Maurice Quinlivan (Limerick City, Sinn Fein) | Oireachtas source

I join with my colleague Deputy Cullinane in offering condolences to the family of Aoife Johnston, especially her parents, James and Carol, and her sisters, Megan and Kate. The people of Limerick, of the mid-west and, I am sure, of the entire the country are perplexed as to how a healthy 16-year-old comes to their hospital and does not return home.

Mr. Justice Clarke's report, which was issued on Friday, notes that the circumstances were almost certainly avoidable. The latter came as no surprise to many of us. This tragic and avoidable death should have been the tipping point for the Government. It should have been the point where it finally got to grips with its failure at UHL, but, nearly two years later, conditions at the hospital remain unsafe. The capacity challenges have not been addressed and scores of people - including 98 people today and every single day - remain on hospital trolleys in Limerick, in corridors, in wards and in the emergency department.

The year 2024 will be the worst ever for the number of people on trolleys. A recent Tweet from the Mid West Hospital Campaign named people who died. I want to put their names on the record - Aoife Johnston, Eve Cleary, Martin Abbott, Michael Cuddihy, Niamh McNally, Johnny Reidy and Tommy Wynne. I knew some of these people or I know their families. They all died and definitely did not have to. I am sure there are many others who have died unnecessarily at UHL, in particular older people, because of overcrowding, a lack of care and an insufficient number of qualified staff in the department.

The capacity problem did not just happen, however. We have had problems with overcrowding year on year since a previous Fianna Fáil Government opted to close the emergency departments in Nenagh, St. John's and Ennis in 2009. This was predicted.

When Fine Gael came to power in 2011, some 3,600 people spent time on trolleys that year. Last year, 21,409 people spent time on trolleys in UHL. Unfortunately, 2024 will be the worst year in history. The three most recent Ministers for Health, Deputies Varadkar, Harris, and Donnelly, have not made any impact. They have failed the people of Limerick and the mid-west, absolutely.

When a previous Fianna Fáil Government opted to close the other accident and emergency departments in Nenagh, St. John's and Ennis, it did so on foot of a recommendation in the Crowe Horwath Report. That report also insisted that a reduction in or relocation of services to UHL by closing the other emergency departments should not take place until the capacity at the Dooradoyle hospital had been increased. This was never done, but the Government of the day opted to push ahead. The outcomes of that are felt in the hospital every single day. The challenges relating to capacity have been raised consistently by my party during the current and previous Dáil terms.

For my part, I have spoken in the Dáil more than 300 times on the matter of UHL and have urged successive Ministers for Health to take decisive action. Again, however, action has not been forthcoming.

The current Minister, who is present, acknowledged in April that the reconfiguration of accident and emergency services in Clare, Tipperary and Limerick was not done correctly. He failed to acknowledge that under his tenure, things have worsened every month, and he has not served properly in that role. There is no doubt that the Minister will spin numbers and statistics, but the people know that he has failed them miserably.

Under the Minister’s stewardship, the number of people being treated on trolleys has increased year on year. In 2021, the figure stood at 12,106, increasing in 2022 to 18,012, and escalating again to an incredible 21,409. These are figures we thought we would never see, but this year, again it will be worse. An incredible 147,797 people have lingered on trolleys without beds in UHL since 2011, which was the year in which Fine Gael came into government. I will say that figure again: it is 147,797 people.

These people are deemed and assessed as being in need of a bed, but no bed was available over those years since Fine Gael has been in government. It worsens and worsens and worsens.

During the Minister’s tenure, he has delivered 118 additional beds to UHL, despite his knowing that there is a shortfall of at least 250. Maybe the Minister does not appreciate that there is a crisis at UHL. Maybe he looks and sees the only TD from Limerick city who raises the matter in the Dáil month after month is myself. Maybe he thinks that because his colleagues in government who hail from Limerick city are almost mute on the issue that there is no issue.

The Clarke report, to which I referred earlier, notes in relation to the death of Ms Johnson, that all the evidence points to the fact that a significant contributing factor to the difficulties encountered in UHL over the weekend of 17 and 18 December was the severely overcrowded nature of the emergency department on that occasion. What will it take for this Minister to act, or to simply admit that he is out of his depth? Maybe a Government Deputy from Limerick could tell him. What will it take for the Minister to act? As of March 2022, a HIQA inspection of the hospital found that it was non-compliant in three of the four categories. The January 2023 protests in Limerick, in which 11,000 people in Limerick marched, did not sway him either.

At this juncture, I want to mention the staff at UHL and want to put on record my appreciation for the medical staff there. They are overstretched and overworked but in spite of this they do the best that they can in very difficult situations and conditions. I have seen them myself. Anybody who has had a family member treated at UHL will know that medical staff and professionals are kind and do their very best, but they are tired and they need our support.

There were 15,000 cancellations in the hospital last year. The emergency protocol, which is supposed to be used in an emergency, was implemented every single day last year in UHL. The crisis has become the norm in UHL. Successive Fianna Fáil and Fine Gael governments have committed to creating a centre of excellence for emergency care at UHL, but what we have been left with is an emergency department that has been referred to as unsafe, overcrowded, akin to a war zone and where people die unnecessarily all the time. Also in 2023, Professor Declan Lyons, consultant physician and geriatrician at UHL, said that the hospital is a “national basket case”, that the environment in the emergency department is now extremely difficult to work in, and that there are “inhumane” and dangerous conditions in UHL.

It is time for the Government to deliver safe clinical care in the mid-west region. It is past time for it to acknowledge that there is a need for an additional model 3 hospital with an emergency department in the mid-west region. The Dublin and the south-east regions have five emergency departments for a population of 970,000 people, but the mid-west has one for a population of 410,000 people. The Government needs to develop and protect inpatient elective capacity in Limerick and the wider region and separate scheduled care from unscheduled care. Inpatient waiting lists continue to increase. In August 2023, there was a waiting list of 4,951 and as of August 2024, that figure has grown to 5,348. The Government must address the staffing capacity challenges in UHL as a priority.

Further, the Clarke report noted in relation to the tragedy in December 2022, that it was an undoubted fact that the number of patients presenting in the emergency department that night was extremely large while the number of nurses was five less than the full roster by reason of absences with the number of doctors also being one below the full roster. While a significant increase in the number of nursing posts for the emergency department was approved in the summer of 2022, these posts had not been filled by December.

Sinn Féin is committed to a model 3 hospital and emergency department. We will also work to establish 24-hour care at Ennis Hospital, Nenagh Hospital and St. John’s Hospital. We will add an additional 28 acute inpatient beds and we will legislate to mandate safe staffing levels in every hospital with the trade unions in order to improve pay and conditions for all front-line staff. The Government, however, has no plan for the people of Limerick, to get us out of this mess and deliver a healthcare system that is fit for purpose, safe and accessible, when people need it.

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