Maurice Quinlivan (Limerick City, Sinn Fein)
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I welcome the Minister of State, Deputy Catherine Byrne, and wish her well in her role as Minister of State with responsibility for drugs issues. It is an issue on which I have campaigned for a number of years so I hope we can work together on it.

This issue is addressed to the Minister, Deputy Simon Harris, and I refer to the crisis in University Hospital Limerick, as over the past seven days the number of people on trolleys has consistently been the highest in the State. Today there are 30 people on trolleys, yesterday and the day before it there were 40 people on trolleys, while on 1 July there were 30 people on trolleys. Will the Minister of State relay the following questions to the Minister? What steps does he intend to take in dealing with the issue? When does he expect the new accident and emergency department at the hospital to be fully operational? A press release in August 2015 from Professor Colette Cowan, the chief executive officer of the hospital group, stated that the new facility would be delivered in the first quarter of 2017 rather than the previously revised date of December 2016. In response to a question at the regional health forum meeting in June 2015, Professor Cowan indicated that capital funding is approved and in place and the group was working towards the completion of an accident and emergency department by the end of 2016. However, at a briefing by Professor Cowan in May this year that I attended, she stated the expected completion date is now March 2017.

In light of the ongoing crisis and the fact that University Hospital Limerick has the distinction of having the highest number of sick and ill patients on trolleys, when will the new accident and emergency department be in operation? Will the Minister of State give an assurance today on the floor of the House that the opening will bring an end to the trolley crisis, as people are on trolleys instead of beds in University Hospital Limerick? I refer specifically to an opening date rather than completion date, as there is a massive difference in the terms.

Does the Minister of State know the additional bed capacity requirements to enable the new accident and emergency department to function without the chronic overcrowding that exists now? This crisis will only be resolved when more beds are delivered. We are dealing with people and not just figures, and unfortunately many of them are waiting for hours and, in some cases, days for care. Many of them are elderly. We must resolve the crisis as quickly as possible and I ask for urgent action.

Catherine Byrne (Dublin South Central, Fine Gael)
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I am taking this Topical Issue matter on behalf of the Minister. I welcome this chance to update the House on the current position on the accident and emergency department at University Hospital Limerick. Pressure on accident and emergency departments throughout the country has been rising as the population is both growing and ageing. Accident and emergency department attendances have been significantly higher this year, and the HSE has reported an average increase in accident and emergency department attendances of nearly 6% compared with the same period last year. The accident and emergency department in University Hospital Limerick is one of the busiest in the country, with more than 60,000 attendances annually. Of those presenting, the proportion of patients requiring admission has also increased.

I completely accept that delays at accident and emergency departments are upsetting and distressing for patients and families. It has long been recognised and accepted that the current accident and emergency department at University Hospital Limerick is not fit for purpose. A new state-of-the-art accident and emergency department, which will triple the size of the current department, is being fitted out and is scheduled to open in the first quarter of 2017. Once built, the experience of accident and emergency department patients will improve immeasurably in terms of comfort, privacy and dignity. Pending completion of the new accident and emergency department, the university hospitals group is following the system-wide escalation framework agreed by the national accident and emergency department task force and issued to hospital groups in December 2015.

Actions being taken to relieve the pressure on University Hospital Limerick accident and emergency department include the transfer of suitable patients from the hospital to model 2 hospitals in the region, including Ennis, Nenagh, St John's and Croom. Also, and where appropriate, patients are being transferred to community care settings. I know that staff in the hospital are working very closely with community intervention teams to provide antibiotics and other basic care in a patient's home or care facility. This will, it is hoped, facilitate hospital avoidance as well as early discharge. With such a system, people might be able to go home rather than stay in hospital. In addition, extra ward rounds are being conducted and elective surgery is being kept under review. Extra ward rounds are being done in order that people may be discharged more quickly.

The hospital is also communicating with local GPs to ensure patients are referred to the accident and emergency department only where necessary and encouraging appropriate use of local injury units. In the mid-west, there are now three local injuries units in St. John's, Ennis and Nenagh. These units are equipped to see patients with minor injuries and play a significant role in diverting patients from the accident and emergency department. In 2015, over 30% of unscheduled care patients were seen in one of these units. An awareness programme to inform the public of the range of services provided by these units was launched in autumn 2015.

I fully acknowledge the difficulties the current surge in accident and emergency department activity is causing for patients and their families. It is also important that I acknowledge that the staff are doing their utmost to provide safe and quality care in very challenging circumstances. I assure the Deputy that addressing accident and emergency department overcrowding is and will remain a priority for this Government. In that regard I am confident that the issue in University Hospital Limerick will be significantly improved in 2017 with the opening of the new accident and emergency department. I do not have a date for the opening but I will ask the Minister to revert to the Deputy on that.

Maurice Quinlivan (Limerick City, Sinn Fein)
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It is difficult to respond as the Minister is not here, but I hope the Minister of State will relay my comments to him. I am especially pleased the Minister of State indicated the unit is not fit for purpose as that is what the Health Information and Quality Authority, HIQA, stated two years ago and the crisis is ongoing. The amalgamation caused the crisis and the Minister of State mentioned the hospitals at Ennis, Nenagh and St. John's. Closing the accident and emergency departments in those facilities caused the crisis.

Is the expected opening in March 2017? If the date has been decided, has the Minister drawn up plans to incorporate existing accident and emergency staff into the new department? In that context has the Minister spoken to the Irish Nurses and Midwives Organisation, the Irish Medical Organisation and other relevant unions and representative associations who will be involved in amalgamating the staff?

If the new unit is established, what new skills will be required? How is the recruitment drive for the accident and emergency department proceeding? In the framework of the hospital's operational plan for 2016, it states that the hospital will need to reduce total staff numbers in 2016 to achieve financial targets contained within the acute hospital division operational plan.

Is there any plan to reform and invest in modern diagnostic services, such as X-ray scanners, ultrasounds, etc. that will allow faster turnaround of patients? Currently, there are not sufficiently skilled staff available to operate existing equipment so the service is running at half capacity. This delay is increasing the number of people staying in beds in the hospital for longer than needed. We could have such people looked after properly in the community, with proper home help and assistance.

Catherine Byrne (Dublin South Central, Fine Gael)
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I have taken note of all the questions the Deputy has asked. Unfortunately I cannot answer them for him, but I will say from the reply the Minister gave that it is good news that University Hospital Limerick will have a new emergency department in the first quarter of 2017 and I will ask him to come back with a specific date if that is possible. I also acknowledge, as the Minister has done in his reply, that the other hospitals in the region are helping out at a critical time when patients' needs are rising, people are getting older and more people are attending the emergency department. It is imperative that we inform people that where there are other facilities within a county, people should also use those. They might be only step-down facilities and there might be units that are not fully equipped to deal with emergencies, so only those cases that need to go to the emergency department should go there. I will relay all the Deputy's questions to the Minister and I will make sure he will come back to him on the specific questions, particularly around the date, because I cannot answer that. As the Deputy heard in the statement and as he acknowledged himself, there is a crisis and the Minister fully acknowledges that.