Maurice Quinlivan (Limerick City, Sinn Fein)
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I express my disappointment that the Minister, Deputy Harris, is not here. It is déjà vuas this is the fourth time I have had a Topical Issue on pretty much the same matter and the Minister has not yet turned up. Senator Paul Gavan and I requested an urgent meeting with the Minister but we have not had a response to that either. I ask the Minister of State to request the Minister to meet me and Senator Paul Gavan as soon as possible. I am disappointed that the past few times I have had a Topical Issue on practically the same matter, the Minister has not been available. As I say, I have tried to raise a number of times the serious position in this hospital and the way patients are treated.

Today, there are 60 people on trolleys in University Hospital Limerick, with 668 people on trolleys nationally. That is almost another outrageous record. Almost 10% of patients on trolleys across the State are in one hospital in Limerick. The hospital consistently has the highest number of people on trolleys across the State's hospitals, and it was the most overcrowded hospital in the State last year. University Hospital Limerick saw 8,869 people on trolleys last year, which is absolutely disgraceful. My constituents are entitled to an excellent facility that is not chronically overcrowded, the same as all other areas. Unfortunately, it seems they are bottom of the priority list for the Minister, Deputy Harris.

When the new accident and emergency department was scheduled to open in May last year, I tabled a Topical Issue and the Minister, Deputy Harris, was not available at that time either. The Minister of State, Deputy Finian McGrath, took the question. I indicated the nurses had a serious concern before the opening of the planned accident and emergency department that 24 patients would be accommodated on trolleys and chairs from the get-go in the new department. At the time, the Minister of State rebuffed what I said, dismissing any such suggestions. He said there was no basis for any suggestion that 24 patients would be accommodated on trolleys in the new department. He said that on 25 May 2017 but it has not been borne out as true. Almost every single day there are more than 24 patients accommodated in trolleys in the new accident and emergency department.

The Minister of State may be aware that these problems stem from the downgrading of Ennis, Nenagh, and St. John's hospitals' accident and emergency departments and establishment of a so-called centre of excellence. That has not worked and the facility has been overwhelmed. One might walk into the accident and emergency department at University Hospital Limerick today and explain to the 60 people on trolleys how the plan has not worked.

I raise in particular the full capacity protocol. The Minister of State is well aware this was designed to be an emergency measure to deal with overcrowding and is not supposed to be used every day. It has consequences and it results in patients being put in inappropriate areas of the hospital, leading to overcrowding in wards, cancellation of elective procedures and aggressive discharging. It is not intended to be used every day and become the norm. In University Hospital Limerick it has, unfortunately, become the norm. It was used on 361 days last year, compared with nine days in 2014. Yesterday, we learned the number of patients waiting for outpatient appointments in University Hospital Limerick has increased by a massive 6,786 people in just one year to an astonishing 32,632 people. It is a 26% rise in one year. The Minister has said he has a handle on the health crisis and I am sure that will be in his response when he gets back to me. The number of patients being forced to wait in excess of 18 months for treatment has more than doubled in one year, rising from 1,517 to 4,124.

I commend the nurses, doctors and staff who work in University Hospital Limerick in what can be extremely challenging conditions. I am running out of time but I could stand here for another 20 minutes highlighting the issues. What action will the Minister, Deputy Harris, take to ensure the full capacity protocol is not implemented in University Hospital Limerick almost every single day, which it was in 2017? How will he ensure it is only ever used when there is a genuine emergency?

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputy for raising this important matter. It is unacceptable that patients must wait on trolleys for long periods, especially those who may be elderly or vulnerable. The full capacity protocol was devised in order to redeploy hospital resources towards surges in demand for emergency care, thereby reducing emergency department waiting times. I accept the argument that the department in University Hospital Limerick is one of the busiest in the country, with approximately 67,000 attendances annually. Demand for emergency department services at the hospital continues to rise, with an increase of 6% in attendances at the hospital in 2017 compared with 2016.

