Pádraig Mac Lochlainn (Sinn Fein)
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I have just become aware of this case in recent days in Letterkenny University Hospital. I could give so many more but this example particularly captures the crisis we have at the hospital in so many respects. A 92-year-old man with pneumonia and an underlying heart condition is gravely ill but for 22 hours he did not have a hospital bed. There are so many examples and not a day goes by that in Donegal we do not speak with families and loved ones about usually elderly parents, aunts or uncles being stuck in this position. It is an absolute scandal and the Government is well aware of this.

Last year there were almost 5,000 people on trolleys at Letterkenny University Hospital, which means almost 5,000 human beings were denied dignity and the service to which they are entitled. That is twice the number from 2016, so the crisis doubled in scale. These are the highest numbers since the records of the Irish Nurses and Midwives Organisation, INMO, began. There was an appeal from the Letterkenny hospital management to re-open the 19-bed short stay ward and approximately €1.8 million was applied for. The Department was told about the crisis we are facing and why these beds needed to be re-opened but there has been absolute silence from the Government.

The issues at the Letterkenny hospital are much bigger. Deputy Pearse Doherty and I submitted a report last year on the need to invest in Letterkenny hospital, documenting years of historic funding discrimination.Letterkenny University Hospital is the sixth largest hospital in the State. The way it has been treated is wrong. The same applies to the treatment meted out to doctors and nurses who are always praised by the public, and I mean the people who managed to get into the hospital. The difficulty is that everyone concerned is being failed and has been let down by the Government. I hope to hear today from the Minister of State that he will sanction funding amounting to €1.8 million so that the 19 beds can re-open thus ending the trolley crisis at the hospital.

The problem in Donegal at Letterkenny University Hospital has been made worse by the fact that one in four beds in the community hospitals located across the county were closed during the period when the Minister of State's party was in government. As many as one in four beds in community hospitals have been closed and one in three nurses let go. Therefore, we have a community hospital primary care infrastructure that has been starved of resources. That situation has a knock-on effect on the hospital, which is also starved of resources. The very least the Minister of State can do, as a gesture of goodwill, is give them the resources they need to re-open the short-stay ward that has 19 beds. I urge him to deal with the current crisis and then he can address the wider issue of funding neglect.

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator for raising this issue.

First, I wish to acknowledge the distress for patients and their families, and the impact on staff, caused by overcrowded conditions in some of our hospital emergency departments, including the one in Letterkenny.

Tackling overcrowding in emergency departments is a key commitment of this Government. As part of budget 2018, an extra €30 million was made available to respond to winter pressures in 2017, with a further €40 million being provided in 2018. As part of these measures, nearly 150 additional beds have been opened this winter in Beaumont Hospital, St. James's Hospital, Naas General Hospital, St. Luke's General Hospital in Kilkenny, Our Lady of Lourdes Hospital in Drogheda, and in Limerick and Galway. Further beds will open throughout 2018, including at Our Lady of Lourdes Hospital, Drogheda, which will see new emergency department and ward capacity come onstream in 2018.

Part of this funding will also be focused on supporting older people to remain in their own homes by providing additional home care packages and additional transitional care beds per week over the winter period. These measures have already been rolled out to targeted hospitals nationally thus helping to alleviate some of the pressure our hospitals are currently experiencing.

In terms of the specific query raised concerning Letterkenny University Hospital, I am aware that a proposal for additional beds in Letterkenny was submitted as part of the winter plan for 2017-18. I have been informed by my officials that these additional beds have not been funded under the winter plan for 2017-18. However, my Department is undertaking a health system capacity review, in line with the Programme for a Partnership Government commitment, the findings of which are due to be published early this year. The review will provide an evidence base for future capacity decisions.

It is important to note that the public hospital system has seen a growing demand for care, and Letterkenny follows this trend. Emergency department attendances at Letterkenny were up by over 1% at the end of 2017, including an almost 5% increase in emergency department attendances by people over 75 years, when compared with 2016. Notwithstanding the pressure on the emergency department at the Letterkenny hospital, it is worth noting that patient experience times in Letterkenny are above the national average. That means patients complete their episode of care more quickly in the emergency department in Letterkenny, which goes back to the point raised by the Senator about the staff, doctors and nurses who work in the hospital.

