Marian Harkin (Sligo-Leitrim, Independent)
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Do we get extra time here or do we just keep going?

Just over six months ago 50 consultants from Sligo University Hospital, wrote to the Minister for Health to highlight the severe pressure being experienced at Sligo University Hospital. Just one sentence from that letter basically says it all. It sates, "We have never seen the demand on our services so high nor the morale of our staff so low." According to the consultants there, Sligo University Hospital routinely has hospital bed occupancy over 110% often with 30, 40 or 50 admitted patients without a bed. They say this is an everyday occurrence. For the record, today there are 45 patients on trolleys at Sligo University Hospital and that is in the middle of May. It is the third highest in the country.

Sligo University Hospital is almost always in the top five - or the worst whichever way we want to look at it - when it comes to numbers on trolleys and today it is in the top three. Unfortunately, the critical situation at Sligo University Hospital is simply a microcosm of what is happening in the entire Saolta region comprising Donegal, Sligo, Leitrim, Roscommon, Mayo and Galway. The Irish Hospital Consultants Association has issued a statement this week which follows a similar statement last year, except this year the statement is worse. This time we have a statement from a national organisation not just from the consultants at Sligo University Hospital. They have said that patient health in the west and north west is at risk due to excessive delays to care. They are singling out that region, the Saolta region, and this is what they are saying.

They quote a raft of statistics to make their argument and some of those statistics are really frightening. They look at the overall picture concerning waiting lists, trolley numbers and new hospital beds or the lack thereof. I just want to quote a few of them to put them on the record. They say public hospitals in the Saolta Region Health Care Group have unmanageable waiting lists with more than 131,000 people waiting for care. Waiting lists for outpatient appointments, inpatient, day-case treatments and procedures in the region have increased by 3% since the start of the year and by 42% since 2015.

The Government's €443 million waiting list action plan has set a target to reduce by 10% waiting lists for appointments for outpatient, inpatient and day-case treatments and procedures this year. However, what has happened in the Saolta area? They have increased by 3%. This is happening because we do not have the beds and because appointments and operations are routinely cancelled. I am fed up coming in here speaking about Sligo University Hospital. We now see there is a wider picture in the whole region. Unless significant investment is put into the Saolta region both in terms of beds and employment of consultants, we will have these statements from the Irish Hospital Consultants Association and they are getting worse year on year.

Peter Burke (Longford-Westmeath, Fine Gael)
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I welcome the opportunity to address the House on this extremely important issue. The Minister for Health sends his apologies. I and the Government acknowledge that waiting times for many hospital procedures and appointments are unacceptably long and we are acutely aware of the great distress this causes patients and their families. Our waiting lists were far too long before the pandemic but have worsened as a direct result of Covid-19. The Government has adopted a twin track approach of investment and reform to deal with the issue.

On 7 March, the Minister for Health published the 2023 waiting list action plan which is the next stage of a new multi-annual approach to sustainably reduce and reform hospital waiting lists. For 2023, funding totalling €443 million is being allocated to tackle waiting lists with €363 million of this being allocated to the 2023 waiting list action plan, to implement longer term reforms and provide additional public and private activity to clear backlogs exacerbated during the pandemic. The remaining €80 million of the €443 million is being targeted at various measures to alleviate community and primary care waiting lists.

Through this plan, we are fast-tracking the development of new elective surgical hubs in Cork, Dublin, Galway, Limerick and Waterford. Based on the successful Reeves Centre at Tallaght University Hospital, these will have a short-term impact on waiting times. For longer term investment, last December the Government approved the preliminary business cases, and preferred sites for elective hospitals in Cork and Galway. The HSE expects to be able to submit business cases with a recommendation to Government to go to tender by the final quarter of this year.

