Tuesday, 22 November 2022
Saincheisteanna Tráthúla - Topical Issue Debate
As the Minister of State is probably aware, an unprecedented event took place over the weekend, when 34 consultants from all disciplines at Sligo University Hospital all sent emails to the Minister for Health and others highlighting that conditions for patients and staff at Sligo University Hospital, SUH, are completely unacceptable and verge on the unsafe at times. These emails did not come out of the blue.
The issues and these concerns have been building for years and have culminated in record numbers of people on trolleys - proportionately the worst in the country when you compare them with the number of beds in the corresponding hospitals and the ability of the hospital to absorb the number of people on trolleys.
This is the tip of the iceberg. That is what is visible. Underneath all of that is totally inadequate hospital infrastructure. The hospital has a single CT scanner. When it is out of action when it is being serviced as it needs to be, there is no scanner and that is the most basic requirement for any acute hospital. There is an ageing MRI scanner that is supposed to provide an imaging service for a quarter of a million people in the north west. There are many more shortcomings but I do not have time to go into them. The emails from the consultants spell them out in shocking detail. SUH is losing its staff and is finding it difficult to recruit. There is no doubt it is reaching a tipping point. There needs to be immediate systemic action first of all to refocus funding allocations to Sligo within the Saolta University Healthcare Group to begin to rebalance the imbalance that is there. Second, there is a need to prioritise the provision of fully operational medical equipment and sufficient amounts of it. Third, there is a need to accelerate the 42-bed block in parallel with surgical, maternity, paediatric, emergency department, radiology theatres and ICU.
The situation at SUH is at breaking point. We have the highest percentage of over-65s in the country, which means we have the greatest demand. We have a bed occupancy rate of about 110%, which is well over the national average of 90% and very dangerously over the acceptable international level of 85%. In other words, people in Sligo are dying because we cannot live up to rates that can be guaranteed to be below 85%. That is a fact.
An unprecedented number of senior consultants serving the catchment area from SUH have shared the despair they are suffering at the hands of our inaction and ambivalence and our inordinate talent for filing reports, doing surveys, researching, agreeing, planning, talking, debating, discussing and finally delivering nothing.
I acknowledge the commitments given to me during the motion of no confidence last July and to Dr. Donal Murray and cardiologists at SUH on improvements the Minister was prepared to provide and the money was provided in the recent budget. I also acknowledge that the 30-plus staff needed to open the already ready-to-go four additional ICU beds at SUH are provided for in this budget but, as Deputy Harkin rightly said, we cannot attract people to Sligo. If you talk to the Irish Hospital Consultants Association, it will tell you things were advertised for six months or a year but nobody responded. We need critical and urgent action this time.
I thank Deputies Harkin and MacSharry for raising the issue of staffing and services at SUH. I was sitting here today when Deputy Harkin raised it on Leaders' Questions. SUH is a model 3 hospital with a 24-7 emergency medicine service. It delivers a wide range of local and regional services on an inpatient, day case and outpatient basis, including a range of specialties such as cardiology, medical oncology, critical care, cancer, maternity, paediatrics, radiology, acute medicine and acute surgery, as well as a number of regional specialties provided on an outreach basis to Letterkenny University Hospital.
As the House is aware, the Covid-19 pandemic led to an unprecedented interruption to normal health services both in the community and acute hospitals system across the country. The HSE, hospital groups and individual hospitals continue to plan for the challenges of providing health services while maintaining patient safety in a Covid environment. This includes planning for winter, planning for service resumption and waiting list management as well as the ongoing Covid-19 response.
The HSE winter plan for 2022 to 2023, which was published in October, will support acute and community services this winter to respond to anticipated high levels of emergency attendances and admissions across the acute sector, long waiting times in emergency departments and high occupancy rates across acute hospital settings.
This Government recognises that SUH has a critical role to play in services in the north west. This is reflected in the significant increase in resources allocated to the hospital. In 2022, the budget allocation for the hospital was €160.8 million, up from €130 million in 2018. From the end of 2020 to the middle of 2022, staff had increased more than 12%, including 71 nursing and midwifery staff. In July 2022, 1,885 whole-time equivalent staff were employed by SUH, which is a 12.5% increase on the end of 2020. This included 72 nursing and midwifery whole-time equivalents notwithstanding the issues raised by the Deputies.
