Dáil Éireann Debate, Wednesday - 20 September 2023
949. Deputy Violet-Anne Wynne asked the Minister for Health who is the final decision maker with respect to the reinstatement of accident and emergency services at a hospital (details supplied); and if he will make a statement on the matter. [40045/23]
View answerIn 2013, the Government approved the Smaller Hospitals Framework, which 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 Hospital, 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 University of Limerick Hospital Group (ULHG), in April 2009, a process of reconfiguration commenced with the closure of the 24-7 emergency departments in Ennis and Nenagh. These emergency departments 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 University Hospital Limerick (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 Emergency Department (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 daily. 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
The introduction of the Medical Assessment Unit (MAU) pathway development in Ennis Hospital and the Mid-West region 112/999 patients commenced on January 9th 2023. It allows patients that meet the agreed clinical criteria to be treated in a Model 2 hospital. This pathway will result in patients receiving medical treatment in a hospital closer to their home, will reduce patient presentations to EDs and will release ambulances more quickly to respond to other emergency calls. The MAU in Ennis Hospital treats 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.
UL Hospitals Group has been approved for funding of €5.2m by the HSE’s National Acute Division for our MAUs. This funding has secured the already extended weekend service at Ennis MAU and allows for St John’s and Nenagh MAU to open seven days per week.
I have expressed concern about overcrowding in the ED in Limerick and acknowledge the distress caused to patients, their families, and frontline staff working in very challenging conditions in emergency departments in UHL and throughout the country. The HSE’s Performance Management and Improvement Unit (PMIU) led an intensive engagement with UHL team members throughout the summer in response to my concerns about the hospital and the findings of the HIQA report following an unannounced inspection of the ED in UHL in March. The engagement supported the hospital and community services in driving a programme of work to respond more effectively to the pressures at the hospital. UHL continues to engage with the support team, working jointly with HSE Mid-West Community Healthcare to respond to pressures faced at UHL.
There has also been significant investment in infrastructure in UHL in recent times. For example, in October 2022, I broke ground on the new 96-bed inpatient block project at University Hospital Limerick. 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. 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. The new injury unit in Ennis for treatment of breaks, sprains, and minor burns was opened on 29th June 2023.
There are no plans at this time to reopen the accident and emergency unit at Ennis General Hospital, but I would like to assure the Deputy that my Department continues to work closely with the HSE to ensure UHL is fully supported and that the necessary improvements to address capacity issues are actioned in a timely manner.
