Violet-Anne Wynne (Clare, Independent)
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First, and I mean this with no disrespect to the Minister of State, I really needed the Minister of Health present here in the Chamber. It was incredibly important for him to be here to answer questions or, at the very least, to have a Minister of State here from within his Department. I am struggling to be able to see where the Minister of State will be able to provide any clarification, which is what I need for my constituents. The Minister of State will only be able to read out the response he has been given and nothing more. I add that this situation is not unusual. We often have a different a Minister or Minister of State taking a question on behalf of the Minister with sole responsibility for that Department. Usually, however, it is someone from within the relevant Department.

They would have some experience or knowledge themselves on the issue, but that is not the case here. This is not the only time this issue has occurred. This is the second time the Minister of State has responded to this matter, once here and prior to that in the Seanad. There has been nothing but confusion created on when Ennis will get its satellite haemodialysis unit, which was announced and promised. I am extremely concerned about it as I hear from within UHL that the question should be whether it is happening at all. Since February, I have been told that the proposal for an externally contracted satellite haemodialysis unit at Ennis General Hospital is currently under review. Then a further sentence was added stating it was under internal HSE review and that funding for any approved proposal would be subject to the standard Estimates process. I received a response to a parliamentary question from the then acting CEO of the UL Hospitals Group saying that the tender process is complete but that funding and HSE board approval are now required.

There appears to be so many versions of the same thing. Is there a straightforward answer? I hope the Minister of State will be able to provide one in his response. In fairness, I have gone from pillar to post on this issue, which requires a simple answer as to when it will happen. Why has there been so much hesitation? That only became apparent after the announcement was made last year. What is going on? It is completely unacceptable.

I ask the Minister of State to go back to the Minister for Health and to relay my exact sentiments. Haemodialysis is a mostly lifelong treatment given to people suffering from severe kidney failure. UHL is the only hospital in the Ennis-Limerick-Nenagh region that offers this service and it has little to no capacity currently to accept new patients. The hospital is under great pressure and a potential disaster is waiting to happen.

The cost of transporting patients from the mid-west to UHL by taxi for this exact treatment was €204,321 last year. If we go back to when the records began in 2017, the cost was nearly €127,181, which indicates a significant increase. I hear through the grapevine that the satellite haemodialysis unit is not going ahead and management is so desperate it has decided to offer night dialysis. There is no sign of additional resources coming forward. This gives rise to a myriad of issues of concern. Is the Minister of State aware of the proposal to provide night dialysis and what is his response to that?

Martin Heydon (Kildare South, Fine Gael)
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I thank the Deputy for the opportunity to address the House on this issue. I send apologies on behalf of the Minister for Health who was unable to take this matter. I offer this response in his place on what I know is a very important issue for the people of Clare and the mid-west region.

Haemodialysis is a life-sustaining treatment. However, for dialysis patients and their loved ones, travelling to treatment several times a week for hours on end is hugely demanding. I reassure the Deputy and all patients in the mid-west that the Government remains fully committed to improving services in the region. The Minister for Health has engaged extensively with the UL Hospitals Group and the HSE in recent months. He announced a series of measures to increase capacity and improve services across the region, including in Ennis. This includes 48 additional acute inpatient beds to be opened in Ennis hospital in the next four years. This will almost double the capacity of the hospital. The acute hospital inpatient bed capacity expansion plan details 382 additional beds to be delivered in this region by 2031.

As the Deputy highlighted, the UL Hospitals Group is seeking to establish a haemodialysis service in Ennis. It is envisaged that this unit will be similar to the satellite centre already in place in the Fresenius Medical Care centre in Limerick. The development of a unit in Ennis would enable more patients in the area to receive treatment closer to home. This development would also ease pressure on the renal department at University Hospital Limerick and on the existing satellite unit in the Fresenius Medical Care centre.

The Deputy can be reassured that the Minister understands the importance of expanding haemodialysis options in the mid-west. I am advised that procurement for this satellite unit is progressing in line with national financial regulations. The HSE has advised that following a tender process carried out this year, significantly higher projected costs than were originally expected to deliver the unit were identified. Additional funding, beyond what was originally projected, is required to support this service. The HSE has advised that the service is still anticipated to commence in 2025, as advised earlier this year. In the interim, additional dialysis slots have been added to the service at UHL to ensure all patients can receive the treatment they need. I appreciate that additional travel and later appointments can cause significant inconvenience to the lives of dialysis patients. The HSE has advised that, where it is possible, the distance patients must travel is taken into consideration when allocating these slots. I assure the Deputy that the Minister welcomes the additional capacity that this expansion of services will bring to the mid-west. He continues to work towards that end.

Violet-Anne Wynne (Clare, Independent)
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I appreciate the response the Minister of State has given and the indication that the service will commence in 2025. It is hard to see how that will transpire given that it is the middle of 2024 and nothing has been progressed. I also appreciate that he outlined that the procurement is progressing in line with national financial regulations but I am unsure as to what that means. I feel that I have entered a twilight zone given that he is responding to this issue for the second time. No definitive timeline was mentioned in the response. I understand that additional costs present a challenge but we must be able to respond, especially given the proposal for night dialysis. The issue is not that people are getting later slots; it is that they are having to do it at night, which poses a number of safety issues. Night dialysis is not a good plan and it must be stopped in its tracks. That is something on which one and all agree.

Another point is that little to no management personnel will be present on night shifts. I mentioned to the Minister on a number of occasions about the need for reform of management in UHL and he indicated a similar line of thought. It is important to mention that no management personnel will be present in the case of night dialysis, and that is a major safety issue.

The introduction of night dialysis is a half measure at best. Although it is claimed to be temporary, it is likely to become permanent. We do not have a definitive timeline. The Minister of State said the service will commence in 2025 but the fact that we are only discussing the proposal at this point does not provide much confidence. That will have serious ramifications for patient well-being. It forces frail elderly people to leave their home at approximately 10 o'clock at night to travel for up to two hours to the hospital and receive a four-hour treatment, returning home at approximately 6.30 in the morning. It is desperately unfair to people in this situation and it also prevents younger people from working.

Martin Heydon (Kildare South, Fine Gael)
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The Minister for Health understands the significant improvements a new haemodialysis unit would deliver to patients in Clare. Dialysis treatment can be demanding for patients and their loved ones. As the Deputy clearly outlined, it puts significant pressure on their time and the effect is increased for those who must travel longer distances to receive the treatment. The Government remains committed to working with all relevant stakeholders to provide haemodialysis services in line with clinical advice and best practice.

As I stated, dialysis patients in Clare continue to receive care in UHL and the Fresenius Medical Care centre. The HSE is using contingency measures to ensure that all patients who need that care continue to receive it while capacity across the region expands. It has also advised that procurement is continuing to progress on the establishment of a satellite haemodialysis service in Ennis as soon as possible. As I outlined in my original response, I am told that will happen in 2025. This is an expensive and specialised service. The HSE is continuing with the procurement process in line with the financial regulations but also with the clinical guidance of the national renal office. The Minister continues to work closely with the HSE to ensure that the new regional executive officer in the mid-west is fully supported in the delivery of healthcare services for the region.