Martin Browne (Tipperary, Sinn Fein) | Oireachtas source

I commend Deputy Cullinane for bringing the Private Members' motion before the House. Before I begin, I want to take a moment to express my sincere condolences to the family, friends and loved ones of Aoife Johnson. The conditions that Aoife encountered when she arrived at the emergency department of University Hospital Limerick should never have been present. Indeed, the conditions that the people of the mid-west have been forced to deal with since the reconfiguration of services should never have been allowed to develop, but they were.

Ahead of the removal of the emergency department at Nenagh Hospital, Ennis Hospital and St. John's Hospital, the Horwath report emphasised that a relocation of UHL and the closing of other departments should not take place until the capacity of UHL was increased. That capacity was never delivered and, as a consequence, UHL has been left as a single point of failure with no back-up in the region. Most recently, the Clarke report reminded us of that by saying: “the fact remains that, even today, some fifteen years later, the capacity of Dooradoyle is significantly below that recommended by the Horwath Report as a pre-condition to closing the other emergency departments in the Midwest Region”.

Even those estimates of the increases that are needed to facilitate concentration in Dooradoyle are likely to be out of date. Instead, hospital bed capacity in the Mid-west is at a ratio that is a 9% shortfall compared with other regions. While there are five emergency departments in the HSE Dublin and south-east regions per population of approximately 970,000 people, the mid-west has only one for a population of 413,000. I also note that patient and client care staffing numbers across the UHL group have all reduced in numbers in the lifetime of this Government. It is hardly right, is it, considering?

Effectively, the mid-west has been disregarded like no other region under successive health Ministers. Given the failure to deliver on this, a HIQA review of emergency care must be tasked with examining a suitable location for the scaling up of services to provide a partner for UHL. The case for a second model 3 hospital with an emergency department for the mid-west region must be pursued, but in the meantime, the issue at hand must be addressed. That is why Sinn Féin would fast track additional bed capacity for UHL to urgently bring the region’s acute bed capacity in line with other regions. We are calling on this Government to do the same.

We are aware of the consequences of this lack of capacity. Some 21,000 patients were admitted to UHL without a proper bed in 2023 alone, leaving scenes that are invariably described by clinicians, patients and families alike as akin to a war zone. Management and staff are working under intolerable conditions. We are calling on the Government to legislate to mandate safe staffing levels in every hospital and expedite the patient safety Bill. Additionally, where is the responsibility? Will the Minister take responsibility for unclear protocols in place to deal with ongoing overcrowding which lead to patients being placed on the wrong pathway to care? Will the Minister admit that the approach that has been followed to date has been wrong, that it has not addressed the huge pressure that the hospital has been under, and the consequent failings at a high level of administration to ensure the emergency department can cope?

We need a thought-out, clinically underpinned and urgent response to what is going on here. Our plan involves the development of protected inpatient elective capacity for the mid-west region and separating scheduled and unscheduled care. What we do not need is a response to each crisis that heaps further burdens on the people of the mid-west. How many people in north Tipperary are being asked to give up places for elderly people at the Nenagh community nursing unit, which is being farmed out to the private sector as a step-down facility? What we do not need is the continuing crisis response that most recently led to the cancellation of elective procedures during the month of August. Again, this negatively impacts the health and wellbeing of people in the mid-west by limiting their abilities to get the healthcare they need. That is why we will also develop a new model of urgent and out-of-care enhanced pharmacy services and 24-7 urgent care at Ennis Hospital, Nenagh Hospital and St. John’s Hospital. The latter has been alluded to by this Government, but again, the people of the mid-west are being left in limbo with no firm indication that this will be provided. The people of the region also need the security to know that this location will not hinder an emergency. That is why we are highlighting the need to fund the National Ambulance Service workforce plan in order to support rapid access to emergency care. Additional bed capacity for UHL must be fast-tracked. Additional emergency and urgent care capacity is needed across the region. The mid-west deserves safe healthcare services and we have a plan to deliver capacity to UHL and invest in emergency and urgent care across the mid-west.

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