Limerick is hosting a conference called 'Healthcare on the Margins' this weekend - a fitting location, given that the Mid-West is seen as the unhealthiest region in the country, and its main hospital is consistently the most overcrowded.
The regional population is more deprived than the national benchmark, according to the 2022 census, with 24% of people in Limerick considered disadvantaged, 23% in Tipperary, and 21% in Clare.
The figure is higher in Limerick city, according to IMO President Dr Anne Dee, who is leading a project on the social factors behind poor health in the region -the focus of the conference.
"We know in the Mid-West we have very high levels of deprivation, one third of the people living in the city would be considered disadvantaged, and we have high levels of poor health because of that," Dr Dee said.
University Hospital Limerick serves this population, but it does not have the capacity to meet the demand for patients who require admission.
"There are a lot of factors putting pressure on UHL, but deprivation is high on the list," Dr Dee said.
"We have conducted research that shows people living in deprivation are more than twice as likely to require care at an emergency department."
Every report conducted into emergency healthcare services in the region has come to the one conclusion: more beds are needed.
The recent report from HIQA could not have been clearer: "The core issue is that there are not enough inpatient beds in HSE Mid-West which are capable of treating the sickest patients who present for urgent or emergency care.
"We recommend immediate action and investment to address current risks to patient safety in the shortest timeframe and safest way possible."
It made three recommendations: expand capacity at UHL, add a second site nearby, or build a completely new hospital in the Mid-West with a second emergency department.
'A centre of excellence' for the region
There was a time when people in north Tipperary could attend the emergency department in Nenagh, and residents of Clare could go to the ED in Ennis. People in Limerick had a choice between St John's Hospital and the Dooradoyle campus, then part of the Mid-Western Regional Hospital.
That all changed in 2009, when the three smaller emergency departments were closed, and emergency care was centralised at Dooradoyle. The then Minister for Health, Mary Harney, said the Mid-Western Regional Hospital would be "a centre of excellence" for the region.
However, that vision never fully materialised, partly due to the financial crash, which left hospitals without the investment needed to deliver on those promises.
Many people in the Mid-West believe political leadership is also required, as well as increased funding. They have long grown weary of the headlines about overcrowding at UHL and the repeated political promises to address it.
A group called Friends of Ennis Hospital has, what they call, the longest running health campaign in Ireland, advocating "a hospital IN Clare FOR Clare".
In a social media post this week, Friends of Ennis Hospital said: "It is imperative that swift action is taken by the minister to activate emergency powers if necessary to build the capacity needed in the Mid-West."
The minister in question is Jennifer Carroll MacNeill. She is the sixth health minister who has promised to address the crisis in HSE Mid-West.
At the opening of a 96-bed unit at UHL last month, Minister Carroll MacNeill said all of the options put forward by HIQA were on the table.
She said a decision would be made by Christmas.
"Christmas is coming but so is the minister’s decision," Friends of Ennis Hospital posted.
A new hospital in Clare?
Clare TD Cathal Crowe said he would be "very disappointed" if the minister does not have a response by Christmas, "because this has been delayed enough already".
In a one-to-one meeting with the Taoiseach, the Fianna Fáil TD told Micheál Martin that this was a once in a lifetime opportunity to sort out the problems in healthcare services in the region.
"I said the overwhelming view in the region is that the outcome needs to be a blend of all of the (HIQA) options," he said.
Deputy Crowe’s preferred option is a new hospital in Clare.
"I know some will say that’s parochial, but it isn’t," he said. "We have detailed analysis that shows that people in Clare are the most medically disadvantaged in the country, particularly those who live in the north and west of the county. Some people live an hour and 50 minutes from an emergency department."
"We have to make a seismic decision that future proofs healthcare in this region so that when the children of the Mid-West reach adulthood, there is a hospital there to meet all their needs," he said.
Politicians in the Mid-West, regardless of party or county loyalty, have a personal stake in the future of UHL that goes beyond simply pleasing constituents.
Deputy Crowe’s mother worked as a nurse at the hospital, while Tipperary TD Alan Kelly lost his father there. On the day the HIQA report was published, Deputy Kelly left his mother’s hospital bed in Nenagh to speak to RTÉ News and asked why people in the Mid-West were being treated as second-class citizens.
The Labour TD said the region did not need more "options" for emergency healthcare - it needed action from the Government to deliver it.
'Stop blaming staff' for ongoing crisis
Top doctors at UHL are standing up for their patients, urging senior health officials to stop blaming the hospital’s hardworking staff for the ongoing crisis.
In a statement from the hospital’s medical board, chaired by Prof Colin Peirce and deputy chair Dr Joe Devlin, they said:
"We hope to no longer hear the HSE or the Department of Health blame staff in HSE Mid-West for problems that have once again been clearly identified as those of physical bed capacity.
"Rather, it would be appropriate to acknowledge the inequitable access, the privacy and dignity deficiencies our patients experience and recognition of the superb work of HSE Mid-West consultants, nursing and support staff in delivering more emergency care than any other Model 4 hospital in the state, despite such inadequate infrastructure."
The doctors warned of the ongoing patient safety risks due to lack of beds and said the pace at which new beds are promised needs to be accelerated.
There has been a marked drop in the number of patients waiting for a bed in UHL since the new unit opened on 13 October. The numbers left waiting for a bed have dropped to between 53 and 67 patients per day, according to figures from the Irish Nurses and Midwives Organisation Trolley Watch.
Sinn Féin TD Maurice Quinlivan said the drop shows "some progress finally being made on the capacity issues facing University Hospital Limerick".
"We need to ensure that these levels of trolley numbers fall much further."
It has been four weeks since the Health Minister promised a decision by Christmas on the options outlined by HIQA for HSE Mid-West.
There are seven weeks to go until Christmas.
