Peter Fitzpatrick (Louth, Independent) | Oireachtas source

I welcome the opportunity to speak on this motion on targeted investment in the health service. Although it is centred around the University Limerick Hospitals Group, the points raised are also applicable to my constituency of Louth and east Meath. The 2010 report of the national acute medicine programme alongside the 2013 framework for smaller hospitals outlined the need for smaller and larger hospitals to operate as a single local hospital group.

Hospital services working in groups to provide acute care, integrated with community and primary care, were outlined from model 1 to 4, based upon the evidence-based needs of the population area. This was termed "the safe provision of patient care within the constraints of available facilities, staff provision, resources and local factors" and resulted in the downgrading of Louth County Hospital and the advised closure of the Navan ED. In that system, a process of reconfiguration commenced in June 2010 with the closure of the 24-7 emergency department in Louth County Hospital. This emergency department was replaced with daytime urgent care centre providing emergency medicine services for patients with non life-threatening or limb-threatening injuries. This was to comprise a medical assessment unit and a local injury unit open seven days a week between 8 a.m. and 8 p.m., with the provision of on-site GP out-of-hours services, subject to local consultation.

In April 2023, it was announced all that the MAUs in the University Limerick Hospitals Group would be open seven days a week following an allocation of a multimillion euro funding package to extend the operational hours of MAUs in St. John’s Hospital and Nenagh Hospital. While the MAU and LIU services provide some relief by easing pressure in County Louth, it is evident our ED and ambulance services are still struggling. In 2022, ED waiting times were at their highest in years, with 67,000 patients waiting at least a day in EDs before being admitted. On top of this, over 812,000 patients were on national public hospital waiting lists at the end of 2022, with 584,600 patients waiting to be seen for the first time by a consultant at an outpatient clinic. The population in the larger catchment area is only going to grow, so action needs to be taken now. For example, one of my constituents has been waiting two years on a urology consultation in Drogheda that keeps getting postponed. While I acknowledge planned consultations, procedures and operations can be postponed or cancelled for a variety of reasons, it is most commonly due to capacity issues stemming from increased scheduled and unscheduled care demand.

On top of high ED waiting times and overcrowding, the decision to close the Navan accident and emergency department will have a significant knock-on effect on Our Lady of Lourdes Hospital in Drogheda, which is already experiencing a deficit in medical staffing. In December 2022, 17 senior clinicians at Our Lady of Lourdes expressed their concerns for patient safety if the accident and emergency department in Navan is downgraded. They warned that the Drogheda hospital is at full capacity and indicated the experience of Our Lady of Lourdes Hospital would mirror the pressure being experienced at University Hospital Limerick if the Navan ED is closed down. Proposed improvements in Our Lady of Lourdes Hospital could never be an acceptable substitute for 24-hour acute medical care in Navan.

In January I spoke about an issue with recruitment, namely, the HSE has gone out to recruit but has not been successful. This is consistent throughout the health services and mental health services in County Louth, whereby in addition to no psychiatrists being available, the only pediatrician available was Dr. Maeve McCormack, who had a four- to five-month waiting list. When I raised the issue with the Minister last year, he agreed the required resources have not been in place for a long time. Deficits in staffing and bed capacity in Our Lady of Lourdes Hospital have a knock-on effect on ambulance turnaround times and the transfer of risk from one hospital to another leads to poorer clinical outcomes for patients.

I fought for Louth County Hospital and reaffirm that the closing of key capacity, within a time of capacity crisis, will not be accepted. Urgent action and funding needs to be allocated to the acute services in counties Louth and Meath. Nobody in this region wants to see what is happening in UHL happen in our region. There is a strong role for smaller hospitals in which they can provide more services, not less. The reopening of Louth County Hospital should seriously be considered. The treatment of stable medical patients who meet the agreed clinical criteria in hospitals closer to their homes, such as the model 2 hospitals, is aimed at reducing ED wait times and releasing ambulances more quickly. However, MAUs and LIUs are only open between 8 a.m. and 8 p.m.

According to an OECD report released in February, Governments should urgently adapt their health systems to better respond to future shocks, given the huge impact of the Covid-19 pandemic on people and the global economy. Even the most advanced health systems in the world were not resilient to the pandemic. The report affirmed that major investment is needed in the health workforce, alongside increased spending on prevention and digital infrastructure. I therefore advocate for the procurement of an electronic health system to replace paper-based health records. This is especially critical after the major ransomware cyberattack in 2021. While I acknowledge the establishment of hospital groups signalled a fundamental modernisation of our health system organisation in line with best international practice, Ireland remains a laggard in Europe for digitisation in the health system and the introduction of electronic health records. The use of such technology could significantly reduce triage times in EDs. Although I acknowledge the significant investment in health and social care services in budget 2023, we need to reduce acute hospital and community waiting lists.

Overall, LIUs deliver efficient, expert treatment to tens of thousands of patients with minor injuries every year and have been of crucial assistance in relieving pressure on EDs, while MAUs play an integral role in ED avoidance. Consequently, I agree with the proposed expansion of MAUs and LIUs to 24-hour, 7-day-a-week operation. However, in order to succeed we need to look into the recruitment and retention issues. I also push for the reopening of Louth County Hospital. There is infrastructure and capacity available immediately which would alleviate the pressures put on our other hospital in Louth, namely, Our Lady of Lourdes Hospital. I and my colleagues in the regional group previously brought a motion on the improvement to regional pre-hospital emergency care and community care. An overhaul in the delivery of pre-hospital emergency care services is also required, to include better training for staff in schools and childcare facilities to an expanded role for MAUs and LIUs. This would help in reducing the numbers of patients attending emergency departments in the first instance. However, in order to succeed we need to invest in our local health service, make efficient use of current infrastructure and invest in our digital infrastructure, specifically the introduction of electronic health records.

On Monday, 15 May, I thought I was going in for a normal day in my busy constituency office, but it was not a normal day. On four different occasions people came into my office and threatened to commit suicide. The first person who came into my office got a lethal injection last week and was taken to Our Lady of Lourdes Hospital. The staff kept him alive. The second person was walking the streets, had no accommodation and wanted to jump off the bridge. The third person was a lady who was going to be evicted and had nowhere to go. She wanted to commit suicide. The last person was there due to a family dispute. Two brothers did not get on together and one of them was put out of the house. He was sleeping in a graveyard. People found him there. He wanted to commit suicide. Louth County Council does a fantastic job, but its staff cannot look after medical issues. I plead with the Minister. Does he think it is right for people to sleep in graveyards, in parks or on the streets? I have been a Deputy for the last 12 years, but I have never seen things as bad. When people come into my constituency office, they think I can give them a house or put them in a hostel. We need the Minister's Government to help these people. I have the phone numbers and contact details of the four people and I will work closely with the Minister, but my staff are finding it nearly impossible to deal with these people. We need help, we need training and so on. Please help us.

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