Oireachtas Joint and Select Committees
Thursday, 16 November 2023
Committee on Public Petitions
Consideration of Public Petition to Reopen Ennis, Nenagh and St. John's Emergency Departments: Discussion
Martin Browne (Tipperary, Sinn Fein)
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The next item on the order of business is our engagement with representatives of the Mid-West Hospital Campaign group to discuss public petition No. P00036/22, entitled Reopen Ennis, Nenagh and St. John's Emergency Departments.
Before we start, I wish to explain some limitations to parliamentary privilege and the practice of the Houses as regards reference witnesses may make to other persons in their evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected, pursuant to both the Constitution and statute, by absolute privilege. They are again reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that may be regarded as damaging to the good name of the person or entity. Therefore, if witnesses' statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.
Before we hear from our witnesses, I propose we publish the opening statements on the committee’s website. Is that agreed? Agreed.
On behalf of the committee, I would like to extend a warm welcome to the members of the Midwest Hospital Campaign: Ms Noeleen Moran, petitioner and campaigner; Ms Marie McMahon, campaigner; Ms Hilary Tonge, campaigner; and Ms Tricia Delaney, campaigner. I suggest that our witnesses should make their opening statements for around five minutes. When all the witnesses have made their opening statements, we will then have questions and comments from members. Each member will have around five minutes. Members may speak more than once. I now call on Ms Moran to make her opening statement.
Ms Noeleen Moran:
Our campaign has been engaging with the public petitions committee since 21 June 2022. We have made continuous submissions to it, creating a full picture of the situation facing the people of counties Clare, Limerick and Tipperary in the aftermath of our hospitals being downgraded to model 2 and our accident and emergency units closed.
We have qualified every assertion that we have made with submissions of local media reports; national media reports; Health Information and Quality Authority, HIQA, reports; the report commissioned by management at University Hospital Limerick, UHL; the Deloitte report; and our own campaign testimonies from local surveys our campaign has conducted. These reports highlight the serious mismatch between capacity and demand that exists at UHL. Over 400,000 people are currently reliant on just one emergency department at UHL. Our region has only one persistently overcrowded emergency department, ED, and no model 3 hospital, which makes it distinct from every other health region. That is why we say it the most disadvantaged health region in the country, by far.
HIQA identified this point in its unannounced inspection of UHL report where it found the hospital non-compliant with national standards. The management of UHL committed to the exploration of a model 3 hospital for the region in its response but no follow-up on this has occurred as far as we are aware.
When we questioned the abandonment of the proposal for a model 3 hospital in a meeting with the Taoiseach, we were told that a model 3 hospital was not the preferred model. In the Taoiseach's constituency of Dublin West, however, Connolly Hospital in Blanchardstown is a model 3 hospital. In 2014, the Taoiseach committed in a newspaper article published that he would not close this hospital on his watch as he directed more funding towards supporting the emergency department at Connolly Hospital. That shows a clear double standard when one considers that there are ten emergency departments within one hour of Connolly Hospital and none within the mid-west hospital region.
Patient dignity does not exist in the corridors of the emergency department of UHL. Lives are being lost, both by those who attend the ED who are not reached in time to be given the care they need because of the levels of overcrowding, and by those who are afraid to attend despite urgently needing care and die at home as a consequence. As part of our correspondence with this committee, we have received communications from UHL management, the HSE and the Department of Health telling us that a Government policy document, Securing the Future of Smaller Hospitals: A Framework for Development, which was published in February 2013, sets out the roles for smaller hospitals and locks us into this situation. We do not believe there is any politician in this country who is unaware of what is happening in the ED at UHL. Last January, 11,000 people from across the mid-west marched in Limerick after a calamitous winter season. As many as 15,000 people have signed our petition calling for our accident and emergency units to be reopened. Like us, the public recognise this could be any member of their family. A mother, father, sister, brother, son, daughter, grandparent or grandchild who is sick and in need of care at any given point could be put at risk because of the failings of the healthcare strategy in the mid-west. Our communities know that people are dying as a consequence. Sadly, people we know have died because of this failed health strategy and family members of the deceased are present with us today.
When the former Minister for Health, Deputy Harris, left the health brief, he acknowledged in an interview to a local newspaper in County Clare that people in the mid-west had been failed. The current Minister for Health, Deputy Stephen Donnelly, also accepted this before he became Minister. Many politicians attend our public protests but there is no follow-up action from them to address the situation. This time last year, we met health spokespersons from various parties because we were extremely concerned that the Christmas period was going to lead to a very serious situation. Sadly, we were not wrong. The Shannondoc out-of-hours GP service collapsed. There was panic. UHL had to declare a major internal incident and surgeries were again cancelled. This year, we have seen trolley numbers trending higher than ever before, indicating that this situation is not improving. On 23 October, a new record was set with 130 members of the public being left waiting on trolleys in the corridors of UHL. The response has been to argue over the metrics, with the Minister for Health favouring a change from the long-accepted Irish Nurses and Midwives Organisation, INMO, Trolleywatch figures to the lower TrollyGAR numbers. Massaging the figures will not do anything for patient care. The response has been to cut funding in the health budget, to introduce a hiring freeze and to introduce a dispersion policy for the elderly to discharge them to nursing homes, regardless of how far they are from their homes or family networks. Given the levels of overcrowding in UHL, we know this will disproportionately affect our communities. Politicians are the policymakers. Everybody knows what is happening in UHL so why the inaction in addressing this? Without a serious change in policy direction, the situation in the mid-west will continue to get worse. That is why we ask members to heed our petition and recommend the upgrading of our hospitals to model 3 and the reopening of our accident and emergency units.
Martin Browne (Tipperary, Sinn Fein)
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I thank Ms Moran. I call Ms McMahon to make her opening statement.
Ms Marie McMahon:
There are 514 people dead. That is a shocking and unforgivable number. Yet, that is the minimum number of deaths the Mid-West Hospital Campaign estimates has happened in our region at the only ED - that at UHL - since our petition, with over 15,000 signatures, was first submitted to this committee on 21 June 2022. Our conservative estimate is based on extensive research carried out by Dr. Chris Moulton and Dr. Cliff Mann, who both have a litany of titles following their names. Dr. Moulton is a consultant in emergency medicine, is involved with the European Society for Emergency Medicine, and is a senior lecturer in emergency medicine at the University of Manchester. Dr. Cliff Mann was the NHS national clinical adviser for accident and emergency care and has other titles. The research was carried out in England in 2019, a country where the ED set-up is very similar to that in Ireland. Further research by other experts in emergency care has since been carried out which supports the findings of Dr. Moulton and Dr. Mann. Based on the outlined research, 514 is the minimum estimate of those who have died as a direct result of delays in the ED at UHL since this petition was presented to this Department. It is a damning indictment on any Government and any health Department that it could ignore five people dying in such a timeframe but over 500 people dying in one small region of the country is unforgivable. It had and has become far too easy to ignore but no more.
Despite extensive lobbying, our political representatives from the counties of Clare, Limerick and north Tipperary have failed to endorse our simple request, which is the reinstatement of our EDs in Ennis, St. John's Hospital and Nenagh. Almost all political representatives from across the region, both in the Dáil and the Seanad, have remained silent on the reintroduction of our EDs.
There has been much deflection. We need more elective hospitals, which do not have emergency departments, more private hospitals, care in the community and ambulance protocol - we have heard it all. Not one political representative from our region has ever acknowledged that this region has only one hospital for a population of over 400,000. Compare that with the furore over Letterkenny hospital – a model 3 with an emergency department – even though the Saolta University Health Care Group region has an emergency department for every 120,000 people. Some political representatives have told us they have spoken to the Minister for Health, officials or colleagues, but they never give us any detail. Words are cheap. We need action. To date, there has been very little.
This campaign continues to do the research. This campaign has worked out just how deprived and starved our area is in comparison to others when it comes to emergency department provision. We have had to do our own research without the help or support of any regional politicians, who have numerous resources, including fully funded staff, to assist them, yet they reassure the region's population that they are on our side. The Minister and many others have talked repeatedly about the investment in UHL and how facilities there are better there than in Portlaoise, Tullamore and Waterford, all of which have emergency departments. The population of Portlaoise's region have 11 other emergency departments to choose from in the same timeframe it would take me and many others in Clare to reach UHL. In Tullamore's region, there is a choice of ten other emergency departments for the population while those in Waterford have a choice of three others in the same timeframe. I do not have that choice. I have one hospital to go to, and that is Limerick. Why are the people of our region treated as second class citizens?
This campaign wrote to the Minister on 5 July following his visit to Clare and Limerick. The reply we received, dated 19 July, failed to address most of the issues we raised. The campaign responded on 19 August and here we are today, 16 November, still awaiting an answer.
