Pádraig Mac Lochlainn (Donegal, Sinn Fein)
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Deputy Doherty and I were here last Tuesday, and no notification was given that the Minister for Health would not be present. We asked that the matter be deferred. That is a whole week. We fully expected the Minister to be present. He is aware of the crisis at Letterkenny University Hospital. He knows that 78 GPs have cosigned a letter. He knows that 11 consultants have cosigned a letter. He knows they have asked him to urgently come to County Donegal to meet them. These are front-line health professionals. He has not indicated he is coming to Donegal. He said today that he would come to Donegal in due course. He cannot even come into the Chamber. The utmost disrespect is being shown to the people of Donegal. Here we are, for the second Tuesday in a row and we do not have the Minister. We have no indication whether he will be in Letterkenny any time soon. We will bring our Sinn Féin health spokesperson, Deputy Cullinane, to Letterkenny University Hospital this coming Thursday. He will show the necessary respect. He will meet with the GPs and consultants and listen to their concerns. They are calling for an urgent independent external review, not just of the emergency department operation, but of the entire operation of the hospital, including the chronic underfunding of the hospital and the discrimination against the hospital. Letterkenny University Hospital is the sixth largest in the State. It had 26,000 inpatients last year. This is a major hospital that is chronically underfunded. Whenever there are consultants who have ambition and drive to develop new specialities, they are undermined, held back and curtailed. We salute the stand they have taken. We demand respect from the Minister as soon as possible.

Pearse Doherty (Donegal, Sinn Fein)
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I can only add to what Deputy Mac Lochlainn said. It smacks of arrogance that the Minister, for two weeks in a row, has decided not to come before the Dáil and listen to what Deputy Mac Lochlainn and I have to say. It is not arrogance towards me or the Deputy. It is to the people of Donegal. It is to the people who tomorrow morning will still be in chairs or on trolleys in the accident and emergency department in Letterkenny. It is the people who have received notification over the past while that their treatment is being postponed once again. It is the people who are wondering if they will ever get the appointment they need to see the consultant to deal with an ailment that could have serious impacts on their health. It is those people that the Minister has affronted tonight. As Deputy Mac Lochlainn said, there are serious with Letterkenny University Hospital. We have both been on our feet over the years explaining to Government after Government that there is a serious systemic issue with that hospital. Deputy Mac Lochlainn pointed out, as he has regularly, that Letterkenny University Hospital is one of the busiest in terms of inpatients. It is the sixth busiest in the State, yet in terms of funding we are the 12th. There is discrimination at the heart of this. We have said, time and again, that this hospital is being kept together with elastic bands and the goodwill of the staff but, bit by bit, they are snapping. They are snapping to the point where 78 GPs across the county had to come together and tell the Minister clearly that there are serious issues and there could be service collapse. Some 11 of the consultants have stood out and put their names to the letter and said there are serious issues. Still, as we stand here, unless the Minister of State tells us differently, we still do not know, weeks on, whether the Minister will come to Donegal and listen to those front-line health professionals. We have serious issues. We had a situation last week where no ambulance was available anywhere in the county because they were all parked at Letterkenny University Hospital and could not offload patients. There are serious issues. These issues are not just about inconvenience to people. As the doctors pointed out, when there is a delay in treatment, it causes adverse health effects, including death.

Mary Butler (Waterford, Fianna Fail)
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I assume it is appropriate for me to answer on behalf of the Minister, Deputy Donnelly.

Catherine Connolly (Galway West, Independent)
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We are going ahead with the Topical Issue matter.

Mary Butler (Waterford, Fianna Fail)
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I welcome the opportunity to address the House on this important issue raised by the Deputies. The Government and the Minister are committed to the ongoing development of regional hospitals, such as Letterkenny University Hospital. Letterkenny is a large, busy hospital and the Government has allocated significant resources to meet the needs of patients using the hospital. There were more than 43,000 attendances at the emergency department in Letterkenny in 2022, an increase of 13% compared with 2019. There continues to be a high level of emergency department presentations in 2023, with more than 40,000 attendances between January and September. This represents a 25% increase in overall numbers compared to the same period in 2019 and, more importantly, the attendance figures for patients aged 75 or over is in excess of 6,200, an increase of 1,100 compared to 2019. Following a meeting between the Minister and the HSE CEO last week, it has been agreed that officials from the performance management and improvement unit will travel to Letterkenny this week to visit the hospital.

