Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Deputies opposite for tabling tonight's motion. It provides a welcome and much-needed opportunity to discuss the additional capacity and reforms that are needed in the mid-west region to provide people with something they do not currently have and that they must have, which is a well-functioning emergency department and timely access to emergency and urgent care.

It is every parent's worst nightmare to lose a child. That nightmare was compounded for Carol and James, parents to Aoife Johnston, who watched their daughter deteriorate at UHL before she succumbed to sepsis. As former Chief Justice Frank Clarke said in his report: "To lose a child in the fraught and traumatic circumstances of Aoife's death is beyond understanding. To be present and feel powerless is unimaginable." Aoife was left without appropriate treatment for more than 13 hours. Aoife faced delays at so many different stages during her time in the hospital, from admission, to triage and assessment, to diagnosis. Eventually, she received treatment that should have been administered many hours previously. As we all know, and as Deputies opposite stated, had Aoife been seen and treated in a timely manner, it is very likely that she would be alive today.

The report by former Chief Justice Frank Clarke highlights a number of factors that contributed to delayed treatment and Aoife's death. It also contains a number of recommendations. The HSE's chief clinical officer, Dr. Colm Henry, is setting up a structure to oversee the immediate implementation of all of the recommendations of the Clarke report, which I accept in full.

Mr. Justice Clarke commented on bed capacity in his report. That goes to the core of what we are debating here this evening. I have said before that there is no doubt the mid-west has had too few hospital beds for too many years. This Government is responding to that with an unprecedented level of investment in new beds. So far, we have added 160 extra hospital beds to the hospital group, including ten new critical-care beds. These ten critical-care beds, along with 108 new beds, have already been delivered and added to UHL but, critically, far more beds are on the way.

Projects that are currently live and under construction at UHL will add another 208 hospital beds. These are: a new 16-bed unit, which will be opened by the end of this year; a new 96-bed block to be delivered in the first quarter of next year and; a second new 96-bed block to open in 2028. Enabling works have already commenced on this second block. In addition to all of this, as part of the new national beds plan launched earlier this year, I committed to another 84 new beds for UHL.

Deputy Quinlivan referenced a report which stated that UHL needs an extra 250 beds. We are adding 410, so we are going miles beyond the recommendation to add 250 beds. To put that into context, the 410 beds we are adding at UHL is the equivalent in beds of a model 4 hospital. In fact, what we are doing is doubling the beds at UHL.

As well as the investment in UHL, we have been and are continuing to invest in more beds right across the region. We are doubling the bed capacity at Ennis Hospital. We are increasing the bed capacity at Nenagh Hospital by more than a half. We are increasing the beds at St. John's Hospital by more than three quarters and we are more than doubling the beds at Croom Hospital.

How does this all add up for the region? When this Government was elected in 2020, there were just under 700 hospital beds in the mid-west. We are adding an extra 542 beds. That is an 80% increase in the number of hospital beds in the mid-west. It is the equivalent in bed numbers to a full model 4 hospital, plus a full new model 3 hospital. A total of 160 of these beds have already been delivered, while more than 200 more are under construction. They will open later this year, and through next year and beyond. The remainder have all been identified at a detailed level for each of the hospitals. Planning is now under way on that.

It is the biggest investment in hospital capacity in the mid-west in decades, possibly ever, but I am not sure. Deputies referenced a Deloitte report from two years ago that was commissioned by the University Limerick Hospitals Group. We are going well beyond the recommendation for the region in the Deloitte report. Why are we doing it? Because it was badly needed. We are very proud to be delivering it. In 2020, when this Government came into office, the mid-west had the lowest level of hospital beds per population of any of the six regions. Between the beds that we are adding and the ones we have already added, the mid-west will end up with the second highest level of beds per capita of the six regions. We are not stopping there. A site has been identified for the Limerick surgical hub at Scoil Carmel. When it is fully operational, every year it will be able to provide an extra 4,000 extra day-case procedures, 6,000 extra minor operations, and more than 18,000 extra outpatient consultations.

As Deputies are aware, we are investing in the workforce to support all of this. In fact, in UHL alone, the workforce has risen by more than 1,100 in the term of this Government. That is a 40% increase in staff in four years. Those staff are doing a very good job. I too commend them for what they are doing. While we are all focused on overcrowding, it is worth pointing out that - thanks to the efforts of local healthcare staff - the waiting lists for outpatients have been falling dramatically in recent years at UHL. In addition to all of this capacity, I have asked our healthcare regulator, HIQA, to consider the case for a second emergency department within the region.

There has been a big increase in community care investment as well, be it primary care teams, older persons' teams, ambulance services and primary care centres, but I will focus this evening on hospital care given that it is the broad thrust of the debate. We have all discussed this matter before and I think we are in agreement on it. While more capacity is essential, it is only half of what is required to deliver the health service the people in the mid-west need and deserve. The other half of the answer is fundamental reform, particularly in UHL. In his report, Mr. Justice Clarke highlights unclear protocols, ad hoc systems, poor internal communication and a failure to deploy the escalation protocol.

The HSE published another report into UHL last week. The report was compiled by Ms Grace Rothwell, who led the turnaround at University Hospital Waterford, Dr. Fergal Hickey, retired emergency medicine consultant, and Ms Orla Kavanagh, director of nursing in Waterford. That report too made very stark observations about work practices at UHL. They reported that they saw limited senior clinicians and management in the inpatient clinical areas. They concluded that "greater presence and input from senior nursing management and the senior medical workforce [consultants] is required to enable more timely responsiveness to patient flow needs." They reported that it was unclear at times who was in charge.

The healthcare regulator, HIQA, has also pointed out that work practice reforms are needed. In its last report into UHL, HIQA noted that progress was being made on a number of fronts, but that the progress was relatively new and not yet at scale. Some steps have been taken. I acknowledge that good work is going on in UHL to bring in these reforms, but greater progress is needed. We know the reforms work. We have seen them work in Deputy Cullinane's local hospital in Waterford, and in Tullamore. We also know the combination of extra capacity and reform works. The reason UHL's emergency department got much worse this year when nearly every other hospital in the country was getting better, is that it was one hospital where the reforms had not been brought in at the level we are seeing in many other hospitals. However, I still fully accept the need for significant additional capacity, which is happening.

This Government recognises the challenges in health services in the mid-west region. I recognise the challenges for people in the mid-west. I hear the concerns they have about going to their own hospital. Nobody should be concerned about going to their own hospital to receive emergency care.

I recognise the distress this causes patients. I have met many patients and have spoken to their families. It causes undue stress and hardship for our healthcare professionals, many of whom I have discussed this with.

I again thank the Deputies for tabling the motion. I agree with a lot of what I heard from Deputy Cullinane in terms of the need for a lot more capacity. I hope he and Sinn Féin join me in stating that while capacity is needed, we must have fundamental reforms, the likes of which we are seeing in other hospitals around the country. We know they work and we have to see them in UHL as well.

See this speech in context