Paul Donnelly (Dublin West, Sinn Fein)
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I will use this chance to raise the situation of the urgent care centre, that is, the walk-in service at Connolly Hospital and its transition to an appointment-only facility. I know that many parents in Dublin West and the wider community were delighted to hear we had got an urgent care centre in Blanchardstown and a place to which they could drop their child, if the child was ill. There was a huge campaign to try to get the children's hospital into Blanchardstown. This was something to which people looked forward. To be honest, people have been absolutely shocked and dismayed at the ending of the walk-in service. One parent contacted me to ask what an urgent care centre meant to Children's Health Ireland, CHI. What is the definition of an urgent care centre, if it was not the ability to walk in and at least see a triage nurse? No one is expecting to be seen there and then but they are deeply worried about the way it is going, because every parent who contacted me said it was getting next to impossible to get a GP appointment in Dublin West. It is also next to impossible to get an appointment with the other option, D-Doc.

People had the security and knowledge they could drop down to the urgent care centre in Connolly Hospital but, unfortunately, that walk-in service is gone and people have to go online. They have to log in, go through a series of questions which is sort of a self-triage of the child, to determine whether they will get an appointment or if their case will be diverted to Temple Street. We all know that Covid exposed the significant digital divide. Accenture produced a report recently, which said that 39% of people in the lower socioeconomic groups use computers on a daily basis, compared to 61% of those in higher socioeconomic groups.

There is already a wide gap in the provision of healthcare and this will most definitely only contribute to it. There is also a very likely possibility that it will put more pressure on other hospitals, such as Temple Street, which is not too far away from Connolly Hospital, depending on the time. Traffic would determine the length of time one would get in there. It also has the potential to put considerable pressure on to the ambulance service. This needs to be changed. Unfortunately, people were quite dismayed with the Taoiseach. I raised this during questions to the Taoiseach's the other day. The answer was that we should see how it works and if it works, it works and if it does not, it does not. That is not the way we need to be looking at children's services in Connolly Hospital.

This serves a population of well over 350,000 people. It is not just Dublin 15 or Dublin 7. People over in Finglas and in Meath, Louth and Kildare all use the Connolly campus for whatever service they are looking for. A considerable number of people use the campus.

Tallaght children's hospital has a 24-7 emergency department. Not alone have we gone from an urgent care centre - my definition of an urgent care centre was that one goes in there and is treated as urgent - it seems the centre covers much less than people would have assumed and now, because it has gone to appointment only, people will go straight to Temple Street. That will put pressure on Temple Street. It needs to be addressed. I am interested in the Minister of State's reply.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Donnelly for raising this issue and apologise for being a couple of seconds late. I was watching the screen, waiting for the round-up and the next minute, I had to dart across. I am taking this on behalf of the Minister for Health, Deputy Donnelly. CHI at Connolly, which opened in July 2019, is a children's outpatient and urgent care centre staffed by specialist paediatric teams, including nurses, doctors, health and social care professionals and support staff. Urgent care is for the diagnosis and treatment of injuries or illnesses requiring medical review, which are not serious enough to require emergency department attendance or inpatient admission.

In March 2022, CHI expanded the service provision at the urgent care centre by it extending to a full seven-day working model. CHI at Connolly offers children, young people and their families living in Dublin, Kildare, and Meath convenient and quality urgent care close to home.

The change in service occurred because the demand for services in CHI at Connolly urgent care centre has steadily increased since it opened. CHI has advised that the urgent care centre is currently seeing daily attendances far beyond the planned level of service activity. This demand is putting significant pressure on the system, resulting in long waiting times and impacting on patient experience, which is difficult for both families and staff. To address these issues, a three-month pilot of an appointments-only approach was proposed by senior paediatric emergency medicine clinicians and the clinical operations group at CHI. CHI has advised that this approach upholds the original principles of urgent care and intended service activity, while addressing the current demand issue to ensure the quality and safety of service delivery. The change from a walk-in service to a same-day appointment service took effect from 22 February, just over ten days ago.

