HSE Mid West working toward equity for region’s disadvantaged

The Mid West region is leading the way in tackling health inequalities, with the development of one of Ireland’s first co-located Inclusion Health services for adults and children. This innovative approach aims to address the extreme health disparities experienced by socially excluded and marginalised children and families.

Led by consultant paediatrician Dr Siobhán Neville, the paediatric inclusion health service holds four outpatient clinics per month, in Ennis OPD, Nenagh Primary Care Centre, and University Hospital Limerick, as well as once-weekly ambulatory care clinics in the hospital’s day ward. The service also provides inpatient care and consultation services to other specialties.

The Mid West paediatric service was launched in July 2024, and since then has engaged with approximately 180 children via more than 400 outpatient appointments and 140 inpatient bed days. Many of the children are experiencing homelessness, or come from families that have refugee status, or are applicants for international protection. Others are members of minority ethnic groups, including the Traveller and Roma communities. The adult service is for now based in the Emergency Department at UHL, working with patients who attend the department and who have additional social issues.

What is Paediatric Inclusion Health?

Paediatric inclusion health is a new specialty in the growing field of inclusion health, which focuses on reducing health inequalities faced by people left behind by traditional healthcare systems, due to homelessness, poverty, or social exclusion. Paediatric inclusion health recognises that children in these circumstances face unique, lifelong challenges.

For these children, the impact of factors like overcrowded housing, food insecurity, limited space for developmental play and recreation, and low health literacy can lead to increased rates of skin conditions, asthma, developmental delays and behavioural issues, among others.

Why Paediatric Inclusion Health Matters

Dr Neville explains that nationally more than 5,000 children were recorded as homeless in July 2025, with many more living in overcrowded or unstable housing. Traveller children face stark inequalities in education and health, with life expectancy up to 15 years lower than the general population. Migrant children may struggle with trauma, language barriers, and unfamiliar healthcare systems. While these children may have differing needs, there are general approaches that can improve their access to appropriate care.

“The paediatric inclusion health services is aiming to provide equity, not just equality; we offer tailored supports to help every child reach the same health outcomes, regardless of their starting point,” Dr Neville said.

Inclusion Health & the Mid West

The regional adult and paediatric inclusion health service is a nationally funded pilot, which follows the successful launch in 2016 of an adult service in St James’ Hospital, and a paediatric service, the Lynn Clinic, which opened at CHI Temple Street in 2020.

Dr Neville stated:

Looking Ahead

The ambitious vision for Inclusion Health in the region includes fully staffed teams for both services. Currently, the adult service Clinical Nurse Manager is based in the ED at UHL, while Dr Neville has recently welcomed a senior medical social worker to the paediatric service.

Dr Neville is focused firmly on the future: “Although we are funded on a pilot basis, the ambition is to expand and make these services permanent. The early results show significant savings in hospital bed-days and improved patient outcomes.

The hope is to achieve in time the systemic change that will make such services unnecessary—but until then, they remain vital.”