A substantial number of people living in the region live over one hour away from Limerick. This does not account for delays in ambulance availability or the difficulties with Shannondoc. No wonder people have said time and again that they do not want to be taken to Limerick's emergency department if they are ill and that they would rather die in their own homes and in their own beds than on a trolley. I wish I had done that for my husband. I would suggest that there are very few families living in the region who have not had, or know of someone who has had, a traumatising experience in UHL's emergency department.
Between 21 June 2022, which is when the petition was submitted, and 13 November, which was the date of this submission, a total of 38,143 people were on trolleys and chairs in UHL's emergency department. Since January 2023, many days have been recorded as having over 100 people on trolleys and chairs in UHL, with a new record of 130 set on 23 October. These figures are counted and published by the INMO, which has been doing this since 2004. It only counts trolleys Monday to Friday, so Saturdays, Sundays and bank holidays are not counted. This is something we as a campaign stress when weekly, monthly and yearly figures are counted, and it is important that this is recognised. The campaign takes a weekly average of Monday to Friday and averages out a figure for Saturday and Sunday. In recent months, attempts have been made to dispute the TrolleyGar figures by Government politicians and HSE personnel. Why now when those figures have never been disputed in more than 18 years of counting? I think we know what the answer is.
My husband died on a trolley back in April 2018. For the first 14 hours he was on that trolley, he would not have been in the TrolleyGar figures because he had not been seen by any doctor. That puts the TrolleyGar figures into perspective.
We in the mid-west region know the reality of having to attend the emergency department of UHL. Sadly, it is our reality and lived experience.
Martin Browne (Tipperary, Sinn Fein)
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I thank Ms McMahon. I invite Ms Tonge to make her opening statement.
Ms Hilary Tonge:
I have lived in Ennis, County Clare, for 40 years. My children were born in Ennis general hospital. Those were the days when we had a maternity service. Now, women from Clare travel from Limerick or Galway to have their Clare babies, that is, if they do not give birth in an ambulance on the way. We also remember how we had an emergency department.
Ennis Hospital is still a great hospital with great staff, but it is not getting the resources it deserves. It has far more potential. There was a large campaign in 2009 to save Ennis general hospital from being downgraded. We were told we were getting a centre of excellence, yet here we are. Everyone in County Clare recognises the value of Ennis general hospital and that it is vital that it be upgraded and our accident and emergency department be opened. This would be in the interests of public safety. The reopening is consistently sidelined and, despite all the promises to address the crisis, the situation has only worsened. We in Ennis are constantly told that UHL is only half an hour away, but the reality is different when someone calls for an ambulance. For example, a sportsman recently waited over an hour while injured on the pitch in Cusack Park before the ambulance could reach him from Ennis town. Sadly, this was not an isolated incident. The change in ambulance protocol has had no impact because beds were closed in Ennis when it was downgraded. Currently, we have three beds set aside for ambulances in Ennis.
The medical assessment unit provides a fantastic service, but the hours have not been extended to 24-7 as promised. Operating from 8 a.m. to 8 p.m. is not good enough, especially when the unit does not accept under-fives even while the HSE is on our radios telling us that RSV can be serious for under-fours. We have no alternative but to go to UHL. People in Clare need answers.
I am here today to stand in for my colleague from Limerick, who cannot be with us. The campaign in Limerick has prepared a statement, which I will now read.
Since the reconfiguration of hospitals in the mid-west over a decade ago, when three accident and emergency departments were closed to make way for a centre-of-excellence accident and emergency unit based in UHL, the people of the mid-west have been failed. According to the 2022 census, the population in Limerick alone has grown by 8% since 2016 and the number of people aged 65 years and over in the county has increased by a significant 23%. In the past, St John’s accident and emergency unit, which was one of the smallest accident and emergency units, closed. It catered largely for the population of Limerick city, with the rest of the county attending UHL. Its removal is having a very detrimental effect on the health of the densely populated working class estates in Limerick. The elderly population in those areas often express their horror at having to attend the overcrowded conditions in UHL, many saying they would rather die at home than lie on a trolley for days. This is a shocking indictment of the health service in the mid-west.
Limerick is a growing city. It is home to many multinationals and the workers that follow them. Project Ireland 2040 envisages population growth of 50% to 60% for Limerick by 2040. Nowhere in health planning for the mid-west is this large population growth catered for. One hospital will not be able to cater for it, let alone for the whole population of the mid-west in the three counties of Limerick, Clare and Tipperary. We in Limerick feel badly let down by the health service being provided for our people.
Ms Tricia Delaney:
My name is Tricia Delaney. I am a representative of Nenagh Needs Its A and E, a grassroots organisation fighting for the restoration of vital emergency department services in our local hospitals, including Nenagh. In 2009, Nenagh Hospital, Ennis Hospital and St. John's Hospital Limerick witnessed a downgrading of their emergency departments to the status of local injury units. The decision in this regard had severe consequences for our communities as it meant that only basic injuries could be treated locally while more serious cases were diverted to UHL. Regrettably, the promised expansion of patient capacity at UHL, the central hub for ED services, has not materialised in the 14 years since the downgrade.
Today, despite the heroic efforts of staff on the ground, UHL's emergency department stands as the worst performing in Ireland by numerous metrics, consistently facing severe overcrowding and posing a clear threat to patient safety. The dire situation in UHL has resulted in vulnerable and sick individuals, including the elderly, enduring shameful conditions. Patients often spend days on trolleys before receiving the necessary treatment or being transferred to a hospital ward. Expert evidence has highlighted cases where patients suffered long-term health consequences or tragically lost their lives due to extended stays in UHL's emergency department. This crisis is not just a matter of statistics; it profoundly affects our community. More than 15,000 concerned citizens have signed a petition, a collective plea for the restoration of full emergency department services at Nenagh Hospital, Ennis Hospital and St. John's Hospital Limerick.
The people have endured 14 years of broken promises and failed attempts to address this escalating crisis. Any solutions put forward by the Department of Health and the HSE have proven to be nothing more than patchwork efforts and have failed. The people of the mid-west deserve more than temporary fixes. It is time for comprehensive, sustainable solutions that prioritise the health and well-being of our communities. We are well aware that many within Government, the HSE and political classes on all sides view our demands as naive. However, in the 14-year period since the ill-fated hospital reconfigurations, neither the HSE nor the Government have presented any effective solutions to address the dire overcrowding at University Hospital Limerick's emergency department. This overcrowding poses an immediate threat to the safety and well-being of well over 400,000 people in north Tipperary and across the mid-west.
On 24 June 2022, the Minister for Health, Deputy Stephen Donnelly, spoke to Tipp FM. When pressed on the success or failure of reconfiguration, he responded, “It clearly hasn’t worked”. We come here today not only as advocates for change but representing a community that has borne the brunt of a failed reconfiguration. We urge the Government to listen to the words of its own Minister when he admitted that reconfiguration has not worked, to consider the 15,000 voices represented in our petition and take decisive action. The restoration of full emergency department services at Nenagh Hospital, Ennis Hospital and St. John's Hospital Limerick is not just a demand; it is a lifeline for the people who signed this petition.
Martin Browne (Tipperary, Sinn Fein)
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I thank Ms Delaney. I now invite members to ask any questions they might have. I see Deputy Higgins's hand is raised.
Emer Higgins (Dublin Mid West, Fine Gael)
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I thank the Cathaoirleach for letting me in. I have to make a contribution in the Dáil shortly, so I appreciate the opportunity to speak early. I thank all four of the witnesses for coming in today, advocating on behalf of their community and sharing their own personal experience. My deepest condolences to Ms McMahon on the loss of her husband in what sound like very difficult circumstances.
We are talking about three different accident and emergency departments here, in Ennis, Nenagh and St. John's Hospital. If the Minister were to change the strategy around reconfiguration, he would obviously have to implement some level of prioritisation as to which would get reopened first. What are the witnesses' views, as a collective, on what the priority should be if one or more of these accident and emergency departments were to be reopened? Ms Moran might be the best person to take that question.
Ms Noeleen Moran:
This is a question that gets asked of us all the time. If there was an offer of an emergency department on the table, that is something we can discuss and flesh out in more detail. Our campaigns are united. We are three different community campaigns, from Limerick, from Tipperary and County Clare. All of us know that if is were a model 3 hospital put in any one area of this region, it will benefit us all. We are united. We will all fight for our own areas and our own turf. Obviously, me being from Clare I will be shouting for Ennis, Ms Delaney will be shouting for Tipperary and the Limerick campaign will be shouting for St. John's but we know it will benefit all areas to at least have one additional emergency department Do not forget that there were three there to begin with and we are only asking that the Government put back what was already there.
Emer Higgins (Dublin Mid West, Fine Gael)
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One additional emergency department in any of those three areas would be a big step forward.
