Róisín Garvey (Green Party)
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We all know how bad the situation is in University Hospital Limerick, UHL, which has become infamous, being possibly the worst hospital when it comes to trolley numbers, accident and emergency services, and chaos. I want to ask if the Minister for Health will make a statement on the extension of opening hours of the injury clinic in Ennis Hospital to help reduce pressure on the emergency department at University Hospital Limerick. So many injuries are happening at night time and this is plain to be seen if one is ever down in the accident and emergency services, in Limerick. It usually kicks off after 8 o'clock, much of which involves limbs being wrapped up and bashes where people are out.

While we are waiting to solve the problems of UHL, the more we can do within the counties around the hospital, including my own county, the fewer the number of people will have to go to the accident and emergency services in Limerick. We have a good new medical centre and and primary healthcare unit in Ennis. I am also wondering about the primary healthcare centres which were due in north, east, and west Clare also. In the meantime, there is a brilliant injury clinic in Ennis hospital. It will not solve all of the problems but I want to find out if there is any plan and, if there is one, when will it extend the opening hours of the injury clinic so people around Clare can go there if they happen to fall or hurt themselves after 8 o'clock at night? The period from 8 a.m. to 8 p.m. cover 12 hours but many accidents happen at night time, especially with older people who may fall out of bed. The last place they want to go is down to the accident and emergency department. People now live in fear of going there and, in particular, our older population. I just want a clear answer on any plan to extend the opening hours of Ennis Injury Clinic.

Martin Conway (Fine Gael)
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I thank Senator Garvey for that question and I absolutely share the concern she has expressed in a very important question. I call the Minister of State to speak now again, please.

Mary Butler (Waterford, Fianna Fail)
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I thank the Senator for her question and it is fair to say that the senior Minister, Deputy Donnelly, working with Bernard Gloster and Sandra Broderick, the new regional executive officer, REO, are trying to use every available lever they have in the area to improve the situation in University Hospital Limerick. It is also fair to acknowledge that a huge amount of great work is done in that hospital too with very many good people working there.

The development of injury units, IUs, is a strategic initiative for this Government to assist with alleviating pressures in our emergency departments. As a result of this strategic plan a national injury unit review was undertaken by the HSE in 2023. The recommendations from this review were: to expand all existing acute hospital governed IUs to operate from 8 a.m. to 8 p.m. and to expand geographical coverage and prioritise locations for the provision of IUs.

Resources are provided under the national service plan to standardise all IUs to open from 8 a.m. to 8 p.m. by quarter 4 of 2024. I must note that Ennis injury unit is already operating to the hours recommended by the review. In addition, an implementation plan for the expansion programme is under development.

Demand for urgent and emergency care in the region has increased year on year, which includes activity in injury units and medical assessment units in the three model 2 hospitals of Ennis, Nenagh, and St. John’s. To address this increasing demand, this Government has invested significantly in additional capacity in the region and at UHL.

The Minister, Deputy Donnelly, has asked HIQA to lead a review into urgent and emergency care capacity in the mid-west region to determine whether a second emergency department is required. While this is ongoing, the Minister, Deputy Donnelly, announced an additional package of reforms and supports for the mid-west region in April of this year. Progress is being made on delivering these improvements, with some services, such as the new nursing and residential home triage tool already being implemented by the National Ambulance Service. Some 150 new beds have been opened in the University of Limerick Hospitals Group since January 2020 and 108 of these beds have been in UHL. Additional health service capacity is being provided through: a new 96 bed block at UHL where it is anticipated that this will provide additional capacity for the region from mid-2025; a second 96-bed block at UHL, the enabling works for which are under way; a rapid build 16-bed unit at UHL, for which completion is expected at the end of December 2024; an additional 84-inpatient beds are being planned at UHL through the Acute Hospital Inpatient Bed Capacity Expansion Plan; and medical assessment units, MAUs, as I have already said, at Nenagh, Ennis and St. John’s Hospitals are extending their service to 24 hours a day, seven days a week on a phased basis.Currently, the MAUs are operational from 8 a.m. to 8 p.m. This will be extended to 16 hours per day, from 8 a.m. to midnight, by the end of quarter 3 2024, which is soon.

The community rehabilitation unit in Nenagh is now operational, delivering 50 beds in Nenagh as a temporary step-down facility. The procurement process for the community rehabilitation unit beds in Ennis has been finalised and the group will now focus on operationalising the additional 25 beds at Ennis. That is in Cahercalla, which I visited a couple of years ago. Bed capacity is being expanded throughout the region through the acute hospital inpatient bed capacity expansion plan, with 24 new beds at Nenagh Hospital, 48 new beds at Ennis Hospital and 42 new beds at St John’s Hospital.

Every effort is being made to increase capacity and build confidence in the region again. That is what everybody wants to see.

Róisín Garvey (Green Party)
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I thank the Minister of State. I take it from her answer that the opening hours will not be extended past 8 p.m. I reject the findings of the HSE working group. To say all injury clinics should be treated the same and all should open from 8 a.m. to 8 p.m. is not good enough for us in County Clare. We are the only region in Ireland that does not have model 3 hospital. There should be a special case made for Ennis Hospital, unless the HSE wants to provide us with a model 3 hospital. I do not see that happening because it has not been mentioned by anyone in the HSE.

The Minister of State indicated that the medical assessment units will open for 16 hours a day by the end of quarter 3, which is in six days' time. Does that mean I can tell everyone in Clare they can relax because we have been told by the HSE working group and the Minister of State that we will see this happen in six days' time?

The answer is not satisfactory. We need the injury clinics expanded to later hours. We have no model 3 hospital. After 8 p.m. people in Clare have to go to Limerick hospitals. To say the HSE working group finds that opening the emergency department until 8 p.m. is sufficient does not give me and the people of Clare any solace.

When I criticise UHL it is never a criticism of the staff. The staff are killing themselves. They are so stressed out and in such a difficult position because they are stuck dealing with patients who sometimes take things out on them. We cannot shoot the messenger. There are huge issues in UHL and we are trying to find some solutions. This is one.

Mary Butler (Waterford, Fianna Fail)
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I understand exactly where the Senator is coming from. Based on the answer I provided, everyone has to acknowledge that more investment and staff have been put into University Hospital Limerick than in any other hospital in Ireland in the last four years. That is a fact. Unfortunately, there are issues that take a long time to deal with. There are cultural issues and the way things are managed.

To take University Hospital Waterford as an example, while I am not saying everything is perfect – it is not – it never has anyone on a trolley. The reason is that when someone goes into to the emergency department of University Hospital Waterford, there are 16 specific pathways. If it is an issue with a limb, for instance, the person goes directly to the area where that is sorted. Again, I am not saying everything is perfect there but for a long time, senior management have been in the emergency department from 7 a.m. until 10 p.m. Four senior managers in the hospital rotate every weekend to ensure people are discharged.

Ms Sandra Broderick is now the regional executive officer and Bernard Gloster and the Minister for Health have focused on this whole area. A huge amount of work has been done. There is the pathfinder, for example, an emergency department avoidance programme run by allied health staff and the National Ambulance Service. The pathfinder aims to deliver safe alternative care at home and is working very well. The extra beds in Cahercalla will make a big difference, as will the 50 extra beds in Nenagh. We are also doing work on hospital avoidance because some people do not need the acute hospital.

I will bring back the issue the Senator raised about the 8 a.m. to 8 p.m. service. I understand where she is coming from, especially the point that Ennis does not have a model 3 hospital and it is a long drive from west Clare to UHL. I appreciate that. I thank the Senator for her advocacy. I hear her speak on this subject constantly.