Michael McNamara (Clare, Independent) | Oireachtas source

I thank Sinn Féin for tabling this motion. I partially heard the Minister's response to it. What I heard was slightly surprising in that, on the one hand, the Minister accused Sinn Féin of playing politics and not going with the clinical advice and, on the other hand, it appeared that he overruled the clinical advice and said they were not going ahead as previously planned.

UHL and what can go wrong have been brought up on a number of occasions. The clinical advice at the time was that we needed to consolidate the provision of emergency medicine at UHL, and that is what was done. On 15 March, there was a surprise visit by HIQA to the hospital. That was not the first surprise visit; there was one back in 2014 since that consolidation of emergency services was done and a damning report was provided by HIQA back then. Rather a lot has happened since. A new accident and emergency department has been built, kitted out and staffed. There was a surprise visit to the department on 15 March last. Notwithstanding that, not a lot has changed. It was a damning report. I see the Minister nodding in agreement. I have not heard the Minister comment on it yet but I expect that I will hear him do so. More than the Minister commenting on it, I expect to see something happen at UHL because it is inadequate. I cannot go into the matter any further.

I have accompanied elderly and vulnerable relatives to the hospital and, like many people across Clare, you pray and hope they will not have an accident and be brought there or end their days in there. The HIQA report stated that the hospital failed to provide dignity to patients. Everybody wants dignity as a patient but that is especially true for an elderly person in their last moments. They want dignity, and it is not being provided there. I had an elderly relative who had a fall in a healthcare setting and an ambulance was being brought. I begged them not to bring an ambulance and I had to sign forms so that they would not be brought to UHL. Instead, I bundled that person, who had lost their mobility, into a car and brought them to another healthcare setting and, thankfully, they received the care they needed. If they had been brought to UHL, they would have sat in a wheelchair or on a trolley in overcrowded conditions, with the attendant risk that they would get an infection - and this was pre Covid - because hospitals are places where, inevitably, despite the best efforts of everybody, people are sick. If you are there waiting for a long period, you have an increased likelihood of at least encountering an infection there. That is not something that would worry me terribly on my behalf because I hope I am reasonably healthy but when you have an elderly person whose immune system is inevitably compromised by the conditions that beset them it is a different environment and it is not safe.

This is being visited upon the people of Navan now. I do now know whether the accident and emergency department in Our Lady's Hospital, Navan, is perfect. It probably is not and I know the clinical director has recommended that the move take place. For God's sake, let that move not take place until there is adequate and sufficient capacity in Our Lady of Lourdes Hospital in Drogheda. I heard Deputies who represent Navan say that, and I have heard Deputies who represent Drogheda, including Deputy Nash, say that. That is exactly what happened in Limerick. I will not recite the HIQA report. I know the Minister has read it. The report refers to: "Circumstances such as the hospital being the only Model 4 hospital in the Midwest region, combined with the hospital experiencing unprecedented numbers of presentations of COVID-19 and non COVID-19 cases to the emergency department." One of the factors, which is repeated throughout the HIQA report, is the fact that it is the only model 4 hospital in the region.

I appreciate that it is clinically recommended that accident and emergency department consultants, doctors and nurses have to see a large number of patients to keep their skills up and it is not considered best practice to have small accident and emergency departments where there are small numbers going through. I appreciate all of that but the alternative we have put in place in Ireland, of which UHL is an example, is not best practice either because it was found that the consistent overcrowding there poses a risk to patients. It is not that the staff in there are reckless or that they are not doing the best they can; it is simply that the overcrowding poses a risk. While there is a risk for patients from being in a small emergency department like in Our Lady's Hospital, Navan, or in Ennis General Hospital, when it was there, there is equally a risk when the alternative is massive overcrowding.

What is going to be done about UHL? I asked the Taoiseach if he was going to take responsibility for remedying this into his Department and if not, what would be done to ensure the situation in Limerick would be remedied. I know he is not here to defend himself but the Minister for Health is here as is the Minister of State, Deputy Butler, so either of them can defend him. His response was highly disingenuous.

He said the HSE is responsible for the delivery and operation of health services and that the capacity is not there for any Department, including the Taoiseach's Department, to begin to run hospitals. I was not for a moment suggesting the Taoiseach go in and manage UHL, or that either of the Ministers present or anybody in the Department of Health do so. I was requesting that a commitment be given to provide the resources required to bring the capacity up to what is needed because that HIQA report talked about the lack of capacity in UHL throughout. I was also requesting that management be put in place that can manage the existing capacity because that was the other part of the report. The part of the report which is as worrying to me is the damning indictment of the current management in UHL. It does not give me any pleasure to say it is an indictment, but it is.

To hear the clinical director coming out talking nonsense on the airwaves is an insult to people whose family members are in there and to people who contact me and every Teachta Dála in the mid-west region to complain about what is going on there. It is an insult to HIQA and to people's common sense. They are excuses one would say were pathetic from a politician, much less from a clinical director of a model 4 hospital. I am sorry but they are inadequate and if they had a shred of honour they would fall on their swords after a report like this. It is not good enough. If, as a clinical director, one cannot stand over the standard of healthcare being provided in one's hospital, surely one has a duty to highlight that publicly and walk away if it is not addressed, but neither is happening at the moment. There seems to be collusion between management in UHL, the HSE and the Government whereby they pass the buck, blame one another and say "It's not my problem that the Government did not give me capacity", "It's not my problem that UHL management aren't doing a bit better" and so on. Ultimately, it is my problem and that of my constituents.

I am one of 160 people who can vote for a Government here. The buck has to stop somewhere. If it does not stop with the Department of Health and is not its problem, then it becomes the Minister's problem because he is democratically accountable to 159 others and we are democratically accountable for the provision of Government services in our areas. I do not want to personalise it because the Minister did not create the problem in UHL. Maybe he could manage it. After all, he has management experience, but he has another job, which is to be Minister for Health. It is his responsibility and that of the Government to put management systems in place, make sure existing capacity is properly utilised. Subject to the availability of national resources generally, and it seems that UHL is under-resourced compared with comparable hospitals around the country and healthcare generally is under-resourced in the mid-west compared with other regions, it is the Minister's responsibility to put resources in place for a decent standard of healthcare.

I will vote with the Opposition on this. There is a slim likelihood I will ever end up in hospital in Navan or Drogheda but I do not want to see anybody witness the chaos I have witnessed or to be afraid that their relatives will be brought to hospital. It is unnecessary given the resources at our disposal in this State.

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