Ms Noeleen Moran:
If I could just have another minute to explain, examining the HIQA reports and the Deloitte reports, the second HIQA report tells us that there is a major mismatch between capacity and the demand in our area. That report tells us that 79,644 people attended the emergency department in Limerick in 2022. The Deloitte report tells us that the emergency department in Limerick was built for a capacity of 70,000. We are already 10,000 over capacity in one emergency department. The effects are what the ladies to my left have been telling the committee about. It is imperative that the emergency departments are put back because this is the reality. It is capacity versus demand. The hospital does not have enough capacity to cater for the needs of the people. We have a population of 400,000 but that swells during summer months with tourists coming into the region, so it becomes even more difficult. It is a year-round problem with the number of people on trolleys and we just keep making new records every year this continues. On 23 October, there were 130 people on trolleys. It is a very dangerous situation for people in the mid-west and something has to be done.
Martin Browne (Tipperary, Sinn Fein)
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Does Deputy Higgins have any more questions?
Emer Higgins (Dublin Mid West, Fine Gael)
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No, that is fine.
Richard O'Donoghue (Limerick County, Independent)
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I thank the witnesses for their presentation. I was one of the TDs at their protest. I have been at every protest since and I will be at all the rest. At the end of May this year, I had a TIA. The one request I had from my own doctor was not to send me to UHL, so I went to Ennis. When I got to Ennis, they could not do all of the tests. There was one test they did not have the machine for so they had to send me back to UHL. I arrived back to UHL at 4.30 p.m. and I was put down as tier 3 and put in a seat. I was seen after an hour and a half and then they said they had to do the blood pressure or whatever and that a doctor wanted to see me. I said that was fine. That happened at 11 o'clock that night and then they said I was not going home and they were keeping me. I said that was fine. They asked if I would mind waiting in the waiting room. I went out to the waiting room and I waited. At 4.45 that morning I went to the reception and asked if I should go home and come back tomorrow. They said if I left I would have to start all over again. I told them I was going out to my car I was going to sit in the car. I gave them my number and said to call me because I could not stay sitting inside but I could not do that. Eventually, they gave me trolley. I think it was 7 o'clock in the morning. I was there for two days on the trolley.
I am very sorry to hear about Ms McMahon's husband. The presentation correctly said that policy is made here. The politicians who are here are the ones who have been fighting for the witnesses since day one but we do not have an overall majority. If we could, we would change it tomorrow morning. I am putting it back on the witnesses. When it comes to the next general election, they should look at the people who tried to change it for them, who will then become the policy makers the witnesses are looking for.
The problem at UHL started when it was made a centre of excellence. I remember as a young person going into Barrington's Hospital. I have been in St. John's and the hospitals in Ennis and Nenagh - all of the hospitals. They should never have closed the emergency services in those hospitals. I know that and we are fighting all the time to have them reopened. The CEO of the UHL appeared before this committee. When the Minister goes down, the hospital is notified and there is a quick clean up and a massaging of the figures, and he does not see anything wrong.
When the petitioner says that no politicians have responded, that is incorrect. Politicians have responded but the Government is the one making the decision for these hospitals. It is not just the witnesses' responsibility, it is our responsibility and that of every person in that region to make sure those policy makers are not returned the next time because they have failed to listen to the people in that region. If each of us was asked here whether we voted for them, people would say "Yes". I was one of them myself. I voted for them. Will I vote for them again? The answer is "No". Why? It is because they have never listened to the real problems and how to fix things. They have made a mistake and then tried to cover it up and patch it up rather than putting their hands up and saying they had made a mistake and should never have closed down emergency services and downsized those hospitals.
Martin Browne (Tipperary, Sinn Fein)
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Regarding claims that the Government has covered up, the Deputy should be careful with the language being used. That is all we are asking. If the Government makes mistakes, that is fine. Let it admit it but the Deputy should not accuse it when it does not-----
Richard O'Donoghue (Limerick County, Independent)
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I will do that on the floor of the Dáil but I am not and never have been afraid to speak up. I will take the advice of An Cathaoirleach. The Government has made mistakes. When you make a mistake, if you stand up, say you have made a mistake, try to fix it and listen to the people who know, it is an honourable thing to do. Anyone can make a mistake. By not fixing its mistake, the Government is putting lives at risk. How many people have come from Ennis and Nenagh, passed those hospitals on the way to UHL and died on the way to hospital? They did not even get there. This is negligence on behalf of the policy makers and Ministers. We must hold them to account for people's lives. I will not stop fighting but the only way we can change policy is by changing Government and this is in the witnesses' hands. It is in the hands of every person in those areas because they can see that there has been a problem for the past 15 years and the only way to fix that problem to fix the policy makers. Unless we have an overall majority, we cannot change it. They are the people we need to target to make sure this happens and they need to be reminded of this.
Martin Browne (Tipperary, Sinn Fein)
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Does Ms Moran wish to respond?
Ms Noeleen Moran:
I know Deputy O'Donoghue has spoken up on local radio and supported us and this is appreciated. What we are talking about here is a recurring theme. On leaving office, the previous Minister for Health, Simon Harris, admitted that the Government failed the people of the mid-west. Before he assumed office, the current Minister for Health admitted that there is a big problem. However, when they are in office, the situation changes.
If members are analysing the HIQA reports and Deloitte report and looking at what has been left out from one to the other, there was a proposal to explore a model three hospital - that was a commitment from UHL management - in the first HIQA report. In a second HIQA report, that was dropped, it has not been followed up and they have not looked at the long-term objectives that were put in place to bring the hospital back into compliance with national standards. This has been ignored. Instead they have replaced it with a proposal to examine floor plans to see how they can space out trolleys better and create room for more. What we hope to get from members is for members to chase that and find out why that long-term objective - the commitment made by UHL management - has been let go and where the long-term plan is because the standards have not changed. The standards the hospital was not compliant with in the first report are the same standards it was not compliant with in the second report. This was one of the main commitments made by UHL management. Where has it gone? It is the answer to our model three hospital, the upgrading of our hospitals first and then the reopening of our accident and emergency departments, which will balance the mismatch between capacity and demand in our region. This is my ask of members.
Richard O'Donoghue (Limerick County, Independent)
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I cannot blame staff in the emergency department in Limerick because they go above and beyond to do what they have to do. A trolley had been moved twice to get a machine out to cater for somebody else. It was something you should not see anywhere but when you got to where you needed to get to for care, you got excellent care within the hospital system. Having to lean over two or three trolleys to get to somebody to help them is not fair on the staff or patients in that hospital. It is not fair in any work environment. I cannot fault the staff. It must come from the management and the Government to ensure we reopen. I hear what Ms Moran is saying 100%. I will check all of that and ask them why those reports have not been implemented. We have been doing things for years and people have been asking for things for years but they have never changed so maybe we should try something new.
Michael McNamara (Clare, Independent)
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I thank the witnesses for their consistent advocacy on this issue, which is probably the biggest issue in the mid-west. They are right. Nobody in the mid-west has not been affected by the hospital there. I have been in the old accident and emergency department and the new one with a family member and I have been in an accident and emergency department in Dublin with a family member purely by accident when they became ill. There is a world of difference between the new accident and emergency department, which is going to solve all the problems, and the accident and emergency department in Tallaght University Hospital. There should not be a world of difference.
Every political party in the State claims to be republican in one way, shape or form and there have been many celebrations of 100 years of the Irish State and how great it is to be a republic. It is nonsense when there is such a gulf between hospital care in one part of the country and another. My son is not a first-class citizen and my parents were not second-class citizens. There is no such thing but that is what we have in this country. I listened to Deputy Higgins - and I do not want to make this about party politics - but which accident and emergency department would she like to reopen? Which one would she like to close in west Dublin? If Tallaght and Blanchardstown both closed or if Deputy Higgins was asked to choose-----
Martin Browne (Tipperary, Sinn Fein)
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The witnesses are in the mid-west. I ask Deputy McNamara to talk about it, or we can finish up.
Michael McNamara (Clare, Independent)
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Nobody asks this question about which hospital we should close in Dublin so we can open one in the mid-west. No one ever asks this question, but they are asked it.
I am, though, going to ask a relatively difficult question. As a public representative, I raise this issue, as does Deputy O'Donoghue, as do the representatives from Fine Gael, Fianna Fáil, Sinn Féin and other Independent representatives from the region. In fairness, everybody raises this issue. We are told it is not possible to safely operate an accident and emergency department without a critical care unit because a certain percentage of patients who come into the department require critical care. Ennis Hospital does not have a critical care unit and, therefore, the idea of opening an accident and emergency department there is said to be unsafe. On that basis, the least I have advocated for is to have any and all services that can be provided in Ennis to be provided there to avoid people having to go to the accident and emergency department.
