Observations on the ongoing Mayo hospital safety saga
by Dr. Richard Martin
I went for a late night walk around Kilkenny Cross recently. Some old school hip hop and pause for thought. Allow my mind to relax and float downstream.
However, a niggling recurring thought kept floating into my consciousness interrupting the relaxation process.
The politics of Paul Lawless. I didn’t want to engage with the thought process, I wanted peace, I wanted to relax.
In the end, I just decided to go with it and thrash it out somewhat in my brain.
I came to the conclusion that the political approach of Paul Lawless is clever. I don’t like his politics. But it is clever. It’s fairly simple too. Complain.
Provide no real practical solutions and then complain some more.
The first task of a newly elected TD is to get re-elected.
Personal survival in the political jungle is the only thing that counts. The statistics don’t lie.
There were 48 new TDs elected in 2020, 35 of those 48 were returned in 2024. Roughly 25% lost their seat. One in four.
His election to the Dáil in 2024 can only charitably be described as fortuitous.
His final tally of 9,506 votes was over 2,000 votes shy of the quota of 11,812.
While he did win the seat, a strong argument can be made that Fianna Fáil lost it.
He is a member of a fringe party (with only two TDs in the Dáil – including himself) with no discernible solid policy platform.
He is, in theory, vulnerable. Aontú policies sway to the left and to the right according to the prevailing wind of populism.
He is of course a populist, but he’s not the first and he won’t be the last.
Those of us who follow and understand politics know that that is what he has to do to remain relevant and be re-elected.
To agree with the government parties on any issue is political suicide.
Like the Healy-Rae’s and Matty McGrath’s he must challenge the orthodoxy at every twist and turn to remain relevant and keep his cushy number in Dáil Eireann.
Whether he will in fact ever effect change is unlikely and irrelevant.
But when he is challenged and scrutinised in the Dáil chamber, as he was by Alan Dillon earlier in the year in relation to FDI and in the last few weeks by Jennifer Carroll McNeill, the mask slips somewhat.
Let’s examine his recent exchanges in the Dáil chamber with the Minister for Health, Jennifer Carroll MacNeill.
On September 18, during a Dáil debate, he raised concerns about Mayo University Hospital.
He asked and pleaded with the minister “to implement the safe staffing framework as quickly as possible.”
He stated that Mayo University Hospital “was in a crisis situation, experiencing over 160 presentations daily despite the fact that just four or five nurses were rostered on a given day.”
Before I go any further, I researched that statement ad nauseum. The daily rate of 160 presentations, in particular.
In 2024 there were 43,625 presentations to the emergency department. That corresponds to an average rate of roughly 120 presentations a day.
Hospital presentation rates oscillate on a daily, weekly and monthly basis.
Having a rate of 160 daily presentations is partially plausible at peak times but implausible as a daily average.
If Paul Lawless can produce hard statistical evidence to support his claim, I along with others would love to see it.
In the eyes of Paul Lawless the solution to the ‘crisis situation’ in MUH is to throw money at it.
Hire a few nurses and that’s that. Not the most original of plans.
If the solution was that simple, surely someone would’ve got there already.
He doesn’t yet understand the complexity of how hospitals operate.
Jennifer Carroll MacNeill became the Minister for Health in January of this year.
Since then she has made two official visits to MUH and one unofficial visit.
There are nine model 3 hospitals in the country, of which MUH is one.
Her response to Deputy Lawless was cool, calm, factual and measured.
Firstly, she explained, using verifiable statistics, that the core issue in MUH isn’t staffing levels, as Deputy Lawless suggested.
She articulated: “The first thing is in relation to staffing. Mayo hospital has had a 30% increase over the past five years.
“When I saw some of these figures I did an analysis of a sample of nine model 3 hospitals. Mayo hospital has the second highest rate of staffing of those model 3 hospitals. The difficulty with Mayo hospital is not the level of staffing.”
Her next statement struck gold.
She explained what the core problem is.
“Mayo hospital is imbalanced. I will give the deputy two examples of that.
“I was there on an unscheduled visit when there were 47 patients in the emergency department. Of those patients, 20 had been admitted for beds, but there was no discharging going on up the hospital.
“Mayo University Hospital remained red all through August, which is completely unacceptable.
“There was not sufficient work being done to discharge during the weekend. There were 16 discharges in the hospital on Saturday, there was one on Sunday and there were 47 on Monday. I ask the deputy to explain that to me.”
Of course, he didn’t and couldn’t answer her question.
In fairness, he would not have had the detail she possessed.
If patients aren’t discharged in a timely manner, it causes chaos at the hospitals main entry point - the emergency department.
Put simply, it becomes overwhelmed.
Nurses and doctors working in a chaotic environment are put under extreme pressure and stress and inevitably leads to mistakes and poor patient outcomes.
The main knock on-effect is that the emergency department itself cannot cope capacity wise and there could be 30/40 patients lying on trolleys in corridors with no privacy waiting to be admitted to the main body of the hospital which at weekends is dormant on the other side.
Adding more nurses and doctors to that one area would be counterproductive.
Having doctors and nurses rostered at weekends to work in the hospital wards and radiology department would be wholly productive. It would restore operational balance to the hospital.
What Jennifer Carroll MacNeill is telling us is that the main body of the hospital must function at the weekends.
She elaborated further: “There is not a single person in this room who can explain that except that there is an imbalance in staffing. I was there on a random Saturday in August and the emergency department was absolutely overwhelmed. There was a serious patient safety issue there. The rest of the hospital was completely empty.
"There were practically no diagnostics going on. There were not even people in the diagnostics area.
“The hospital is not understaffed but it has an understaffing area in the emergency department, specifically because it is not being correctly staffed on the other side.”
Whether you like or dislike Jennifer Carroll MacNeill, the force of her logical response is overwhelming.
After the Dáil exchange, Deputy Lawless then released a statement to this newspaper supporting nurses on a nationwide strike on staffing issues and then doubling down on his faulty assertions.
His final coup de grâce was a request for “the minister to return to Mayo University Hospital and spend a full 12-hour shift with the nurses and doctors - not just 10 minutes - to truly understand the gravity of this situation.”
My immediate thought when I read that statement was fundamental.
Perhaps he should take his own advice!