Violet-Anne Wynne (Clare, Independent)
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7. To ask the Minister for Health if he will reinstate an accident and emergency department at Ennis Hospital; and if he will make a statement on the matter. [9591/24]

Violet-Anne Wynne (Clare, Independent)
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I have raised this with topic with the Minister and his Cabinet colleagues on many occasions. There has been considerable consensus on those occasions that the reconfiguration failed. I would be grateful if the Minister would put on the record of the House whether he intends to reinstate the accident and emergency department at Ennis Hospital

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for the question. I visited Ennis Hospital not that long ago and must say I was hugely impressed, especially by the work carried out by healthcare professionals in the injury unit and the medical assessment unit, MAU. We are investing at a significant rate in Ennis Hospital, including in urgent and emergency care. In 2022. I provided €2 million for the Ennis injury unit, which has gone from strength to strength. Currently, one in three unscheduled care cases received treatment in the mid-west injury units.

Last year, we allocated funding of €1.6 million to extend the opening hours of the medical assessment unit in Ennis. In February of last year, a 999 pathway was introduced for the medical assessment unit. This allows for the transfer of patients who meet the agreed clinical criteria for treatment in Ennis

In June of last year we launched the Pathfinder service, which I know is very important and has been welcomed by the Deputy's constituents. It was extended to Clare. It helps the NAS support older people living at home. All of these measures have been put in place to alleviate the pressures on people in Clare seeking urgent care and by association, the very significant pressures we are all aware of in University Hospital Limerick.

I am very aware of the calls for a full emergency department to be opened in Ennis. To that end, I spoke directly with the chief clinical officer. We will both be aware that the clear clinical advice over many years has been that it would not be safe to open an emergency department in Ennis. The thing to do is to invest in the injury unit and in the MAU. In my response, I can give the Deputy some of the response I got back recently from the chief clinical officer on the issue she has raised.

Violet-Anne Wynne (Clare, Independent)
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I thank the Minister. I would like to receive that information. I had a recent response from the HSE on the expansion of the injury unit. It seems it is not possible to expand it any further than has been done up to now. There were 121 people on trolleys this morning in UHL during morning rounds. This is 50 patients more than the next most overcrowded hospital in the State. There is consensus that the reconfiguration failed and yet, as far as I can see, no significant action has been taken on Ennis emergency department.

The Minister has mentioned the investment in Ennis up to this point. The decision at the time to close Ennis was a political one, based on the Hanly report. The report actually recommended updating the facilities, but instead Mary Harney closed it. It is a matter of urgency that the Ennis emergency department be reinstated. I acknowledge what the Minister has said about clinical advice but what about the golden hour, which we know from trauma studies is essential to limit morbidity and mortality? We cannot have people coming from Carrigaholt. They are not going to make is within that hour to UHL

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy. She raised two really important issues. One is the unacceptable level of pressure for patients and healthcare workers in UHL. It is not acceptable. On any given day now, UHL can make up one in five, or even one in four of the number of patients on trolleys in the entire country. At a national level, the good news is that the number of patients on trolleys fell very significantly last year, particularly in the second half of the year . The pressures are now in a smaller number of hospitals, Limerick regularly being number one or number two. A huge amount of resources have been allocated there. I am working very closely with the HSE and my Department to help drive the necessary reforms in UHL. If I may Deputy, I will come back in my next response on the response I got from the chief clinical officer in terms of the emergency department. My view on this is that political decisions are around funding but in terms of urgent and emergency care, we have to be led by the clinical view as to what is in the best interest of the patients. I will revert with that information .

Violet-Anne Wynne (Clare, Independent)
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The Minister has mentioned increased investment in UHL but as it currently stands, we still need the revenue to provide the first 96-bed block and the capital and revenue for the second 96-bed block to be progressed as a matter of urgency. The Minister could be building capacity at Ennis but instead the surgical hub is located at an old school in Limerick city. The HSE has told me in replies to a parliamentary question recently that there is no intention to expand stroke, cancer or coronary care in Ennis. Why not? Ennis is a fantastic facility and we should be expanding capacity there. We should also be expanding the services that are already on site. Last year, the House passed a motion to have 24-hour MAUs and injury units. Before Christmas, the CEO of the HSE told me that this is not currently possible because of recruitment and retention issues. I accept that but what I do not understand is why we cannot roll out 24-hour services in MAUs and injury units in Ennis, Nenagh and St. John's in the short term, until the Minister for Health of the day sees the writing on the wall and reinstates Ennis accident and emergency department. We are the only CHO served by a single model 4 hospital. This is a teaching hospital and is not backed up by a model 3 hospital. We could reduce the number of people on trolleys in UHL by half.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank both Deputies for this. I fully appreciate where they are coming from in the context of how the people they represent are genuinely worried about going to the emergency department at University Hospital Limerick. I get that.

We have to do two things. We must continue to invest in Ennis Hospital. We have been investing in it year on year, we have expanded its opening hours, its urgent care capacity and its medical assessment unit capacity and we will continue to invest in it. At the same time, we must fix the emergency care situation in UHL. This is not a capacity issue; we were asked to invest additional capacity and we have done so. Some 192 beds are being built on site and we have already added many beds. Believe it or not, we have increased the staff in UHL by 1,000 in the lifetime of this Government. There has been vast investment but, unfortunately, that investment has not been mirrored with the requisite reforms, such as through the weekend discharge and the rostering of senior decision-makers - I do not refer to them being on call, but rostered - in the evenings and at the weekends. I refer also to the kind of co-operation we need between community care and acute care, such as that which we are seeing in other parts of the country.

I will finish on this point. I can assure the Deputies that we are we are building those 192 beds. Those beds will be staffed. We will continue with very significant investment, including the surgical hubs and more capacity to get the situation resolved.

I have the letter from the chief clinical officer and I did not read it out. I apologise to the Deputies. I will arrange for my Department to share the letter with the Deputies.

Violet-Anne Wynne (Clare, Independent)
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I thank the Minister.