Deputy O'Donoghue gave an example of several tests being able to be carried out in one short visit. I do not know and perhaps I am a political coward but, of course, one model 4 hospital in the mid-west is going to be inadequate. This idea of an elective hospital will, I am certain, make money for private healthcare, but I have concerns regarding whether it will improve healthcare for people across the mid-west. What are the views of the witnesses on this argument regarding the need to have a critical care unit to open an accident and emergency department safely? Is there something that can be done short of this? This is not to say it should not be a long-term ambition or that it is not a valid one.
My point, though, is that if it is not possible to staff the accident and emergency department in UHL, then it is unlikely it will be possible to staff another accident and emergency department in another hospital immediately. There are, however, things that could be done within 12 months or two years. I say this because we work in the short term in politics. I will be a TD until the end of this Dáil, as will Deputies Wynne and O'Donoghue, and it will be likewise with Senators and the end of this Seanad. It is all about short-term periods. In the lifetime of one Dáil, in five years, which is the maximum a Dáil term can be, what is the maximum that could be realistically achieved in this regard?
Michael McNamara (Clare, Independent)
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What is possible from a hospital perspective?
Ms Noeleen Moran:
We are not clinical experts. Former clinicians at UHL have already stated that patients, from County Clare especially, should be moved through Ennis Hospital and filtered from there. Only those patients needing the most intensive care should be sent on to the accident and emergency department in UHL. We do not, though, have the hospital at that level yet. It has not been upgraded and we do not have an accident and emergency department, so that cannot happen. The ambulance protocol brought into being resulted in only three beds being set aside in Ennis Hospital. I think it is the same in the hospital in Nenagh. Tricia will confirm that. Three beds are not going to make a drop in the ocean when the figure for overcapacity in the accident and emergency department in UHL is 10,000.
When we met with Bernard Gloster, the CEO of the HSE, he told us his hands are tied because he is administering a policy that has been handed to him. It is clinicians who are advising the Department of Health. We asked if there was representation from the mid-west among them, because it does not feel like it. He did tell us he would come back to us and give us more detail on what is happening about who these clinicians are who are advising and designing the programme for the mid-west, because it is clearly not working and functioning for us.
I do not know if I can answer the Deputy's question because I do not have the expertise to do so. I know it is not necessary to be an expert to recognise when something is broken, not working and not serving the people of County Clare, Nenagh or Limerick. The Deputy has spoken a great deal about this issue during his time in office. Regarding what can be done in five years, it is in the hands and power of the Oireachtas Members to do it. The policy document being blamed for this situation, the small hospitals framework development plan from 2013, needs to be scrutinised and examined. We are being told our hospitals are locked in as model 2 hospitals and cannot change out of that shape because they are guided by this policy document. In the next few months before the next election comes around, I suggest this document be examined and pulled apart.
Martin Browne (Tipperary, Sinn Fein)
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When did you meet Mr. Gloster? Did he give any indication of when he would come back to you all?
Michael McNamara (Clare, Independent)
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I thank the witnesses. That is my question. Most people accept there will be a need to have another model 3 or model 4 hospital in the mid-west if the population continues to increase, etc. In the meantime, however, it is a question of what is safe or what can be done in the short term to improve a dire situation. I think Noeleen has answered this question. Even if it is not possible to have an accident and emergency department in Ennis Hospital, many of the facilities can be provided there. If Ennis, Nenagh or St. John's were properly equipped and resourced, dealing with people in those hospitals would save many people having to go to the accident and emergency department in UHL.
Martin Browne (Tipperary, Sinn Fein)
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Work away.
Ms Marie McMahon:
I mentioned earlier the figure of 400,000-plus people in our region. We are the only region with one hospital. The one nearest to us, with three accident and emergency departments, is the Cork-Kerry region, and those departments each serve a population of 230,000. Even if we had an additional accident and emergency department, therefore, we would still be near the bottom but at least we would not be deprived. As I said, there is always a furore now about Letterkenny hospital. In the Saolta university hospital group district, there is an accident and emergency department for every 120,000 people. I just read recently, and this is something I have to follow up on, that there are plans to upgrade the hospital in County Mayo, which is also in the Saolta district. If it can be done there, and if the politicians can make such a fuss over the hospital in Letterkenny, why can we not have the same in counties Clare, Tipperary and Limerick?
This is all we are asking for. We are only asking to be treated with equality. As was said earlier, we are second-class citizens in our regions when it comes to healthcare provision. It is not right. I meet people all the time, as we all do, and I am sure the members of the committee could back this up as well, including in County Clare, who tell me they have told their families that if they get sick, need an ambulance and have to go to the hospital in Limerick, to please leave them at home to die. When people are talking like that, something is fundamentally wrong. When the majority of our politicians, and I am sorry to Deputy O'Donoghue, because I do not mean all politicians, are not prepared to listen, then something is wrong. All we are asking for is equality, that we do not keep suffering and that people will not have this fear. Fear does not help when you are not well. It brings you down even further. I just wanted to clarify this point.
Michael McNamara (Clare, Independent)
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I thank Ms McMahon.
Martin Browne (Tipperary, Sinn Fein)
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Would any other witnesses like to contribute? Is Deputy McNamara finished?
Michael McNamara (Clare, Independent)
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I thank the Cathaoirleach. There is a Bill in the housing committee chaired by Deputy Matthews that I need to go to. I am sorry. I thank the witnesses very much for their presentations.
Martin Browne (Tipperary, Sinn Fein)
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I thank Deputy McNamara. On my own behalf, I express my condolences to Marie regarding her husband-----
Michael McNamara (Clare, Independent)
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I join that expression of condolence.
Martin Browne (Tipperary, Sinn Fein)
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I call Deputy Wynne.
Violet-Anne Wynne (Clare, Independent)
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I thank the witnesses for their presentations and contributions. I commend the work that has gone into their campaign. The collection of the 15,000 signatures is extremely significant, as is the time they have spent on this matter, raising it as best they could. I have several points I wish to raise and then one or two questions, which I might just leave until the end.
Between them, the four witnesses have touched on all the most important aspects of access to healthcare. It is about equity and equity of resources, especially for the mid-west. It is important to note that, from the start, with the then Minister for Health, Deputy Harris, right through to now with the Taoiseach and the current Minister for Health, Deputy Donnelly, there has been an admittance of the failings in the downgrading of the accident and emergency departments.
There is this so-called centre for excellence, which I call a centre for chaos, because that is our experience on the ground. There is such fear among rural constituents that they do not want to attend the emergency departments. It is so prominent, especially among the elderly, who are terrified that they will ever have to face the emergency department and what their experience will be.
I express my condolences to Marie McMahon regarding her husband. I commend her because she shows so much strength each time she speaks about that horrible situation and experience and how it continues to impact her family to this day. It is important to say that.
Some speakers have discussed information they have received. They are referring to the recent UHL briefing we all attended during which many of us raised points around the diminishing access to healthcare because it is not just the emergency department there. Our guests have rightly pointed to Shannondoc and the issues around access to that out-of-hours service and how inconsistent it can be, including how it just fell apart completely last Christmas. Calls were not answered and people did not get the necessary access they required at the time.
Then there is the loss of the maternity unit. Ms Tonge mentioned that. I am thinking of my own experience of having to deliver a baby on the side of the road. I was lucky, it went fine, but the anxiety and anticipation of facing into that is something I hear quite often, especially from women out in west Clare. They have often had to deliver by themselves without any medical assistance whatever; just them on their couch with their sister or mother helping. They know this happens. Many pregnant women who are far from emergency departments are suffering a lot of anxiety when pregnant, which is unfortunate. Ms McMahon also mentioned fear. It is the most negative emotion we can experience and it has detrimental impacts on our mental well-being and our health.
Reconfiguration failed because it was not backed up with resources and funding. Consultants have noted this. The acknowledgement of failure was one thing but the fact it has not been backed up since by any long-term plan or the resources necessary to pave the way to that result has been a disgrace, to put it mildly. I have been trying to follow up on this. I had a meeting with Bernard Gloster. He said his hands were tied and it was a policy decision and has to come from the Government. I have chased that up with the Minister or HSE and tried to come at it from a different angle to ascertain the costings required to pave that pathway, but they have been unable to give me any costings so far. When it comes to who is responsible for outlining that plan and how we get there, one will point to the other. The HSE points will point to the Government and the Government will point to the HSE. That has been frustrating.
The numbers attending the emergency department in UHL who do not receive care was highlighted in the summer. It it is nearly 10,000. That is of huge concern and the writing is on the wall for the reasons the campaigners have outlined. They must reinstate the Ennis emergency department. I know our guests support the reinstatement of the three emergency departments. I would prioritise Ennis because I am based in Clare.
