Marian Harkin (Sligo-Leitrim, Independent)
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I apologise to the Minister of State; I am recovering from laryngitis but I really wanted to raise this issue. It is a crucial issue concerning how a 17-year-old, a young person who is a child under Irish law, was treated at an emergency department at the weekend. I received a message from a constituent at the weekend outlining how this young person cut the top off his finger. He was brought to NoWDOC in Carrick-on-Shannon, but it was closed and his sibling drove him to Sligo hospital. He was bandaged there and told to go to Galway. They drove to Galway, which at this point was 145 km away, and arrived there at about 9 p.m. that night. When he arrived in Galway, he had the other part of his finger with him on ice and in a plastic bag. He was told that there was no one to see him at the hospital. He was in excruciating pain and was told he could either go home and come back the next morning at 7 a.m. or that he could get bed and breakfast accommodation as no trolleys were available.

The family had to drive back to Carrick-on-Shannon. His dad said they were on their way home none the wiser, with the lad with half a finger home with him and the other half left in a fridge in Galway hospital. It was 115 km back to Carrick-on-Shannon, another 115 km back to Galway in the morning, and then another 115 km back that afternoon. It was almost 500 km in total. Apart from the fact that nobody should be turned away from hospital, a child was turned away. I do not know what the Minister of State thinks but I think this is completely and totally unacceptable. I hope this will be dealt with by the Minister for Health. It is a pity he is not here tonight but I am glad the Minister of State is present.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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What age was the child?

Michael Fitzmaurice (Roscommon-Galway, Independent)
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I thank the Minister of State for coming in. It is a pity the Minister for Health is not present. I think an inquiry needs to be held into this. The child is 17 years of age. He had an accident. NoWDOC is in chaos in Carrick-on-Shannon. This child went to Sligo hospital but it does not have the facilities to deal with his situation. We are supposed to have so-called centres of excellence that include Galway hospital. The Minister of State's buddy, the Minister, Deputy Eamon Ryan, does not want to see a new road built, when we talk about the need for it, between Sligo and Galway, which would cover Collooney and all that area. It is being blocked at the moment. That youngster went into the hospital in Galway with his parents. The exact words they were told was that the hospital would put the part of the finger that was cut off in the fridge. They were given tablets or whatever to try to kill the pain. The words that were used were: "Get a B&B and come in in the morning at 7 a.m. and we will try to do something."

It is disgraceful that in what we call a centre of excellence a youngster of that age is treated in that way. Whatever the hope was of saving the finger, there was no hope when they had to head home again, leave part of the finger in the fridge, come back in the morning, and then wonder if it would be sewn together. The game is over at that stage. I am not a doctor but I know that much. We talk about health services improving. It is unbelievable that for emergency surgical cases that come in, where quick movement is needed, that all this family was told in Galway hospital was that the finger would be put in a fridge and they should get bed and breakfast accommodation. You would swear that family was raking money in. Following all their trauma, they headed home and had to come back the next morning. Unfortunately, my understanding is that the finger was not saved. That child has to live life. If he were to do a trade or something, it will unfortunately probably be a hindrance to him. At least if you made an honest rattle at it, or tried to solve it, everything would be done, but nothing was done. It is a disgrace.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I suspect if that child was taken to a bush hospital, he might have got better care than what the Deputies described.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Not necessarily, a Cheann Comhairle. Emergency surgical services are an issue everywhere. I understand this involves a 17-year-old child. I have a response for the Deputies around the provision of emergency surgical services. However, I will say I have an 18-month-old child who required emergency orthopaedic surgery. We turned up at Crumlin hospital, which is a paediatric centre of excellence, on at Saturday night at 11 p.m. The registrar and surgeons do not come in until 7 a.m. the following morning.

I am not saying it is a solution but I managed to get emergency surgery at 10 o'clock on a Sunday morning. A lot of it is a matter of the rostering of registrars and consultants who can identify and prepare for surgery at whatever time of the day or night.

The Deputies also raise a really important question of the costs of children in hospital. As they have said, they were to go and stay in a bed and breakfast or take two round trips as it will turn out by the time they get back. The cost of petrol is really very significant. It is something I have tried to highlight again and again. I do not mean to sound trite but when people are in a children's hospital, the last thing they are thinking about is costs. Costs, however, are extremely important. The additional needs payment is available to people - I have confirmed that through the Minister, Deputy Humphreys - to be able to recoup some of those very difficult costs, such as bed and breakfast costs, very significant petrol costs, or other childcare costs. Indeed, the family may have had other children who may have been younger. They would have had to leave not once, but twice late at night and they would have had to make sure they got the care that was necessary. I really am very sorry to hear that the matter was not resolved and that the finger was not saved.