I shall conclude by noting the commitment given by this Government to develop and improve services at Letterkenny University Hospital, as evidenced by the significant level of investment in capital projects in recent years. These developments include multiple remedial works following flooding in 2013, a new state-of-the-art blood science laboratory in 2015, a new medical academy and a clinical skills laboratory opened last year.

In addition, the HSE has advised that several important staffing posts are currently being progressed, including for a second consultant endocrinologist and advanced nurse practitioners.

Paul Coghlan (Fine Gael)
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I thank the Minister of State for his reply. Senator Mac Lochlainn can make a brief supplementary comment.

Pádraig Mac Lochlainn (Sinn Fein)
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The Minister of State's response is quite extraordinary. He acknowledged that an application for funding amounting to €1.8 million was received to re-open the 19 beds. The provision would take some of the pressures off the nurses and doctors who must work in impossible conditions every single day they work in the emergency ward. He has acknowledged the application has been received but the scheme will not be funded. He also mentioned that an evidence-based health system capacity review is under way.What more evidence does the Department of Health need? The numbers have doubled since 2016.

When the Fine Gael Party entered office in 2011, there were hundreds of people on trolleys in hospitals in County Donegal. Most of those on trolleys at the time were elderly people who had worked and paid taxes all their lives and who expected to be treated with dignity when they got older. Now, the numbers on trolleys in hospitals in County Donegal runs to thousands. In 2017, almost 5,000 citizens ended up on trolleys in Letterkenny University Hospital. How can this evidence not be more clear in terms of the need to invest in more beds in that hospital? It is an absolute sin that a ward of 19 beds is lying empty when it could be put into service and we could solve this current crisis at the hospital. The Government refuses to invest €1.8 million in that hospital. The Minister of State's response is unacceptable. I appreciate that he is taking guidance from hospital management in Letterkenny, but it is an insult to the intelligence of the people of County Donegal to talk about 5,000 people on trolleys, some of whom were processed more quickly in Donegal than in other hospitals. The Minister of State knows that is not an acceptable response. I consider him to be a decent human being. The response he delivered is indecent and intolerable. I appeal to the Minister of State to deal immediately with this matter so that the funding sought to reopen the short-stay ward and bring the 19 beds into operation will be forthcoming. That will take the pressure off the heroic nurses and doctors who are dealing with this crisis. Then we should address the wider issue of Letterkenny hospital later this year.

Jim Daly (Cork South West, Fine Gael)
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I thank Senator Mac Lochlainn. I appreciate his frustration. I also appreciate his role as a public representative; he is doing a very fine job. He has brought this issue to the notice of the Seanad with passion and conviction. I agree with him and I support him on the principle of opening transitional care beds. That is the way to deal with the issue in the future and that is the way to take the pressure off emergency departments. We need to invest more in that area.

Last year, an additional €30 million was invested in transitional beds. However, this was not sufficient to open additional beds in all the locations in which we wanted to open them. The HSE must work to strict criteria in deciding where to open these beds. For a variety of reasons, it is not always possible to open beds. In my constituency, there are 25 empty beds that are not in operation due to union issues and objections. There are a number of considerations involved - I am not suggesting that this is an issue with Letterkenny - but there are myriad reasons why beds can and cannot be opened at a given time and why beds were opened in some places and not in others. The budget was €30 million in 2017 and an allocation of an additional €40 million was made in the 2018 budget to deal with the winter overcrowding in this coming year. I cannot give the Senator any commitment because, as he knows, this is an operational matter for the HSE. However, I can guarantee that the position of Letterkenny University Hospital will be looked at very seriously again. As resource allow and as other matters fall into line, I hope we can open additional step-down care beds in Letterkenny. That is the practical solution to the problem.

Paul Coghlan (Fine Gael)
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I thank the Minister of State and the Senator