Additional facilities needed at CGH’s Emergency Department – Inadequate facilities and patient numbers increasing – Brendan Smith T.D.

   Deputy Brendan Smith: In May 2014 I instigated a Topical Issue debate on the need to provide a new emergency department at Cavan General Hospital. The hospital opened in June 1989 and since then the number of patients presenting at the emergency department has grown substantially. That particular debate, to which the then Minister for Health, Senator Reilly, replied at the time, highlighted the need to provide appropriate resuscitation and isolation facilities at the emergency department and in particular the need to provide more examination cubicles. I also highlighted the benefits that would accrue from having a minor operating theatre within the emergency department.

The layout of the department is not suitable due to the numbers presenting nowadays. That has been accepted by the HSE and by all medical and nursing clinicians as well. There has been an increase in the population of the Cavan-Monaghan area, which I very much welcome. When I raised this issue in 2014, the population of both counties at that time was 133,500 people. Today, thankfully, it has reached 137,562 people. I raise the point about population because there is a high proportion of older people in the Cavan-Monaghan area. It is well above the national average. As the hospital also provides services for our friends and neighbours from counties Meath, Leitrim and Longford, it has a major catchment area. Over the years, thankfully, there have been major developments at the hospital and I welcome the provision in 2009 of a medical assessment unit. A paediatric assessment unit was also provided. In 2014 an outpatient facility for paediatric cystic fibrosis patients opened and that occurred with huge input from the local community as well. From 2000 to 2011, a major capital programme was in place in which more than 20 additional beds were provided for the hospital, as well as a magnetic resonance imaging, MRI, unit, a computed tomography, CT, scanner, oncology services and a major expansion in renal dialysis services. Thankfully, today services are provided at Cavan General Hospital that once one could only access in the tertiary hospitals in Dublin.

We welcome the provision of additional services but they pose additional demands on the emergency department. When capacity is expanded – which I was very glad to support and to work towards achieving – that creates an extra demand on the emergency department. In the meantime the investment has not taken place in upgrading existing facilities or providing additional facilities. A number of years ago, the HSE brought the design plans to a very advanced stage on three or four occasions. There was going to be a major capital investment but each time, it did not happen. It would have been a very substantial project with additional facilities that everyone would have welcomed. In the meantime, plans were put in place to have a more minor investment that nonetheless would be very important. It was a programme that had advanced through planning. We were told the money was in place but unfortunately it still has not happened. The smaller project, which would be very welcome, would provide eight more cubicles. That would be extremely important. People with family members who have attended and people who have worked in the hospital over the years have told me the extra accommodation – comprising of examination cubicles – would be key in providing a better service to the patients presenting. I have been told, via replies to parliamentary questions, correspondence with the HSE and meetings with successive Ministers and senior representatives of the HSE, that a resuscitation area is being developed. Nothing has happened on that, to my knowledge. I would appreciate if the Minister could give me an outline of what is proposed at present, because nothing has happened so far. The numbers presenting are increasing on an annual basis. That is a clear fact.

End of Take

The HSE is fully aware that in 2016 approximately 35,000 people presented at an emergency department which lacked adequate facilities to deal with such patient numbers.


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   Minister of State at the Department of Health (Deputy Catherine Byrne): On behalf of the Minister for Health, Deputy Harris, I thank the Deputy for the opportunity to update the House. I will reply to the issue as tabled and then maybe pick up on some of the Deputy’s concerns. The emergency department in Cavan has been performing well this year. Performance information from the HSE shows a 51% reduction in trolley numbers at the hospital in comparison with the same period in 2016. This is a positive performance especially when we consider that the overall public hospital system is seeing growing demand for emergency care.

This year emergency department, ED, attendances are up nearly 2% overall that is over 15,000 more patients attending EDs nationally as compared to 2016. In addition, Cavan General Hospital has been performing well in terms of patient experience times in the ED. Up to the end of August, 72% of all patients completed their episodes of care in the ED within six hours. The Royal College of Surgeons in Ireland, RCSI, Hospital Group has identified the need for development of the resuscitation area in Cavan emergency department. Future investment in Cavan General Hospital will be considered within the overall acute hospital infrastructure programme, the prioritised needs of the hospital groups and within the overall capital envelope available to the health service.

