deal, increase home support hours, and provide additional transitional care to facilitate timely discharge from acute hospitals and free up beds for patients awaiting admission.

There has been a consistent increase in the number of staff in the HSE in recent years with approximately 10,000 more staff working in the HSE than in the same period three years ago. Naas General Hospital employed 747 whole-time equivalents, WTEs, in October 2019.

This is an increase of 13 WTEs since the same period last year. The Minister for Health is confident that together with the more immediate measures being undertaken under the winter plan and the strategic approach undertaken by the Government under Sláintecare, progress will be made in addressing the difficulties in the emergency departments. I accept the points made by the Deputy and I will bring them back to the Minister

Bernard Durkan (Kildare North, Fine Gael)
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I thank the Minister of State for a comprehensive reply that, to be fair, deals with the issues have arisen. The problem is how soon we can expect a resolution. Patients and their families always look to know how quickly help can come. I am not so sure that it will come quickly enough. I saw a number of people who were there at midnight last night and I could see that they were not pleased. They were upset. They had been there for a long time, including all day or from mid-morning the day before. In those situations, there is a need for an urgent response. The child in question, who was under the care of CAMHS, has been looking for a place and a proper programme for the past two or three years but it has not happened. It cannot happen because there is no bed available in Stillorgan or any of the other places tried by the parents. It is very sad to see the parents crying while waiting for some kind of action. It only affects us all when it comes to our own door.

The time has come to take an initiative in respect of this hospital. I would suggest an immediate review of the facilities there and the number of staff available, on call and ready to work at any given time, particularly over the remaining winter months, to preserve the good name of the hospital because the staff are good if given the chance. It is not fair to them, the patients and members of the public who might become patients and it is not fair for the Minister of State, who has to repeat this again and again despite the fact that he has the best interests of all concerned at heart. I ask that this initiative be taken ahead of the winter initiative with a view to identifying the immediate problems.

Finian McGrath (Dublin Bay North, Independent)
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I agree with most of the points made by Deputy Durkan. I take on board his question about how soon this will happen. I agree with him that we need a reliable health service. I will bring his point about a review at Naas General Hospital back to the Minister. We cannot have issues like that affecting families in that situation. I understand the impatience and concern of many of these families who do not see things moving quickly enough. I commend the Deputy on his personal commitment and how he was there at midnight last night and saw at first hand what was happening on the front line.

Attendances at accident and emergency departments are growing year on year. The health service capacity review published last year was clear on the need for a major investment in additional capacity in both hospital and community - so there is already an agreement there - combined with widespread reform of the manner in which healthcare services are provided and their location. As set out in Sláintecare, moving care options for patients closer to their homes and into local communities is a key part of the solution. Improving timely access for patients is at the heart of Sláintecare. Building upon the progress made in recent years, the Sláintecare action plan 2019 published by my Department includes a specific work stream on accessing and waiting lists. In addition, many of the other service reforms included in the action plan will support timely access to care for patients in the coming years.

I also wish to clarify that there is no national recruitment embargo in the HSE. There is, however, a requirement for all HSE services to maintain or reach an affordable staffing level that is sustainable through 2019 and 2020 while prioritising the delivery of safe services within available resources. There has been an increase in the number of staff in the HSE, along with an increase of more than 250 doctors since the beginning of 2019. The number of WTE nurses and midwives has increased by almost 800 since September 2018.

The points raised by the Deputy are very serious. We need a review to see what is happening. The HSE has established a medical workforce and patient safety oversight group and workforce planning is incorporated in the Sláintecare action plan.