Thursday, 13 October 2016
Accident and Emergency Departments
I thank the Minister of State for being here to discuss this matter.
I am quite sure the Minister of State is aware of the ongoing issue relating to the emergency department in Beaumont Hospital. Over the past number of years, as an active representative and a Member of the Oireachtas, I have visited the accident and emergency department in Beaumont Hospital, I have met staff there and I have met senior management on a number of occasions.
What the senior management have told me in stark terms is that the accident and emergency department is physically not fit for purpose. There are other issues around problems in the department. There are staffing issues and also the fact the demographic around Beaumont Hospital is of a particularly elderly nature. It is not only the physical issue of the department, but that is part of the issue. These are eminent staff who are experts in the field. They know their hospital well and they care for their patients extremely well. Anybody who has visited it will attest to the fact that the physical environment of the accident and emergency department is not up to standard and if the senior management team in the hospital is saying that it is not safe and they cannot stand over it, clearly something has to happen.
We are obviously now in a period where the Exchequer is in a healthier place. The management of the hospital has put together a plan. They have a vision of investment in the accident and emergency department that can bring it up to standard and provide a much better service for the local community and the Dublin and wider region. They have estimated its cost at €45 million. The previous Government, in the guise of the then Minister for Public Expenditure and Reform, Deputy Howlin, and myself, met the senior management. We were in a position to commit to working with the senior management of Beaumont Hospital to deliver this plan, that the investment would happen, and that the accident and emergency department would be reconfigured and reconstructed to be a much better physical fit for the hospital. I have been running a local campaign and constituents who want to see this investment happen have been engaging with it.
Has the Minister for Health and the Department committed to this €45 million plan? Has the Minister met senior management? Is it part of the Estimates process? Is it something that will be delivered in the short to medium term because anybody who has visited the accident and emergency department in Beaumont will realise that the situation there cannot continue? While I did not see anything in the Estimates process and the budget announcements regarding Beaumont Hospital, I was eager to have this discussion today because, before we head into the winter months, it is important for the staff in Beaumont and for the wider community to know that the Government takes this issue seriously and wants to deliver a better service for that hospital.
I thank Senator Ó Ríordáin for raising this important issue. It is appropriate because I have just come from a meeting in Hawkins House. I will deal with the response to the Beaumont Hospital issue later in my contribution.
The year 2016 has been an exceptionally busy year in our acute hospitals. The increase in hospital activity can be seen across the board, particularly in our emergency departments.To date this year, the Health Service Executive, HSE, has reported an average increase of approximately 5% in patient attendance at our accident and emergency departments. This increased demand is being driven in part by demographics and an ageing population profile. In this context, it is worth noting that the 2016 census identified 8% growth since 2011 in the population of Fingal, which is predominantly served by Beaumont Hospital. Being cognisant of the current demands on the Beaumont accident and emergency department and projected population growth in that area, the development of a new accident and emergency department at Beaumont has been identified as a commitment of the Programme for a Partnership Government.
It is noteworthy that the Programme for a Partnership Government also commits to proceeding to the design and planning stage for a dedicated cystic fibrosis unit at Beaumont Hospital for inclusion in the 2017 capital plan review. The HSE cystic fibrosis clinical programme is currently developing a cystic fibrosis model of care that will be important in ensuring that the unit proposed for Beaumont Hospital will meet the needs of patients and the health service. It is my understanding that both of these projects are also a priority for Beaumont Hospital and the Royal College of Surgeons in Ireland hospital group, of which it is a part. As such, Beaumont Hospital is currently in the process of finalising business cases for these new developments. The business cases will then be reviewed by the HSE's capital and property steering group, which approves projects for inclusion in its multi-annual capital plans in line with the Department of Public Expenditure and Reform guidelines. As part of this process, funding provision will be made available for the planning and design phases of these proposed new developments in preparation for the capital plan review in 2017.
I would also like to mention that as part of the recently published winter initiative for 2016 to 2017, Beaumont Hospital will be provided with the resources to open ten additional beds to increase capacity in order to support its accident and emergency department during the crucial winter period to meet the expected surge in volume. Furthermore, under this initiative, funding has also been provided to expand community intervention teams, additional home care packages and transitional care beds in north Dublin that will support Beaumont through the winter months. This measure is part of a much larger package of €40 million of additional funding to the HSE aimed at managing winter pressures on our health system by striking a balance between hospital avoidance measures, supporting patient flow through acute hospitals and increasing the availability of social care services.
I assure the Senator that Beaumont Hospital is very important. I accept the point that we need capital investment in our accident and emergency services and there is an issue with the ageing population in our local communities. The physical environment of the accident and emergency department is not up to standard and that is something that will be pushed along over the next couple of weeks as well.
I thank the Minister of State for his reply. I sometimes get a little worried when people use the phrase "it is my understanding" and I had hoped for something a little stronger. The Minister of State indicated that Beaumont Hospital is currently in the process of finalising business cases for these new developments but it is my understanding that the hospital had completed its business case for the accident and emergency department because it was handed to me almost a year ago. It details the €45 million it feels would be required for it.
He stated the business cases would be reviewed by the HSE capital and property steering group, which approves projects for inclusion in the multi-annual capital plan in line with the Department of Public Expenditure and Reform guidelines. The business case has been finalised, in my opinion, but the Minister of State's reply indicates it will be reviewed by the capital and property steering group, and that as part of the process, funding provision will be made available for the planning and design phases of the proposed new developments in preparation for the capital plan review in 2017.
I was hoping there would be a commitment that the capital plan, as already outlined by the senior management in Beaumont Hospital, of which I have a copy, is being taken seriously and will be delivered. The reply seems to suggest the business plan has not been finalised but it has been. The reply also implies that it will be reviewed. The community in the Minister of State's constituency was hoping for something a little stronger. I totally understand there are other issues, including staffing and demographics that are particular to Beaumont and the wider area. The business case has been produced and I am worried about timelines and the commitment that can be given about the delivery of the physical infrastructure that the hospital says it needs. Currently, it cannot stand over the service it provides, which I am sure the Minister of State will agree is extremely worrying.
I thank Senator Ó Ríordáin for his response and I am always concerned too when I see phrases like "it is my understanding". I assure the Senator and give him a commitment that we will have movement on this particular issue and we will provide timelines. On the business plan, I have discovered in recent days that they needed a more comprehensive business case than what was referred to by the Senator. That was in order to comply with the Department of Public Expenditure and Reform guidelines, as set out in the public spending code. I also requested my adviser to meet the Secretary General of the Department of Health in order to set out a work plan to accelerate this process and they met the same day as the Beaumont Hospital submission was received by the Department of Health. This work plan involves the Department of Health, the HSE and Beaumont Hospital prioritising and clarifying the timeframes for the submission, with appraisal of a fund business case for approval of the project team and establishing a design team appointment.
This work is a priority and as I stated, I raised the matter this morning with the Department of Health at the ministerial and management advisory committee meeting. I have also contacted the chief executive officer of Beaumont Hospital, outlining the next immediate steps that will be taken, that the project is a major priority and it has our full support. I have secured the funding for the planning and design phases in preparation for the capital plan review in 2017. I have also contacted the Minister for Public Expenditure and Reform, Deputy Donohoe, both verbally and in writing, seeking funding priority for this project in 2017. The planning and design figures are in the region of €3.6 million and the capital plan goes past the €20 million mark. I give a commitment that I will not accept any kind of windy statements from any sections. I will demand movement on this because it is a very important local hospital. We have a wonderful staff and we need commitments. I have given a commitment this morning but we also need timelines. We need to get on and do the job.