Mr. Bernard Gloster:

I thank Ms Day for that.

On the wider issues and on the delayed transfers of care first, I reviewed the position in Limerick in the first week I was here, not because I am from Limerick, but the INMO came knocking at my door, and rightly so. In fact, I am meeting the INMO tomorrow afternoon in respect of the national pressures we are continuing to experience. Delayed transfers of care in Limerick were not reported to me two weeks ago to be a substantial problem, in that they were flowing, but I would still have a difficulty with the number, given the pressure Limerick is under. It may be that we will have to continue to invest in delayed transfers of care at the cost of reduction of spending in other parts of what we are doing. It is just intolerable that 600 people across the country would be in hospital when they do not need to be, and fewer than 600 people are on trolleys. The maths are easy. The delayed transfers are not easy because they are complex and come with lots of social issues, legal issues and so on, but in the majority, they should not be of high numbers. I accept that, and I have made that clear to all of the community chief officers across the country, not Limerick alone. The reality is that we are just going to have to deliver better on that.

Regarding Limerick's capacity overall, as the Senator is aware, there is a 96-bed configuration going there. There has been an indication of further bed capacity there but it is not funded in any capital plan, to be fair. I have asked them that in the building of the 96, that they look at any potential ability to create the foundation or shell for future bed capacity, and that is something we will bring back to the Department to see if it is affordable and doable. I have asked the CEO and the head of estates there to advance that.

On the elective hospitals, I have to be very clear with Senator Byrne. The elective strategy determined as a result of Sláintecare and the Government decision is three elective hospitals, and that is what is in the plan at the moment. I do not see that altering. What I would like to see is whether there is any additional help in the short to medium term. This would include the development of things like the new private hospital which the Bon Secours system is developing in Limerick, and whether there is any potential sharing of arrangements that would help us and the public in that context. However, I do not want to stray into that, because there are lots of things associated with that, including procurement rules and so on. We have to look beyond the hospital in Limerick.

I made the point here last week that it is my intention not to focus on individual hospitals but to focus on regions and the totality of the health system in that region. I will be talking to the CEO of UHL within the next few weeks; I am due there shortly and it will be in the next couple of weeks anyway. When I talk to them now, I talk to them as a total health system. I am very familiar, having been there, with what that can actually achieve. Part of our problem is capacity but a part of our problem is process.

On the delayed transfers, I am told, as recently as yesterday, that I will soon be getting the bill because about €6.5 million of additional delayed transfer of care activity had to go into Limerick over the last short period to buy specialised placements for people, particularly people with complex disability.

On the mental health therapy issue, I was not aware that was an issue but I will absolutely look into it. I am very familiar with the acute unit in 5B, on there being an issue regarding requirement for therapy, as in physiotherapy or something like that, I genuinely was not aware there was an issue. I am aware there are people delayed there because there are not high-support capacity beds available in the numbers we would want. If, however, there is an issue of therapy there, the challenge I would be giving back across the country, whether it is in Dublin, Cork, Limerick or anywhere else, is that if we really have patients who need that right now today, I want to know what we are doing with all the physiotherapists we have recruited into enhanced community care. The community owns those patients. It is not the mental health service, as if they go off into another world. I will be challenging the system around that, and there certainly are a lot of physiotherapists in Limerick, so I would be surprised if that is a significant problem. However, I will absolutely look into it.

On the use of other hospitals: in Mr. Stephen Mulvany's time, during the pressure period, the National Ambulance Service was looking under protocol at the utilisation of medical assessment units, MAUs in Nenagh Hospital and St. John's Hospital, Limerick, for medically stable patients. It is too early to say what the evidence is as to how effective that is or is not. I do not think it has achieved high-volume numbers but if it has improved the experience of some people, that is a good thing. Only two weeks ago, I approved the expansion of the MAU in Nenagh and St. John's to seven days for a two-month period to see if that would alleviate some of the pressure. I am told by the hospital CEO that it would, so I agreed to that because they are in a pretty difficult spot. Nobody disputes that.

However, there is one flip side of the question about beds, and the CEO in Limerick does not take any offence when I say this, because again, it does not matter if it is Limerick or anywhere else. When we do put in additional beds, are we seeing any change or improvement to the patient flow and the capacity issues? That seems to be a serious challenge there. It is part of it but they certainly have our full support to try and resolve it. Ultimately, the people who are on those trolleys are our people, and we have to care for them and do better by them.