Mary Butler (Waterford, Fianna Fail) | Oireachtas source

At the outset, I wish to offer my heartfelt sympathies and condolences to the family, friends and community of Aoife Johnston on the death of a beautiful young girl. I cannot even begin to imagine their loss.

The Government recognises the challenges in health services in the mid-west region and the distress these have caused to patients, their families and staff. From the start, this Government has recognised the need for investment in healthcare in the mid-west region. The increase in hospital budgets, the significant capital investments and the significant increase in staffing in all hospitals in the mid-west are testament to our commitment to facing these challenges. However, it is a combination of both capacity and reform that will make the difference for the people of the mid-west. With the establishment of the new health regions, and the appointment of Sandra Broderick as the new mid-west regional executive officer last December, this Government is overseeing significant reforms.

With significant investment in both acute and community services, these reforms are realising the vision of an integrated health service.

This Government recognises the important role the whole health system in the mid-west plays in reducing the pressure on UHL's emergency department. We are delivering improvements in public health, enhanced community care, diagnostics for GPs, care for older persons, additional primary care centres, and enhanced pharmacy services.

A common theme in both the independent investigation by the former Chief Justice, Mr. Frank Clarke, and the expert support team assigned to UHL in May is the need for reform in working practices at UHL. Mr. Justice Clarke identified a number of factors that contributed to delayed treatment and the tragic death of Aoife Johnston. These are extremely serious and concerning findings. Reform is essential and must not be delayed. The HSE’s chief clinical officer, Dr. Colm Henry, is setting up a structure to oversee the immediate implementation of all of the Clarke report recommendations. The expert support team has also identified a range of changes in working practices that need to be implemented to improve patient care.

The Minister for Health has funded a comprehensive package of measures aimed at alleviating pressure in the hospital. In April, he announced a series of additional investments and reforms to reduce pressure on the emergency department at UHL. These include: accelerating the building of two new 96 bed blocks on the UHL site; commissioning 16 additional fast-build beds on site, with construction anticipated to be completed by the end of 2024; procurement of 20 additional step-down transition and rehabilitation beds in Clare; extending opening hours of the region’s three medical assessment units to 24-7, from 12 hours a day, seven days a week on a phased basis, which is currently being progressed; making UHL one of two national test sites for acute virtual wards; and providing GP and advanced nurse practitioner on-the-door services at the UHL emergency department for cases that can be streamed to primary care.

At the same time, the CEO of the HSE directed a number of reforms in the delivery of services in the mid-west, taking from measures that have been successful in reducing overcrowding at University Hospital Waterford. These include senior decision-makers being rostered on site at UHL, both in the emergency department and throughout the hospital, after hours and on weekends. Deputy Cullinane and I know these measures work because we are very familiar with University Hospital Waterford. What is being done also includes an all-of-hospital approach to treating emergency department patients. This involves: the use of non-emergency department consultants to support emergency department colleagues; senior management in the UHL emergency department in early mornings; a targeted campaign to increase the number of consultants at UHL on the public-only consultant contract; a strong patient flow team in place at UHL seven days a week as part of a single mid-west bed management system and patient flow; weekend access being extended to scheduled diagnostics for the emergency department; increasing community and health and social care professionals support for weekend discharges; a social inclusion hospital-to-community team to tackle the demographic and social challenges which lead to overuse of hospital pathways; and a CAMHS paediatric liaison team to provide in-reach to the paediatric wards to support children with mental health needs.

In May, the Minister published the acute hospital inpatient bed capacity expansion plan. Overall, the projects detailed in this plan will increase bed capacity at UHL by up to 292 beds by 2028. In total, 542 new inpatient beds will be delivered in the region by 2031. In May, the Minister also announced an update on the rapid progression by the HSE in constructing surgical hubs, which will open to patients this year and next year across the country to deliver more elective day-care procedures. A site has been identified for the Limerick surgical hub at Scoil Carmel. When fully operational, each hub is expected to deliver approximately 4,000 additional day-case procedures, 5,800 additional minor operations and 18,500 additional outpatient consultations annually.

These additional projects sit alongside a significant programme of capital works across the region to ensure that the infrastructure is in place to meet the needs of those accessing our health services. A new blood science and pathology facility is currently in detailed design phase at UHL. Enabling works are ongoing to reconfigure and extend the current UHL radiology department and provide an additional MRI. Work is ongoing to provide kitchen, catering and fire safety upgrades to existing UHL buildings. Following the opening of a new €2 million injury unit at Ennis Hospital in 2022, a new theatre block is currently in detailed design phase at the hospital.

At the same time, as has already been underlined, this is a health region that has seen a significant increase in resources under this Government. The budget of UHL has increased by 59%, an additional €158 million since 2019, from €265 million in 2019 to €423 million in 2023. Investment in the hospitals in the region has increased by 58%, an additional €213 million, from €369 million in 2019 to €582 million in 2023. Some 150 new beds have been opened in the University of Limerick Hospitals Group since January 2020, and 108 of these have been in UHL. Staffing at UHL has risen by 41%, an increase of 1,167 whole-time equivalents since 2019, with 3,981 staff in place in July 2024. Safe staffing has been fully funded in UHL. It was implemented on 13 medical and surgical wards, and on the acute medical assessment unit in 2023. Extension of safe staffing to all inpatient wards at the hospital will be complete by the end of the year.

To deliver all of these capacity improvements and reforms, the Minister and his officials have had significant and sustained engagement with the HSE on the challenges in the mid-west region. The Minister has visited the hospital and the region on numerous occasions. It is a combination of capacity and reform that leads to better access for patients.

This Government is determined to continue progress in the mid-west by adding more beds, diagnostics and theatres, hiring more healthcare professionals, rolling out enhanced community services, modernising working practices and improving patient flow to ensure the services needed are available when patients need them. The people of the mid-west deserve access to responsive urgent and emergency care, and that is what this combination of new capacity with much-needed reform aims to deliver.

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