This Government also recognises the capacity issues at SUH. As a result of the 34 senior consultants emailing the Minister for Health, the Minister met with consultant doctors from the hospital yesterday evening to hear their concerns. The emergency department is under sustained pressure. Between January and October, there were more than 37,000 attendances, up 4.8% on the same period in 2019 and 12.2% higher than the five-year average. Associated metrics such as waiting times in the emergency department and trolley numbers are also increased on previous years.
Hospital management, in concert with the Saolta University Healthcare Group and the wider HSE, has advanced several capital projects in order to address such capacity issues. These include an emergency department modular unit, additional ICU isolation rooms, a 42-bed ward block extension, a second CT scanner and MRI replacement and a new emergency department surgical block.
In particular, the proposal for a new surgical and emergency department block will involve construction of a new multi-storey extension to the hospital. This facility will provide the consolidation of theatres, provide surgical and maternity wards together with a new emergency department, radiology and integrated paediatric departments. In 2022, funding was allocated to appoint consultants to complete a strategic assessment report-preliminary business case. As this would be a major capital project, this is one of the steps required to progress this project under the public spending code. This Government recognises the valuable work done by the staff at SUH and aims to support the ongoing development of services.
The Minister of State spoke about three issues. She spoke about the winter plan. Seven of the ten actions involve recruiting extra staff for SUH. When I wrote to the HSE asking how many extra staff had been recruited, I received a response not two weeks ago that told me that it was expecting to start recruiting soon. We are in the middle of winter so there is no winter plan here.
Second, the Minister of State tells me that the budget allocation in four years has increased by 25%. I do not know how much the health budget has increased by but I guarantee that it is way more than that so giving us raw figures without looking at how they compare elsewhere is meaningless. I did not have time to check those figures but I will.
Finally, the Minister of State spoke about the new surgical block. To be fair, the Taoiseach said today the issue from hereon is delivery and whether we can accelerate the timeline for construction. The question is, will we?
We are failing consultants, doctors, nurses and all our medical professionals through not providing the safe environment they require. They are accountable but through our failure, we are leaving them vulnerable in terms of their accountability and endangering patients' lives. That is a statistical fact.
The Saolta University Healthcare Group is too Galway-centric. This is a major issue. Take the example of the four ICU beds. The Minister, the Minister of State, Deputy Feighan, Deputies Harkin and Martin Kenny and myself were trying to get them opened. They will be opened. However, at the very last minute at the pre-budget stage, the Saolta University Healthcare Group with HSE management tried to take two out.
There is a disconnect between what we are looking for, what we are hearing from patients and consultants and what the Minister of State is telling us, what HSE management is doing and where within the Saolta group resources are being allocated. This needs to change.
I thank both Deputies. I could hear the passion in both their voices as they spoke about this issue, and the genuine concerns they both have.
The HSE winter plan for 2022-23 will support community services this winter to respond to anticipated high levels. Specific initiatives for SUH include three healthcare assistants to support community services on the chronic disease hub, three administrative staff to support referral pathways between SUH and the community, one clinical nurse manager to act as GP liaison, three emergency medicine consultants and one registrar to assist with pre-admission patient flow. In keeping with the principles of Sláintecare, the Government will continue to support the strategic development of SUH.
I am glad that the Minister met with the consultants last night. When 34 consultants put pen to paper and write to the Minister about their genuine concerns, I am glad he acted so quickly and that he met them. As I outlined earlier, there are several capital developments in train at the hospital, but I know that the two Deputies are really concerned about the here and now and the challenges of the winter we are facing into. I was struck by the fact that Deputy MacSharry said that the highest number of over-65s were in there. I also take on board the point he made about the CT scanner, the MRI replacement and the single point of failure when there is only one machine and it does not work.
I will pass on the Deputies comments to the Minister. The Minister was in the house earlier when the Deputy raised this matter. I will certainly raise all of the concerns expressed with him. I thank the Deputies for their time.