Revealed: Full transcript of Minister's assessment of Mayo University Hospital

The following is a transcript of the letter emailed yesterday by the Minister for Health Jennifer Carroll MacNeill to local elected representatives in respect of her analysis of Mayo University Hospital.

I am writing to you as a public representative for Mayo to provide you with an update on Mayo University Hospital (MUH).

For some time, I have been concerned about the sustained high levels of congestion in the hospital’s emergency department, and its ability to fully deliver timely care to which the people of Mayo are entitled.

While these challenges are not unique to MUH and are shared across the HSE West and North West Region, I am addressing this letter to you, as a Mayo public representative, to outline my concerns, clarify what may be some misconceptions and outline the steps I have taken to recover this situation for the staff and patients and residents in the catchment area of MUH.

The baseline position that has generated my elevated concern is that 80.2% of days to date this year, MUH has been in the “red” (or unsafe) threshold.

That means out of the first 242 days of this year, for 194 days this year, 10 people, or more, have been on trolleys as of 8am in the ED of MUH.

This is the most severe situation out of all Model 3 hospitals in Ireland, with the next most serious case at 62% of the 2025 period to date.

To me this is utterly unacceptable, as I know it is to you. We have to work together to improve the patient flow experience in Mayo and, since September 19 when I committed in the Dáil to writing to you, I am pleased to say I see some good evidence of early improvement.

As we approach winter, the risks associated with poor patient flow become more acute. It is imperative that MUH rebalances its activity across the week to support better patient flow, reduce pressure on staff, and improve safety for patients.

I met with the hospital manager, Catherine Donohoe, at our recent productivity conference on September 11 and I know she is committed to improving the situation.

Over the past weeks, I have asked the HSE to take specific actions to support MUH in this effort.

1. I asked the Chief Nursing Officer of the Department of Health, along with the HSE’s Nursing Advisor to the CEO, to engage directly with MUH’s management on the approach to safe staffing levels. She attended the hospital on October 6 to reignite the safe staffing framework. If a further programme of work is required, we will support that.

The HSE CEO, based on a comprehensive analysis of agency use, overtime, and workforce data, will engage with the region to identify where the HSE can provide support and where internal changes may be needed to address pressures.

2. In addition, the HSE CEO has now deployed expert national support to the Region this week to fully support local management and to develop a plan that addresses the immediate and unacceptable levels of trolleys observed levels which, as a Region, are currently the most challenging in the country.

Based on the feedback from this deployment, the CEO will brief me on appropriate next steps.

3. Finally, the Department of Health’s Irish Government Economic and Evaluation Service lead will work with MUH and the wider Region, together with the HSE National Workforce Intelligence Lead, to ensure that all metrics and analysis are reviewed in a helpful and supportive way to deliver the best possible outcomes for both the public and staff.

Staffing in Mayo University Hospital

There has been commentary suggesting that MUH is understaffed. To test this, I requested a detailed update from the HSE CEO. The data confirms that MUH is not understaffed.

Indeed, as you can see in Table 1 below, as of July 2025, MUH employs 1,502 Whole Time Equivalents (WTE), ranking seventh among the 17 Model 3 hospitals nationally.

Table 1: Staffing in Model 3 Hospitals

Model 3 Hospital Staffing - July 2025

Since December 2019, staffing has increased by 31%, amounting to an additional 352 WTE. This is a significant and above-average increase compared with other hospitals.

In terms of nursing, MUH currently has 617 nurses in post, with 42 vacancies, most of which are replacements rather than new development posts.

Table 2 : Breakdown of staff increases in MUH

Maternity leave rates are in line with national averages, though the sick leave rate is higher than average, which does affect the overall availability of staff hours.

Significant levels of absenteeism have been noted amongst approximately 9% of the nursing workforce, a 3% increase since 2023.

The hospital has approval to recruit a further 82 WTE by year-end, again primarily replacements, and has agreed to a closer focus on the absenteeism rates.

Safe Staff Framework for Nursing

Safe Nurse Staffing is an essential policy to which the government is committed and has funded. It has been implemented in full or in part by hospitals nationally.

I am aware that there has been a difficulty in its implementation in MUH.

Uniquely among our hospitals, MUH was not originally included in the estimates for national baseline implementation of Phase 2.

This was due to various local administration delays. It is imperative that MUH now fully implement that Safe Staffing Framework and I have put in place measures to support this happening quickly.

During the recent visit by the Chief Nursing Officer (October 6) and her team along with the HSE, did a review on progress with implementing the Framework.

It was highlighted to the CNO that the nursing and midwifery workforce in MUH has increased by 40% since 2016.

Crucially, and very helpfully, MUH already have well established senior nursing posts and nursing governance structures. This is an important foundation for implementation and sustaining the framework.

Full implementation of the Framework has not yet been achieved by Mayo University Hospital.

Phase 1 required 29.5 WTEs for full implementation of that phase – which applies to general medical and surgical wards. This has been ongoing with 27 .5 of those posts now in place and remaining staff commencing employment by the end of October 2025.

Phase 2 applies to the emergency department settings. Unfortunately, this had not progressed with MUH and an application for staff was not made in the estimates for 2025.

Following an intervention made at my request, the Chief Nursing Officer has made an assessment, and we have ensured that the staff (18.5 WTE) that are needed are sanctioned for recruitment.

