‘New hospital, full stop’

Calls to develop a Model 3 hospital providing the Mid-West with a new emergency department have intensified following last week’s publication of a HIQA review on emergency healthcare in the region.

Coming at the end of a month that saw a record 2,386 patients on trolleys at University Hospital Limerick’s long-suffering ED, the report has led to hope of opening a second emergency department in the Mid-West, possibly in Nenagh.

HIQA has presented the Minister for Health with three options for addressing the risk to patient safety in the region. These include the expansion of capacity at UHL on the Dooradoyle site (Option A); the extension of the UHL hospital campus to include a second site in close proximity under a shared governance and resourcing model (Option B); or the development of a Model 3 hospital, providing a second emergency department for the region (Option C).

HIQA is of the view that options A or B will likely yield the required inpatient capacity in the Mid-West within a shorter timeframe. Option C may have the potential to meet longer-term bed requirements, but would be least capable of addressing immediate capacity deficits.

NOT AN OPTION – A NECESSITY

Reacting to the report, local TD Alan Kelly said the minister would have to take the third option. “It’s not an option – it is a necessity,” Deputy Kelly stated. “It’s as obvious as the nose on your face that the Mid-West needs a new Model 3 hospital with full emergency and ICU facilities, whether in Nenagh, Ennis or Limerick.”

The Labour TD questioned why there was a need for HIQA to carry out a report into the matter and why it took 16 months to come up with “options”.

“I’ve been fighting against the downgrading and subsequent lack of services in the Mid-West literally my whole political career. Today’s report is another insult to the people of the Mid-West as it drags out decision making yet again and more years are lost,” Deputy Kelly said after the report was published last Tuesday week.

“We need a new hospital, full stop. We need a site identified and planning put in. It can be built in stages in order or help with capacity in the short term.

“However, the idea that somehow this isn’t a guaranteed recommendation is beyond my capacity as a public representative who’s been close to this issue all my political career to understand.”

‘THE BEST OPTION’

Fianna Fáil TD Ryan O’Meara welcomed the HIQA report, which he said involved a wide consultation process with 17 in-person meetings with stakeholders, over 1,100 public consultations received and the establishment of an expert advisory group.

“As part of the review, the ESRI also undertook a study to determine the increased demand in healthcare services up to 2040,” Deputy O’Meara stated. “As part of that, the ESRI determined that anywhere between 299 and 593 extra bed spaces would be needed in the Mid-West Region up to 2040.

Deputy O’Meara said he would be calling for increased investment to deliver beds needed in addition to the new 96-bed block - which is due to open atUHL next Monday. “I will also be addressing the three options with the Minister for Health and with an Taoiseach, with the view of determining which of the three options will best meet the long-term needs of the constituents that I represent.

“Considering that anywhere between 299 and 593 new beds are needed in our region between now and 2040, it appears to me that option C, the development of a Model 3 hospital in the HSE Mid-West region, is the best option for meeting that demand.”

Giving his reaction to the HIQA report, Deputy Michael Lowry described it as a “belated formal conclusion and acknowledgement” of problems he and others have been talking about for many years. “It is now important that the preferred option is selected and acted upon as a matter of urgency,” the Independent TD said.

‘ALL THREE OPTIONS’

Meanwhile, local Sinn Féin representatives and the Mid-West Hospital Campaign have called on the Minister for Health to implement all three options of the HIQA report.

Damian O’Donoghue of Sinn Féin in Nenagh said the report provided “obvious solutions - there was always a clear need for a second emergency department in the Mid-West, given population increases and the extreme crisis at University Hospital Limerick.

“UHL desperately needs more capacity. The mistakes made when Ennis and Nenagh were downgraded cannot be repeated. September is already the worst month for trolleys at UHL ever. This could be the worst year yet for UHL,” Mr O’Donoghue said.

“Personally, I would like to see Nenagh hospital restored to a Model 3 hospital with a fully functioning emergency department to service the population of North Tipperary.”

Dan Harty, the party’s Thurles-based representative, said the Government “must now act urgently to resource a plan to deliver a second emergency department and Model 3 hospital in the Mid-West, while simultaneously expanding safe capacity at UHL. An additional emergency department at another hospital is the only safe option. Up to 600 more hospital beds are needed in the region and should be delivered across the two hospitals.”

However, Mr Harty described indications that the Government would include only three new major elective hospitals in the National Development Plan as “a sore lack of ambition”.

Dr Conor Reidy of the Nenagh Needs Its A&E / Mid-West Hospital Campaign expressed disappointment with the HIQA report. “We were hoping for a bold rethink. What we got was more tinkering around the edges,” he said.

Dr Reidy regretted that HIQA’s terms of reference did not call for an answer over the “reckless decision” to proceed with reconfiguration in 2009, despite the economic crash. “In that sense, accountability for all the suffering and undignified death that resulted from that decision is as far away as ever,” Dr Reidy stated.

The local campaign groups called for “urgency, courage and ambition” in pursuing all three options – “not another committee, not another delay”.

“All three options should be pursued together: more capacity at UHL, a second site to ease the load, and a Model 3 hospital to give this region what every other part of the country already has.”

‘EXTRAORDINARY CAPITAL INVESTMENT’

“Yes, that will require extraordinary capital investment. But let’s be clear: the human cost of delay has already been extraordinary.

“We are appealing directly to Minister Carroll MacNeill: the time for talking is over. Families in the Mid-West cannot wait another 16 years.”

Also calling for swift action on the HIQA report was the Irish Nurses & Midwives Organisation. “Since the downgrading of services in Nenagh, Ennis and St John’s in April 2009, over 176,870 patients have been on trolleys in University Hospital Limerick. Over 2,386 patients have been on trolleys in September 2025 alone,” said INMO Assistant Director of Industrial Relations for the Mid-West, Mary Fogarty.

“Whatever decision is made regarding the expansion of care in the Midwest region, it will be meaningless unless there is a funded workforce plan incorporating robust recruitment and retention strategies. The capacity issues that currently exist in UHL are exacerbated by ongoing staffing shortages, which the INMO has highlighted for years. There are approximately 300 nurse staffing vacancies with over 30 vacancies in the ED alone.”