TROLLEY CRISIS – Reopen the Accident and Emergency departments at Nenagh General Hospital and Ennis General Hospital, reopen Our Lady’s Hospital Cashel and lift the moratorium on both staffing and home help hours.
From 2002 on, successive Governments have espoused and implemented the downgrading of hospitals and the transfer of acute hospital services to so-called centres of excellence. We all know that that policy has created chaos. It was wrong then and it is wrong now, and it should never have happened.
We in South Tipperary were lucky, that people power, that 15,000 people on the streets stopped the transfer of our services to other areas, but other areas were not as lucky. It is now time to recognise that failure of policy and reverse that policy failure.
The trolley figures are a clear example of the chaos. Those figures, and we are talking about human beings on trolleys in accident and emergency departments, on corridors and in wards are a clear example of the chaos, are a clear example of the failure and a clear example of the indignity suffered by thousands upon thousands of patients over the past ten years. The figures for October, 11,452, are absolutely outrageous. The figures are climbing year on year, and of course we haven’t really entered Winter at all yet.
One of the areas which has suffered the brunt of the policy that I am speaking is the mid-west, including Limerick, Clare and north Tipperary, which is part of my constituency. There are knock-on effects at South Tipperary General Hospital in addition. University Hospital Limerick and South Tipperary General Hospital consistently among the highest trolley figures in the country. Today’s trolley figures are absolutely obscene. Patients are suffering and patients are dying on trolleys in our emergency departments, something the Irish Association for Emergency Medicine has warned us about for the past number of years. Today’s figures are the second highest ever recorded.
Mary Harney, the former Minister for Health, declared an emergency when there were 602 patients on trolleys. Today there are 679 patients on trolleys. The particular problems at University Hospital Limerick and in Clare and north Tipperary started with the closure of the accident and emergency departments at Nenagh General Hospital and at Ennis General Hospital. There is now a campaign locally and there have been a number of very successful meetings to demand the reopening of the Accident and Emergency departments both at Nenagh General Hospital and at Ennis General Hospital
The chaos resulting from the policy I have described has been compounded by two moratoriums. Everybody in this Chamber, including the Taoiseach, knows they are real.
We have a moratorium on the recruitment of staff. There are currently 432 vacant posts for staff nurses, public health nurses and staff midwives. There are more than 500 nurse vacancies in mental health services. I know three nursing posts have been vacant for the past six months in South Tipperary mental health services, in the child and adolescent mental health services and a Clinical Nurse Specialist for mental health services in the accident and emergency department in Clonmel.
Is it now time to accept that the policy of downgrading hospitals has failed and that the policy should be reversed? Isn’t it now time to agree to the reopening of the accident and emergency department in Ennis and Nenagh? And isn’t it now time finally to recognise what we all know that there is a moratorium on both staffing and home help hours and that that moratorium should be lifted immediately.
I have to say that I am shocked at the lack of urgency that the Taoiseach displays, almost indifference, almost as if this situation is normal. The trolley figures are absolutely obscene. We have people suffering on trolleys in our hospitals and people are dying on trolleys in our hospitals. The Taoiseach is the leader of this country and I have to say that he has a responsibility for this obscenity, he has a responsibility for the suffering and a responsibly for the deaths of these people on trolleys in our hospitals over recent years, a position that continues to this day. The Taoiseach can solve this problem.
He absolutely can solve this problem. I ask him to introduce immediately a supplementary budget to tax the 1%, the very wealthy people, the billionaires who own 27.3% of all the wealth in this country. They are not paying their fair share now, nor have they ever done so. I want the Taoiseach to reopen the accident and emergency departments at Nenagh General Hospital and Ennis General Hospital and to reopen Our Lady’s Hospital Cashel, a state-of-the-art hospital which has been vacant for the past ten years. The Taoiseach has the responsibility to solve this problem. He can do it. The question is whether he has the political will to do it.
Earlier today Deputy Seamus Healy TD raised again in the Dáil at Leaders Questions with the Taoiseach the issue of the lack of adult inpatient psychiatric beds and the need for the provision of a properly resourced, properly funded and integrated mental health service in Tipperary with the Minister, He will as always keep you updated.
To ask the Minister for Health his plans to open adult inpatient psychiatric beds in County Tipperary; and if he will make a statement on the matter. [28609/18]
Priority Question 5. To ask the Minister for Health his plans to open adult inpatient psychiatric beds in County Tipperary; and if he will make a statement on the matter. [28609/18]
Séamus Healy (Tipperary, Workers and Unemployed Action Group)
This raises again the need for the provision of a properly resourced, properly funded and integrated mental health service for County Tipperary with particular reference to the need to reopen adult inpatient psychiatric beds wrongly closed at St. Michael’s unit in Clonmel in 2012.
Jim Daly (Cork South West, Fine Gael) The provision of acute inpatient care to the adult population of north Tipperary, which is in CHO 3, is provided between the acute unit in University Hospital Limerick, which has 50 beds, and the acute psychiatric unit in Ennis, which has 39 beds.
