Robbie Gallagher (Fianna Fail)
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I welcome the Minister of State, Deputy Jim Daly, to the House. I would like to discuss the ongoing overcrowding in accident and emergency departments and the potential role of smaller hospitals, such as Monaghan Hospital, in alleviating the current problem. To put it mildly, it is very unsatisfactory to see thousands of citizens, most of them elderly, lying on hospital trolleys. We need new, imaginative thinking to address this.

I noted the recent comments of Professor John Hyland, the president of the Royal College of Surgeons of Ireland. He said the normal response when the number on trolleys increases is to cancel elective and non-urgent surgery. This is heartbreaking for those waiting on that surgery because many have been waiting for years. Many are elderly and many are in pain. They build themselves up for the procedure only to be told it will not go ahead. We make the decision to cancel elective surgery lightly but we sometimes fail to think about the consequences of such decisions. Therefore, we need new thinking if we are to address this. It is important that we concentrate on the role that small hospitals, such as that in Monaghan, could play in relieving the pressure in our major hospitals.

Monaghan Hospital had its services stripped. It was one of the first hospitals in the country to receive such treatment. There has been a follow-on in that other hospitals have had their services removed. In the case of Monaghan, however, a sledge-hammer was used in that too many services were stripped from it. People realise that we cannot have major trauma surgery and other serious surgery taking place in a small hospital such as that in Monaghan but statistics indicate that 85% of people who present at accident and emergency departments could easily be treated elsewhere. Therefore, the time has come for new thinking.

I welcome the fact that the Minister of State is new to the job. He brings common sense to the role. It is time that we re-examined the smaller hospitals from which services have been removed. Monaghan Hospital is a prime example.

The current circumstances, whereby people are lying on trolleys for days on end, are very unfair. Yesterday, the number was the second highest ever. We need new thinking, as I stated. What is being done to the people involved, most of whom are elderly, is heartless. It is very unfair on the staff who are completely stressed because of their workload. I would like the Minister of State or the Minister to visit Monaghan to ascertain what services or potential exists within the hospital. There is a feeling that Monaghan Hospital could play a greater role in helping to relieve the current pressure in major hospitals.

Monaghan Hospital currently has a minor injuries unit. Before it was taken off call, it was a brand-new facility. It has considerable potential. We feel that Monaghan could be doing much more, especially at the medical end, to relieve the pressure on the major accident and emergency departments in Cavan and Drogheda.

There is a state-of-the-art theatre in Monaghan. Many thousands of euro were spent on it before it was taken off call. The theatre is totally underutilised. Professor Hyland made the point that when elective surgery is cancelled when the trolley numbers increase, hospitals that do not have accident and emergency departments, such as that in Monaghan, could have a role to play, rather than cancelling surgery. Beds could be ring-fenced so people awaiting non-emergency procedures could be dealt with in hospitals such as Monaghan Hospital. The pressure would be taken off accident and emergency departments as a result.

I would like the Minister of State to visit Monaghan and see the facility for himself. He should determine the potential that exists in order that Monaghan Hospital, along with other smaller hospitals, could play a role in ending the heartbreaking circumstances whereby people, mostly elderly, are lying on trolleys.

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator for his contribution. He speaks a lot of sense. He issued an invitation that I would be delighted to accept. If he sends it to my office, I will be quite happy to ensure it is followed up. I would be very happy to visit Monaghan, as I have done previously in my role, because I have not seen the hospital there.

I agree with the Senator. I am a proponent of what he spoke about. If we always do what we always did, we will always get what we always got. If we are to be serious about bringing about real change and considering how to proceed differently, we need a new approach. As a Minister of State in the Department of Health, I very much welcome the role of public representatives in articulating alternative approaches. The Senator has a good sense of the local issues in his area and of the potential of Monaghan Hospital to make a real contribution to addressing the overarching issue of trolley numbers.

We must never forget that, while trolley numbers dominate many headlines, there are people on the trolleys. They face significant delays in gaining access to treatment. If there is a better way of proceeding, it is incumbent on us, as political leaders, and HSE management to work together through the Department of Health to ensure we explore the options. That is my responsibility as Minister of State. I will assist in this regard to ensure this avenue is explored.

The Cathaoirleach and I are very familiar with similar issues in west Cork. Bantry Hospital makes an enormous contribution to the well-being of people and has greater potential. The Cathaoirleach has for many years fought the battle in this regard. I hope to continue with it. I support the Senator very much and would like to see what is proposed happening.

As the Senator may be aware, Cavan and Monaghan hospitals operate within one hospital group servicing the local population, with the emergency department located in Cavan and the facilities in Monaghan focused on elective care and the streaming of appropriate patients to the minor-injuries clinic. At the end of December 2017, Cavan General Hospital was showing a 3% increase in attendances by patients 75 years or older by comparison with 2016. Furthermore, the admission rate grew by 7.7% in general in this period and by 5.2% for those 75 years or older. Notwithstanding growing demand, Cavan has seen the number of patients on trolleys decrease by 40% in the same period. We must always keep in mind that behind every trolley number, there is a real patient in need of effective, timely and compassionate care from our health service, as I said already.

In 2017 there were over 360 fewer patients waiting on trolleys in Cavan hospital by comparison with 2016. I accept that is still not good enough. While it is a positive indicator, there is certainly farther to travel. I absolutely accept that. There is a tangible improvement but we must continue to try harder. Therefore it is essential that we share the learning and experience of hospitals such as that in Cavan and the RCSI hospital group across the system.

In October 2017, the HSE organised a winter ready conference, which gave all hospital groups and CHOs an opportunity to share best practice and their plans for this winter. I assure the Senator that the Government remains committed to driving this type of improvement in all emergency departments nationally.In October 2017 the HSE organised a winter ready conference which gave all hospital groups and community healthcare organisations, CHOs, an opportunity to share best practice and their plans for the winter. The Government remains committed to driving this improvement in all emergency departments nationally.

Robbie Gallagher (Fianna Fail)
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I thank the Minister of State for his response and welcome his commitment to visit Monaghan. I will contact his office to arrange the visit as soon as possible. He has said we cannot keep doing the same things and expect different results. I am heartened by the fact that he is a doer rather than a sayer because this problem requires new thinking and somebody to lead the HSE away from its current way of thinking. It was a mistake at the time to strip Monaghan General Hospital of all services because it has a genuine role to play and I would not be wasting the Minister of State's time if I thought otherwise. I would like him to visit with an open mind and look at the facilities available, including the state-of-the-art operating theatre and the minor injuries unit, to get an idea of the hospital's potential. Such a visit would be worthwhile and lead someone like the Minister of State to drive the HSE to change and look at things afresh. It must look again at smaller hospitals such as Monaghan General Hospital and the positive role they could play in helping to reduce the heartache associated with hospital waiting lists and patients on trolleys.

Denis O'Donovan (Fianna Fail)
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Monaghan General Hospital is a little like the hospital in Bantry. It is a chestnut that has been around for a long time, but it is still functioning. I thank the Senator and the Minister for State. I am sure the Minister of State will honour his commitment to visit the hospital and that his visit will have a positive outcome for the people of County Monaghan. It is not too long since a Member was elected to this House on the back of a campaign related to the hospital. This is an important issue in the county.