Deputy McNamara mentioned the critical care unit. At the UHL briefing, it was mentioned it would put lives in danger were they to reinstate the emergency department without the critical care unit. I was confused because why would you say you would reinstate an emergency department without putting in place a critical care unit? This is something the campaigners here have felt and experienced.
Did the committee request that a Minister would attend? Did they come back on that? The campaign group met with the various health spokespersons from each of the parties. Did any of those spokespersons give a commitment by their respective parties to reinstate the emergency departments? Individual TDs and Senators may speak in support of reinstatement but I am yet to get that commitment from parties. Have they received that? Ms McMahon gave a figure of 514 who may have died since this group submitted its petition to the committee. That is shocking and a damning indictment on the current Government and its instance of sticking with the policy it has in place.
Ms Noeleen Moran:
On commitments from parties, we had constructive meetings this time last year with each of the health spokespersons from various parties. They all committed to show support but there was no commitment to follow up on that. One party, the Social Democrats, has been very good about putting questions for us but we have not received follow-up from those particular meetings or a commitment to the reopening of the emergency departments.
We have made requests through the petitions committee in our written submission where we suggested various people who might come before the committee, but I do not know if that is something that is on the cards.
Martin Browne (Tipperary, Sinn Fein)
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There is a list of people the campaign has asked us to bring in in front of the committee. I will propose later that we will try to bring those people in and we can quiz them.
Martin Browne (Tipperary, Sinn Fein)
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I will say the list is long and it would be difficult to try to get them all here in a short time. It is asking for nine or ten groups to come in. That would be nearly four meetings and that would be splitting a meeting into two. I have it down to talk to the petitioners and see if we can break it down to, perhaps, the three most important people they would feel the committee could invite in to ask questions and try to get answers. I hope we can but I want to make everyone aware that trying to bring in ten different groups to committees can be next to impossible.
Violet-Anne Wynne (Clare, Independent)
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Was the Minister aware this group was coming here today, do we know?
Martin Browne (Tipperary, Sinn Fein)
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I imagine none of the Ministers know who is coming into the committees.
Violet-Anne Wynne (Clare, Independent)
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I know that the committees can request a Minister to come in at any given time.
Martin Browne (Tipperary, Sinn Fein)
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Yes, but this meeting was for the petitioners to come in and we would talk to them-----
Violet-Anne Wynne (Clare, Independent)
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Fair enough.
Martin Browne (Tipperary, Sinn Fein)
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-----and take away whatever we feel we can to progress the petition afterwards. While we are talking about it, the witnesses have asked for the Minister for Health, the author of the HIQA report, the CEO of the UL Hospitals Group, the former clinical director of the UL Hospitals Group, the HSE representative, representatives from the Sláintecare implementation committee, union representatives, representatives of workers in Shannondoc and the ambulance service and community representatives in the mid-west. We need to cut it down a small bit and try to get people in. If they come in, we can try to get the concern the petitioners have. I will come back to that afterwards. Does the Deputy have any more?
Violet-Anne Wynne (Clare, Independent)
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I think I touched on everything. The only thing I did not mention outside Shannondoc was the issue with GP care in County Clare and how we have 25 fewer than the national average of GPs. I am contacted quite often - every week, actually - by people who are either unable to get an appointment for two or three or they have no GP whatever.
Then there are those who have relocated to County Clare. I believe Ms Tonge mentioned that the population of Clare had risen by 8%. That is in line with the national average but I have no doubt we are actually higher than that because of how census 2022 was collated and published. To put another number to that, that figure is just below 10,000 people of an increase we have seen in the county. This issue will continue to get worse and I am happy to support the campaign group as best and in any way I can because the work the group is doing is vital. This is giving the public a voice and a platform when they organise their protests and everything else, and I know a great deal of work goes into that. I commend the group on its work and support it.
Martin Browne (Tipperary, Sinn Fein)
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I call Senator Gavan.
Paul Gavan (Sinn Fein)
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I thank the Chair and the representatives of the Mid-West Hospital Campaign. A day like today really shows the value of this committee where it gives a voice to people who have been campaigning tirelessly to highlight the horrendous circumstances in which we find ourselves in Limerick, Clare and Tipperary. I have a long history with this issue. I represented workers in Nenagh in 2009 and I remember standing and sharing a platform on a truck in the square in Nenagh with people who were about to come into power a couple of years after. I remember everything they promised with regard to the reconfiguration and what they would do to ensure our hospitals were protected. They got into power and did exactly the opposite. We have had well over a decade of failure.
I will touch on a couple of points which were raised. Ms Moran is absolutely right to highlight the scandalous issue of the hospital trolley numbers which the Minister was always happy to accept when in opposition and which previous Ministers, in fairness to them, such as James Reilly, with whom we would have had many political differences, never disputed. Yet suddenly, this year and at the back end of last year, the Minister, Deputy Donnelly, started disputing the trolley numbers. This is all on the record in the Seanad where I have had stand-up rows with him in this regard because it is a gross insult to the members of the Irish Nurses and Midwives Organisation, INMO, in particular and all of the staff, to dispute these figures. Of course, anyone across the mid-west will tell you the INMO figures are valid.
What has been more frustrating is that both Deputy Quinlivan and I have tried to address this issue through various Topical Issue debates and Commencement matters, and the last four times we tried to do this, the Minister has not even come in to address us. I find that entirely unacceptable. The point made by our guests is absolutely right in that we should not be treated less favourably than other people.
This is all been compounded by a recruitment freeze. I, along with Deputy Quinlivan, met staff from the hospital only three weeks ago. They are in absolute dread because of the recruitment freeze. One of the workers said she expects the hospital to turn into a nursing home during the winter because there just will not be the ability to move patients to get the care they need outside of the hospital. One clear example is the home help situation, where there are 6,000 people on the waiting list and a freeze is now in place, so we cannot even hire any more home helps. As things stand, things are only going to get worse.
The other point I would share with the witnesses is that the turnover rate for staff in University Hospital Limerick, UHL, is just shy of 21%. One in five staff members is leaving. It is an extraordinary rate, even by HSE standards, but it shows the depth of the crisis there and now the hospital cannot actually replace those staff members. We had an horrendous collapse across the entire service at the end of last year and the beginning of January and now we have a recruitment freeze to contend with as we head into this winter, so it is very concerning.
The status quocannot stand, which is the clear position Sinn Féin has. We have seen more broken promises on this. Again, Ms Moran and others are quite right to point out that Ministers, after they have left or before they take the job, say it is not acceptable, but we continue to be denied the health services that we are required to have. I also agree with what Ms Moran said that none of us are medical experts and we cannot prescribe what needs to be done, but Sinn Féin has been very clear in calling for an independent clinical audit to be done as a matter of urgency and to consider all possibilities, including the reopening of accident and emergency departments, and to report back as soon as possible. Does the Mid-West Hospital Campaign support that call because I believe that is the key to having this issue finally resolved? That and, as Deputy O'Donoghue correctly said, a change of Government are needed because we are not going to see change under this Government.
I want to thank our guest speakers for having come in to our committee today.
Ms Noeleen Moran:
Of course we support the calls for any reports but we just feel there have been enough reports. HIQA identified the same point that the overcrowding was as a result of the fact there was not a model 3 hospital in the region. That then led the university hospital management committee to the long-term objective of exploring the option of a model 3 hospital for the region. That did not come to fruition because the second HIQA report, which followed up on the short-term and medium-term measures, did not report on the long-term measures.
We have had report after report and if that is how the Senator sees a means to an end, by all means commission another report, but can the Senator see my point here? There have been several reports. If they are studied and if the analysis is done on them, the information is already there and we believe HIQA staff are experts in their fields and have identified the issues in those reports. Deloitte, which is commissioned by the management of the hospital, gives a balance to both sides, where you get both views of what is going on here. We completely support anything that leads to the means to the end or that leads to an improvement of the situation, but we just feel there has been report after report and sometimes that can be a bit of a time-wasting exercise in kicking the can down the road. If you study those reports which have already been published, the information exists and is in them and the consultants themselves have raised these matters. I would be very interested in knowing who the clinicians advising the Department of Health are and what their advice is. Perhaps the Senator is in a better position to find out those answers and to determine what they are basing their advice on.
Ms Marie McMahon:
I agree with everything Ms Moran has said, and to be honest and to put it bluntly, I am tired of reading reports and of reading different opinions. I have seen and read it all. In the meantime, people are dying. What we want is a solution to that, and my question to the committee would be to ask if it supports our campaign's ambition to reopen emergency departments in this region. Does it support that?
