Victor Boyhan (Independent)

I welcome the Minister to the House and thank her for giving her time. It is important that when we discuss this that we set the scene, because I am always conscious there are people outside of here looking in who will be looking at the Oireachtas report later on. We know HIQA publishes terms of reference. In a press release issued on 21 August 2024 the authority: "The HIQA has published its terms of reference for an independent statutory review to inform the delivery of safe quality urgent and emergency care in the mid-west region of Ireland."

We also know that through an examination of Oireachtas parliamentary questions, hundreds and hundreds of questions, motions and matters of discussion were raised with various Ministers for health. We have had the parties in Government in some form or shape for many years. I acknowledge the new Minister has clearly demonstrated a capacity to focus and a determination and emphasis on this particular issue, and on other issues. I acknowledge that and pay tribute to her for that.

The terms of reference were, of course, developed following a request by the then Minister, Stephen Donnolly, for HIQA, as the independent health and social care regulator, to conduct this review. It is important to stress this review was conducted under section 8(1)(e) of the Health Act 2007. I understand the review sought an evaluation of evidence-based and key factors to inform decision-making around the design and delivery of urgent and emergency healthcare services, including the case for a secondary emergency department within the region. Following completion of the review, the report ultimately landed on the Minister's desk and was published.

Before I go into some key questions to ask or points I wish to raise with the Minister, it is important we acknowledge the many patients that suffered within this region. Their cases were articulated well in this House by a number of my colleagues. That is important. In addition, what the key health workers, medical workers, front-line workers or any workers or service supports and anybody within the health service in this region had to tolerate for years was totally unacceptable. It has taken so long, and it is a pity it has taken so long, but we are now clearly on a trajectory for something new, which is important. The Minister mentioned the ERSI. I studied some of its documentation relating to this report and it is important we acknowledge that independent thought process feeding into it.I thank all stakeholders engaged in the process. Let us now move on. Enough of the old history listen, let us look at the key asks today.

We have three options. Option A talks about expanding. The three key issues are expand, extend and develop. Option A is to expand capacity at University Hospital Limerick, UHL, on the Dooradoyle site. Option B is to extend the UHL campus to comprise a new second site in close proximity under a shared governance and resourcing model. Option C is to develop a model three hospital in the HSE mid-west region, providing a second emergency department for the region.

The Minister has to put in place timelines. Clearly we cannot wait. There are issues, let us be honest, about resources that have to be secured. There is planning. There is a whole range of issues as consultation with all stakeholders. It is also important to acknowledge that HIQA completed this extensive research. We know that there were 17 in-person meetings with the stakeholders and that there were 1,121 public consultation submissions. I have looked at some of the correspondence that supports all of this. We know that an expert advisory group was convened to consult the independent review. Of course, then we need to go back to the core issues here. What was the core recommendation? The core issue of this was that there were not enough inpatient beds. Keep it simple. There were not enough inpatient beds in the HSE mid-west region capable of treating the sickest patients who presented for urgent or emergency care. This is a summary of HIQA's own report to the Minister. HIQA recommended "immediate action and investment to address current risks to patient safety in the shortest time frame and safest way possible". That is the kernel of what the Minister is saying. Therefore, we now have to go back to the options.

The time for deferral is over. There are three key options. What is HIQA saying about some conglomeration of option A or B? HIQA's view is that options A and B are most likely to increase the number of available inpatient beds of the required type in the shortest timeframe, addressing the immediate risk to patient safety. It acknowledges this risk. I suggest that this is the focus. This is what the ask is. I would be interested to hear what the Minister is proposing or planning. When will she have a timeframe in terms of kickstarting the recommendations? I presume she will have talks internally with her own officials and with the Government as well. We need to know today or certainly in the next few weeks, and the people in this region want to know, what is happening.

We have identified the problem and the weaknesses. We have acknowledged that people suffered. We acknowledged that patients and their safety were put at risk. We acknowledge that staff had to tolerate dreadful conditions. People were embarrassed. The medics and politicians who represent the region were embarrassed. Loads of parliamentary questions were asked and there were debates and motions. What do we need to do today? The heavy lifting is done. The Minister is committed to focusing on getting things done. What I would like to hear in the short term, for the people of this region, is what options she is recommending, what options she is going to fund and what timelines are involved for delivery. This will be progress and action, which is the key ask here.