Pauline Tully (Sinn Fein)
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Before I start, may I ask why there is no Minister or Minister of State for health here? I was not notified that there would not be one. This is nothing against the Minister of State, Deputy Grealish; he is here to represent whatever Minister there is. This is very disappointing. This is a very important health issue, yet there is no Minister or Minister of State for health here. The Minister of State is not going to be able to give me a comprehensive answer because it will be a pre-prepared statement. It is very disappointing.

Maria Byrne (Fine Gael)
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All I can do is give the commitment to bring the Senator's comments back to the Department of Health and the Minister-----

Pauline Tully (Sinn Fein)
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Yes, please.

Maria Byrne (Fine Gael)
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-----to ask the question. Obviously, the Minister of State, Deputy Grealish, will do his best.

Pauline Tully (Sinn Fein)
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I know, and it is nothing against the Minister of State.

Maria Byrne (Fine Gael)
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I understand that, but I will give the Senator the commitment that we will contact the Department and the Minister's office.

Pauline Tully (Sinn Fein)
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I thank the Leas-Chathaoirleach.

I wish to raise a couple of cases relating to Cavan General Hospital. Aaron is a 12-year-old boy who was admitted to Cavan General Hospital in severe pain on Monday, 27 April. An ultrasound was carried out and it was determined that he had appendicitis, so he would have keyhole surgery on the Tuesday. On Tuesday morning at 3 a.m., he was in extreme pain and a nurse constantly called for a doctor, but no doctor came. Later on Tuesday morning, he was prepped to go to theatre for the operation. He spent all day waiting while fasting and having no water, and he was not brought to theatre until 10.20 p.m.. A 12-year-old spent a whole day without food or water and was in pain.

He had the operation and his parents were told it went fine. However, on Wednesday afternoon, Aaron was very unwell. It was only then that a senior consultant admitted that the appendix had ruptured and that the operation had been much messier than it should have been and they had admitted to. They gave him antibiotics, but the parents were very concerned he would contract sepsis. He remained very unwell in hospital for a few days. He was given a huge cocktail of antibiotics, but it then seemed that the antibiotics were having an adverse effect on his liver.

Aaron was taken off those antibiotics and was discharged on Monday, even though there was still an infection in his body. He had to be rushed back to hospital on Tuesday by ambulance, and to Temple Street on Wednesday, where he had surgery on the Friday due to complications in his bowels with an obstruction. We do not know the reasons for that, but we assume it had something to do with the initial keyhole surgery and how it was much messier than it should have been. Aaron is home now but is still very unwell and his parents are very concerned they are not at the end yet.

Orán is a 20-year-old who was admitted to hospital on 16 September last year while extremely unwell. He spent all night on a trolley in accident and emergency, with no scans and nobody seeing to him. The next day, 17 September, he got an MRI scan and an ultrasound, which showed he had appendicitis and needed keyhole surgery. An operation was performed at 1.30 p.m., but again, he was very unwell. It was only a couple of days later that the hospital admitted the appendix had ruptured in his case, too. He remained very unwell, and on the Friday, his parents were very worried about him, but there was no doctor to be seen until Monday evening. He spent the whole weekend without a doctor.

I also meant to say that, in both cases, a drain was put in and there was a very putrid discharge. Oran ended up having to have another operation on Tuesday and was in the ICU for several days before going back to the ward. He was discharged the following Monday but had to be readmitted on the Thursday, as he was still very unwell. He was eventually transferred to Beaumont a week later. He spent a week in Cavan General Hospital just being managed and then eight days in Beaumont on a cocktail of antibiotics, where they thought they had got him out of bother. However, he ended up back in Beaumont in November, where it turned out that there was a bowel obstruction due to adhesions from the surgery in Cavan. That young man ended up losing out on a semester in college and still has another operation to go to relieve all the issues resulting from the surgery.

This is happening too often. There have been several other cases where people have been left too long and their appendixes have also ruptured. We need to see some inquiries being made into this and a proper investigation of what is going on. Is it a case of staff under-resourcing, incompetence by certain members of staff or a combination of both? We really need the Minister for Health to look into this.

Noel Grealish (Galway West, Independent)
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I thank the Senator for raising this issue. As she rightly said, I am taking this on behalf of the Minister, Deputy Carroll MacNeill.

As regards the two issues the Senator raised, I hope that those two young lads will get back to full health. I will ensure that the Minister gets a transcript of what the Senator raised here and I will ask her to reply directly to the Senator on those two issues.Nobody wants to hear of situations like that but, at the end of the day, we hope they will be okay. I will now read the script I have been given by the Department.

I thank the Senator for raising this issue, which I am taking on behalf of the Minister for Health, Deputy Carroll MacNeill. Cavan Monaghan General Hospital is part of the Dublin and North East hospital group. The two sites are 46 km apart and operate as a single hospital with an integrated managerial and clinical governance system, care pathways and support functions. The hospital currently provides services to the population of both counties and surrounding areas. All acute inpatient services are based in Cavan General Hospital. Both hospital sites provide extensive outpatient, theatre and day services, and Cavan General hospital provides 24 hour emergency care.