The 44 bed department of psychiatry based at St Luke’s General Hospital, Kilkenny, is the designated approved centre for acute inpatient services for south Tipperary, which is in CHO 5. This enables all acute inpatient admissions for this CHO area to be managed at a single site. Referrals to St. Luke’s are through a consultant psychiatrist who makes the clinical decision to admit based on the level of acute presentation or need. In addition to the department of psychiatry, a dedicated psychiatric liaison team operates out of the emergency department in St. Luke’s. All service users presenting to the emergency department who require psychiatric assessment will receive that assessment within agreed timeframes in line with relevant guidelines. Onward referral pathways are agreed with all service users upon completion of psychiatric assessment in the emergency department. Pathways can include admission to an acute unit, referral to a relevant community mental health service team or referral back to a GP.
There are a range of other mental health services for adults in Tipperary. These include, for example, psychiatry of old age teams, non-acute beds, day hospitals and day centres. In addition, there are community mental health teams and high, medium and low-support community residences. In respect of those under 18, there are three CAMHS teams operating in Tipperary, one in north Tipperary and two in south Tipperary. The CAMHS acute units at Eist Linn in Cork and Merlin Park in Galway, which have a total of 42 beds, serve the Tipperary catchment area.
The HSE indicates that the south east community healthcare area has the second lowest rate of acute psychiatric bed provision. If this area were to be provided with the national average rate of bed provision, an additional 18 acute psychiatric care beds would be required. Evolving demographic pressures have recently led to over-occupancy at the departments of psychiatry at both St. Luke’s General Hospital Kilkenny and University Hospital Waterford.
The Deputy will be aware that I met local delegations on several occasions over recent months to discuss current and future provision of mental health services in Tipperary, including reviewing bed capacity. I also visited mental health facilities in south Tipperary in February last. Further to my correspondence of 11 May with the chief officer of CHO 5, the south east mental health service management team met a delegation of local representatives and discussed in detail all issues concerning the delivery of mental health services in Tipperary, including the potential for additional acute psychiatric beds across the south east community healthcare area. South east community healthcare mental health services has also engaged with HSE estates on the potential to develop psychiatric inpatient beds at the four acute hospital sites in the region.
I will continue to monitor the development of all mental health services in Tipperary, particularly in the context of progressing new service developments agreed under the HSE service plan and through additional investment for mental health provided by Government.
Séamus Healy (Tipperary, Workers and Unemployed Action Group)
I acknowledge the interest and involvement of the Minister of State in this issue since his appointment. As he said, he met representatives of the Save Our Acute Hospital Services Committee and Oireachtas Members on two occasions in Leinster House. He has visited the services in Clonmel and met all the stakeholders involved, including mental health service management in the south east. There is a serious and growing concern about the state of mental health services in the county, specifically that they are substandard and that there are no inpatient beds. A new umbrella organisation, Tipperary’s Fight for Mental Health Services, has been involved recently in public meetings and a public march on this issue. That organisation is supported by all the local Oireachtas Members and a large number of councillors as well. The Save Our Acute Hospital Services Committee has been engaging with mental health service management in the south east. At our most recent meeting, the management accepted that there was a shortage of beds in the south east and that Tipperary had a strong case for additional beds. They also indicated it would be helpful if the Minister of State was in a position to meet the negotiating team. Will he do that?
Jim Daly (Cork South West, Fine Gael)
The Deputy was present at the meeting with local Oireachtas representatives on 2 May and he has consistently been proactive on this issue. On 11 May, I wrote to the chief officer of CHO 5 outlining that there is a need to restore some acute bed provision for adults in Tipperary following the closure of St. Michael’s unit some years ago and given the consequent transport and access difficulties to St. Luke’s mental health unit in Kilkenny and to Ennis, which were highlighted to me. I emphasised the need for progress to construction as quickly as possible of the new respite crisis house in Clonmel to replace the existing facility there, including the provision of a construction date for that facility. I also highlighted the inadequate enhancement of community-based services since 2012 to compensate for the closure of St. Michael’s, particularly comparing the level of services envisaged by the HSE against what has been delivered, and referred to the inadequate staffing levels for both adult and CAMHS teams in Tipperary. I referred to the further issue of poor access to Eist Linn CAMHS unit in Cork, resulting in long stays for under-18s in adult health facilities in Tipperary, which has always been a concern of mine. The Deputy will be aware that I have spoken to a number of parents of children who have been left waiting in South Tipperary General Hospital, which is not appropriate or acceptable.
Séamus Healy (Tipperary, Workers and Unemployed Action Group)
The representatives of the Save Our Acute Hospital Services Committee have met mental health service management on three occasions. On the most recent occasion, they accepted that there is a need for additional beds in the area and that south Tipperary has a strong case. They also indicated that the Minister of State’s involvement at a future meeting would be helpful and I ask again if he would be prepared to do that. At this stage, we need action and political input at the highest level to move this issue forward.
I would be more than happy to continue the engagement I have had with the Deputy. I am concerned about the issues in south Tipperary and have a good understanding of them. I am awaiting a response from the chief officer of CHO 5. I asked my officials this week to follow up to ensure that I get a written response, which I expect to have in the next week or ten days. As soon as I have it, I will certainly be happy to engage further with the Deputy. There is potential in the development of the new 50-bed unit. I have asked HSE estates section to consider the provision of a number of those beds for mental health services without distorting the plans that are in progress. It should not create a delay. That is the route I am following and I will certainly meet with the Deputy, Oireachtas colleagues and whomever they want me to meet in Tipperary. My focus on working with the HSE and as soon as I receive a response from the chief officer, I will progress the issue.