The improvement of emergency department waiting times is a priority of the Minister and Department, and reform of service delivery across the entire health system is a key part of achieving this. Improvement in patient flow in acute hospitals can be achieved by reducing unnecessary attendances and improving discharge supports. Expansion of community care and other measures to provide people the care they need outside of the emergency department can improve this patient flow and allow our emergency department resources to be better utilised, delivering care to those most urgently in need.

The budget for the hospital has increased from €142 million in 2019 to almost €178 million in 2023, an increase of just under 25%. As of April 2023, 2,144 whole-time equivalents were employed by Letterkenny University Hospital, an increase of over 20% since 2020.

A National Ambulance Service-led service called Pathfinder went live in Letterkenny in April. Pathfinder is designed to safely keep older people who phone 112 or 999 in their own home, rather than taking them to a hospital emergency department. It improves outcomes for older people by providing safe alternative care at home rather than in hospital.

There has been significant investment in services in Letterkenny University Hospital in recent years. Capital projects completed in the past two years include the expansion of gynaecology services; the opening of the acute stroke unit; the provision of an additional endoscopy theatre and a new maternity theatre; and the provision of additional patient beds. There are several capital projects under way which will add additional capacity in services for patients. Projects planned and under way include the expansion of the renal department, the expansion of the oncology day unit and the electrical infrastructure upgrade.

As part of last year’s national winter plan, there was a bespoke site-level plan for Letterkenny University Hospital. While the winter plan officially ended at the end of last winter, many of the plan initiatives continue to be implemented. The Minister asked the HSE to develop a new approach to urgent and emergency care, UEC, planning to reflect the year-round demands on emergency departments, including in Letterkenny University Hospital. The approach to UEC planning is twofold. First, an operational plan for UEC for 2023, which was approved by the Government in July, will be delivered and, second, a three-year multi-annual UEC plan is expected to be submitted to Government later this year.

Pádraig Mac Lochlainn (Donegal, Sinn Fein)
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It is extraordinary there is no commitment in the response from the Minister as to when he will come to Letterkenny University Hospital to meet with the GPs and consultants. There is no acknowledgement that the hospital has been chronically underfunded in that it is a model 3 hospital but had more inpatients in 2022 than five model 4 hospitals. It should be a model 4 hospital. We have talked about the surgical hub that is needed for Letterkenny and Sligo. Given that such hubs have been announced for regions below the infamous line running from Galway across to Dublin, which everybody is aware of, we are being treated as second-class citizens. The Minister's statement does not reflect reality or any sense of urgency.

I appeal to the Minister of State to convey to her colleague that he should have been here tonight in person, that he has shown disrespect to the people of Donegal and that he needs to get up to Donegal urgently.

Pearse Doherty (Donegal, Sinn Fein)
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Speaking on local radio, Highland Radio, last week, one of the consultants at Letterkenny University Hospital stated the hospital has five intensive care beds, which is probably the number we needed about 20 years ago. A report done nearly a decade ago stated we needed over double that, yet that is still the position. The consultant explained what that means. When somebody is in a ward, their health is deteriorating and they need intensive care, they cannot get it in Letterkenny University Hospital. It is not just about inconvenience. People die as a result of not having the proper and adequate resources in our hospitals.

The Minister of State spoke about the solution without even talking to the GPs or consultants because the Minister will not come into the House or go to Donegal to listen to what they have to say. The Minister of State said the performance management and improvement unit will be sent, which is established 24-7 and is supposed to be helping these hospitals in the first instance anyway. This is a permanent unit which is supposed to help Letterkenny, Limerick and other hospitals. What about the nearly 90 beds we need in Letterkenny University Hospital? The Minister announced 1,500 beds three times this year, yet he is not funding these beds in Letterkenny.

Mary Butler (Waterford, Fianna Fail)
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Following a meeting between the Minister and the HSE CEO last week, it has been agreed that the performance management and improvement unit is to travel to Letterkenny University Hospital this week. The Minister has offered to meet with representatives of GPs working in County Donegal in the coming weeks, and he also hopes to visit Donegal in the near future. Saolta has advised that will continue to engage with consultants in Letterkenny University Hospital on an ongoing basis. Saolta management has recently written to GPs in the region and extended an offer to meet and discuss the issues of concern.

Pearse Doherty (Donegal, Sinn Fein)
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God almighty, they want to meet the Minister.

Pádraig Mac Lochlainn (Donegal, Sinn Fein)
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They want to meet the Minister.