Seán Kyne (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister, Deputy Donnelly, to the House. I do not have the passion of Senator Cassells on the matter this morning. While one person on a trolley is one too many, things have not been as bad in Galway this year as they were in previous years. There is a reason for this. The temporary emergency department in Galway opened in the autumn and it has improved the situation. It has also allowed the old emergency department to be used and for ten beds to be placed there. These ten beds were not available in the winter of 2021-22. They have been available in 2022-23. Will these beds be available for the winter of 2023-24 or will the site be given over to the builders to clear it, decant and do all that is necessary for the planning for the new emergency department?

This goes show that, as I have said, although there were still too many people on trolleys, the situation was better with the provision of a small number of beds, in this case ten beds. This is important because for a long time Galway suffered with the highest number of people on trolleys. In the winter plan for 2021-22 no additional acute beds were provided in Galway. This year there were, slightly by accident. The question is whether they will be available for winter 2022-23. This is an important point.

It would be remiss of me not to mention someone who is close to somebody on my team who has had a very positive experience of the system in Galway in recent weeks and is still doing so. It is a credit to the staff and management of the hospital. On the other hand I also know of an individual whose mother spent 24 hours on a chair in Beaumont Hospital. Those of us from the west always think everything is fine in Dublin but it is not always so. She eventually got a bed in a ward and that is welcome but to be on a chair for 24 hours in this day and age is not good enough. Her husband was with her. Thankfully she got a cup of tea but he did not even get the offer of one when they passed by with the trolley. Small things such as this can make a difference. In this day and age in a capital city there should not be people on a chair for 24 hours. I wonder whether these patients are being mentioned in the trolley numbers of the INMO or the HSE? Is it just trolleys? There were a number of people on chairs in Beaumont Hospital in recent days. It is not acceptable in a capital city, just as it would not be acceptable in any hospital or emergency department in the west of Ireland.

Regarding longer term plans for Galway, pardon the pun but there is an acute need for acute beds. There is an absolute necessity for additional beds in Galway. There have been numerous plans for a long time. For the first time since I came into the Houses there is a vision in the Saolta hospital group for exactly what is needed in Galway. This was not always there. It was at sixes and sevens with debates about sites, appropriate assessment and the best place to build this or that. At least there are now plans for a cancer care centre on the University Hospital Galway site, new emergency, paediatrics and maternity departments in Galway, new replacement laboratories in Galway and an elective hospital in Merlin Park. We have to progress these. We have to pick the project, for example, the emergency, maternity and paediatric departments, that is furthest advanced, prioritise it, push it and get it delivered.

It is a long time since there was talk that planning would be lodged before Christmas 2018. Planning has still not been lodged. The project has changed somewhat but I still do not understand the delays. I understand the strategic assessment report has been with the Department since last June or July and still has not progressed. These are the delays that frustrate people and that we need to push on and find a solution. I ask the Minister to engage again in the Department on the strategic assessment report and get the emergency department, maternity and paediatric project moving to the next stage.

Eugene Murphy (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Tá sé go hiontach an tAire a fheiceáil anseo sa Teach inniu. Is fear an-ghnóthach é agus gabhaim buíochas leis as a bheith anseo. I welcome the fact the Minister has been to the House on four or five occasions. I also welcome the fact that the Ministers of State at the Department come to the House. In the past there was a very poor record, particularly of Ministers coming to the House. The Minister is doing better than many did in the past and it should be acknowledged. I also want to say about the Minister's statement today, and I have said this previously, that I always acknowledge his honesty on situations and the challenges we face. There is no point in any Minister of whatever Department not acknowledging that we have difficulties.

I support Senator Kyne's concerns about Galway. I know that because of the Minister's intervention things are moving. I hope they can move swiftly, particularly with regard to cancer care. I want to go back briefly to the closure of the accident and emergency department in Roscommon. We do not want to go back over old ground but a former Taoiseach, a former Minister for Health and a former Minister of State from the constituency, Mr. Finneran, secured that accident and emergency department with very good backup. Unfortunately, another Government came in, the HSE announced it would close it and it was closed. I want to put this on the record because sometimes it is not recognised that we had given a guarantee with regard to the accident and emergency department and it was in place. It was unceremoniously closed just like that. We all remember the episode and Deputy Naughten resigning from the party.

Coming in here to criticise everything is not the way to go either. We all know about the waiting lists and the challenges but what is being invested gives me hope. I do not fully agree with Senator Keogan but she makes some good points. I would say money is being well invested now. We have an extra 17,000 staff. I understand that almost 5,000 of these are nurses and midwives. We have 1,000 new beds. The Minister might clarify today, if he can, the cost of putting in place a hospital bed. Many people think it is a couple of hundred euro. The public might be shocked if they knew the real figure for putting in place a hospital bed. By the way, we need more beds. The Minister has acknowledged that he is trying desperately to get more beds into the system. We also have 600 new community beds. This is all progress. There are also increased diagnostics and improvements in women's health. It would be wrong to say that we have a health system in collapse but I fully acknowledge the anger of people throughout the country. I fully acknowledge the battle people have and they have gone on the streets to protest in a decent and fair way about it.

