Michael Lowry (Tipperary, Independent)
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2. To ask the Minister for Health his views regarding the feasibility of the proposal to extend the opening hours of the medical assessment unit at Nenagh Hospital. [39333/24]

Michael Lowry (Tipperary, Independent)
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Will the Minister give me his view regarding the feasibility of the proposal to extend the opening hours of the medical assessment unit at Nenagh Hospital? The idea and principle of expanding the opening hours of the medical assessment units at Nenagh and Ennis are understandable and logical. This could work if implemented properly. It would create more activity in Nenagh Hospital and mean that patients from north Tipperary could be referred by GPs to Nenagh rather than to Limerick. Patients could be assessed and triaged in Nenagh and only those who needed to be would be sent to Limerick. It would alleviate the pressure on accident and emergency services at University Hospital Limerick. It would also help to rotate beds faster for patients from north Tipperary who need acute care in Limerick. There is only one big problem - it is not working in practice. The existing medical assessment unit in Nenagh is malfunctioning and not being used to its full potential.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for the question. I support his call for ongoing investment in the medical assessment unit in Nenagh Hospital. The unit has been providing a valuable service locally. In many cases, it is an alternative to the emergency department for GP referrals. It is currently open seven days a week from 8 a.m. to 8 p.m. Last year, more than 4,000 patients were referred to the medical assessment unit in Nenagh. Already this year, the number of patients is in excess of 3,000 and climbing rapidly.

The Deputy will be aware that there was considerable investment of €2.3 million in the medical assessment unit in Nenagh. That allowed an extension to a seven days per week service from a five day per week service. Opening hours increased to 12 hours per day in July 2024. The service was provided five days per week and is now provided seven days per week from 8 a.m. to 8 p.m. I confirm that the policy is to move to 24 hours per day. Recruitment is under way and the posts have been sanctioned for that. There is ongoing discussion with the representative bodies and unions. They have raised concerns around rosters and working patterns with which the HSE is engaging. I would like those issues to be resolved because, as I said, the funding and posts are there. I want to get those posts hired into as quickly as possible so that we can open a 24-7 service, as the Deputy said. Once the ongoing engagement with the unions ends, we can move in that direction very quickly.

Michael Lowry (Tipperary, Independent)
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The problem is that the medical assessment unit in Nenagh Hospital is currently staffed and available but every day, several available slots are not used. Patients are not presenting to avail of the service. Consultants, nurses and support services are assigned to the hospital but there are not enough patients to treat. That is the reality. Considering that the current hours of service are not being used, what is the point in extending the hours of opening? We are not taking up what is available at the moment. It is a big issue that has been brought to me by the union and staff in the hospital.

Why are GPs reluctant to refer patients to the medical assessment unit at Nenagh Hospital? Why are they referring them directly to Limerick instead? A discussion needs to be had to get the considered views of GPs as to what are the stumbling blocks and why they are not referring directly to the assessment unit in Nenagh.

Stephen Donnelly (Wicklow, Fianna Fail)
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The number of presentations does not reflect the concerns that people are bringing to the Deputy. I will share the relevant numbers. In 2021, there were 1,300 referrals. In 2022, there were 2,500 referrals. Last year, there were 4,100 referrals. This year's number will be in excess of that. Between 2021 and 2023, years for which we have the figures, there was a 300% increase in the number of referrals. The referrals are climbing rapidly. If the Deputy has specific concerns that have been raised with him, he should by all means bring them to me.

The unions have raised concerns with the HSE. My advice is that those concerns are not about the use of the medical assessment unit but are about objections in respect of the staffing rosters. If legitimate concerns are being raised with the Deputy and he shares them with me, I will be happy to go back to the HSE with them.

Michael Lowry (Tipperary, Independent)
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The fact is that the front-line staff, the people in the hospital, are asking me what is the point in extending hours when the existing slots are not taken up. Consultants, nurses and everyone else are waiting around with no patients. That is the reality. There is a problem with the referrals from the GPs. The GPs obviously have good reason for not sending patients to Nenagh Hospital and we need to know what that reason is.

Management must engage with the staff in the hospital. Those in management must listen to the staff and respect their opinions. They must make decisions in conjunction with the staff. None of that is happening. That lack of consultation has led to uncertainty, confusion and resentment. That resentment is now manifesting in the fact that the Irish Medical Organisation, IMO, is to ballot its members on strike action. Whatever information the Minister is getting is not accurate. I am getting information from people on the front line, people on the ground, those who are working in the service every day. They are completely disillusioned.

Stephen Donnelly (Wicklow, Fianna Fail)
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This is probably the first conversation I have had where any Deputy has called for a reduction in healthcare service provision in a constituency. I do not think I have ever heard hospital staff calling for fewer services to be provided. We need to treat this carefully.

As I said, the number of referrals is not in line with what the Deputy is hearing. The number of referrals tripled in just two years. There is a run rate of nearly 100 referrals per week. If there is more that the GPs can be doing and there is a need for engagement with the GPs to make them aware, let us do that. However, rather than saying there are slots available so we should reduce the service or not increase the service, and I know the Deputy is not saying that-----

Michael Lowry (Tipperary, Independent)
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I am not saying that. I am saying we should use the service to its maximum.

Stephen Donnelly (Wicklow, Fianna Fail)
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I know the Deputy is not saying that, and of course we will do as he says. It is interesting that the concerns the unions are raising with the HSE are that they do not want to work the rosters that are being offered. That is what the HSE is hearing. The Deputy might share specific examples of unfilled slots and I will ask the HSE about it on the back of this conversation. It goes without saying that we must fully use the capacity we have. Perhaps further engagement with the GPs is required. Let us see.