David Cullinane (Waterford, Sinn Fein)
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The reason there is a number of speakers is that this relates to the Saolta University Health Care Group and the latest data which have come from the Irish Nurses and Midwives Organisation and the Irish Patients Association regarding the number of patients in the north-west and west region who are on long waiting lists. In addition, the trolley count is particularly high. In fact, it is the highest of any part of the country. Last week alone, and despite the fact that there were widespread cancellations of elective surgeries in all the hospitals in the Saolta group, there were 614 patients on trolleys. There were 226 in Letterkenny, 169 in Galway and 104 in Sligo. I have very little time, but there are particular problems in this region and in this group. The question we are asking, and I have raised this directly with the Minister, Deputy Stephen Donnelly, is: what can be done to ensure that whatever resources need to be put into all those hospitals to reduce the waiting times and take people off trolleys is done?

Rose Conway-Walsh (Mayo, Sinn Fein)
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Like my colleague, Deputy Cullinane, I wish to discuss the Saolta hospital group and, in particular, Mayo University Hospital. Mayo University Hospital is in a deep crisis at present, both in terms of the 15,000 people who are waiting for treatment there and in terms of access to the emergency department. People are waiting for hours without treatment. It is not good enough in this day and age. It is not good enough to say that we spend X amount of money. There must be accountability within the system. We also need the resources to be targeted. We have built enormous primary care centres, even in parts of Mayo, yet people cannot have access to a general practitioner, GP, or to proper healthcare. Something has gone badly wrong. There must be capital investment in Mayo University Hospital. There is no point in telling us it will happen in 2024 or 2025. There has not been capital investment in Belmullet hospital as well and that is obviously having a knock-on effect on step-down services for Mayo University Hospital.

Mairead Farrell (Galway West, Sinn Fein)
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Covid-19 has shown that we need capacity and bed numbers to keep patients safe and away from risk. Sadly, this is not the case at present. Galway University Hospital has long had an issue with capacity, which means that, as the Minister of State knows, most families in Galway have had a loved one stay on a trolley rather than in a hospital bed. Indeed, it was this capacity issue that left us on the back foot at the onset of the pandemic and it still impacts on our fight against Covid-19 now. It was horrifying to see that once again this month there were hundreds of people lying on hospital trolleys in Galway and across the west. These are not just numbers, but real people. We have to finally deal with the capacity issue and support the tremendous work that is being done by staff who are dealing with overcrowded conditions daily as they try to do their best for the patients who are admitted to Galway University Hospital.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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The issue across the entire hospital group is capacity more than anything else. We hit it all the time and the number of people on trolleys and on waiting lists comes up in the Chamber regularly. The staffing issues in Sligo University Hospital, particularly in the emergency department, have been at crisis point for the past number of months. We met the management of the hospital who told us that new nurses were being recruited and that 14 were to be in place before the end of November. The hospital has got some of them, but not all of them. The staff had organised a lunchtime protest today because of the staffing levels in Sligo University Hospital. They postponed it because negotiations are taking place to try to do something about it. However, it is a crisis situation. There are issues with bed capacity, diagnostic capacity and theatre space. There is a range of problems, and not just in Sligo. It is in Letterkenny and in all the hospitals in the region. It is a very poor reflection of how the west is being looked after when one considers that the Saolta hospital group is in such a crisis.

Anne Rabbitte (Galway East, Fianna Fail)
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I suppose I should be glad you are in the Chair tonight, a Leas-Cheann Comhairle, or you would be adding your voice on this matter. I acknowledge the Saolta group as I am a resident who accesses the Saolta group. It is important to put that on the record.

I thank the Deputies for raising this important issue. The Saolta group serves a relatively older and dispersed rural population in Connacht and Ulster and is of vital importance to those communities. I should have said at the outset that I am replying on behalf of the Minister, Deputy Stephen Donnelly. The group has six hospitals across seven sites. Emergency department congestion, waiting times and other challenges vary across the group over time. There is significant capital investment in Saolta under way or in planning, which I will outline shortly. However, I acknowledge the scale of the challenge facing our emergency departments as we head into what is expected to be a difficult winter. I agree with Deputy Mairéad Farrell. I acknowledge and thank emergency department staff for their ongoing commitment to delivering a high standard of care to emergency department patients while acknowledging the distress that overcrowding causes to patients, their families and to front-line staff.

The Minister, Deputy Stephen Donnelly, published the HSE winter preparedness plan for 2021-22 on 15 November. The plan centres on three core objectives - emergency department avoidance, patient flow and hospital egress - to mitigate the expected challenges in providing emergency care this winter while also continuing to respond to Covid-19. We are investing €77 million in this year's winter plan in addition to the 2021 funding, which has been retained. This year's winter plan recognises that a whole-system response is required and outlines how the HSE proposes to manage winter challenges across primary, community and acute care, including measures to allow the public system to access private healthcare capacity. The acute hospital capacity review identified the need for significant additional bed capacity.

