David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I thank the Minister of State.

First, I welcome the fact that since the three emergency departments in Ennis, Nenagh and St. John's were closed, this is the first time the Dáil has passed a motion saying that a second emergency department and a second model 3 hospital are needed for the mid-west. I think that is significant. There is a HIQA review that will look at this. That review needs to focus on where the best location is and what the best hospital is to deliver that second emergency department.

I have been in the mid-west probably more than any other region, in the context of visiting hospitals and healthcare settings, since I took the post as Sinn Féin spokesperson for health. I have been in UHL four times, once with the Oireachtas health committee and three times on my own, meeting with hospital management and clinicians. I have also met with campaigners in the region. I have met with healthcare professionals and healthcare trade unions. With respect, there have been different options put to me as to what should happen in the mid-west. Some campaigners and individuals have said that we need four emergency departments in the region. Some have said we need a second emergency department in the region. Some have said we do not need an additional emergency department and what we need is to put capacity into UHL. We do, however, have to land on what is safe for the people in the mid-west, however. We have to have a plan, in the first instance, that is safe, because what is happening is not safe. We have to look at population growth and the fact that we have an ageing population and ensure that we are providing the healthcare services needed for people who live in the mid-west. We also have to have a clinical underpinning of all of the decisions we make. That is accepted across the House.

I hope that everybody in the Oireachtas accepts that there is a compelling case to not just put capacity into UHL but to look at what is happening in other regions compared with what we have in the mid-west, and acknowledge that there is a need for a second emergency department and a second model 3 hospital.

The Minister of State mentioned University Hospital Waterford. We are all proud of the advances that have been made in the emergency department there. It is not that the hospital is perfect and it is not the case that there are not issues there. When we refer to how successful it is, I instantly get messages and calls from people who say, "Hang on a second, I have not had the best experience" or "I have been left waiting in the hospital". They are maybe not on hospital trolleys but they have been left waiting on a chair for far too long in the emergency department.

It is far from perfect but it is certainly better than it was and it is certainly one of the better-performing hospitals. I am fortunate enough to live in the south east. The people in the south-east region have access to three emergency departments. If you live in the south east, you have Wexford General Hospital, St. Luke's hospital in Kilkenny and University Hospital Waterford. I do not think anybody in the south east, whether from Waterford, Tipperary, Carlow, Kilkenny or Wexford, would accept it today if any Government said it was going to close one or two emergency departments in the south east and that everybody should go to Waterford.

After we had the fire in Wexford General Hospital, people from Wexford had to go to Waterford. It put enormous pressure and strain on the hospital in Waterford. It was the first time that we saw real pressures in the emergency department, because we had to take the overflow, rightly so, of patients coming from Wexford. I do not think I, as a person who lives in the south east, can tell people who live in the mid-west that they have to continue with one emergency department or one model 3 hospital.

We need to look at how we scale up capacity. How do we scale up the capacity of University Hospital Limerick? All the beds that the Minister promised are needed. In fact, I would say we need more. I am also conscious that as Mr. Justice Clarke said in his report, the site in Limerick is coming to full capacity. The opportunities to advance emergency care, acute care and hospital care in the mid-west region will have to come from elsewhere, whether additional sites in Limerick or scaling up capacity in other hospitals. I also believe that we need to look at elective care in the mid-west region. I know the Minister is talking about a surgical hub that will be in the Limerick area but this State, as the Minister of State knows, is committed to a number of elective-only hospitals. The locations have been chosen, yet we are not even at the starting gate in reality for most of them. I know there will be such a hospital in each of Galway and Cork and potentially two in Dublin. We are still waiting for sites to be identified in Dublin. We need to accelerate those. I believe we need to look at some sort of elective facility in the mid-west region and in Limerick. One of the big problems in all emergency departments which causes many of the problems is a clash between scheduled and unscheduled care. I looked on in horror when the people of the mid-west had almost all their elective procedures cancelled for the month of August and a bit longer than that. There was a wholesale cancellation of elective procedures. It caused consternation for the people who lived there. They were waiting for their appointments, had appointments scheduled, and they had to be cancelled because of the overcrowding in the emergency department.

I also read and have seen all the media coverage of the inquest into Aoife Johnston's death. It was absolutely tragic, heartbreaking reading. The parents of Aoife were comforting her when she was in the hospital and were telling her that she was in the right place. We now have a report from Mr. Justice Clarke, who said that not only was she possibly not in the right hospital, but even within the hospital itself, she was in the wrong area and the wrong section of the hospital. How heartbreaking is that for any family? A beautiful 16-year-old girl was left for 13 hours without getting the healthcare she needed. That report has made recommendations and outlined the challenges in the mid-west region. It clearly brought us back to that moment in 2008 and 2009 when services were closed on the promise that a centre of excellence would be built in the hospital in Limerick, which has not happened.

I am proud of my record of consistently calling for services in the mid-west that are safe, clinically underpinned and serve the people of the mid-west region. I have been asked about this on more than one occasion and have always answered that if I was Minister for Health, in a heartbeat, I would deliver a second emergency department if the clinical advice was to do it. We now have a HIQA report. That needs to be expedited. We need to see the findings of that published as quickly as possible. It has to do its work but I believe that report will be valuable. I hope that report will look not at whether there is a need for a second emergency department, but at where it should not be. I am putting my position on the record that I do not believe the region can sustain four emergency departments. We have to look at what is possible, viable and safe. We also know that emergency departments in model 3 hospitals require critical mass. They require volume. To operate safely, you have to have that. To attract clinicians and make sure there is the patient throughput, as well as specialists who can work in those hospitals, that has to be put in place.

I believe there would be significant progress for the mid-west if we can get the capacity into Limerick, including the additional beds, the 24-hour urgent care, and all of the primary and community care which is needed too, because that is as important as what is happening in the hospitals. If people do not have alternative care pathways, including care in the community, the option of homecare, rapid access to a GP, community intervention teams, chronic disease management teams or the integrated care programme for older people, ICPOP, or if those pathways are patchy, the problem is that people who should be treated elsewhere end up going to an emergency department. Part of the solution is also building up capacity in primary and community care and making sure those alternative pathways are present. It would be a big step forward for the mid-west region if we could sort the problems out for University Hospital Limerick. It would be a big step forward if we can finally start to plan. We can wait until HIQA recommends the location for a second emergency department or which of the hospitals in the region should be scaled up to a model 3. That will be a significant advance and will finally give the people of the mid-west region the safe and accessible healthcare services that they need.

We owe it to Aoife Johnston and her family. We owe it to all the others whom Deputy Quinlivan and others have named who have suffered in the hospital because of the lack of capacity. We cannot tolerate any part of the country where people do not feel safe going into their own hospital. It is intolerable that people do not feel safe in their own local hospital and that parents were comforting a 16-year-old, telling her that she was in the best place and was going to be looked after, and unfortunately, she died. As the report said, it was a death that was almost certainly avoidable. For her memory, for her family and for everybody who lives in the mid-west region, let us do what is right and deliver the healthcare capacity that the region deserves.

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