Tuesday, 3 December 1996
Dáil Éireann Debate
Mr. B. O'Keeffe: I wish to share my time with Deputy Dan Wallace. Cork University Hospital accident and emergency department became totally overloaded last week with the result that the section could not accept any more patients. The situation was replicated today when it became almost impossible to cater for the demand placed on the hospital's service. This is not surprising when the inadequacy of the department's layout and the lack of staff to provide the necessary lifesaving service is considered. The situation is no better at the Mercy Hospital or the South Victoria Hospital. There is too great a demand on the services in those hospitals as well.
Accident and emergency is a high risk area in terms of litigation and demands that the quality of the care and the clinical decision-making be of the highest standards to meet patient expectations and minimise the potential risk of legal action. Staffing is a key component. Staffing must have acceptable levels of seniority and experience to deliver a quality service at minimum cost and in the most efficient manner. It is stated in a report presented to the Minister for Health that the involvement of GPs at Cork University Hospital could save £1 million in the throughput of 100,000 people in the emergency services. It is also recommended in that report and by nursing unions generally that staffing levels should be one per 1,500 patients. Examination of the situation in any of the three accident and emergency departments in Cork will  show that the staffing levels do not attain anywhere near that level.
The Accident and Emergency Department in Cork University Hospital is underfunded and understaffed and there is a glaring lack of facilities, which is unacceptable. It is not that the Minister has not been forewarned about the difficulties. I raised this at the Southern Health Board over 12 months ago and on an Adjournment debate in the House. Since then a review group was set up and reported in August 1995, but no action has been taken to alleviate the situation. The lack of space, the lack of staff and the appalling facilities for children in the accident and emergency department are appalling. A corner is set aside for children with a few toys and no privacy for assessment. The Minister had no difficulty in providing £30 million for Limerick Regional Hospital, but the accident and emergency services in Cork are a forgotten entity.
A letter which I received from an eminent emergency consultant physician stated that “emergency health services at Cork University Hospital have been sadly neglected and are the poorest I have seen for an equivalent development country”. I call on the Minister to rectify this situation immediately.
Mr. D. Wallace: I thank Deputy O'Keeffe for allowing me to make a brief contribution. I support what he said. The situation at Cork University Hospital is unacceptable. It is a service that people use at a time of trauma for both patient and families. There is genuine concern that things will get so bad that the accident and emergency department will not be able to cope.
Deputy O'Keeffe outlined the major concern last week because there were not enough facilities to treat the large numbers of people needing to avail of the facility. The facilities in the accident and emergency department at the hospital in Cork have been long documented, but there has been a poor response. At a time when huge resources are being spent in health care, we are the bottom of the ladder in relation to facilities.
There is widespread concern at the fact that treatment is not available. The medical and ambulance staff are overworked and understaffed, and the demands on medical services are great at this time of the year. This is not helped by the present situation at Cork University Hospital. I appeal to the Minister to provide the necessary resources to remedy the unsatisfactory situation which cannot be allowed to continue.
Minister for Health (Mr. Noonan,: Limerick East): In the recent past the accident and emergency department at Cork University Hospital has experienced severe pressures due to increased attendance at the department. As a result, there was a temporary change in policy and GP referrals and inter-hospital transfers were  rerouted to other hospitals in the city. However, during this period the hospital remained open and continued to operate under normal procedures for other admissions. The hospital has now reverted to normal functions for all admissions.
As the Deputy is aware, a working group on the reorganisation of accident and emergency services in Cork was established by the Southern Health Board in May 1995 to review the organisation of accident and emergency services in Cork. The group met on a number of occasions under the chairmanship of Mr. Stephen Cusack, accident and emergency consultant at Cork University Hospital. The group completed its report in March 1996 and I understand that its recommendations have been endorsed by the Southern Health Board, subject to a small number of modifications. In recent days the board has forwarded a copy of the report for consideration within my Department.
On preliminary examination of this report I note that it addresses key staffing, facilities and equipping needs of accident and emergency units in Cork. I will consider the measures required to implement the report's recommendations in the light of considerable expertise gained in dealing with this problem in other hospitals in the past two years.
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