Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I very much welcome this timely motion on healthcare capacity in the mid-west. I thank Sinn Féin for tabling it.

Following publication of the Clarke report into Aoife Johnston's tragic death, there must be accountability at both political and management level. Notwithstanding its shortcomings, the report effectively highlights the underlying causes of compromised patient care and safety at UHL, which led to Aoife Johnston's "almost certainly avoidable" death, as the report said. They include failures in systems, missing pathways of care and persistent overcrowding. The report found that systems and care pathways were either deficient or completely absent. That is a clear failure of hospital management. The accompanying support team report noted that it is "unclear... who is in charge on the UHL site on any given day". This is a shocking assessment. I appreciate that disciplinary proceedings are under way and that management structures are set to change under the new regions, but we must ensure that accountability is more than just a buzzword. There must be consequences for the negligence that contributed to Aoife's tragic death.

Political accountability is also required. The chronic overcrowding and lack of capacity in UHL is a result of political decisions. That must be reckoned with. There has been a persistent and outrageous denial of the failure to adequately resource the original reconfiguration in the mid-west. The accountability for those decisions rests with a number of Ministers for Health right up to the present day. As it stands, University Limerick Hospitals Group is the only hospital group in the country without a level 3 hospital. Five other hospital groups have at least three model 3 hospitals and some even have multiple model 4 hospitals. University Limerick Hospitals Group has only one level 3 facility. It is a complete outlier in having only one emergency department. All the other hospital groups have multiple emergency departments.

It is more than two years since HIQA stated that the absence of a model 3 hospital in the region significantly impacted the effective working of UHL's emergency department. I do not know why the Minister has to look for a second report from HIQA. The authority has been very clear on what the problem is in the region. The question must be asked as to why has it taken the current Minister for Health until this year, 15 years after reconfiguration, to examine again whether a level 3 hospital is required in the mid-west. The 2008 Horwath review of acute hospital services in the mid-west made clear that the closure of other emergency departments should not occur without increased capacity in Dooradoyle. The report recommended a capacity of 642 inpatient beds in UHL as a precondition to closing the other emergency departments. This was ignored and the three smaller emergency departments in Ennis, Nenagh and St. John's hospitals were closed. At the time, UHL had only 375 inpatient beds. While that figure has substantially increased to 535, it is still well below the 642 recommended back in 2008. We see how much the population of the region has increased since then. According to this Government's own inpatient bed capacity expansion plan, last December, the mid-west region still had the lowest ratio of inpatient beds, with two beds per 1,000 people.

Questions also remain about the scarcity of consultants in University Limerick Hospitals Group. The Minister has pointed to the low number of consultants who have taken the new public-only contract, which means they are still working only a five-day week and there are problems with cover and decision-making at the weekends. That is a valid point. However, the fact remains there are far fewer consultants in University Limerick Hospitals Group than there are in other emergency departments. When I raised this with the Minister in May, he was unable to explain how University Limerick Hospitals Group had such a low ratio of consultants. In total, the group only had 230 consultants at the time, meaning it trails very far behind all the other hospital groups, which, on average, have between 600 and 700 consultants.

Why is the mid-west region being treated so unfairly in the allocation of resources? We still have not had an answer from the Minister to that question. In many ways, he is in denial about it. How can this postcode lottery be justified any longer? It cannot be justified. I note that a step-down facility has recently been opened in Nenagh, which was supposed to be a community nursing home. Another step-down facility is planned for Ennis but serious questions remain about it. I understand that in Ennis, similar to Nenagh, beds for local long-term care and respite are now to be converted to step-down beds for UHL patients. That is just robbing Peter to pay Paul. This provision is being sold as an increase in beds but it is not that at all. According to an HSE regional profile of the mid-west, the largest community healthcare network in the mid-west region is in west Clare, with a population of almost 79,000 people. Yet, Ennis General Hospital only has 50 beds. Clearly, that is not a fair allocation of resources. I accept that an additional 48 inpatient beds are planned for Ennis General Hospital, and that is welcome, but it could be up to four years before they are delivered.

What happened to the plans for 24-hour medical assessment and minor injury units in Nenagh, Ennis and St. John's hospitals? In March, Bernard Gloster said he was awaiting sign-off from the Cabinet. However, in response to a parliamentary question from me last July, the Minister said he had no plans to expand those services to 24 hours. Is the extension of services going to happen? Can he explain why he seems to have reneged on his earlier commitment? Without a model 3 hospital, an 8 a.m. to 8 p.m. service that does not even treat under-fives is simply insufficient to meet local need.

Another factor which must be considered is the age profile of this region. The mid-west region has a comparatively older population. The 75-to-79-year-old age group increased by almost 40% between 2016 and 2022, while the 85-years-and-older age group increased by 25%. As a result, there is an increased need for home care services. This is reflected in the home care waiting lists, with the mid-west accounting for 16% of the total national waiting list at the end of May. A total of 347 people were waiting for a carer to be assigned in Clare, with a further 285 people in Limerick and 110 in north Tipperary. This must be dealt with. We know that home care provision is particularly strained in rural areas, but that will never be addressed without increased hours, paid mileage and a statutory right to home care.

There is also a serious issue around access to GPs. Will the Minister please provide this House with an update on his strategic review of general practice? We should not have to wait any longer for that. It is urgently needed.

Separately, the continued absence of specialist eating disorder services in the region is completely unacceptable. When the current Taoiseach was Minister for Health, he promised 20 specialist beds by 2023. What happened to those? What happened to that promise?

Finally, the mid-west, like the rest of the country, is still dealing with the negative impacts of the recruitment freeze and continuing constraints on hiring. This is compromising safe staffing levels and patient care. There is a major problem with the lack of adequate resources in the mid-west region, and there has to be political responsibility for that.

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