Paul Gavan (Sinn Fein)
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I have been consistent throughout my time as a trade union official and as a member of the Seanad in calling for the most urgent action on this issue. As Ms Moran has said and I readily agree with her, I am not a medical expert and that is why I take the position I have. Another excellent point made by Ms Moran was to ask what type of advice the Minister is getting. That is why we need, not another report, but an independent audit looking at all of the options to report as soon as possible so that we finally put an end to this crisis. That is my call and I am glad to see Ms Moran supports that call. I believe that is the pathway to finally resolving these issues, but I have to be frank that it will not happen under this Government.
Ms Marie McMahon:
I accept what the Senator is saying and I agree with Ms Moran, but from my point of view, I have heard the clinical experts, whoever they are. They have been allowed to dictate. The information is there and there is report after report. If you reads the work and report done by Dr. Moulton and Dr. Mann in England, it is all there. The information is there.
Paul Gavan (Sinn Fein)
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I have read that report and Ms McMahon is absolutely right to highlight that. I would say I have highlighted that at least half a dozen times.
Paul Gavan (Sinn Fein)
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People's lives are being lost. I checked this morning and, even as we speak, I believe there are 84 people on trolleys this morning.
Paul Gavan (Sinn Fein)
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That will mean at least one further life lost. I would just give one other statistic for the record and for the committee, which is that last year the horrendous total was 18,012 patients for the whole year.
Paul Gavan (Sinn Fein)
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Right now, today, we already have 18,963 patients who have spent time on trolleys. We have already broken our horrendous record and there is still another six weeks to go before the end of the year. It continues to get worse and words genuinely fail me with regard to the Minister and the Government's failure to address this.
Ms Marie McMahon:
Just to clarify something I said earlier, the figure is not 18,000. It is nearly 27,000. I am doing this from memory. The figures the Senator is quoting do not include Saturday, Sunday or bank holidays. Our figures reflect that to the best of our ability because we do an average weekly.
Paul Gavan (Sinn Fein)
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I agree; it is even worse than I stated. My point is when we keep seeing it get worse and worse each year, the failure and inaction at Government level is what completely flounders me. It is entirely unacceptable.
Martin Browne (Tipperary, Sinn Fein)
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We have a list of what we need to break down. We are not going to be able to answer the questions Ms McMahon is asking today. We need those people sitting where our guests are in order that the members can start putting the questions to them and they can give us the answers.
Paul Gavan (Sinn Fein)
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That is perhaps the most valuable part of today, the fact the witnesses have brought that list. Hopefully through this committee we can hold the relevant people fully to account. That is the key to this. I commend each of our guests for their presentations and the passion with which they have made them today. I hope the committee will follow through on this. I thank Deputy Buckley for allowing me to go early.
Pat Buckley (Cork East, Sinn Fein)
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The reason I let the other speakers go first is that it is their immediate area. I am very proud of this public petitions committee because it is a last chance for the likes of yourselves to be heard. That is what is powerful here. We try not to play politics inside here. It is one of the strange committees because we try to get things done. Listening to the witnesses, there is nothing I can disagree with. It is bonkers. Why try to fix something that was never broken? I hear the pain in all of our guests on different issues. I was actually worried. They are all being realists. Even if only one emergency department was restored, however, it would only be a sticking plaster. On the demographics, the population is expanding, the older population is increasing and percentages are going up. We need to be future-proofing the plan. My biggest fear is for what happens in ten or 12 years. It is major investment but it is investing in people.
The Cathaoirleach already read out what our committee can do. What is so powerful about this is that our guests have made their statements here and they are now on the record. We now have the ability to ask those questions of those who are responsible and accountable. I was wondering when Ms Moran mentioned it, and I would be interested to know who these commissions actually are and who the advisers are. They seem to be going totally against the common-sense approach and the policy approach. I sat on the Sláintecare committee, the membership of which comprised all parties and none. It was a fairly difficult job. We put politics aside because we had to come up with a plan for the benefit of everybody, our parents, our grandparents, if we are lucky enough to have them, and our kids.
The Government policy over the past number of years has been centralisation. I heard the population comparison between the mid-west and Cork and Kerry. Every one of us has been in an accident and emergency department. It is the same story around the country. People do not want to go there any more. They are afraid to go to hospital if they get sick. We can sometimes be very critical of the HSE, but it is not the front-line workers. The issue seems to be with those in top management protecting their patch and moving to privatisation instead of going in the opposite direction. The Sláintecare approach is community led, fully integrated and with each service complemented by another.
There is a massive vacuum at the moment for our guests. They have been at it a long time now and it is going to take another long time even to get something back. I seriously think that no matter what Government is in place, there has to be a major, realistic push on what kind of health service we want in the future. Even our own policy on that was working towards Sláintecare as our own national health service for the country, where it serves the people. The NHS was mentioned. My next-door neighbour is rewriting all the mental health policy over there at the moment. People do talk. This committee is very powerful. I am very glad to listen to all the statements today but it does take time even to get people in as witnesses. Now our guests have opened the door and put their thoughts on the record. They are looking for answers as to why things are not happening. At least if we get to the end of those answers, we might get the solution to why it is not happening or how it can happen again. This committee is possibly the best way to push this case forward.
I suspect there are other areas in the health service, and we are well aware of them in the mental health services, where they are moving away from the community-led models of respite care and pushing it into the cities again. It is definitely a massive policy change that is needed. Unfortunately, with policy change, if we get to the end of this one the first thing I will be trying to find out is who the advisers are and the clinicians who are advising the HSE. It happens an awful lot that there is no co-operation, things are siloed and everybody is protecting their own patch. Again, it comes down to money. Everybody is protecting their own budget instead of being like our guests, who are from all different counties, coming together, pooling their resources with a plan for an end result that benefits everybody. At least they have the model of that work and thinking. The problem we have here is that the clinicians and HSE people are led by the policy, as Ms Moran said. We have to get the clinicians, HSE and policy-makers together to come up with a realistic plan. I always say that you could keep putting the same ingredients into a pot and expect it to taste different every time. It will never taste different unless you change one of the ingredients. This is what we are going to have to do within this system.
I do not play politics with this committee. It is very powerful when it comes to giving an individual or groups their say. I keep saying that this is not our House, this is our guests' House. We are here to work on their behalf. I am a very open and realistic person. Sometimes people will not like my responses, but sometimes the truth is a bitter pill to swallow. Our guests are on the right path now. We will be able to assist them and at least we have the roadmap of who we need to bring in and we have the questions. We can get the answers and move on from their. I wish our guests the very best of luck but I suspect they will not be the only group coming in here in the next year. We have been dealing in committees with respite centres. They are closing them in Tipperary. They are probably closing one in Portlaoise. They have closed the one in Clifden. There is one down by me that was a 22-bed centre. It was lobbying and pushing that got Mr. Gloster to make a commitment to put a ten-bed unit back in there. It is a start. We have an ageing population. We had 22 beds. They have given us back ten, if we will ever see it.
Martin Browne (Tipperary, Sinn Fein)
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Does anyone want to respond to Deputy Buckley?
Ms Marie McMahon:
I thank the Deputy for that. It is good to know we have the support of the committee. It is hard. As the Deputy said, we all do work well together. We have not had any major falling-outs yet. We are very united in our aims. At the end of the day we have all suffered the same fate at various levels. We have a common goal and that is to get what is best not just for ourselves but for our families, neighbours and friends.
As I said earlier, when people say they do not want to go to UHL or to Limerick and would rather die in their beds at home, then we have a problem.
There is something else I want to add that I did not say earlier, which is that the workers in UHL are amazing. I cannot praise the workers in Shannondoc enough. They come under the brunt of it. They are the front-line staff and they are the ones who have to put up with people understandably being angry. Unfortunately, however, the people who are the decision-makers, and we will go back to the clinical experts, do not have to stand and account for it. It is the workers who are taking the brunt of it. Last Christmas, God only knows what the workers went through. I know the ones at Shannondoc were pulling their hair out. We have their backs as well. We want it for everybody. Of course, there will be times when we all get frustrated but this is a constant thing; it is ongoing. I just needed to mention the workers as well. We appreciate all they do and the sacrifices they make. It is not easy. We know they support us as well and that is great.
Martin Browne (Tipperary, Sinn Fein)
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I am sure Ms McMahon has the full support of everybody on the committee with regard to the workers. They have the misfortune of being the people who get caught on the front line, as Ms McMahon said, in all situations right across the board.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I will pick up on Ms McMahon's positive point in terms of the staff right across the healthcare service. I hear what she is saying about UHL but, indeed, they do exemplary work right across our health service and we would be lost without them. They certainly go above and beyond. Ms McMahon spoke of her own experience and knowledge of UHL and I agree with her.
I missed the earlier part of the meeting as I had other business in the House. I apologise, therefore, if there is some repetition in my questions to each of the witnesses. I appreciate them coming in. It is an important conversation to have, certainly, from the bits I heard online and here in the room and from the briefing information material supplied by the witness, which is beneficial.