A digital swift-queue process on the CHI at Connolly website allows families to book an appointment at short notice. The Deputy raised the matter of logging in. There is a digital swift-queue process and options for those who do not have online access. CHI has prepared for a transitional period of three to four weeks during which patients will still attend without an appointment and will be shown how to schedule any further visits. This approach will improve patient experience by reducing on-site waiting times for families. It will also redirect attendances that are more clinically suited to primary care or an emergency department. CHI is monitoring the impact of this change across the CHI sites during the three-month pilot period.

I reiterate that the appointment approach at the urgent care centre at Connolly seeks to address the long waiting times caused by the significant increase in demand, and to support families in attending the most appropriate level of care for their clinical needs. This is in line with the Government's steadfast commitment to ensure children and their families receive the right care in the right place at the right time, in line with Sláintecare. CHI is trying to manage the situation as best it can. It has decided on a pilot process for three months after which it will re-evaluate it. For the first three to four weeks, patients who present without an appointment will still be looked after. A hands-on approach is being taken to see how this will work. We all look forward to seeing the evaluation at the end of the three months.

Paul Donnelly (Dublin West, Sinn Fein)
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While there is obviously demand for services, that is not the reason this decision has been made. When there is demand, that demand needs to be met. One does not change a service to suit the fact that demand cannot be met. That issue has not been addressed. I appreciate CHI will continue the current approach for four weeks but parents will continue to bypass Connolly Hospital and go to Temple Street. I asked what is the upper limit on the number of appointments that can be taken given that there is already massive demand for this service and I am still waiting for an answer.

I appreciate CHI will meet Deputy Cullinane and me next week. We are raising these serious questions, not just about the walk-in service but also about the future of children's services in Dublin. Connolly Hospital is approaching this in the wrong way. If there is demand for services and it cannot be met, it needs to figure out what resources are required to meet the needs of the young children coming to our centre. We must also look at the reason people are going to Connolly and why that demand is there. The reason is that people cannot get a GP appointment or a D-Doc appointment. Their only option is to go to the urgent care centre at Connolly. That service is now going to be appointment only. The fear of parents is that if they cannot get a GP or D-Doc appointment, the time may come when they cannot get an appointment at Connolly. That is the fear people have. Incrementally, over recent years, it has become virtually impossible to get a GP appointment in Dublin 15. This is the consequence of that.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for his contribution and the sentiments he expressed. In 2022, nearly 24,000 children presented at the urgent care centre, 91% of whom were discharged after their visit. As the Deputy knows, the urgent care centre at Connolly Hospital has a significant number of short-stay observation beds, in addition to the contemporary use of ICT to support ambulatory and urgent care and avoid unnecessary admissions.

Since March 2022, the demand for the urgent care centre at Connolly has grown beyond the planned level of service activity. This has resulted in long waiting times and has impacted on patient experience. Following clinical advice, CHI at Connolly is piloting a same-day appointment service over a three-month period. As I said, a digital swift-queue process on the CHI at Connolly website allows families to book an appointment at short notice. This may work. We need to give it a chance to work because the current situation is not favourable for the clinicians or the children and their families. As we all know, there is nothing worse than a young child who is sick having to wait for hours. At least parents will be able to book an appointment and then stay at home until they are ready. This appointment approach will result in less on-site waiting times for families, thereby supporting a better patient experience.

The appointment service will also redirect families, as appropriate, to the level of care most suitable to the patient's clinical needs, which could be a GP or an emergency department. I take on board the Deputy's point that in some cases it is difficult to find a GP and this is the reason families end up attending this service.

A pilot scheme will run for three months and there will be flexibility during the first month. I welcome the fact the Deputy will meet with CHI Ireland this week. We look forward to hearing the results of the audit.

Paul Donnelly (Dublin West, Sinn Fein)
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We will see how it goes in three months.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the Deputy for raising the matter and the Minister of State for being here to deal with it.