The Saolta University Health Care Group’s six hospitals serve a significant portion of the population, covering more than 830,000 people. The Government’s commitment to the group can be seen in the increase in the combined budget of the hospitals and group to €999 million in 2022, up €194 million since 2018. Budgets 2021 and 2022 in particular have provided significant amounts of funding for a large-scale permanent expansion of the health service workforce and investment in capital projects. For example, staffing in Sligo University Hospital at the end of December 2022 was at 1,907 whole-time equivalents, an increase of 70 from the end of 2021. For Letterkenny University Hospital, Saolta has advised staff numbers have increased by 323.94 whole-time equivalents from 1,768.68 to 2,092.62 whole-time equivalents by the end of 2022. For Galway University Hospitals, comprising both the Merlin Park and University Hospital Galway campuses, by end of February 2023, there were 4,286 whole-time equivalents, an increase of 13% since December 2020. In the past five years to March 2023 overall consultant numbers have increased by 104.

Resources have been also allocated to provide increases in bed capacity, with Saolta reporting 11 beds opened in Sligo University Hospital since 2020, 32 beds opened in University Hospital Galway and 28 beds opened in Letterkenny. A range of strategically important capital projects are in train across the region. Some projects have been recently delivered, such as the €56 million radiation oncology facility at Galway, and treatment of patients commenced on 19 April 2023.

Other major developments are at various earlier stages in the capital process, with projects to deliver extra capacity and services advancing at a number of hospitals. For example, a new 50-bed ward at Portiuncula University Hospital is currently under construction. These investments show the commitment of the Department and HSE in improving service delivery and meeting the needs of patients and the population in the west and north west region.

Marian Harkin (Sligo-Leitrim, Independent)
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The Minister of State quoted many figures. One was the €443 million to cut waiting lists by 10%, yet since the beginning of the year, as I said a few minutes ago, waiting lists have increased by 3% in the Saolta region. Some 3,400 people have been added to the main hospital waiting lists in the region since the start of the year because the shortage of beds is so severe that severely ill patients are admitted and essential surgical and other care has to be cancelled. The Irish Hospital Consultants Association is not just speaking about an overall picture. It is saying, quite clearly, that patient care and patient health in the west and the north west is at risk due to these excessive delays to care. It is worse in the Saolta region than it is anywhere else. The Minister of State quoted statistics about beds. I can only quote what is in front of me from the Irish Hospital Consultants Association. It says just 69 additional inpatient beds have been opened over the past three years at all hospitals in the Saolta group and that amounts to 7% of the national total. We have 16% of the population. According to the IHCA, we are not even getting half the number of beds that we should be getting.

When I raised this issue with the Minister last November, I specifically raised Sligo University Hospital. He talked about looking at progressing the emergency department modular unit, the ICU isolation rooms and the 42-bed ward block extension. Where is this work now? It was at a very early stage last November. Unless we see immediate progress here, we will keep getting these statements from the IHCA. In truth, people in the west and north west are getting worse care than anywhere else in the country. It is simple as that. That is what they are telling us. It is not me saying it. I am just relaying their words.

Peter Burke (Longford-Westmeath, Fine Gael)
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I thank the Deputy for raising this issue. As has been acknowledged, many patients wait for an unacceptably long period. While significant work continues to positively impact waiting times and improve pathways to elective care, acute hospitals are still impacted by operational challenges arising from the pandemic. For the Saolta group, geography is a major challenge, as the population is dispersed and mostly rural, with approximately one sixth of the national population spread across one third of the land area of the State.

To address these issues, in addition to the waiting list action plan funding, significant increases in budgets have been allocated to hospitals in the group, including an increase in Sligo University Hospital's budget from €145 million in 2019 to €175 million in 2023. Galway has seen its budget in the same period increase by more than €70 million, to €441.7 million, and Letterkenny has risen from €142.7 million to €177.8 million in 2023. The Government recognises the importance of investment and is committed, with the HSE, the hospital group and individual hospitals, to ongoing investment in the strategic development of services in a challenging and geographically dispersed area. Through investment and reform, this Government is working to sustainably reform hospital waiting lists and to reduce times and waiting times, which will deliver improved access to care for patients throughout the north, north west, and the whole State.