Averil Power (Independent)
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On 22 October last, the Irish Nurses and Midwives Organisation, INMO, called for Beaumont Hospital to go off-call as the accident and emergency department was dangerously overcrowded. By the early evening, there were 41 admitted patients in the accident and emergency department awaiting a hospital bed and numbers were set to rise as the night went on. As the Minister will be aware, the department is also short of nurses and doctors and staff are concerned that it is impossible to provide a safe level of care to patients in these conditions. Almost half of those awaiting a bed on the night to which I refer night were over the age of 75 and many of them had been forced to spend days on trolleys and chairs in frantic, bright and noisy conditions waiting for beds to become available. Waiting on a trolley in such degrading and inhumane conditions is unacceptable for people of any age but it is particularly cruel for frail older individuals in their 70s, 80s and 90s.

Accident and emergency overcrowding also creates an unacceptably stressful working environment for staff and is exacerbating the problem with emigration of nurses and doctors from Ireland to other countries where they can work in better conditions. I appreciate that the problems at Beaumont accident and emergency did not just appear on this Government's watch but they seem to be getting worse. According to the INMO, overcrowding at Beaumont increased by 40% in the first nine months of this year compared with 2014. There is a major concern that the position will deteriorate further and that Beaumont Hospital may well be facing its worst winter ever.

As the Minister will recall, the CEO of the hospital, Mr. Liam Duffy, described Beaumont as unsafe during last year's similar overcrowding crisis. The former clinical director of the hospital, Professor Shane O'Neill, resigned over patient safety concerns. I recently met the CEO, Mr. Duffy, and accident and emergency staff to discuss the accident and emergency crisis, and particularly what can be done to address it. A number of things need to happen. First, we need to reduce the number of people presenting at the accident and emergency department by improving primary care and out-of-hours services. D-Doc was a great service when it started but it is suffering from a lack of resources. I obtained figures from the HSE last year which show that some people classified by D-Doc as urgent had been waiting over 13 hours to see a doctor. The rational course of action in such a circumstance is to go to accident and emergency and yet the service is supposed to prevent those who use it from having to do so. Second, there is an urgent need for more convalescent and nursing home beds in the area. Often Beaumont has up to 100 patients awaiting discharge for whom it cannot secure nursing home or convalescent home beds. Some even have been there for over a year. As the CEO explained to me, the average time in Beaumont is three or four days and in those circumstances - where there are particularly difficult cases and a place cannot be found for someone - 100 others are denied places because 100 patients could go through that bed in the same amount of time. Third, even with these measures, improving out-of-hours services and reducing those presenting to accident and emergency, there will still be a crisis at Beaumont because of the older demographic relating to the area. Beaumont has one of the most elderly populations in the country. Given that the people who live in the area are going to continue to age, there will always be a need for acute accident and emergency medical services at Beaumont far more advanced than those currently provided there.

The accident and emergency department was built for only 35 patients and is often home to 100. Work is ongoing in respect of designs for a new accident and emergency department on the Beaumont campus and the authorities there are in discussions with the HSE about the matter. However, the Government has not yet committed to building that new facility. I raised this matter in order to urge the Minister to ring-fence the necessary funding and give a solid commitment that funding will be available as soon as those plans are finalised to build a new accident and emergency facility at Beaumont Hospital.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Senator Power for raising this issue. I wish to assure the House that reducing emergency department, ED, overcrowding is an objective of the Government and the HSE. I convened the emergency department task force in December 2014 to provide focus and momentum in dealing with the challenges presented by ED overcrowding.Significant progress has been made on the implementation of the ED task force plan. Delayed discharges nationally are reducing steadily from 830 in December 2014 to 570 last Tuesday, and this has freed up more than 200 beds every day for acutely ill patients. In October 2014, Beaumont Hospital had between 80 and 90 patients awaiting discharge home with supports or to a nursing home, and this number decreased to between 55 and 65 in October 2015, freeing up a whole ward for acutely ill patients every day. The waiting time for the fair deal nursing homes subvention scheme has decreased from 11 weeks at the beginning of 2015 to between two and four weeks now. By the end of 2015, more than 1,200 additional home care packages will have been provided as well as 149 additional public nursing home beds, 24 nursing home beds contracted for Moorehall in County Louth and 65 beds in Mount Carmel Community Hospital.

