Dáil debates
Tuesday, 30 January 2024
Saincheisteanna Tráthúla - Topical Issue Debate
Health Services
11:40 pm
Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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Carlow health services are important to us all. As the Minister of State is no doubt aware, injury units treat recent injuries that are not life threatening and are unlikely to need admission to hospitals. Such units can help with many of the injuries people go to emergency departments with. For example, with broken bones, dislocation and minor burns, patients can get treatments, X-rays and plaster casts. That is important. The HSE has advised that approximately 130,000 patients attend 12 local injury units in the country each year. They are designed to provide the same level of care as would be available in emergency departments, but more locally and with a shorter waiting time.
A HSE review of the injury units and medical assessment units looked in detail at the activity, capacity, staffing and operations of existing units across the model of what is called two hospitals, as well as areas having the most potential need for additional injury units. This is why I am glad we have someone to take this tonight, and I thank the Minister of State for taking this. There is an implementation plan for the recommendation from the review, which is now being developed. I am pleading that Carlow would be part of this. Carlow has grown by 9%, and is one of the fastest growing counties in the country. Carlow has a population of 62,000. The CSO figures show the population of Carlow town at 27,351. Kilkenny city is a little smaller at 27,184. The Carlow town population figures include Graiguecullen, which the Minister of State knows is just bordering Carlow. In the census, 1,262 people reported bad or very bad health in the county. That was up from 936 people in 2016. Carlow needs its own injury clinic, and I would like this to be supported and for Carlow to have this; we really need to expand in Carlow.
I want to talk about the X-ray unit. We have a fabulous building in Carlow called St. Dympna's. It was a hospital many years ago. We now have the X-ray department there, but it only operates on a part-time basis. This old hospital is a beautiful building, but they have other health services in it. Part of it is an X-ray unit, but it only opens part time; it is not open full time. At the moment it is closed for refurbishment. People from Carlow have to go to Kilkenny for an X-ray. One of the biggest challenges with people accessing healthcare in Carlow is in ambulance response times. The 2014 HIQA report into pre-hospital emergency care highlighted the dynamic development process as a measure to improve response time from the NAS performance generally. This happened, and it is a concern. We have fabulous ambulance paramedics in Carlow. They do an excellent job. However, this dynamic model of ambulance development allows the service to prioritise resource allocations to higher calls that require immediate emergency response. It also allows the categories of non-serious or non-life-threatening calls. This provides a resource appropriate to the patient's clinical need. I am sure the Minister of State is aware of this. The ambulance base in Carlow town supports five emergency ambulances on Monday and four during the remainder of the week. At the moment, a project is commencing to provide a new ambulance base in Carlow town, which was included in the 2023 capital plan and is currently at the appraisal stage.
Neale Richmond (Dublin Rathdown, Fine Gael)
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I thank the Deputy for raising this issue. At the discretion of the Chair, I thank her for the warm welcome to Carlow last Friday. It was wonderful to be there. As a segue, I met former Deputy Charlie O'Connor yesterday and I told him that the Deputy had assumed the mantle of Jennifer "Carlowman" O'Connor. He was happy to see that his moniker lives on.
The National Emergency Medicine Programme, EMP, model of care recognises the need to support the development of injury units. These units provide care locally in cases where injuries are unlikely to require hospital admission. I am pleased to say that 13 local injury units are open around the country, each one providing an important service to their local communities. These units are designed to provide the same level of care for certain conditions as would be available at an emergency department, but more locally and with a shorter waiting time. This care includes direct referral to specialties such as orthopaedics, plastic surgery or maxillofacial surgery, in the small number of cases in which this is indicated. As a result, these units also play an important role in reducing the waiting times for patients in emergency departments throughout the country. The services provided at injury units are held in high esteem by patients. This is evident by the large and growing demand for these services. Approximately 140,000 patients attended injury units in 2022, an increase of 30% since 2019. This represents approximately 7% of all urgent and emergency activity in Ireland. I can advise that the HSE has carried out a review of injury units, which was completed in July 2023. The review considered the activity, operations and governance of 13 injury units across the country. These recommendations of the review are broadly based on three themes. These are the need to standardise existing services; consistency of operating hours across established units; and to identify options for future development of injury units in the medium to long term. I believe this is where a case for Carlow may come in. All recommendations will of course also be subject to resource and other considerations and will be delivered through the Urgent and Emergency Care Plan, UEC, for 2024, and successor plans as appropriate.
I think we are at the stage where the assessment has been carried out and the review completed. It is going through the process, but now is the time where local advocates such as the Deputy will continue to push the case for an injury unit in their particular region, or indeed another region as they see fit. I undertake to bring the points made by the Deputy this evening to the Minister, Deputy Donnelly, and his colleagues in the HSE. I would be more than happy to support the efforts to secure that unit for Carlow.
Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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At the end I was going to thank the Minister of State as he was in Carlow last Friday. We were delighted to have him in the enterprise board. It was great that we can show off what Carlow has to offer. I thank him for coming to Carlow. These injury clinics are so important when we now see how Carlow is growing. We have Kilkenny hospital, which is also an excellent hospital, but it would be beneficial to everyone if Carlow had its own injury clinic, and it would be great if people could go there. We have the services ready. The Minister, Deputy Donnelly, is aware of this. I have spoken to him several times about an injury clinic for Carlow. I spoke about the ambulance paramedics who do an excellent job. The system is failing at the moment. A mother came to me last week, who had called an ambulance for her two-year-old daughter who had a seizure. She was waiting six hours for the ambulance to come. I believe the child is now getting tested for epilepsy. If we had the injury clinic it would help everyone. It would help the ambulance paramedics and the great job they are doing. It would help Kilkenny hospital. The main thing for me is that it would be there for the people of Carlow. It would be a service the people of Carlow need. We really need to have it there. We need that service, and it would be of great benefit to everyone. I ask the Minister of State, in his role, to go back to the Minister, Deputy Donnelly on this. I have spoken to the Minister about this several times.
The one thing that needs to be looked at is the urgency of this injury clinic. We have a lovely X-ray unit in Carlow. If we could just expand that to get bigger premises, it would be an absolute win-win for the people of Carlow.
11:50 pm
Neale Richmond (Dublin Rathdown, Fine Gael)
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The services provided at injury units provide a safe and convenient delivery of the right care in the right place at the right time and make an immediate positive impact on patients' experience. I once had my ear stitched back on at the side of the pitch in Oak Park. I would have definitely much preferred to have gone to an injury unit. However, that was not today or yesterday. The HSE is reviewing the recommendations and developing an implementation plan for further development of services at injury units. The implementation of these recommendations will be through the urgent and emergency care plan 2024 and subsequent plans, as appropriate. The work is ongoing subject to resource and other considerations. No decision has been reached by the HSE on specific new locations for injury units. However, increasing the number of locations is under consideration, subject to available resources. We all know the demographic changes that are going on throughout the country, but particularly in large towns like Carlow, and the need for additional services. It would make sense to have new injury units. I know the people of Carlow can be assured the Deputy will continue to put this case to the Minister, Deputy Donnelly, and I am more than happy to join in that call.