The HSE has advised that Cavan General Hospital operates in line with national healthcare standards and established clinical governance frameworks. Both the surgical and emergency departments follow protocols, with care delivery guided by national policies, clinical guidance and regular oversight mechanisms. The hospital is subject to ongoing monitoring, audit and quality assurance processes which are designed to maintain high standards of safety and effectiveness. As part of the ongoing quality assurance process, HIQA inspected Cavan Monaghan General Hospital in 2024. The emergency department and four ward areas were assessed during this unannounced inspection. The findings of this inspection were positive, with ten out of 11 standards found to be compliant or substantially compliant.

In Cavan emergency department, trolley numbers have decreased by 20% in the last year. In the same period, waiting times have also reduced. It is important to note these improvements occurred in the context of increased emergency department attendances. Additionally, the waiting list for inpatient and day case procedures in Cavan has reduced by 15% compared with April 2025. Any concerns regarding care or procedures are addressed through established review systems including incident reporting and clinical audit. There has been significant investment in Cavan Monaghan General Hospital in recent years. The combined budget for the hospitals has increased by 5% from €115 million in 2020 to €183 million in 2026. Staffing has increased by 325, an increase of 28%, and bed numbers have increased by 11, a 4.8% increase since 2020.

According to the acute inpatient hospital bed expansion plan, which aims to deliver 4,367 acute hospital inpatient beds by 2031, a total of 97 beds will be delivered at Cavan Monaghan General Hospital by 2028. This includes 23 beds delivered between 2021 and 2024 and 74 beds delivered between 2025 and 2028. The hospital delivers safe and timely access to patients and the community and performs highly in national unscheduled care and emergency department key performance indicators. A new purpose-built emergency department and additional bed capacity received planning permission and started to progress through the development stages in 2025. The provision of a new extension block to the existing hospital front entrance, including a new oncology unit and upgraded pharmacy services, is currently at design stage.

Pauline Tully (Sinn Fein)
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The people of Cavan and I are delighted that we have a general public hospital in our county but we want a hospital we can trust. We want to know that when somebody goes in there for whatever reason, he or she will be cared for in a timely fashion. I have had wonderful experiences in the hospital and there are wonderful staff in there but they are overworked. Hospital management has said that it operates at safe staffing levels and so forth and the Minister of State's response says the same, but that is not the feeling these individuals, their families and many others have when they go into the hospital. They see staff who are rushed off their feet and who do not have time to see to patients properly. It is not fair. It is putting pressure on them and that is when mistakes are made. In this case, mistakes were possibly made and, as I said, we need answers as to what happened here. We also need to ensure it does not continue to happen.

I have become aware of four cases in the last year. There was a young lad in February who was left too long and his appendix ruptured as well, but thankfully he did not seem to have any bowel complications afterwards. Another young woman told me that her colon was perforated when she was getting her appendix removed. There are complications there and the issue is staffing levels. We need more staff to ensure patients are seen to promptly. These families were traumatised. One mother who reached out to me said they could not speak about it for months afterwards because they were so traumatised by what they went through and so worried about their son at the time.

I would appreciate this being brought to the attention of the Minister so that we can get a comprehensive reply to the specific issue raised.

Noel Grealish (Galway West, Independent)
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I assure the Senator that I will personally bring this issue to the attention of the Minister and ask her to revert to the Senator on it. Nobody wants to hear of cases like this. At the end of the day, the staff in the health service, as everyone in this House will acknowledge, do tremendous work.

Pauline Tully (Sinn Fein)
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Yes, they do.

Noel Grealish (Galway West, Independent)
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In some places they are under pressure and we all know that. Recruitment is a problem as well. It is to be hoped the hospital will be able to get on top of these issues. I will ask the Minister to revert to the Senator on it and I thank her, once again, for raising this matter today.

I reiterate that Cavan Monaghan General Hospital operates in line with the national healthcare standards and established clinical governance frameworks. Both the surgical and emergency departments follow protocols, with care delivery guided by national policies, clinical guidance and regular oversight mechanisms. Patient care is supported by multidisciplinary teams, ensuring treatment decisions are made collaboratively and in accordance with best practice. The hospital is subject to ongoing monitoring, audit and quality assurance processes which are designed to maintain high standards of safety and effectiveness. Any concerns regarding care or procedures are addressed through established review systems, including incident reporting and clinical audit. In this context, it is important to emphasise the hospital's positive inspection report following its last HIQA inspection. In the last year there have also been improvements in waiting times for both emergency patients and those awaiting inpatient procedures. The Government is committed to ongoing investment in service enhancements in the region. Substantial improvements have been put in place, including an uplift in bed numbers, staffing and budgets. Additionally, a new purpose-built emergency department and oncology unit are progressing.