I have a number of questions. The campaign group was established in 2019. Is that correct?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Have all the witnesses been members since 2019?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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They all started this journey together. That is very good. In terms of the three hospitals we are speaking about today, similar to what Deputy Buckley just said, ideally, everything would return to the way it was. In terms of looking at reopening each one, I see from the briefing material that the witnesses have had many meetings, much correspondence and a lot of engagement. I believe it was Ms McMahon who said she was tired of reports and I hear what she is saying on that front. That said, in terms of the meetings they have had, has there been a discussion around the prioritising of the three hospitals to reopen? I see that everyone is looking at Ms Moran. She must be answering this one.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I apologise for the repetition. In terms of prioritising one over the other, not than anybody would want to, but if they had to or if it was necessary, what would they do?
Ms Noeleen Moran:
This is a question we get asked time and time again. The problem with it is that all our communities had these services to begin with. We have come together. We will all prioritise our own home areas, obviously, but we recognise that even the addition or reintroduction of one emergency department back into the mid-west would make a substantial difference to our community. There is a total mismatch between capacity and demand at University Hospital Limerick. I quoted the HIQA figures earlier. According to the second HIQA report, 79,644 patients attended University Hospital Limerick in 2022 alone. The Deloitte report, which was commissioned by UHL management, determined that 70,000 is what the emergency department was built to cater for, so we are already 10,000 over capacity. The second HIQA report also stated that we have a bed occupancy rate of 105% in UHL. The recommended rate is 85%, so we are way over capacity as it is. When it comes down to this, our campaigns have united because we agree that even the addition of one emergency department in the area will make a substantial difference to all patients in the mid-west region and, therefore, we are not prioritising-----
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Ms Moran is not saying one would be better than the other.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Excuse my ignorance because I obviously do not know the capacity of each one. Which would have the greater capacity?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Yes.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I understand.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I am sorry for cutting across Ms Moran. Who represents which area so that I have a sense of it?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Ms Tonge is just trying to confuse me.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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And Ms Moran?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Okay, very good. In terms of the meetings, I heard earlier that there has been some engagement and, obviously, the reports have been referenced. From 2019 onwards, be it locally or regionally, who have the witnesses met within the HSE? What kinds of stakeholder or decision-makers have they met?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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When was that?
Ms Noeleen Moran:
It was 2019 or 2020. I can get the record for the Deputy. We submitted it to the petitions committee as well. We also raised it at the regional health forum and got the backing of the forum. We raised numerous questions to the HSE officials who attended that meeting. Therefore, we have been in engagement with this for quite some time.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Has there been direct engagement in meetings between the campaign group and the HSE locally or recently?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Recently, obviously.
Ms Noeleen Moran:
Yes. The HSE will tell us that it will only meet with elected representatives. It will not meet with the campaign. As part of the regional health forum motion, an invitation was extended to our campaign members by the representatives of the various councils that attended it. However, the HSE said "No" and that it only meets with the elected representatives so we were left out of that meeting. We have engaged with Mr. Gloster and also the Minister for Health. We met with Leo Varadkar as well, but he is obviously not with the HSE.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Okay. When was the meeting with the Minister for Health? I am just trying to get a timeline on that.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Okay. What is interesting from Ms Moran's evidence is that she mentioned the regional health forum. That was leading to my next question so she has answered that already. Decision-makers locally and regionally attend the health forum. I used to be a member of the health forum and I think the Cathaoirleach may have been too in his previous capacity. Certainly, however, it is very good for issues like this because we are talking about the clinical leads within that area. While I appreciate that the public cannot attend the meetings, it is great to have that support of which Ms Moran spoke, particularly with the backing of Clare County Council. Has it gone to any other council chamber in that area or in the Limerick region?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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The reason I am asking is that engagement on behalf of the public, through the public representatives and regional health forum, is a very good vehicle. While the HSE might not meet the campaign group for whatever reason, this is where this committee comes into its own. We have done this previously but in terms of their campaign, have the witnesses written to or engaged with the Joint Committee on Health as well? That is specifically within its remit.
Ms Marie McMahon:
We did on 5 July this year. Prior to that, the Minister, Stephen Donnelly, was actually in County Clare. We wrote to him. We did not meet with him. We did write quite a lengthy email to him on 5 July, however.
We received a reply on 19 July and, because various people were on holidays, we followed it up on 19 August. As of today, we still have not had a reply.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Sorry, I meant the health committee here in the Oireachtas.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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It is okay. That was another question, so I thank Ms Mahon.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Is it the case that the campaign group has not written directly to the health committee?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Okay. As Deputy Buckley said, we are the end of the road for many groups or individuals who have exhausted all correct and relevant avenues. That is not to deter the representatives from their campaign today. They are here today and that is important. Yet, in my experience, it would be best to go through the health committee, because the Minister will attend it on a regular basis, as the representatives can appreciate. That is just an aside.
In terms of questions-----
Martin Browne (Tipperary, Sinn Fein)
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Sorry, just before Deputy Devlin goes ahead, on 20 September 2022, the committee stated:
The Joint Committee on Health will meet tomorrow, Wednesday, 21st September for a discussion on the serious issues raised in the HIQA report in relation to the Emergency Department at University Hospital Limerick at 9.30 a.m. in Committee Room 2".
That is when it was heard there.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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That was last year.
Martin Browne (Tipperary, Sinn Fein)
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Yes, there was a referral by this committee. That is when it was referred.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Is Deputy O'Donoghue a member of the committee?
Richard O'Donoghue (Limerick County, Independent)
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No, but I was there.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Of course, you would be there.
From a campaign perspective, if it is health-related it should be submitted to the health committee and should not be referred. I think the witnesses need to do that. If they have not done so already I suggest they do. Ms McMahon made an earlier point about actual engagement, such as with the head of the HSE, regional decision-makers, or indeed the Minister and his officials. That is important. While this committee has a good standing, health is not our first remit.
Deputy Buckley made the point about how we in this committee are not political. Is the campaign group apolitical or is it political?
Martin Browne (Tipperary, Sinn Fein)
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Can I answer that? As far as I know-----
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Cathaoirleach, I am asking the witnesses.
Martin Browne (Tipperary, Sinn Fein)
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As far as I know, it is not political.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Is it the case that nobody has political affiliation in the group?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I am not asking who they vote for either. I am just wondering if the campaign group is apolitical.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Yes, that is not uncommon.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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No, obviously. Is it the case that the committee itself is apolitical?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Okay. From our perspective as a committee, we had a recent experience with a number of petitions where we brought in various individuals, such as from the HSE and HIQA. Ms Mahon mentioned the report. In what year was the Deloitte report published?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I suggest in response to the petitioners and the campaign that the best thing for us as a committee would be to extend invitations - reference was made to some of the questions that were put by the campaign group - to the relevant individuals, whether those are within the HSE or more locally and regionally so that we can hear from those clinical decision-makers.
If I may, we got some briefing notes in advance of the witnesses' attendance here today. I will read some of it out here. It regards "the HSE national support team on patient flow and decongesting the UHL site ... following an initial four-week programme". That was back in early July and I presume the witnesses are aware of that. Have they seen any progress following the initiative the HSE undertook in early July?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Even in early July through August, the numbers were still continuing to climb.
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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They did not decline at all in UHL.
Ms Noeleen Moran:
No, even after expert teams had been brought in the previous year. At Christmas there was pretty much a crash where all services went into failure and a major internal incident was declared at the hospital. In early January, more experts were sent in to stabilise and support the services at the hospital. Yet, if you watch the trolley numbers, you will see them continuing to grow and grow. We are heading into another winter. Our main concern, given that these measures have not worked and that we had that catastrophe last winter, relates to the plan for this coming winter. What supports will be in place and how can we ensure that people will be kept as safe as possible, given the conditions this coming winter?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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My final question is about the initiatives that have been put in place. The HSE’s performance management improvement unit has been directed to lead the process in partnership with the UHL team members supporting the hospital and community services in driving a programme to work to respond more effectively to the current pressures. It does not say exactly when that began, but I understand from the briefing note that it is relatively new. Again, there has been no direct engagement with the campaign group. Are the witnesses seeing evidence of any improvements in terms of staffing, staffing levels, bed capacity or any other initiatives that are being run in the hospitals?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I got that figure earlier. Is it the case that they have not seen any evidence of any-----
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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My final point is on staff. Does the campaign group have engagement with staff working in the hospitals?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Sorry, are unions still involved in the campaign?
Martin Browne (Tipperary, Sinn Fein)
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Does Deputy O’Donoghue want to come back in?
Richard O'Donoghue (Limerick County, Independent)
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On the basis of staffing, UHL has one of the highest turnovers of staff in the country. Why do you think that is?
Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I do not know.