I fully support Senator Cassells and the people of Navan. They should not give in to the closing of that hospital. Otherwise they will end up like Roscommon. It does not make sense. We have to realise that for some people who do not have a medical card, hospital charges are a big issue. I welcome the progress the Minister has made on this and the statement he made on it this week. It is moving in the right direction. I acknowledge that all of these things cost more money. One of the problems with the health system, and the Minister is not to blame for it because he was not there at the time, is that we do not seem to have allowed for the increase in population in our country in terms of proper accident and emergency departments and more accident and emergency departments and beds in the system.

We also have a ferocious problem in the country with getting staff to fill vacancies. In the area of mental health area, we had the report on CAMHS this week that was quite disturbing. We have never had more money put into this system but in many areas we cannot get the required staff. I spoke about CAMHS earlier as well and the great difficulty in getting staff into this system. I restate what I said earlier. I think we should undertake an all-out appeal or campaign to look at Irish people working in the NHS in the UK. I suggest this because I have had this aspect brought to my attention on numerous occasions. I refer to Irish people working in the NHS who have sought to be employed in HSE and who have claimed to me that they do not always get a fair crack of the whip. We should have an all-out campaign to encourage people to come back. By the way, these people will not have an issue with housing or living in a certain area. This is a fact and I can give it to the House. I suggest that this is something we could look at, and perhaps we could have a real campaign in this area in order to try to get some of those staff that we desperately need. I thank the Minister for coming to the House and I thank the Cathaoirleach for listening to me for the past several minutes.

Maria Byrne (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for coming in today to discuss this all-important issue. It will not be the first time he has heard from me regarding hospital waiting lists, and specifically those in UHL. I acknowledge the staff of the hospital and the patients and families who have gone there to access services. It is certainly a fine hospital. I also acknowledge that between 2020 and 2022, the Government invested in the region of €95 million in the UHL Hospitals Group. This must certainly be acknowledged. The fact that so much has been invested and yet we have a broken system in some areas in the hospital shows this is maybe not all about money and investment. We must examine this matter.

We all want a hospital that is safe and secure for the patients accessing it and the staff working there daily. I acknowledge that staff have been working in very difficult situations over several years. There has been much investment, but seeing 11,000 people protesting on the streets of Limerick city last week means this is a situation that must be looked at. I acknowledge the fact that changes have been made in the hospital since 3 January 2023, when an incident was called on that day. I refer as well to the changes made in Ennis hospital and to the better use of other hospitals in the region.

We have UHL and the other level 2 hospitals in the group. We do not have a private hospital in the area. Other Senators who have spoken have referred to beds being used in other hospitals. We do not have that luxury unfortunately. The new system brought in, though, is beginning to work. On one day alone this week we had nine people on trolleys, whereas in December and early January there were more than 100 people on trolleys in one day. I acknowledge, therefore, that some progress has been made, but much more must be made.

I also acknowledge the open letter from the consultants today. I am sure the Minister has received a copy of it by now. They are calling on us all to work collectively to deliver a better process. The investment in the hospital needs to be accompanied by the required staff. It is clear to me that in certain areas there is a shortage of staff. There is a shortage of consultants and nurses, especially in some key areas, as well as other staff. I understand that an up-to-date IT system is needed too and that much time is spent on things being done manually and this information must then be transcribed and input into a computer system. This may be an area that needs to be explored.

Reference was made to surgical clinics in the online meeting we had with the Minister and the Taoiseach and the senior management UHL in the past ten days. Limerick hospital is to be one of five included and I would like to see this process accelerated and brought forward as soon as possible. I refer to making short-term, medium-term and long-term changes. We can have all the long-term changes, but I request that this clinic be brought forward quickly.

We also spoke about the two other 98-bed blocks needed in terms of the hospital. I ask that we explore the possibility of waiving the requirement for planning permission to allow the preparation and consultation process to build these blocks to start now. We have one 98-bed block under way, so I am sure the other will have the same design. In that context, can a design team be appointed as soon as possible? It is necessary.

In the past, St. John's Hospital submitted a proposal for a 150-bed block. The then Minister for Health, Deputy Harris, was looking very favourably at this proposal. It was set to be included in the capital programme, but I do not think it ever got to be finally listed. This is another issue we must examine. St. John's Hospital has only ten procedural beds available daily and I ask if we can look at other areas in this regard. Specifically, I ask that the crisis management team the Minister brought in to work alongside the senior staff at UHL explore other areas, because so many have worked so well in the hospital. It is the accident and emergency department that is under the most pressure, and other smaller areas. The fact that some procedures had to be cancelled in recent weeks has led to waiting lists. We must, therefore, look afresh at this situation. I look forward to working with the Minister in this regard.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I reiterate my acknowledgement and that of the Government that what is happening in some accident and emergency departments - not in all of them but in too many- is not acceptable. It causes immense distress for patients and families and it is a very difficult working environment for our healthcare professionals. It is a very serious situation and one we have had for many years. I acknowledge it is not good enough and unacceptable and that it is causing great distress.