The House will be aware that overcrowding at the hospital's emergency department has been a concern for some time. It is frequently working above capacity using full capacity protocol and this contributes to inefficient ways of working and poor patient experience. In recognition of this high demand, funding of €24 million was provided for the new accident and emergency department at University Hospital Limerick, which opened in May last year. The new facility is triple the size of the old department and immeasurably improves the experience of patients in terms of their comfort, privacy and dignity. The Minister, Deputy Harris, visited the department on its opening last year and was very impressed with the pod-based design to streamline patient pathways.

I accept the Deputy's point. The emergency department at UHL continues to be challenged and sees too many patients on trolleys each day. The Minister has been in direct contact with the director general of the HSE, the hospital group chief executive officer, the group clinical director and the head of the HSE's special delivery unit to express his concerns about high trolley numbers and to seek assurances that action is being taken to address the situation urgently. The special delivery unit has been working closely with hospitals currently experiencing emergency department pressures with a view to improving patient flow and reducing the number of patients on trolleys. At the request of the Minister, Deputy Harris, UHL has submitted an emergency department performance improvement plan which sets out in detail how performance will be improved. The plan is currently being implemented and I expect to see incremental improvement.

To alleviate overcrowding pressures, 17 new surge capacity beds opened in the old emergency department in UHL in September 2017. These beds will be converted into a medical short-stay unit in 2018 which, again, is a measure to combat the requirement of using the full capacity protocol. UHL was also chosen as a pilot site for a national HSE programme designed to improve patient flow across acute hospitals and the wider health service. This programme is aimed at developing and assessing different approaches to the improvement of patient flow.

To conclude, the Minister is acutely aware of the current situation in UHL in terms of using the full capacity protocol and is monitoring the situation closely. The Department, the HSE and the University Limerick hospital group are carrying out measures to improve this situation and reduce the need to utilise the full capacity protocol.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I agree the new emergency department in Limerick looks great but, unfortunately, the concerns we raised before it opened have come to pass. Huge numbers of people are waiting on trolleys and for unnecessary durations of time. My fear is that I will be in the House again next year highlighting the same problems in that hospital. The Minister, Deputy Harris, brought a bed capacity review to the Cabinet today. However, we do not need any more reviews, studies or investigations. What is needed in UHL is more money, extra beds and more staff today, not ten years hence, to accommodate the number of patients presenting at the hospital.

The Minister of State might be aware that the interns and non-consultant hospital doctors, NCHDs, are to ballot on industrial action in the hospital next week. We do not know when the 96-bed extension will be up and running. It will alleviate the problems but it is years late. There is no point in constantly talking about it. If the work begins immediately it will be years before there are extra beds for patients in the hospital. Has the funding for the 96-bed extension been allocated? It has been talked about for a long time but when will it be built? Obviously, if the Minister, Deputy Harris, were present he might be able to answer that question but perhaps the Minister of State will relay my concern to him. What interim measures are being put in place to bring down the hospital trolley count or will the Minister just sit back and hope that the influenza passes, which will bring down the numbers?

The main question in this Topical Issue, however, is: what measures will be introduced to stop the use of the full capacity protocol? Does the Minister think that using the full capacity protocol - having extra trolleys in the hospital every day in 2017 and every day so far in 2018 - is safe and does he stand over the fact that it is happening? Will he confirm if any additional staff will be assigned to deal with the outpatient waiting list, which has grown by more than 6,000 in a year? These problems are massive and urgent. They require comprehensive solutions. If the Minister cannot provide them he should consider why he is in office.

Finian McGrath (Dublin Bay North, Independent)
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Of course, we accept the Deputy's point. He is correct that the Minister, Deputy Harris, brought the bed capacity review plan to the Cabinet today. There was very strong support for it because we accept there is a need to invest in extra beds, particularly in 2018 and 2019. However, there is also a historical issue here. Before our time in Government, the accident and emergency departments in Ennis and Nenagh were closed. This was part of creating a logjam in the system. I accept the Deputy's argument that extra new beds are needed, and we are determined to provide them. The Minister is committed to action.

With regard to the specific issues in Limerick hospital, the Minister has been in direct contact with the director general of the HSE, the CEO of the hospital group, the group clinical director and the head of the HSE special delivery unit. I am optimistic that action will be taken. We must ensure that people are no longer left of trolleys. As regards the funding issues, I will raise them with the Minister, Deputy Harris, and we will refer back to the Deputy with a further detailed response.