Since January 2020 we have added approximately 800 new acute beds. Projects of note in Saolta hospitals include ten new beds in Mayo and 26 in Letterkenny, with a further 23 due before the end of the year. Portiuncula has two projects under way to provide 62 beds. In Sligo, there is the building oftwo additional 21-bed wards and in University Hospital Galway, 12 cardiothoracic beds are currently being built, as well as the new radiation oncology unit. The handover of the temporary emergency department in Galway is expected in early 2022, and Merlin Park's two new orthopaedic theatres will be operational shortly. Roscommon's specialist rehabilitation unit has been delayed due to Covid-19, but work continues to progress this project. These projects will provide the bed capacity to improve patient flow through the hospitals and improve emergency department performance.

I accept that our waiting lists are far too big. Many patients are waiting an unacceptably long period of time. The waiting lists were too long before the pandemic but have worsened due to Covid-19 and the cyberattack. We are taking action to address this. For 2022, an additional allocation of €250 million will be used to fund additional activity in both the public and private sectors to reduce hospital and community waiting lists. The additional funding means there will be a budget of €350 million available to support vital initiatives to improve access to acute hospitals and community health services.

There is an acknowledgement in the response, and I echo it, that there is tremendous pressure in all the hospitals across the Saolta group.

The staff are working incredibly hard, but my reading out tonight what beds have arrived and what beds are coming on stream does not provide the care to the families who need it and does not give the hospitals the staff they need. Funding is not the issue at the moment. It is really hard to recruit staff into clinical posts. That is a major problem being faced in Sligo.

David Cullinane (Waterford, Sinn Fein)
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The statement the Minister of State was given referred to additional beds that have been brought into the system. In her speech, she mentioned 800 new acute beds and she went on to detail some of them. She did not say that many of these beds are actually replacement beds. A few days ago, I was in Portiuncula hospital and met the hospital manager. The Minister of State spoke about 62 beds, but 50 of those are replacement beds and only 12 are new. They are single isolation room beds which are replacing wards that are being repurposed for other uses. These are not new beds and do not bring additional capacity. It is unfair to suggest to people they are new beds when they are not new beds.

Rose Conway-Walsh (Mayo, Sinn Fein)
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The people in Mayo deserve better and need better at this point. The Minister of State has spoken about staff and looking after them, and I acknowledge the Trojan work they do. Why do we not do exit interviews with all the nurses who are leaving? Why do we not offer contracts that are flexible to meet the family needs of nurses? Why are we going around the world recruiting nurses when only 4% of students who do pre-nursing PLC courses go on to be nurses? The pathways are not there for our own people.

Mairead Farrell (Galway West, Sinn Fein)
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I echo the words of my colleague, Deputy Martin Kenny. This really is a capacity issue. While budget after budget outlined the additional capacity that would be added to our hospitals, the reality is people in Galway having to leave their granny overnight on a trolley in Galway University Hospital as so many families have had to do in recent weeks. That is just not good enough. They need to see the impact on the ground.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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The Minister of State referred to the recruitment of staff as being impossible. We need to drill down on the reasons for that. The reason is that the HSE is trying to recruit staff into a chaotic situation where they are required to work in an understaffed ward with one person having to take on all the responsibilities which should be shared among three or four people. As a result of that people do not want to stay in the HSE system and are therefore emigrating to other countries where they can at least make progress in trying to qualify. Those problems exist across all HSE areas and not just in the west because of the chaotic system that has arisen over years of underinvestment.

Anne Rabbitte (Galway East, Fianna Fail)
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The 2018 health service capacity review was clear on the need for a major investment in additional capacity in both acute hospitals and in the community, combined with wide-scale reform of the manner and location of the provision of health services. Approximately 800 beds have been provided on a permanent basis over the number available at the end of 2019. We have hired more than 6,000 staff - doctors, nurses, midwives and therapists - since last summer.

On 7 October the Minister, Deputy Stephen Donnelly, published an acute waiting list action plan, aimed at mitigating the impact of the pandemic and the cyberattack on scheduled care activity this year. He is also establishing a ministerial task force to oversee a long-term multi-annual plan to address this enormous challenge. He has said that reducing waiting lists will be a priority for us throughout 2022. The Department, the HSE and the National Treatment Purchase Fund are focusing on improving access to elective care in order to reduce waiting times for patients. These plans include increased use of private hospitals; funding weekend and evening work in public hospitals; funding "see and treat" services for minor procedures while providing at the same time an outpatient consultation; providing virtual clinics; and increasing capacity in the public hospital system.

He has accepted that a key part of the solution for the Saolta group is additional beds and the expansion of facilities. I earlier outlined many of the recent and current developments under way at each of the hospitals across the group. All these are significant steps in addressing the needs and will provide additional capacity and staff to meet the needs of the population. The Department of Health and the HSE will continue to work with the local group management to further improve the patient experience in the Saolta University Hospital Care Group.

The 50 beds in Portiuncula hospital have been out of operation for some time and the additional 12 beds relate to where the hospital could not have the old Victorian-style units.

David Cullinane (Waterford, Sinn Fein)
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They are still open.

Anne Rabbitte (Galway East, Fianna Fail)
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They have not been open for many years.

David Cullinane (Waterford, Sinn Fein)
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They are open now.