Dáil Éireann Debate, Tuesday - 11 July 2023
736. Deputy Mattie McGrath asked the Minister for Health who decided to go ahead with reconfiguration of the mid-west region despite the 600 beds required by the Hanly Report to offer safe patient safety not being in place; if he will launch an investigation into this decision, given that it has caused untold suffering on patients and staff in the mid-west region for 14 years; and if he will make a statement on the matter. [33755/23]
View answer738. Deputy Mattie McGrath asked the Minister for Health following his comments that reconfiguration was not working (details supplied), if he will put an urgent plan in place to reopen Nenagh, Ennis and St. Johns accident and emergency departments, given the new 96-block bed unit will only actually realise 48-beds meaning that the mid-west region will still not be at the 600-beds needed to provide patient safety according to the Hanly Report; and if he will make a statement on the matter. [33757/23]
View answer739. Deputy Mattie McGrath asked the Minister for Health if he will publish the evidence he relied upon when he stated that reopening an accident and emergency department in Ennis Hospital was inadvisable on safety grounds; and if he will make a statement on the matter. [33758/23]
View answer740. Deputy Mattie McGrath asked the Minister for Health if he will commit to meeting with TDs and Health Forum members from the mid-west as requested by the HSE Mid-West Forums meeting recently; and if he will make a statement on the matter. [33759/23]
View answerI propose to take Questions Nos. 736, 738, 739 and 740 together.
The Government remains committed to improving services in Limerick and the Midwest region. I have engaged extensively with the University of Limerick Hospital Group (ULHG) and the HSE regarding the challenges being experienced, particularly in UHL. This includes convening a meeting earlier this year involving An Taoiseach, senior management from the Hospital Group, and Mid-West Oireachtas Members, including the Deputy. I have also made a number of visits to UHL and the regional hospitals in the Group, most recently at the end of June this year.
In relation to the issues being raised by the Deputy, in 2013, the Smaller Hospitals Framework defined the role of smaller hospitals and outlined the need for both smaller and larger hospitals to operate within Hospital Groups. The Framework identified the activities that can be performed in smaller Model 2 hospitals, in a safe and sustainable manner. In developing our smaller hospitals, the first and overriding priority is the safety of patients. This Framework provided a stronger role for smaller hospitals, like Ennis, Nenagh and St John’s Hospitals, in delivering a higher volume of less complex care in many cases closer to patients’ homes. It also ensures that patients who require true emergency or complex planned care are managed safely in a larger hospital environment. Regarding hospitals in the ULHG, in April 2009, a process of reconfiguration commenced with the closure of the 24-7 emergency departments (EDs) in Ennis and Nenagh. These EDs were replaced with Medical Assessment Units (MAUs) for GP referrals; and by local injury units/urgent care centres for self-referrals and operating 12 hours a day, seven days a week. These changes were supported by an Emergency Care Network, which had been set up in the region and led by consultants in emergency medicine. These consultants, while based in UHL, have clinical responsibility for the Injury Units in Ennis, Nenagh and St John's. Additional consultants in emergency medicine were recruited to support these changes in addition to Advanced Nurse Practitioners for the Injury Units in the smaller hospitals and for the ED in UHL. Within the ULHG, there are two Model 2 Hospitals, Ennis and Nenagh Hospitals. St John's Hospital is classified as a Model 2S Hospital, i.e. St. John's can carry out intermediate surgery, which requires in-patient stay and accommodation in addition to day case surgery. These hospitals play a pivotal role in the delivery of high-quality patient care within the region. The model 2 hospitals accept transfers of appropriate patients from UHL on a daily basis. These patients can either be stepped down from an inpatient ward in UHL or they may, where a clinician has decided it is appropriate, transfer to Ennis, Nenagh or St John's directly from the ED in UHL.
ULHG remains committed to investing in their Model 2 hospitals to enhance non-acute patient care. In April 2022 the new purpose built €2m Injury Unit at Ennis Hospital opened replacing the existing unit that had operated out of the main hospital building since 2013. The new Unit, which I formally opened last month, has brought an immediate improvement in the clinical environment and experience for healthcare staff and the thousands of patients who use this service every year. There has also been investment in equipping the Outpatient Department, including provision of X-Ray Room and other diagnostics, in Phase 1b of the redevelopment of Ennis General Hospital and in redevelopment works to provide two replacement theatres and supporting facilities.
In addition, ULHG has confirmed that, through funding of €5.2m secured from the HSE, the MAUs at Ennis Hospital, Nenagh, and St John’s now all operate seven days per week. This funding will see 51 additional WTEs recruited across a number of specialties for the MAU services.
Another development in Ennis and Nenagh Hospitals has been the introduction of the MAU pathway for 112/999 patients. This allows patients that meet agreed clinical criteria to be transferred by ambulance and treated in a Model 2 hospital. This pathway is resulting in patients receiving medical treatment in a hospital closer to their home, is reducing patient presentations to EDs and is helping to release ambulances more quickly to respond to other emergency calls. The MAUs in Ennis and Nenagh Hospitals treat patients referred by GPs, ShannonDoc, and now National Ambulance Service paramedics. 112/999 patients that do not meet these clinical criteria will continue to be transported to EDs for assessment and treatment. In addition to Ennis and Nenagh, it is envisaged that the MAU pathway for 112/999 patients will commence operations at St John's Hospital, Limerick by the end of July 2023. ULHG has advised that there are currently 867 inpatient beds across the Group, which includes 530 beds in UHL. 150 additional beds have been opened in the ULHG since 1st January 2020 and 98 of these beds are in UHL.
There has also been significant investment in infrastructure in UHL in recent times. For example, work on the new 96-bed inpatient block project at UHL commenced in October 2022. This project represents a total capital investment of just over €90 million, and will deliver a 4-storey, 96 single bed acute inpatient ward block and will go some way toward addressing capacity issues in the region. Pre-planning meetings on a second 96-bed Ward Block at UHL have been also held and it is anticipated that planning permission will be applied for this month. In 2021, a new 60-bed modular ward block opened. This follows the completion of two separate rapid-build projects, constructed in response to the Covid-19 emergency, which provided an additional 38 inpatient beds on site at UHL.
Following these and other investments across the wider ULHG, consideration is also being given to future capacity requirements. It is noted that ULHG has developed proposals in this regard. These proposals will be considered by the hospital group and the HSE in line with their governance processes.
Complementary to the development of the new Elective Hospitals, the HSE also plans to work with Hospital Groups and forthcoming Regional Health Areas to progress proposals for a shorter-term measure by developing ‘Surgical Hubs’ in Cork, Galway, Limerick, Waterford and Dublin with a narrower scope of procedures. Regarding the Surgical Hub for Limerick, planning is at an early stage, and I have asked the HSE to expedite the development, so it is operational as soon as possible. My Department continues to work with the HSE to ensure the improvement of services for all patients in the Midwest region continues. For example, while I recognise that there is more to be done in UHL, particularly in relation to the ED, improvements are being made. This was acknowledged in the context of HIQA’s recent inspection report of UHL against the National Standards, in comparison to their previous report from March last year. In that regard, I am confident that the measures set out in the published Compliance Plan will help to address the issues raised in HIQA’s report and thereby further improve services at UHL.
