Brian Leddin (Limerick City, Green Party)
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The challenging situation at University Hospital Limerick, UHL, has been well reported over the past few weeks. Just last weekend, thousands of citizens from across the mid-west region marched in Limerick city to demand that the situation be resolved. One of the demands is that the accident and emergency departments at Ennis, Nenagh and St John's hospitals be reopened. I acknowledge that there are competing points of view as to whether this is the correct course of action but I know the Minister, Deputy Stephen Donnelly, will take the loud call seriously. Whatever decisions are made must be in the best long-term interests of the mid-west.

It is with the medium- to long-term challenge in mind that I raise this matter. This evening, I want to discuss the potential role of St. John's Hospital's in the provision of healthcare in a city and region that is expecting and targeting steep population growth in the coming years. Indeed, I believe that kind of growth can happen only if infrastructure projects such as that proposed for St John's are developed. After all, we will struggle to attract people and jobs to Limerick if we do not have adequate healthcare infrastructure.

The national planning framework targets a 50% population increase for Limerick city in less than two decades. State policy is to grow the city population at twice the Dublin rate. The State also has a firm policy of compact growth, meaning we should build up our cities and reverse the pattern of development of the past 70 years. In those decades, before we realised how misguided an approach it was, we allowed and even encouraged our cities to sprawl outwards year by year, with them creeping farther by farther in all directions through a process of enabling and planning development on greenfield sites. We have seen this in every city in Ireland, but Ireland is far from unique in this regard.

The consequences of the misguided approach have been car dependency and the decline of town and city centres. In fact, UHL was one of the first outward pushes of the city in the 1950s. The suburb of Dooradoyle sprung up around it. It was because of this and a series of other major suburban developments that the city centre fell into decline. St John's, of course, is very much the heart of old Limerick, which suffered so badly over the decades in question due directly to the policies of unfettered greenfield development. Now we are bringing the old city back to life in many Limerick are involved in this effort. Those of us in government are helping by scrapping the policies of sprawl. In the coming years, through the development of multiple sites, tens of thousands of new citizens will live near St John's Hospital.

When we plan any infrastructure, we do so first by trying to assess future needs, but our thinking has to go beyond just considering this because any infrastructure development has powerful impacts. These can be good and bad. Supporting the St. John's proposal to develop a 150-bed block would have a powerfully positive impact on a city that can and should have bold ambitions. It would make Limerick city stronger, and stronger Limerick city would deliver a stronger mid-west region and fulfil our national aspiration to rebalance growth away from Dublin, as laid out in the national planning framework.

From a healthcare point of view, I believe it is the right decision. The Minister, Deputy Donnelly, and I have spoken in private about this on a few occasions. I have always appreciated those engagements. Most recently, he indicated there had been no decision on whether a fourth public elective hospital would get the go-ahead. I do not believe that the rationale that Cork and Galway, being within a 90-minute drive of Limerick, can meet Limerick's needs is sound given how development policy has been turned on its head recent years. I ask that the Minister support the development of St. John's Hospital in Limerick city.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this important issue and welcome the opportunity to address the House.

While acknowledging that there are significant challenges in the provision of healthcare services in Limerick and the mid-west region, there has been and continues to be substantial investment in UL Hospitals Group. For example, in October 2022 the Minister for Health broke ground on a new 96-bed inpatient block project at UHL. This capital project will deliver a four-storey, 96-single-bed acute inpatient ward block and will go some way toward addressing capacity issues in the region.

In 2021, a new 60-bed modular ward block opened at UHL, and prior to that an extra 38 inpatient beds were provided at the hospital through two rapid-build projects, constructed in response to the Covid-19 emergency. There has also been investment across UL Hospitals Group, including the new injury unit at Ennis hospital, which opened last April, as well as a modern state-of-the-art ward complex, which opened at Croom orthopaedic hospital in 2021.

Separate from these initiatives, the Government approved in December 2022 the next stage of the enhanced provision of elective care programme. New national elective hospitals will be delivered in Cork, Dublin and Galway. No other locations are under consideration at this time. The locations were chosen to allow for new facilities of a size and scale to implement a national elective care programme that will tackle waiting times nationally.