Richard O'Donoghue (Limerick County, Independent)
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The questions Deputy Devlin asked the witnesses were good. If he is looking for the facts, I am a Limerick man myself. I am very thankful to the people from Clare and the representatives who are here. There is the question as to why there is such a turnover of staff. A major problem within UHL at the moment is that there is a massive language barrier within the staff.
Richard O'Donoghue (Limerick County, Independent)
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There is a major language barrier with the staff and the recruitment in UHL. They are all health professionals and I have no doubt about that, but it is a major problem when there are elderly people who cannot understand different languages. From the point of view-----
Martin Browne (Tipperary, Sinn Fein)
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Deputy, every hospital in the country faces that.
Richard O'Donoghue (Limerick County, Independent)
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No, actually-----
Martin Browne (Tipperary, Sinn Fein)
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I do not think-----
Richard O'Donoghue (Limerick County, Independent)
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No, if the Cathaoirleach will let me finish the point, I will be able to clarify it further. As a person who has been in other hospitals around the country, I welcome all the healthcare staff. Yet, I hear from the staff themselves - staff of all nationalities - that there is a problem with a language barrier that affects consultants, staff, etc. That is for all nationalities, and not just for people who speak English. They say there is an issue with the language barrier within the hospital itself, which has the highest turnover of staff in the country.
Martin Browne (Tipperary, Sinn Fein)
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I will stop you there, because I do not think either the committee or staff agrees. This clouds the problems that the witnesses are trying to highlight.
Ms Marie McMahon:
Can I just go back to what Deputy Devlin was asking, which was whether there was any noticeable difference in figures since July?
In August the figure was kind of creeping up. All through September and during the first two weeks of October we had record-breaking numbers. For the first time, in the first week of September the number went over 700. Every week through September we had more than 700 on trolleys. That was an average of more than 100 a day, and it was the same for the first two weeks of October. The number was more than 700. To answer the Deputy's question, no, it has not made any difference.
Martin Browne (Tipperary, Sinn Fein)
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Do you wish to come back in, Deputy O'Donoghue?
Richard O'Donoghue (Limerick County, Independent)
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I again thank the witnesses who came in today. I thank them for their courage and for the way they have united together, from Limerick to Clare to Tipperary. From what we can see, the people who are at the coalface of this will understand where it needs to happen and what needs to happen, which is the safety of the public. We can understand this. It has been going on for far too long. As I said, we have had the CEO of UHL in here. The matter has been before the health committee since 2022. It has been going on since the hospital was made a hospital of excellence, which was what created the problem. It never catered for a rise in population. Any time you are doing anything, whether you are in business, no matter what business you do, or whatever else, you do projections, and your projections are based on the turnover of your business and on the population within the area. The hospital of excellence, when this was set out, did not take those factors into account. We can see that an 8% rise in County Limerick alone has created another pressure on UHL. I have said this before and I will say it again: it is not a reflection on the staff within UHL or the work they do. They go above and beyond. It is the conditions they have to work in, which are not safe.
Martin Browne (Tipperary, Sinn Fein)
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I have just three quick questions myself before we finish up or before anybody else comes back in. We hear from the Ministers about the minor injury units, MIUs, and so on and that they would take the pressure off the emergency department. What feedback are the witnesses getting from people who cannot access the likes of them and who finish up in the emergency department in Limerick?
Ms Noeleen Moran:
The reports back are that if you can get in there, they are fantastic services, but they run only from 8 a.m. until 8 p.m., so if you have a sick child in the middle of the night, they are not an option. It is the same with the local injuries unit, and it is the same for Nenagh as for Ennis, as for St. John's. The hours work the same. They are absolutely brilliant services but they are not properly resourced or staffed and cannot operate 24-7.
Martin Browne (Tipperary, Sinn Fein)
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If they were on a 24-7 basis, would it take pressure off?
Ms Noeleen Moran:
Yes, it definitely would, but the beds have to be opened to do that. The promise, if Members remember, was that those services would be extended to 24-7. That has not materialised. It is the same with the changes that were made to the ambulance protocol. That was brought into effect, but only three beds were opened in the hospitals, so only three ambulances that find patients who meet the criteria can be left in Ennis. The rest have to bypass Ennis or Nenagh and be brought to University Hospital Limerick. It is just not at the scale it needs to be.
Martin Browne (Tipperary, Sinn Fein)
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The witnesses have been asked about meeting various groups. Have they ever been offered any opportunity to discuss this with the likes of the Minister, the CEO and so on? Have those in power ever offered to sit down around a table with them?
Ms Noeleen Moran:
Similar to the response to Deputy Devlin a few minutes ago, as part of a motion that was brought before the regional health forum west, it was requested that we would be included in discussions with the HSE and the various representatives from the regional area, and that request was declined, so we did not-----
Martin Browne (Tipperary, Sinn Fein)
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So, from the health forum, that request-----
Martin Browne (Tipperary, Sinn Fein)
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But no one outside of that forum who had known the witnesses were a group of concerned people ever made an offer-----
Ms Noeleen Moran:
No, except for the petitions committee, which has given us a platform. Given the fact it has dragged on a lot longer than we had hoped and because of the seriousness of the issue, we hope to get this moving much sooner. A year has passed since we brought it up initially, but we are here now.
Martin Browne (Tipperary, Sinn Fein)
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I was going to come to that. It has been explained that we apologise as a committee and that it was an administrative error. The witnesses are here, and what we want to do going forward is cut down this list a bit that they gave us in order that we can get some of these people in and try to start to answer the questions the witnesses have asked of us. I am quite sure there are many other TDs who want to ask those kinds of questions of them as well. Coming to that list, can we get back to the witnesses as we try to cut this down?
Martin Browne (Tipperary, Sinn Fein)
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That is what I propose. If someone will second me, we will do that. We will get three or four off the list of ten the witnesses have brought in and we will sit them in this room again in order that the members can quiz them on the witnesses' behalf. Would they be happy with that, that over-----
Martin Browne (Tipperary, Sinn Fein)
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The secretariat will be in contact with the group and we will cut down that list and start trying to move it on as quickly as we can in that way. Senator Eugene Murphy is not here. Deputy O'Donoghue, do you have any more-----
Richard O'Donoghue (Limerick County, Independent)
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No.
Martin Browne (Tipperary, Sinn Fein)
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Before we let the witnesses go, does anybody on behalf of the group wish to make any closing statement?
Ms Noeleen Moran:
No. We just thank all the members who came in here and supported us today. Obviously, the big concern for us is this coming winter and getting something in place to protect the citizens from our communities, be it at Shannondoc level, be it at GP level, be it at the local injury units and medical assessment units or, majorly, in the emergency department. Nobody wants to end up there, but it is the reality for many people who have no alternative that they will have to go there when the other services go on holidays - not go on holidays, but the staff have to take breaks for Christmas. That is understood and respected, but a plan needs to be put in place to cater for the public and not allow a situation such as last year to happen again.
Martin Browne (Tipperary, Sinn Fein)
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I can guarantee you, and I can speak for the rest of the committee, that we will move this on as quickly as we can. It is slow trying to get answers from the Departments and from Ministers and so on, but I say on behalf of us and on behalf of the witnesses and other petitioners, that the staff and the work they do are unbelievable. We will try to move this on as quickly as we can.
Martin Browne (Tipperary, Sinn Fein)
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That is probably something on which we as a committee can contact the Department on the witnesses' behalf and try to move.
Ms Marie McMahon:
We cannot have a situation such as we had last Christmas and into the new year, where staff in both the emergency department and Shannondoc were left to cope. There was no way of contacting any management. People were coming to us, texting us, ringing us, contacting us by email, asking where they could go to get a doctor. We could not get a doctor for about four or five days and we could not contact anybody. There was no system whereby any manager seemed to be contactable. The staff were left to deal with that, and that is totally unacceptable.
Martin Browne (Tipperary, Sinn Fein)
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Was it ever put to the Minister or the Department that even if the MIUs were 24-7 at this stage, it would take massive pressure off-----
Ms Noeleen Moran:
Yes. We were campaigning on that this time last year, when we met every one of the health spokespersons from the various parties. That was something we were pushing, as was the extension of the ambulance protocol, which was being trialled only in Mallow at the time. That should be rolled out, but I think it was the CEO of UHL, Colette Cowan, who said that was not feasible due to staffing and bed issues. We should be able to get clarification on that. It was promised, it was announced, but it did not materialise.
Martin Browne (Tipperary, Sinn Fein)
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On behalf of the committee, I thank Ms Moran, Ms McMahon, Ms Tonge and Ms Delaney. As soon as we hear anything back, we will try to get those answers for you. We will try to get people in before us here. As soon as we get that, there will not be the same delay again. We promise you that.
The meeting is suspended for five minutes while the witnesses leave the room.