The HSE will continue to apply the available funding for hospital development in the most cost effective way possible to meet current and future needs of the health service. The new capital envelope announced last week in the context of budget 2018 will be used by the HSE to revise the capital plan for 2018 and will form the basis of the Department’s submission for the forthcoming ten-year national investment plan. Community health organisations and hospitals are all currently in the process of planning for increased demand for health services. They are developing integrated winter plans to cover the period October 2017 to March 2018. These plans, including the plan for Cavan General Hospital, have been submitted to the HSE and will be approved before the end of October. As part of budget 2018 an additional €40 million was announced for 2017 to prepare for and manage the expected peak in demand for our health services over the upcoming winter period.

A bed capacity review is also ongoing within the Department of Health. This review is examining key elements of hospital capacity. The findings of this review will provide a basis for determining the capacity requirements over the next 15 years. It will also identify the type of capacity needed at a national and regional level with regard to acute hospitals, primary care and community care. A final report will be published before the end of the year.


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   Deputy Brendan Smith: I thank the Minister of State for her reply. If the small project I mentioned were to be provided eight more cubicles and minor surgery could be provided in that accommodation. That would cost less than €1 million. That would ease the pressure considerably on the staff in the emergency department and provide better facilities for the patients who are our number one consideration.

Poor accommodation and inadequate facilities place a huge additional burden on staff. It saps morale. I compliment all the staff in all the different disciplines in the emergency department in Cavan General Hospital and throughout the hospital. They work extremely hard and provide a very good service under very difficult conditions. A few years ago the HSE stated in a report that the emergency department was not fit for purpose. In the meantime it has not invested. The need is urgent. I would settle tomorrow morning for the smaller project if it got the go ahead and the additional accommodation could be provided.

It is not acceptable that when people come into hospital and speak to the reception staff, who are under pressure too, the next person in the queue can hear what they are saying. When we present at an emergency department we do not want to know the name or the details of the person ahead of us or why that person is there. The least that can be provided to patients is privacy. It is not possible for the staff to provide that privacy because of the lack of accommodation. The staff in that department and throughout the hospital are working under tremendous pressure, providing a very good service.

I have raised separately the need to appoint additional nurses to the hospital. I hope the Minister will tell the RCSI Hospital Group of the need to have more nurses appointed to Cavan General Hospital. I had the opportunity to meet him privately on this issue. Could the Minister of State bring back to him the clear message that I am trying to impart here this evening, namely, the need for that additional accommodation to provide people with the service they need when they present at the emergency department? The number of patients presenting at the emergency department is increasing annually. They are not just repeat patients. That is a significant factor in the assessment of the demand on the hospital. My colleague and good friend, Deputy Breathnach, who was a very prominent and active member of the old north eastern health board, the HSE forum for the north east and a great advocate for the development of services in Cavan, Louth, Monaghan and Meath shares my concerns about the inadequate provision of emergency departments for the four counties concerned. I would appreciate if the Minister of State would speak to the Minister about my concerns and ensure that the HSE moves to provide additional upgraded accommodation and new facilities at Cavan General Hospital’s emergency department.

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   Deputy Catherine Byrne: For the first time in a long time, there is a possibility of increases, particularly in capital spending in the budget for 2018. It is not acceptable that people entering an accident and emergency department do not have a proper room where they can speak one-to-one without everybody else listening to their business. I have never been in Cavan General Hospital, so I am not sure of its lay out. I will, however, relay this to the Minister. I will take on board what the Deputy said about capacity there to build extra cubicles that could assist in the overall administration for people who come into the accident and emergency unit. With regard to what the Deputy said about the increased population in Cavan, I know people who have moved from Dublin to the Cavan area. That is happening weekly or monthly. I have taken detailed notes of what the Deputy said and I will make sure the Minister responds to the Deputy.