Cathal Crowe (Clare, Fianna Fail) | Oireachtas source

I welcome the announcement that HIQA will examine the possibility of a model 3 hospital in the mid-west region. It is so essential and we have had many private conversations on this. I thank the Minister, over the past 18 months, for meeting with Deputy Willie O'Dea and myself one evening in his office. he came down to Ennis and met with the Friends of Ennis Hospital Committee and he met with Angela Coll, the chairperson of that committee just recently in Dublin. I thank him for all that background dialogue and we have had many exchanges here in the Chamber. This is essential for our region. While the Minister's focus has rightly been on UHL and working our way out of the incessant crisis there, there has to be a big picture view for the region. This is moment where the wrongs of 2009 can be addressed. That political decision in 2009 was absolutely and fundamentally wrong and it has haunted the mid-west region every day since. I have never held the Minister r personally esponsible for that. He came into the political sphere many years after it and some of his statements he has made from the very seat in which he sits now, have been very positive in the past year where he has addressed the shortcomings of the period between 2009 and 2024. Funding alone does not work its way out. What happened in 2009 was a systematic winding-back and closure of accident and emergency departments in Ennis, Nenagh and St. John's hospitals. My mother was a nurse. She graduated in St. Finbarr's in Cork and came to work in Limerick in the early 1980s. At the time when she was working in what was then Limerick Regional Hospital, now UHL, the region had five accident and emergency departments - Limerick Regional, Ennis, Nenagh, St John's and Barringtons hospitals.. The population of the mid-west has grown exponentially since. Now we are down to one 24-hour accident and emergency department with 500,000 people being funnelled through that system, compared with Dublin where there are 1 million people who can avail of eight accident and emergency departments.

It is incomparable. Time after time, we have seen funding and investment disparities in the mid-west versus the rest of Ireland. This is the grasp-the-nettle moment for our region, for all the people who have suffered on trolleys and for people who lost their lives in the acute hospital system that is UHL. This is also the grasp-the-nettle moment for the Government. I thank the Minister for leading out that initiative. Many stakeholders brought this point forward. There is a unanimous political voice in the region on this issue and also among civil society. Many hospital campaigners have held rallies and protests. The Minister met some of them. One group that I found extremely constructive from County Clare - I have a Clare bias, naturally enough - is Friends of Ennis Hospital. Rather than just protest, it brought a document to the Minister. I think there were 22 pages in that document, which sets out the problems - it is easy to identify the problems - but also sets out the solutions. I pay tribute to the chairperson of Friends of Ennis Hospital, Angela Coll, and Deirdre Culligan and Cillian Murphy. Their work has been outstanding. That body of work formed some of the backbone of what the Minister, Sandra Broderick from the HSE and HIQA will examine. That is positive.

The Minister will tell me we need to manage expectations, that this is a review and whatnot, but I am going to get a bit ahead of that because I believe there is an inevitability. I used this language in this Chamber only a few weeks ago. There is an inevitability that this has to be addressed. My hope is that this review states loudly and clearly that there is a need for an additional model three hospital in the region. It may state there is capacity in existing hospitals to build that and to add on wings or it may state a new hospital is required. That will come out in due course. That work needs to begin in earnest. Mr. Justice Clarke's report is imminent and it will lead to the terms of reference being devised. We cannot delay too much longer on this. There is speculation that there could be a general election in the late autumn. Some say it could be March. I hope this work is completed by then so that the party the Minister and I are members of can have it in our manifestos and so too can Opposition parties. It has to be in the next programme for government, whoever is in government. I hope it will be the Minister and I and I hope the Minister will still be leading health. Who knows, in the world of politics but politics does not matter here because, for patients and public healthcare and safety in the mid-west, this has to be in the next programme for government. It has to be a deliverable that work begins on a model three additional accident and emergency department in the mid-west. It should be in County Clare, not just for bias reasons. I am not just wearing the Clare jersey. I am not just saying it because I am a Clare representative. Looking at the map of Ireland and where the other model three hospitals and accident and emergency departments are, there is no getting away from the peripheral nature of Ennis and north and west of it. People have no access to accident and emergency departments. A reason given to close down Ennis accident and emergency department in 2009 was that there was not a critical flow of patients to justify remaining open. There were also safety issues but the flow of patients was the main reason. I hope my figures are correct; I think in the last year, presentations of Clare patients was 28,000. That exceeds the very figure used as an argument in 2009. It has now been exceeded. We can only put right that woeful decision in 2009 by reopening an accident and emergency department in the region.