Senator Power is correct in identifying services such as D-Doc and convalescent home places as vital parts of a comprehensive solution to the overcrowding which we see in Beaumont all too often. This integrated approach has led the Director General of the HSE to co-chair the ED task force implementation group until March 2016. This will ensure all parts of the health and social care services work together and optimise resources to deal with the particular challenges associated with the winter months.

The rate of increase in the population of older people living in Ireland is greater in north Dublin than in any other part of the country, including other parts of Dublin. In 1997, only 5% of people in Dublin aged over 65 lived in the areas served by Beaumont Hospital. By 2011, this had increased to 24%. With this older population in mind, additional short-stay convalescent beds have opened this year in St. Vincent's Hospital, Fairview, Clontarf orthopaedic hospital and St. Mary's Hospital in the Phoenix Park. Hospitals on the north side of the city were also prioritised for access to the 65 additional beds opened in Mount Carmel Community Hospital. However, given that most people prefer to remain in their own locality, where it is easier for friends and family to visit, a tender inviting private providers to supply additional short-stay and long-term nursing home beds in the area is also in process. It is hoped that it can be agreed in the coming days or weeks. The HSE will continue to target additional short-stay beds as part of its winter planning process for dealing with pressures on acute hospitals.

The HSE is reviewing GP out-of-hours services throughout the country, including D-Doc, which provides an out-of-hours GP service to the population of north Dublin city and county. This review is expected to conclude shortly and will contain recommendations for changes and improvements to the delivery of service in each area. Funding has been provided to Beaumont to extend its day hospital from two days a week to five days a week as an alternative pathway for admission and assessment for elderly people referred to the hospital by their GPs, thus allowing them to avoid the emergency department.

On the question of a new emergency department at Beaumont Hospital, a design team has been appointed, incorporating architects and health care planners, to undertake a feasibility study on the location, size and cost of building a new emergency department at the hospital. This work is at the stakeholder consultation phase and the report is expected to be available in mid-December 2015. When the hospital board approves a design, the project will be submitted for consideration by the Royal College of Surgeons in Ireland hospital group, of which Beaumont Hospital is part, HSE Estates and the Department of Health.

Averil Power (Independent)
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I thank the Minister for his reply and acknowledge that there has been an increase in short-stay convalescent beds in the area, which is very positive. I also welcome the review of D-Doc and hope it leads to improvements in the service, given that it has great potential to deflect patients from Beaumont accident and emergency. However, as I pointed out, and the Minister acknowledged, the rapid increase in the number of older people in the area is causing particular pressures. While the design is open to discussion, everybody agrees there is a need for a new, far larger accident and emergency department. I am disappointed the Government has not committed to funding it and I will keep pushing for it.

Leo Varadkar (Dublin West, Fine Gael)
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A commitment would be premature given that the hospital's board has yet to approve it. The board must do a feasibility study, cost it and approve it before the Government can make such a commitment. A new emergency department alone will not solve overcrowding. Among the emergency departments throughout the country, new and old, some of the new ones are overcrowded. However, a new emergency department might provide a better service and patient experience, and it may be worth doing on this basis, separate from the overcrowding issue.There is a ward currently closed in Beaumont Hospital. This is creating difficulties at the moment. I think it is St. Damien's kidney ward. It has partially reopened this week and will fully reopen by the end of the month. I hope this will ease the situation. Over many years, the authorities at Beaumont Hospital have consistently explained the hospital's problems by reference to the number of delayed discharges. For example, 90 beds were not available to acute patients because people could not get home care packages or nursing home spaces. There has been a considerable reduction, from 80 or 90 to 50 or 60, in the number of delayed discharges at Beaumont Hospital. That should have made a difference but it has not. In fairness to the hospital, it has acknowledged that and, as a result, is looking at its own practices. It is examining specialty wards and considering changes in the way things and people work to improve patient flow in the hospital. Such measures have been demonstrated to have real effects in other hospitals.