The majority of emergency surgical services provided in the area referred to by the Deputies fall under the Saolta University Health Care Group, which serves a population of 830,000 and provides acute and specialist hospital services to the west and north west, including Galway, Mayo, Sligo, Donegal, Roscommon, Leitrim and parts of adjoining counties.

Geography is a major challenge for the group because the population is dispersed and rural, with approximately one sixth of the national population being spread across one third of the land area of the State. The combined budget for the hospitals under the remit has risen from €795 million in 2018 to more than €1 billion in 2023, an increase of more than 35%. Key hospitals in the region providing 24-7 emergency medicine services include Sligo, Galway and Letterkenny. Sligo University Hospital, which is a model 3 hospital, delivers a wide range of local and regional services on an inpatient, day case and outpatient basis, including certain specialities, acute medicine and acute surgery, as well as a number of regional specialities provided on an outreach basis to Letterkenny University Hospital.

In 2023, the budget allocation for the hospital was €175 million, which was up from €130 million in 2018. Between the end of 2020 and December 2022, staff had increased more than 13.6%. Galway University Hospital is a large, busy hospital. As the Deputies will be aware, this Government has allocated significant additional resources to the hospital to meet the needs of the patients. Its staff has increased by 13% since 2020 and the hospital’s budget has increased from €338 million in 2018 to €441.7 million in 2023. Similarly, Letterkenny Hospital’s budget has increased from €131 million in 2018 to €178 million in 2023. Its staff has increased by 18% since 2020.

However, access to high-quality services, including emergency surgical services, is a necessary priority for the Government, as is providing these services as close to home as possible, particularly late at night when emergencies actually happen, as appropriate and in line with Sláintecare. The investment underlines the Government’s commitment to improving services for the people across the north west.

Marian Harkin (Sligo-Leitrim, Independent)
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I thank the Minister of State for not just reading what was before her. She gave us lots of statistics but none of them mattered to a child who presented at Galway University Hospital. Anybody under the age of 18 under Irish law and the UN Convention on the Rights of the Child is a child and should not be turned away. I can understand that perhaps with rosters that there may have been a difficulty. It is not acceptable but I can understand it. Yet, to tell people to get a bed and breakfast or go home and do a 230 km round trip is simply not acceptable. Trying to get a bed and breakfast booking in Galway during the summer is difficult, never mind the cost of it. My question is this: Galway University Hospital is a level 4 hospital. Is it an acceptable that a child can be sent back, turned away and told that there are no trolleys, no room at the inn and to go home or get a bed and breakfast?

Michael Fitzmaurice (Roscommon-Galway, Independent)
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A total of €22 billion is being spent on health in this country. It is ironic that the Minister of State says that a sixth of the population is in that area, which covers one third of the country. It is a big area and we should try to bring the services as close as we can. These people were prepared to travel. There is no question of that.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Yes, I know. I was not saying there was.

Michael Fitzmaurice (Roscommon-Galway, Independent)
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These people were prepared to travel 115 km each way. Yet, we did not have a service in the whole of the west of Ireland. We did not have it in Letterkenny, Sligo, Castlebar, Roscommon or Galway, which was to be the centre of excellence. It is a damning indictment of our country - and I come from the agricultural sector - that if that night I had an animal that lost part of its foot or was sick in any way, I would have had a vet at my house in 15 minutes. Yet, when it comes to a human being, we are not able to stitch on a part of a finger. That says it all about the state of our country at the moment.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The question of timing is very important, particularly the time patients arrive at a hospital. They can end up with a very long wait until 7 or 7:30 the following morning when the surgical teams come back in. Therefore, if they turn up at 11 p.m., and I have personally experienced this they can either stay until 7 a.m., or they can go home and come back.

In my case, I was in Crumlin, the services were not available. Whether people are in the north west or in Crumlin, they will have the same experience from a paediatric care perspective. The surgical services are available from 7 a.m. If we take out the question of going home and coming back, the services are available from 7 a.m. The only way to remedy that is a different contracting model for consultants and registrars to provide surgical services overnight. On the question of emergency surgery, timeliness really is very important. I do not know what time it was possible to come back to the hospital to avail of that surgery.

The overall question is the availability of surgical services overnight, whether that is in Dublin, Crumlin, the west or the north west. Emergency surgical services are really a matter for the consultant contract. I hope that will improve in the very significant extension of hours that will follow from the consultants’ contracts. I hope that will be of benefit to people who are looking for emergency surgical procedures, because I am not sure that there is a geographic issue here. As I said, I have a very direct personal experience of this in Crumlin hospital and there would not have been any different outcome in terms of timing whether I had been Crumlin or the north west. Whether people stay at home or come back, the service is not available because staff will not be there until 7 a.m. or 7.30 a.m. I am not saying that is good enough, but I am saying that the extension of the contracting hours to up to 80 hours per week over six days should, as I understand it, provide significantly extended hours of operation for the surgical services. That really seems to be what is at issue here.