Martin Browne (Tipperary, Sinn Fein) | Oireachtas source

Is that agreed? Agreed.

The second petition is No. P00035/22 entitled “Amend Child Care Act 1991 to Provide HIQA with the Necessary Powers to Sanction Tusla, Child and Family Agency when it Fails to Meet its Statutory Obligations” from Ms Anna Kavanagh. The Alliance of Birth Mothers Campaigning for Justice, ABC, requested that the committee initiate the necessary steps to amend the Child Care Act 1991, as amended in 2011, to provide HIQA with the powers to sanction Tusla when it fails to meet its statutory obligations. The Alliance of Birth Mothers Campaigning for Justice is Ireland’s leading advocacy group for birth mothers whose children have been taken into State care by Tusla. HIQA carries out inspections in each of Tusla’s 17 service areas. HIQA publishes the results of these inspections, the vast majority of which find serious non-compliance in one or more standards inspected. HIQA does not have the power under the Child Care Act 1991 to sanction Tusla. The latest report published by HIQA on 8 June 2022 found the Cork service area, which has 26% of the total child population of Ireland, was compliant in just two of 12 standards inspected.

The secretariat received a response from the Ombudsman for Children's Office, OCO, via the committee, dated 31 January 2024 regarding the correspondence from the petitioner. The OCO stated:

1. It is clear that ABC and the OCO are in agreement as to the value of a self-improvement model of oversight when it is working well and when all parties are working with all necessary resources and an openness to change.

2. However, ABC believes that Tusla has continuously failed to show the capability to learn and improve following numerous HIQA reports of non-compliance and poor risk management.

3. The OCO also believes that it is beyond the remit of their Office to comment on the particular employment sanctions that could be considered in cases where HIQA has identified such systemic failures if such an amendment was ... made to the Child Care Act 1991.

The OCO recommends that any further correspondence to the committee on this subject should be referred to HIQA for its opinion. The recommendation is that the correspondence from the Ombudsman for Children be forwarded to the petitioner for comment within 14 days; to send the correspondence from the petitioner to HIQA for comment within 14 days; and to invite the group thereafter to put its case to the committee and then the ombudsman. Do members have any views? Is that agreed? Agreed.

Third is petition No. 00036/22 to reopen Ennis, Nenagh and St. John's emergency departments and it is from Ms Noeleen Moran. The petition relates to the 2009 Government decision to downgrade hospitals at Ennis, Nenagh and St. John's hospitals and to close the emergency departments. This decision directly contributed to an increase in overcrowding at UHL and poorer access to healthcare for those in the mid-west. Trolley Watch data highlights the extent of this overcrowding. It is estimated that there is one extra death for every 82 patients admitted to an emergency department whose transfer to an inpatient bed is delayed beyond six to eight hours from the time of arrival at the emergency department. In June 2022, there were only three days when the numbers on trolleys was lower than 82.

The updated information we have is that the petitioner has raised concerns over the time taken to progress the petition and the lack of response from the Minister for Health. On foot of these concerns, the secretariat completed a full review of correspondence issued and received in respect of the petition. On completion of the review, it was identified that the Minister’s office had responded on 23 January 2023 and, due to an administrative error, this item was missed from the correspondence list for the committee. In the Minister's response it was stated that in 2013, the smaller hospitals framework defined the role of smaller hospitals and the need for both smaller and larger hospitals to operate within hospital groups. The Minister states that this framework provided a stronger role for smaller hospitals, like Ennis, Nenagh and St. John’s hospitals, in delivering higher volumes of less complex care in many cases closer to patients’ homes. The response goes on to state that in April 2009, a process of reconfiguration commenced with the closure of the 24-7 emergency departments in Ennis and Nenagh.

These emergency departments were replaced with medical assessment units for GP referrals, and by local injury units-urgent care centres for self-referrals, which operate 12 hours a day, seven days a week. These changes were supported by an emergency care network, which had been set up in the region and led by consultants in emergency medicine. This reorganisation coincided with the establishment of the motorway from Ennis and Nenagh, of which the response states that the travel time by ambulance between the hub and spoke was never more than 30 minutes. The object of reconfiguration was to provide safer care to patients with acute health problems while also striving to make specialised services more accessible to patients in their local hospital. Ennis and Nenagh hospitals have an integral role to play in the future growth in healthcare in this region, in the provision of ambulatory care, chronic disease management, day surgery, five-day surgery, endoscopy, local injury and medical assessment units and much more besides.

The Minister has expressed his concern about overcrowding in the emergency department in Limerick and acknowledges the distress caused to patients, their families, and front-line staff working in very challenging conditions in emergency departments in UHL and throughout the country. The HSE’s performance management improvement unit has been directed to lead a process, in partnership with UHL team members, supporting the hospital and community services in driving a programme of work to respond more effectively to the current pressures. This process will ensure that all necessary immediate steps are taken to address the issues identified, and a detailed plan is being developed to ensure that they do not reoccur.

The following four witnesses were requested to appear before the committee on Thursday, 8 February 2024 but were unable to, citing the following reasons. First, the Minister for Health, Deputy Stephen Donnelly, was unavailable on this date. Second, the SIPTU representative for health workers in the mid-west region who was involved at the time has now retired and the union will appoint a new person in that area. The third reason is in two parts, the first of which relates to the UHL clinical director for the HSE, Professor B. Lenehan. The HSE has claimed that due to the response sent by the HSE to the committee on 11 December 2023, there is no requirement for the professor to attend. The second part of this reason relates to the committee's invitation to the CEO or a representative of HSE in place of the professor. The response was they are unable to attend on this date. Fourth, in respect of representatives from HIQA involved in the UHL unannounced inspections, HIQA has said they are not available for the meeting.

The committee recommends that the correspondence from the HSE be forwarded to the petitioner for comment within 14 days. Do members have any views?