Barrington's hospital in Limerick is up for sale. The HSE or Department of Health should buy it. It is configured as a hospital at the moment. An accident and emergency department cannot be shoehorned in there; that day has been and gone. It is a long time since it was equipped like that. Surely, some elective and day surgery cases that UHL ordinarily handles could be moved to that facility. Knee and hip operations and MRIs and whatever else is required could be moved into the city centre and out of the acute environment of UHL in Dooradoyle. I would love to see that examined. Things do not stay for sale forever. I hope the Minister will examine that.

I wish to raise the issue of postpartum psychosis and post-natal depression. I mentioned them to the Minister many times. Approximately 12 months ago, I raised the issue during Questions on Promised Legislation. We all have some awareness - I say this as a man, so my awareness is less than that of female Members. Post-natal depression is a huge issue. I had very little awareness of what postpartum psychosis involved. There are pretty decent, although not perfect, pathways for treatment and therapeutic support for post-natal depression but postpartum psychosis treatment is sadly lacking. When a woman has given birth, that beautiful baby, unfortunately, becomes the trigger for that psychosis and that deep dark place in her mind. The baby is taken from her and that mother receives acute care in a psychiatric care environment. Last year, I mentioned it with the blessing of a woman who had been through such an experience. She said she was brought into an acute environment where the walls were padded. It was more like an exclusion zone in a prison. The people in her unit were largely people coming down from drug-induced psychosis. There is a woman in room one who has given birth and has postpartum psychosis, and in rooms three, four and five, there are people with post-drug-taking psychosis. It is incomparable. At the end of this stay in an acute unit, the baby is presented back to the mother because she has completed her treatment - here is the baby. She is given back the very trigger that caused that psychosis in the first place. There has to be a better way. There could be a facility colocated on a maternity hospital campus that is more caring and allows the child to be colocated with its mother so it is not just presented back to the mother after three weeks. The child and the mother should both get high quality of care and other family members in that care bubble for the child should be allowed to come in; it resembles a home. All the support and therapy are there to build that mum back up again in a safer environment.

I raise the issue of Newmarket on Fergus GP practice. The Minister met a group from the town some months ago. He was fantastic and there was a good outcome. It is one of the largest towns in County Clare without a GP practice. David Griffin, who the Minister knows well, is a candidate in the local elections. He is an outstanding Newmarket on Fergus man advocating for this. David and I and others in the community have concerns that the bungalow being offered in Carrigoran to host the Saffron and Blue practice has been repurposed. It is now being used for something else. There is a risk of the practice leaving the town entirely. I would love if the Minister's team looked at that.

Through a series of parliamentary questions, I examined the capacity for public dental care in the mid-west region recently. In CHO 3, we have been faring rather poorly compared with other parts of the country. Approximately one third of the target for dental screening for children are being seen. I thank the Minister because I received a very good response this morning from some of the officials in the HSE that beyond any recruitment embargo, there is now authorisation to proceed with the appointment of two full dental surgeons and a dental nurse, with, I hope, more to follow. I do not think it is just in County Clare. I imagine it is in all parts of the country that many private practice dentists are simply saying "No" to the medical card at the moment. People have dental problems that could be fixed; I always think things can fixed. I am no dentist but a root canal be treated, fillings can be put in and teeth saved but people are now having teeth extracted. People are also taking the gamble of booking a Ryanair flight to Poland, Romania or Turkey, wherever it might be, to get cheap dental care. The system works quite well with GPs but not perfectly. If we pay dentists to take medical cardholders, we need to double down on that and make sure they are adhering to contractual arrangements. I am far moreau fait with the contract with doctors; I am less au fait,I must admit, with the contract with dentists. Something has gone very awry because right now, if you phone up and you have a medical card, you are asked on the phone if you have one and then told, "We are very sorry, we cannot see you". Something has to be worked out.

The model three hospital review needs to begin in earnest. I thank the Minister for the leadership he has shown on this issue. He has brought us on a long way more than predecessors in his Department have done for many years. He has shown leadership on this issue. It is now time to follow through.

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