We must also bear in mind the context for what is happening this year. Healthcare systems all over Europe are facing different versions of what is being experienced here. This is happening in Northern Ireland, in Britain and in countries right across Europe. These are countries analysts would say have more beds, or more this or that or where things are run differently. This is happening right across Europe, but this does not excuse the situation or mean that we do not do everything we can to fix it. It is important that we remember the context for this situation, which is a perfect storm of three respiratory illnesses hitting the country at a level that has never happened before and which is causing huge pressure right across Europe.

I am sorry our colleague from Sinn Féin has left. I sat here listening to some extraordinary language from the Opposition about our healthcare services, which is, ultimately, a reflection on those running the services. Regarding the fatalism we have heard today around our services, we would swear there is not a doctor, a nurse, a GP or a health and social care professional anywhere in the country providing a great service for patients. I want to refute that. There are healthcare professionals all over this country, in hospitals, in general practices, in primary care, in community care and in nursing homes, who provide the very best of care every day. The HSE cares for 30,000 men, women and children daily and they receive excellent care. I am not talking now about the people waiting in accident and emergency departments. Up to November, our hospital system provided 4.2 million episodes of treatment to men, women and children. The vast majority of people I speak to say that, when they get access, the services are excellent. You would swear that there is not a medical or nursing graduate in the county who is interested in working in our healthcare service. If the rhetoric from the Opposition were true, that would be fair enough but, of course, it is not true. This scorched earth description of our public health service is simply not true but our healthcare professionals have to listen to it every single day. Let me tell the House what they tell me. They tell me that it is exhausting for them to hear the kind of language we have heard from Opposition Members here today. Nobody is denying that there are issues in respect of access at some of our emergency departments and that our waiting lists are too long. However, it is exhausting for our healthcare workers to listen to the kind of language we heard here today and they hear it every single day.

Our Sinn Féin colleague would have us believe that there is no nursing student in the country who wants to work in the HSE so I checked. Some 90% to 95% of this year's nursing graduates are considering offers to work in the HSE.

Eugene Murphy (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Hear, hear.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Every single day, I meet nurses in hospitals and in community care who love their jobs, who provide great care to patients and who are immensely proud of what they and their colleagues do. You would swear there was not one who was doing a decent job based on what we hear in the Dáil and what we have heard here today from Opposition Senators. We do have real challenges. There is a real challenge with regard to access to emergency departments and consultants, particularly for outpatients. We know that. That is why we are responding like never before through the provision of money, beds, workforce, diagnostics and community care. Over the last 18 months, the number of people waiting 18 months to see consultants for an outpatient appointment has fallen by half. The number waiting more than 12 months has fallen by 40%. We are going to keep moving with this progress. We are going to reduce the waiting lists and, quite rightly, we are starting with the people who are waiting the longest, 18, 12 or six months. Progress is being made right across the board. Why? It is because our doctors, nurses, managers and healthcare professionals are stepping up to the challenge. We are providing them with the resources they need and they are responding.

I read the letter from the doctors at UHL and I agree with it. The letter they wrote was very reasonable. They make the case that the 2019 reconfiguration was not done in the right way and I fully agree. When that reconfiguration happened, there should have been a very large investment in additional capacity for the region in recognition of the new configuration and that did not happen. While is not the only cause, it is a direct contributor to what is happening in Galway, Limerick and other parts of the country. However, we are addressing that. Since 2020 or 2019, the budget for Limerick hospital has increased by 20%. The workforce has increased by 1,000. Since Covid arrived, UHL has gained 132 extra beds. They are there. That has happened since the Covid pandemic began. A further 96 beds are on the way. There is a new oncology wing. There are more resources for the emergency department teams and the hospital has launched a very positive measure, a new geriatric emergency medicine unit. That is not enough, however. That is why we are going to attach a surgical hub to UHL and why we are bringing in a new consultant contract, which will allow us to hire many more consultants and, critically, to hire them in ways that can lead to better outcomes and better access for patients. Colleagues have made reference to UHL's interest in two more 96-bed blocks. I have spoken to UHL about this. As I said earlier, we do not build healthcare infrastructure quickly enough in this country. It takes too long. I am working with the HSE, the Department, Government colleagues and the Attorney General to find ways to speed that up. We owe it to patients and to our healthcare professionals to get these beds and other infrastructure projects in place.

Jerry Buttimer (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I ask the Minister to conclude.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I will finish on this point. As I have said, capacity is part of the answer. Reform is the other part. There has not been a patient on a trolley at University Hospital Waterford in more than three years. In hospitals such as those in Portlaoise and Tullamore, the number of patients on trolleys is consistently very low. Why? It is because they roster differently. They provide access to senior decision-makers in a different way and manage patient flow differently. They engage with the nursing home sector and with private hospitals differently. They are doing things in ways that speed up access for patients. We need to continue to invest, and we will, but we also have to see best practice, which we know is working in some areas, in use consistently across the country. We know what the answers to this are and we know that our healthcare professionals and hospital managers want to make use of them so we have to give them the supports they need. If we do that, if we continue to grow capacity, community care and integrated care and, critically, if we reform how care is delivered to patients, which will include providing much more access to discharge over the weekends, this is something we can consign to history.