I am pleased to say MUH are now progressing this and I know you will support them in this work.

MUH do not currently have the IT system ‘Trendcare’ in place. This has been identified as an important priority to ensure accurate data and evidence for sustained implementation of the Framework. It is important that this is also prioritised.

MUH also need to stabilise the nursing workforce by addressing the high absenteeism and overtime usage.

The framework includes a staffing % to facilitate leave requirements, however the absenteeism rate exceeds the allowance.

This has been prioritised by the hospital. And indeed, it is my hope that a safe, more stable environment, especially in the emergency department, will help staff whom I know have understandably struggled with conditions in the emergency department.

Emergency Department Problems in Mayo University Hospital

The real issue at MUH is not the number of staff, but how staff are deployed and managed. During an unscheduled visit to the hospital on Saturday, August 2, I observed 47 patients in the emergency department, 20 of whom had been admitted but were waiting for beds.

What struck me most was the lack of visible activity elsewhere in the hospital to support overall patient flow.

Patient flow must be carefully managed by each hospital seven days a week. The number of patients admitted and discharged must be kept balanced to avoid congestion.

In hospitals that manage this effectively, the entire hospital works together in a coordinated manner across diagnostics, discharge planning, and community engagement.

This has not been happening effectively in MUH, nor indeed across the HSE West/North West region more broadly.

For example, on Monday September 15, I joined the HSE’s national operational oversight call regarding emergency department situation report.

The discharge figures in MUH from the weekend preceding that call was concerning.

On Saturday, September 13, there were only 16 discharges, and just one on Sunday, compared to 47 on Monday.

This imbalance in activity places undue strain on the ED and delays the return of ambulances to the community.

However, it is clear to me that many hospitals consistently achieve good “operational grip”, thereby avoiding congestion in the emergency department.

Model 3 hospitals that excel in this area, such as Midland Regional Hospital Tullamore, Portiuncula, Connolly Hospital Blanchardstown demonstrate that it is possible to maintain safe and efficient patient flow even under pressure.

Since July 2025, there has been a transformation in patient flow in Tallaght University Hospital demonstrating that it is possible to consistently improve patient flow even in hospitals that seemed to have intractable issues.

This is the future I see for Mayo University Hospital.

Over the coming weeks and months there will be a sustained focus on operational grip, leadership and UEC performance in sites of concern including MUH.

I have been informed that there is very good progress in efforts to ensure that patient safety is maximised through nursing initiatives, leadership and improvements to patient flow.

It is also important that the clinical community give their full support to the work of management in implementing the Public Only Consultant Contract and I know you will be supportive of management in this effort also.

The following tables demonstrate that MUH has the most problematic emergency department in Model 3 hospitals, and this cannot be explained by staffing or demographics. It is a function of the distribution of staff and patient flow throughput the full hospital.

Table three is an analysis of all of the model three hospitals and indicates that may has a higher average number of people on trolleys than any other. Table four is the proportion of days this year that each model three hospital is in “red”.

In both cases, the situation in Mayo demands intervention in the interests of patient and staff safety.

Table 3 : Average Trolley No. at 8AM for first 242 days in 2025

Table 4: No. of days Trolley numbers (8AM) were in Red in Model 3 hospitals in 2025YTD (242 days)

For 17 out of the first 19 days of September, MUH was in red. In the 25 days since then, only 6 have been in red – including only 3 so far this month in October. This is significant improvement.

I have full faith in MUH to sustain this improvement and to be a leader across the West/North West in achieving real and sustained operational grip. I will write to you again in November to update you on what I hope will be a sustained improvement for all.

Conclusion

There is little doubt that our health system experiences pressure in various locations for a multitude of reasons.

However, I am advised by the HSE CEO that it is not a simple binary issue of resources alone being the cause.

Performance improvement and public safety depend on a combination of policy reform, resource allocation, and operational performance.

I am satisfied that the HSE West/North West Region is not disadvantaged in any major way in terms of policy or resources that would explain the current difficulties.

While I will continue to support the region, I also have made it clear to the HSE that serious improvements are required in operational performance and in how the valuable resources already in place are used to maximum effect.

While MUH, like all hospitals, faces pressures and requires ongoing support, I believe that the actions outlined above will help MUH move forward in a way that benefits both staff and patients.

I will continue to monitor developments closely and I await further updates from the HSE CEO. I will remain actively engaged to ensure that the necessary improvements are delivered and sustained.

There is a basis for real improvement here. I hope fervently that staff can feel some benefit, that patients can feel some benefit. I am asking for your help and support in continuing to drive change and to support the interventions being implements by the HSE and local management.

I am aware that there has been a ballot by nurses on site to have industrial action. I hope it is clear that the hospital is well staffed and I am confident that the hospital patient flow can be improved in a way that makes the hospital safe, easier place to work and enhances patient safety – which I know is the absolute primary concern of the excellent staff at MUH.

I hope that if we see this sustained improvement we can work to avoid that.

Please also get your flu vaccine and encourage others to do likewise. The hospital is undergoing enough change at the moment, and we need to minimise the exposure to the risk of flu.

The flu came early and quite hard in the southern hemisphere, it is important as many people as possible get the vaccine in the coming days and week.