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Leaders’ Questions Tuesday 7th February

Michael Lowry (Tipperary, Independent)

My question relates to health issues, particularly as they relate to Tipperary. On behalf of my colleagues in this Independent group, Last night's programme was disturbing and distressing and it reflected poorly on the health care system and its inability to respond to serious urgent care needs. I am delighted with the response from the Taoiseach and that this matter will now be treated as urgent. However, the message in last night's television programme has been conveyed consistently to the HSE by the consultants and doctors of the patients who featured in it. I guarantee that every patient had representations made on his or her behalf by probably every Member of this House at some stage and that our recommendations have been ignored. It takes a television programme to get action. Where is the response from the HSE to representations made by elected representatives?

The issue I wish to raise with the Taoiseach is the principal health care issue in County Tipperary. It revolves around the disgraceful situation at South Tipperary General Hospital, which has a grossly inadequate number of acute beds to manage the crisis in acute services. It routinely has 140% occupancy, whereas the desired occupancy rate for hospitals of its size is approximately 85%. Therefore, when there is a surge in demand, there is no flexibility in the system, as a result of which we regularly have the highest trolley count in the country. In South Tipperary General Hospital there are only 150 acute beds per 100,000 of population. This contrasts with the national average of 230 beds per 100,000. That speaks for itself. We have a problem in Clonmel. It is like a battle zone. On any day one goes into the hospital there, one will see the walking wounded. It is completely overcrowded with trolleys literally coming out the door. There are mixed wards of male and female patients where there is no dignity in the patient care. There is intolerable pressure on the management and staff of the hospital. They have been seeking help and looking for support. The Minister visited the hospital, and we came to the conclusion that an interim solution is required, namely, a modular-type complement of beds, and that South Tipperary General Hospital should be included under the capital programme review. Many people are criticising the Minister. My view is he is accessible, approachable, sincere and knowledgeable. However, he needs the support of Government because this is a national crisis and it needs a collective response from Government to address it.

2:45 pm

Enda Kenny (Taoiseach, Department of An Taoiseach; Mayo, Fine Gael)

It is a national situation and requires a whole-of-Government response, which it will get. In the case of South Tipperary General Hospital, Clonmel, and Our Lady's Hospital, Cashel, the Minister has recognised that addressing the capacity issues there must be a priority. My understanding is that a tender is due in the coming weeks requesting proposals for temporary accommodation in Tipperary. The HSE has been asked to maximise the use of the Cashel campus and is considering every option to support South Tipperary General Hospital with both community and primary care services, as referred to by the Deputy. I am also advised that the HSE is working towards providing extra capacity through the fit-out of additional space on the first floor of the hospital to alleviate pressure on the emergency department. This extra capacity is expected to be available from early May of this year and I understand it could be used to accommodate for space of up to 11 beds.

Also as part of the winter initiative, South Tipperary General Hospital has been identified, as the Deputy is aware, as one of the nine focus sites experiencing the greatest challenge in terms of emergency department pressures. Consequently, under the initiative, additional measures have been put in place to support the hospital to respond to increases in demand for emergency care over the busy winter period. These actions include improvement in early discharging and increased access to community intervention teams and to diagnostics. The winter initiative has allowed for a further additional three home care packages per week at the hospital until the end of February this year.

The winter initiative also recognises that there are specific capacity challenges at South Tipperary General Hospital. As such, additional options are being considered, including the use of the national framework for alternative accommodation on hospital sites, to which the Deputy referred, to provide additional capacity through a temporary inpatient solution at that site. The site in Cashel, which includes Our Lady's Hospital, provides mainly primary care services. There is a small residential facility on the site, together with other services, including day and outreach services. The residential unit, which includes elderly mental health and intellectual disability beds, is currently fully occupied. The development of the campus as a centre for non-acute health care services arose from the decision by the former South Eastern Health Board to centralise acute hospital services for the south Tipperary area on one site in Clonmel. This took place, as the Deputy is aware, in 2007. The Cashel primary care team is based on the campus. A range of services are provided on and from the site, including physiotherapy, occupational therapy, public health nursing, social work and disability services, as well as home help co-ordination and community mental health nursing. Among other services facilitated are the south Tipperary community intervention team, a nurse-led service supporting early discharge and the avoidance of hospital admission. An ambulance station is also located on the campus.

2:50 pm

Michael Lowry (Tipperary, Independent)

Many people in County Tipperary cannot understand why major surgery is cancelled in Clonmel with early discharges because of lack of beds, not enough step-down or convalescent beds, insufficient home care packages and reductions in home help hours. People are baffled and bewildered because while this is happening in Clonmel, there is a magnificent building up the road in Cashel, which was refurbished at a cost of €20 million since 2007. Three of its floors, which could take between 30 and 35 beds, are empty. They are in excellent condition. I ask that Cashel be reopened and developed as a primary, community care centre. It is a premium facility lying idle. It is shameful and mind-boggling that the Health Service Executive, HSE, is not using the building to its maximum potential at a time when the other problems exist in Clonmel. Will the Taoiseach and the Minister for Health give priority to reopening Cashel and making it available to deliver health care services to the people of Tipperary?

Enda Kenny (Taoiseach, Department of An Taoiseach; Mayo, Fine Gael)

The Minister was surprised at the scale of what he saw in that building when he went to Cashel. He has given the HSE an instruction to come up with a list of proposals for better and more use of what is there. I expect he will have that report shortly. Given the scale of investment the Deputy mentions, much more could be done with it than is currently planned. He has instructed the HSE to revise that.