This is a large and complex report and I’d like to acknowledge the work that has gone into it, from HIQA themselves, but also the many members of the public, health care campaigners and the team within the Mid-west HSE, who all contributed to it.
I would also like to commend all the staff in UHL, they have shown through a number of recent reports that they are delivering more than most other hospitals in the country in the face of an historical lack of investment in services and infrastructure. They are stretched to the limit, and to suggest there is any more left in the tank from a productivity and efficiency perspective is to fail to recognise the intolerable overcrowded conditions they are working under and the sheer scale of the population of the areas they serve.
I would also like to take the opportunity to highlight the excellent work done by healthcare campaigners on this issue for years. I’d specifically like to mention the Friend of Ennis Hospital who have continuously taken a positive and solution focussed approach and have provided many of us elected representatives with excellent data over the years.
Firstly, I welcome the acknowledgement in the HIQA report that the Mid-West region needs additional bed capacity to ensure appropriate levels of emergency care are provided to the people it serves. That is a fact many of us have known for a very long time. For too long the excuse for the lack of investment in the provision of new emergency care facilities was that clinical advice does not support it. Thankfully, we now have a report that clearly states exactly what we do need.
I note the three options contained in the document. I do not believe Option A, the expansion of services on the existing campus, to be a reasonable and future proof solution. I understand from speaking with HSE staff that there is concern as to the capacity within the UHL campus for much further expansion, and what space there is, is fraught with complexity and risk, given one of the new 96 bed blocks is now subject to planning review and unlikely to be delivered before 2029. The co-location of the University Maternity Hospital Limerick to the UHL campus also provides further constraint, this commitment given by Minister Carroll McNeil to me in a reply to a PQ submitted in July, is unlikely to change, given that mothers must have access to a full range of medical and support services should the need arise. The availability of these services within a Model 4 campus helps ensure the delivery of an optimum, safe service, particularly for high-risk mothers and babies.
The proposal to build a new Model 3, Option C, would really worry me. The time frame for the delivery of it would be extremely significant, if achievable at all. It will not alleviate the bed capacity issue at the core of the ED problems in the short term, therefore unable to provide the necessary services to manage the current demand and as they are capped at a capacity of 200 beds is unlikely to ensure adequate levels of service into the future. The Mid-West is the engine room for economic development for the west of Ireland and to build something that will not support population growth for the next 50 or so years would be extremely short sighted and lacks a proper vision for appropriate long term emergency care for the region. I would also be concerned, given the context of the Children’s Hospital, as to the appetite for undertaking the work of delivering a full brand-new hospital. Calling for a new Model 3, while politically expedient, is to ignore the reality of delivering one.
I believe Option B, the development of a new campus is what we should be pursuing. It will see increased bed capacity and acute services being provided in the near term on a staged basis, alleviating pressure on the existing hospital while potentially leading to a new ED ‘front door’ in the future. From the perspective of future proofing emergency care provision for the region this option looks to me the most sensible and pragmatic. However, underlying this must be recognition of the huge issues around ambulance cover in the more peripheral areas of the region. I am glad to see reference to this within the document. I repeatedly hear from constituents who experience extremely long waiting times for ambulances. Regardless of the location of any new emergency care services, we urgently need increased levels of resources, staffing, vehicles and bases in the NAS for the county.
I am wholly committed to anything that will provide an improvement in the provision of emergency healthcare in the Mid-West, and more specifically for the communities I represent here in County Clare. The closure of the A&E in Ennis was undoubtedly the wrong decision, it has had a generational impact. We have to make sure the correct decision is made this time to ensure that impact does not continue to negatively affect future generations.
I will be writing to all my fellow Oireachtas representatives in the Mid-West region, and will include those in East Galway, and North Cork and Kerry, to invite them to a meeting to discuss the recommendations in this report. We must ensure there is a unified approach to the political push needed to deliver the best long term solution that will provide appropriate emergency care provision for the area for the next 50 or more years. Anything less than that will delay any delivery of the necessary infrastructure to address the core issue identified by HIQA, a lack of bed capacity.