These hospitals will provide significant additional capacity, enabling the separation of scheduled and unscheduled care. This will change how day cases, scheduled procedures, surgeries, scans and outpatient services are arranged across the country. These hospitals will ensure greater capacity in the future and help to address waiting times. This new delivery capability into the public healthcare system will benefit the whole population, including those who do not fall within the immediate traditional geographical catchment.

It is envisaged that the new Cork and Galway facilities combined will cater for up to 350,000 patients or procedures annually, which would include patients from the mid-west.

Complementary to the development of the new elective hospitals, the HSE also plans to develop surgical hubs in Cork, Galway, Limerick, Waterford and Dublin to provide a narrower scope of procedures. The HSE will work with hospital groups and forthcoming regional health areas to progress these proposals in the shorter term. An advantage of the surgical hubs is that they will be developed much quicker than the elective hospitals. This intervention will also support efforts to consider the necessary reforms and enablers needed to separate unscheduled and scheduled care pathways that will be required in the longer-term provision of the elective care programme.

A capital submission for the development of a 150-bed facility at St. John's Hospital has not been received. However, I assure the Deputy that the Department of Health continues to work closely with the HSE to ensure that UL Hospitals Group and, indeed, the mid-west are fully supported.

Brian Leddin (Limerick City, Green Party)
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I thank the Minister of State for the reply. I acknowledge her final remark that the HSE and Department will continue to work with UL Hospitals Group. I want to make the case strongly for St. John's and believe I have done so, notwithstanding that the capital submission has not been progressed.

The thinking around development in this country has completely changed. It is not acceptable that the St. John's project is not being actively considered at this time.

I believe this is a misalignment with the national planning framework. I will speak about it again to the Minister for Health, Deputy Donnelly. I acknowledge absolutely the substantial efforts that have been made to address the challenges in health in the mid-west region. I acknowledge the efforts of the University Hospitals Limerick Group, and to point out and agree that we are in a very unprecedented situation given the viruses that have gripped the world at this time. There is, however, a whole lot we can do. When we are thinking about healthcare we must think about the medium and long term. It is in that context I bring this matter this evening. We need to think to 2030, 2035, and 2040. I ask that the Minister of State, Deputy Butler, would say to the senior minister in the Department, the Minister Deputy Donnelly, that St. John's Hospital makes absolute sense in the context of the provision of healthcare in the mid-west region. It will not be acceptable to the people of Limerick or to the people of the mid-west region that Cork and Galway are the cities they must travel to. It is not acceptable that we are planning infrastructure on the rationale of these hospitals being within a 90 minute drive. The Minister of State, Deputy Butler, coming from Waterford, will sympathise with this sentiment. I will engage further with the Minister and with the Minister of State, Deputy Butler. I hope that in time we will develop an excellent care facility at St. John's.

Mary Butler (Waterford, Fianna Fail)
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The Minister, Deputy Donnelly, the Government, along with the Department of Health, remain fully committed to improving services in Limerick, the mid-west region and across the entire country. I believe that only recently the Minister, Deputy Donnelly, and the Taoiseach, met with the elected representatives in that area.

It is very clear that after what has been a very difficult couple of years for the University Limerick Hospitals Group significant efforts are being made to ensure that issues such as delays to elective care are being addressed as matters of priority.

Deputy Leddin referred to the situation in the past few weeks and the perfect storm we had of three viruses: we had Covid, flu and RSV. We saw unprecedented overcrowding, and especially in University Hospital Limerick. As I have said, there has been, and there continues to be, substantial investment in the University Limerick Hospitals Group, of which the Deputy is very much aware.

To conclude, a capital submission for the development of a 150-bed facility at St. John's Hospital has not been received. I am not sure if that is going to be progressed. The Department has not received it as yet. I will certainly bring the Deputy's comments on what he has said. The Deputy has spoken about Limerick so eloquently, and the fact that it had the sprawl and now it is moving back in. I will certainly bring the Deputy's concerns to the Minister for Health, Deputy Donnelly. I thank the Deputy.