Richard O'Donoghue (Limerick County, Independent)
Link to this: Individually | In context | Oireachtas source

In University Hospital Limerick, there were 86 patients on beds on 24 January; 97 patients on 25 January and 111 patients on 26 January. Where is Paul Reid? I know there are patients who are not discharged on time. They have not been met to be discharged. What is the cost to the insurance company? I want an audit done to see how many patients are in hospital in a private capacity. Patients are admitted for tests that can easily be done on a day-care basis and they are in the hospital for four days.

I also want the bullying of nurses in the hospital to be addressed. How many nurses have left that hospital due to bullying by management? The number of nurses we have lost from that hospital is unbelievable. I have asked, not only on this occasion but on many occasions, for the management to step down. It failed us before and during Covid and it is failing us now. It is failing the front-line workers in this hospital.

Michael McNamara (Clare, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State, Deputy Butler, for coming in here today. For a while, I was afraid that the Chief Whip would be responding on behalf of the Minister, Deputy Stephen Donnelly. Is the Minister back in the country? It is good to know that he is, because while he was away, overcrowding in Limerick reached a new record level. It reached a record for Limerick and then the next day, it reached a national record. I raised the issue of the necessity of some kind of an independent review with the Taoiseach. He seemed to take the idea on board and said he would refer it to the HSE and the Minister for Health.

I, along with my Independent colleagues from the region, have raised this matter to ascertain what is happening with this independent review. Will we proceed with it? I do not have the answers. I know what the problems are and, undoubtedly, the Minister of State does too. It is very obvious. We have massive overcrowding in Limerick and have had for a long time. We were told that the new 96-bed unit would solve the problem with overcrowding-----

Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

The Deputy had one minute.

Michael McNamara (Clare, Independent)
Link to this: Individually | In context | Oireachtas source

I apologise.

Mattie McGrath (Tipperary, Independent)
Link to this: Individually | In context | Oireachtas source

I will add my voice to this on behalf of the three rural Independents who are up the midlands, where we are. The problem is historic. The new 96-bed unit is supposed to be there. That sod was turned by the then Minister, Mary Harney, 20 bliain ó shin. The HSE is a failure. It has badly failed Limerick people and the people of north Tipperary.

I salute Independent councillor Séamie Morris on the work he does and the other people of Nenagh who resisted the closure of the accident and emergency units in Nenagh and in St. John's Hospital. We are told this will be a centre of excellence in Limerick, but it is chaotic and people have been left on trolleys. The trolley crisis is unimaginable there and there is stress and trauma on staff, families and everybody else. We need a whole sea change here. We need a clean-out of management and a re-evaluation. We need to reopen St. John's and the perfect unit in Nenagh.

People are shouting now. Deputy Kelly made his career out of the closure of Nenagh. Deputy Lowry supported it at the time and here we are. People have been denuded of the services. We do not have mental health beds in County Tipperary. The Minister of State has responsibility for mental health. We have to go either to Ennis or Kilkenny.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome this opportunity to address the House on the issues raised by the three Deputies. It is not the first time any of them has raised this. We hear it on a consistent basis. I acknowledge the distress that overcrowded emergency Departments cause to patients, their families and front-line staff working in very challenging conditions in hospitals throughout the country.

The health sector is facing significant challenges in providing emergency care over the winter period while also managing the demands of Covid-19.

The emergency department in Limerick is one of the busiest in the country, with over 76,000 attendances in 2021, which was up 16% compared to 2020 and up 7% compared to 2019. However, the numbers of patients waiting on trolleys for admission in University Hospital Limerick, UHL, in 2021 was 4.7% lower than in 2020 and 35% lower than in 2019. I appreciate that this is cold comfort to anyone who is on a trolley. The University of Limerick Hospitals Group has reported that it is continuing to deal with high volumes of patients attending the emergency department at UHL. This pattern has been sustained over a number of months and is being replicated around the country. UHL is working to ensure care is prioritised for the sickest patients. As part of its escalation plan, additional ward rounds, accelerated discharges and identification of patients for transfer to UL model 2 hospitals are under way. Surge capacity has been opened to manage the extremely high levels of activity.

There has been, and continues to be, substantial investment in UHL and the wider hospital group in recent years to address capacity issues. For example, a new emergency department opened in 2017. Since the start of 2020, 98 new beds have opened at UHL. This included the 60-bed modular ward block, which became operational in November 2020. It was established to provide a rapid-build interim solution to begin to address the bed capacity issues at UHL and improve patient flow. This also included a 24 single-room bed block, which functions as a haematology oncology unit, and a temporary 14-bed single room block, which has been designated for confirmed and suspected Covid-19 patients. These were initiated in May 2020 under the national action plan in response to Covid-19.

