Joe Carey (Clare, Fine Gael)
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I wish to express my thanks to the Ceann Comhairle for affording me the opportunity to raise this issue. I welcome the Minister for Health to the House and thank him for taking the debate. As he will be aware, the medical assessment unit at Mid-Western Regional Hospital, Ennis was established following reconfiguration of acute hospital services in the mid-west region.

Medical assessment units, MAUs, facilitate the immediate assessment, diagnosis and treatment of patients presenting with medical conditions. Patients are referred to the MAU by a case manager, their GP, Shannondoc, or through University Hospital Limerick, once it is established they are suitable for the service.

Since its opening in Ennis in 2013, the number of patients presenting at Ennis MAU has increased every year, with between 20 patients and 35 patients attending it every day. Following a comprehensive business case submitted by the University Limerick hospital group to the Department of Health, the service was extended from a five-day to a seven-day service in May 2016. The then Minister for Health, Deputy Varadkar, visited the hospital where he received a comprehensive presentation from Dr. Tom Peirce, the consultant in charge at the MAU, on the merits of extending the service into the weekends. I was delighted when the service was extended. I compliment Dr. Tom Peirce and his team for delivering a top-class service to the people of County Clare. The stated aim of the MAU team is to have same-day diagnosis, treatment and discharge of patients whenever possible.

Last Tuesday, however, a misleading claim was made in the House that weekend MAU services at Ennis Hospital will be discontinued. That misinformed charge has led to unfounded headlines in local newspapers declaring proposed reductions in services at the unit. Following discussions with the chief executive officer of the University Limerick hospital group, Professor Colette Cowan, and with the Minister for Health on several occasions yesterday, it is my understanding that the seven-day MAU service is secure and will not change. In fact, it will be improved with the construction of a new MAU area, a new minor injuries unit and a new radiology area.

I thank the Minister for being in the Chamber this evening, as he is now in a position to bring absolute clarity to this situation. Will he place on the record of the House the accurate position regarding the future of the MAU at Ennis Hospital? Such clarity is now required following the unfortunate events of this week.

Simon Harris (Wicklow, Fine Gael)
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I welcome this opportunity to provide assurance to the House regarding the continued operation of the Ennis MAU. I thank Deputy Carey for tabling this Topical Issue matter and providing me with a chance to allay any concerns in Ennis or County Clare regarding the continued operation of the MAU. I also acknowledge the presence of Deputy Harty, Chairman of the Oireachtas Committee on Health, in the House.

Ennis Hospital is a constituent hospital of the University Limerick hospital group. As such, it plays an important role in meeting the health care needs of the population of the mid-west. The smaller hospitals framework, published in 2013, outlines the need for smaller hospitals and larger hospitals to work together in hospital groups.

The MAU in Ennis Hospital operates Monday to Friday, 8 a.m. to 6 p.m., and on weekends from 10 a.m. to 6 p.m. Patients are referred there for medical assessment by their GP or by Shannondoc via the Bed Bureau. The service is consultant-led and facilitates the immediate assessment, diagnosis and treatment of patients presenting with medical conditions such as chest infections, urinary tract infections, fainting episodes, anaemia or non-acute cardiac problems. The Ennis MAU opened in 2013. In May 2016, it became the first of the four MAUs within the University Limerick hospital group to operate on a seven-day basis. The numbers of patients attending for medical assessment has increased over the past year, with between 15 to 25 patients assessed daily.

The hospital group chief executive officer, to whom I have spoken directly on this issue, has advised the current concern surrounding the future of the seven-day service does not arise from any top-down initiative or proposal from the University Limerick hospital group. I have also been assured by the Department and the HSE that, not only has no such decision been made, there is no such proposal from group management.

Deputy Carey will appreciate the executive and clinical directors are required to visit all hospitals in the group to review and discuss service delivery as per normal oversight arrangements and in line with good management practice. It is important that senior management and clinical directors would visit smaller hospitals to check data, assess how they are doing and look at the metrics.

In that context, I understand that last week the chief clinical director and clinical director for medicine met the team at Ennis Hospital and many issues, including the MAU, were discussed. The chief clinical director and clinical director for medicine sought data on the weekend usage of the Ennis MAU. This information will allow the executive to assess the impact and effectiveness of the MAU and inform how best the service can be optimised in the interests of the people of Clare. Ennis Hospital is integral to the proper functioning of the University Limerick hospital group. A properly functioning MAU and injury unit are essential to help minimise unnecessary presentations to the emergency department at University Hospital Limerick in Dooradoyle.

University Limerick hospital group continues to identify opportunities to increase activity in Ennis Hospital. It is examining proposals to increase vascular and plastic surgery at the hospital. The national patient experience survey carried out in May 2017 found that 88% of all inpatients in Ennis were happy or very happy with their overall experience. This is a tremendous tribute to the staff and management at Ennis Hospital and the care they provide. The programme for Government commits to extending opening hours of MAUs. If anything, I want to see Ennis Hospital do more, as does the University Limerick hospital group. We will look at other opportunities to do so. There is no proposal from the University Limerick hospital group, the HSE or the Department to reduce the opening hours of Ennis MAU.

Joe Carey (Clare, Fine Gael)
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I thank the Minister for bringing absolute clarity to this situation first-hand in the House. It is also reassuring to hear of the positive developments happening at Ennis Hospital. The retention of seven-day MAU services is important as the more patients who can be diverted from University Hospital Limerick, the better.

Notwithstanding the opening of a new €25 million state-of-the-art emergency department in University Hospital Limerick, there is an issue with bed capacity in the mid-west which is compounding the trolley crisis in University Hospital Limerick. The Minister is aware of the proposal to provide 96 additional acute beds in the hospital which has been submitted to the Department. Will this proposal be included in the capital plan to be published tomorrow? Will the Minister give us a sneak preview of it?

Simon Harris (Wicklow, Fine Gael)
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After receiving such clarification on the first matter, Deputy Carey is now trying to get me into awful trouble by having me reveal details of the Government's capital plan, which will be considered at the Cabinet meeting in Sligo tomorrow and will be published in the afternoon. He is correct that the people of the mid-west have been left without proper hospital bed facilities. Bizarrely in the past, Governments in boom times thought it was a good idea to reduce the number of beds in our hospitals. Thankfully, that is not the policy of this Government. We are committed to expanding the number of beds.

I commissioned a bed capacity review, which I published in full and is available on my Department's website. It stated that even after the health service is reformed, we will still require 2,600 additional acute hospital beds by 2031. I am conscious that the people of the mid-west and in the University Limerick hospital group have a shortage of hospital beds and require more. I am pleased we were able to invest €25 million of taxpayers’ money in a new state-of-the-art emergency department in Limerick, serving the people of Clare. However, it is clear we need to put more beds in.

I am aware there is a 96 bed ward proposal from the hospital group. I would like that to be looked upon favourably. It is badly needed and should have been delivered years ago. It is terrible it was not delivered during the time of the previous economic boom. I am determined we will deliver it.

I am also conscious we need to relocate and redevelop the maternity hospital and move it alongside the acute adult hospital in Limerick. The Government knows the needs of the people of Clare. Deputy Carey and his Oireachtas colleagues from Clare highlight them regularly.

I hope that, as part of the €115 billion capital plan that we will publish, we will tomorrow be able to show good faith and commitment to the people of Clare in terms of advancing some of those important projects.

The outpatients department at Ennis general hospital has also been reviewed in terms of quality and capacity requirements. As the Deputy will probably know, the HSE is in the process of procuring new accommodation for the department, which I hope is good news for the people of Ennis.