Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I thank Deputies Breen and O'Donnell for raising this issue and for giving me an opportunity to outline in the House the current position on this matter. In regard to trolleys, it is important to recognise that while there has been a deterioration in recent months in the number of patients on trolleys waiting to be seen, the situation throughout the country remains much better than it was in 2012, 2011 or during any period under the previous Government.

There are significant pressures on the University Hospital Limerick emergency department which arise from the restrictions of the physical infrastructure of the department. Many of these pressures were noted in the recent review by HIQA of the University of Limerick hospitals group. To address this situation, an extensive capital project is under way for a new emergency department for Limerick which will open in 2016. I understand from the HSE that there is no scope for speeding up this development without introducing significant risks for procurement, cost, health and safety.

In the meantime, pending completion of the new emergency department, a number of initiatives are in place to help address the limitations for patients and staff in the emergency department. In particular, a dedicated paediatric emergency area is now open. This means children are seen separately in a child-friendly space. In a major step for acute hospital services in the region, a new critical care unit has opened which allows for better patient flow for seriously ill or injured patients presenting to the emergency department. The acute medical and surgical assessment units are open, and these take direct referrals from GPs and the emergency department. A 17-bed short stay unit opened in April 2014. This unit is managed by the acute medicine physicians and aims to complete treatment or assessment of patients within 48 hours of admission. Three patient flow managers are in place who co-ordinate the transfer of lower acuity patients from University Hospital Limerick to Ennis, Nenagh and St John's hospitals to release capacity for emergency department admissions in the main hospital.

All hospitals within the University Limerick hospitals group take part in a daily teleconference, chaired by an executive management team member, to discuss the bed situation across the group. The group is raising awareness among GPs and the public about the local injury units in the other hospitals in order that patients can make better use of these. They will be seen much quicker if they have minor injury and they go to Nenagh or Ennis hospital.

In parallel with these measures, the special delivery unit will support the University of Limerick hospitals group, with interim and long-term sustainable solutions to deal with bed capacity, excessive trolley waits and overcrowding in the emergency department.

Analysis by the SDU indicates a requirement for additional bed capacity at UHL. The hospital and the HSE are in discussions about increasing capacity on the hospital site, with a range of measures being considered in the 2015 service plan process. This process must take account of the financial constraints facing the hospital and the HSE's budgetary limitations next year.

At a national level, the HSE is establishing a winter planning group, with representation from social care and acute hospitals. The group will identify immediate actions to address winter pressures in acute care. It will also examine medium term plans for delivering sustainable solutions. The SDU will also participate in this exercise. I look forward to the ongoing development of emergency services in the Limerick group, both in terms of the new facilities and modernising the way in which these services are provided. These will be of significant and lasting benefit to patients in the region and to UHL staff.

While there is a serious problem, as referred to by Deputy Breen, with 47 patients on trolleys on Monday, 29 September, requiring emergency action, yesterday morning at 8 a.m. there were six people on trolleys in the entire hospital, only one of whom had been waiting longer than nine hours. This morning there were ten people on trolleys, only six of whom had been waiting for nine hours. For whatever reason, the situation is the best it has been in several weeks, which is encouraging. It is of concern that UL hospital group is 16% over budget. It is more over budget than any hospital group in the country. Spending is up, not down, and while one might be able to justify higher spending if we were seeing shorter waiting lists and fewer people on trolleys, it is very disturbing to see a hospital group with an increasing budget overrunning its budget but not achieving the goals that patients would expect.

See this speech in context