The winter plan for 2021-22 was published on 15 November and builds on the significant investment in last year’s winter plan. It aims to address the significant combined challenges faced by the health service over the winter period and recognises that a whole system response is required across primary, community and acute care. The scale of the challenges and demands faced by our health system requires both a plan and an associated system of governance and accountability. This system includes leadership, governance and operations to reflect the scale of the challenges faced and investments provided. The winter plan sets out the national, area and site level leadership and governance arrangements that are in place.

On the question of a review of UHL, the Health Information and Quality Authority, HIQA, is closely monitoring the overcrowding situation in a number of hospitals, including at Limerick over the past number of weeks. It has also had recent correspondence with the hospital group CEO regarding its evaluation of the current factors influencing crowding in the emergency department. HIQA has also written to HSE senior management to highlight its intention to initiate inspections under the national standards for safer and better healthcare.

The matter of performance in hospital emergency departments is under constant review by the Department through ongoing engagement with the HSE. The Department will continue to monitor the situation closely. On the question of a review at UHL, HIQA is closely monitoring the overcrowding situation in a number of hospitals and there are no further details in the response from the Minister for Health.

Richard O'Donoghue (Limerick County, Independent)
Link to this: Individually | In context | Oireachtas source

A review by HIQA is a review by the HSE. There is no such thing as an independent review of the HSE because it is the HSE auditing itself. This goes for every case that we have had in the High Court and everything; it is the HSE investigating itself. Therefore, that is not an independent review. These are people who are within the HSE sector and are paid by the Department. They are nominated by the Ministers to go on these reviews and they are investigating themselves. I am sorry, but that is not a review.

The hospital has introduced a three-minute assessment for a patient to be assessed. If a patient gets an extra minute, the management comes down and chastises the person who is trying to look after a patient. That is not right, either.

The management of UHL has to step down and let a new management in that will bring the morale of the hospital up. It is not front-line workers who are the problem; it is the management.

Michael McNamara (Clare, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for her reply, scant as it is. HIQA has a certain remit and I do not think it has the remit to recommend that model 2 hospitals be upgraded to model 3 hospitals. HIQA does not have a remit to look at the population, for example, if there is population growth or if the population of a region is greater than anticipated when originally planning hospital capacity. While I welcome the fact that HIQA is closely looking at this, I have two questions.

First, will the correspondence the Minister of State referred to be published? I do not think any of us want to go through the jig of looking for it through Freedom of Information. Ultimately, there has to be accountability by the Government, the permanent Government, the HSE and HIQA, through the delivery of health services in this country to democratically elected representatives. Can we see that correspondence?

Second, is the idea of a review no longer being considered? If that is the case, I am very disappointed. While I respect the work that HIQA is doing, its remit is limited.

Mattie McGrath (Tipperary, Independent)
Link to this: Individually | In context | Oireachtas source

The audacity of Mr. Watt and indeed the Minister for Health to go to Dubai to look at best practices during Covid speaks for itself and shows how out of touch they are.

My good friend and the Minister of State's former colleague, the former Minister of State, Máire Hoctor, did her very best to keep Nenagh accident and emergency department open. She was hounded out of office by Deputy Kelly and others who attacked her at the time. We have to go back and revisit and open Nenagh accident and emergency department, which was a perfect unit. We also have to open St. John's accident and emergency department again as an interim solution until we get a new building that is capable of dealing with the number of patients from north Tipperary, Limerick, Clare and beyond. South Tipperary General Hospital has an overflow of people coming in now because they cannot get into Limerick and they are afraid to go there because of the trolley crisis. Many things are wrong.

HIQA investing this is a pure joke. It has written to the management to tell it is coming in to investigate, yet it goes into nursing homes with no prior notice, inspecting them and closing them down. This charade of the HSE has to be disbanded. We have to open up the perfect accident and emergency units that were in Nenagh and St. John's Hospital.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I have to put on the record of the Dáil that HIQA is an independent body. I know from dealing with nursing homes, community nursing units and community hospitals throughout the country, and from any dealings I have had with HIQA, that it is an independent body.

The 2018 health service capacity review was clear on the need for a major investment in additional capacity in both acute hospitals and the community, combined with a wide-scale reform of the manner and the location of where health services are provided.

I will follow up today on Deputy McNamara's two questions - about the correspondence being published and a review being considered - to try to get him a substantial answer. I am aware that in relation to the question of the review of UHL, HIQA is closely monitoring the overcrowding situation in a number of hospitals, including Limerick over the past number of weeks and has had recent correspondence with the hospital group CEO regarding its evaluation of the current factors influencing crowding in the emergency department. I will bring the Deputies' concerns to the Minister, Deputy Stephen Donnelly.