Jan O'Sullivan (Limerick City, Labour)
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Three of us from different parts of the mid-west region and of different political perspectives are raising this matter, which relates to the intolerable position faced by patients in the mid-west as a result of overcrowding at University Hospital Limerick. Looking at any statistics for the past month or year, the hospital has been at the top of the list regarding people waiting on trolleys. There is no sign of that letting up, even during the summer when one might think things are going to be a bit easier. We simply cannot allow this to continue and face another winter, or perhaps more than one, before we get the promised 96-bed unit. We absolutely need interim solutions now. Such solutions exist. For example, we could open all the available beds in the area. A number of us have raised the idea of a modular unit. It is essential that the level of staffing is sufficient for the needs of the people in the mid-west. I do not have time to get into the statistics involved but a senior clinician, Dr. Gerard Burke, has demonstrated that there is an inequality in the number of whole-time equivalent acute hospital staff in the mid-west compared with other regions. It is estimated at 10.16 per 1,000 in the mid-west, with the national average being 11.4 per 1,000. We are understaffed and under-resourced. We absolutely need a solution and funding in the service plan and forthcoming budget to ensure this matter can be addressed quickly.

Michael Harty (Clare, Independent)
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There is constant and recurring overcrowding at the Limerick hospital and this is down to multiple factors. There is a deficiency in bed capacity and staffing. Bed capacity at Limerick runs at approximately 97%, when 85% is the maximum at which a hospital can work efficiently. This leads to poorer outcomes for patients and an increased incidence of cross-infection and hospital-acquired infection. The mid-west has a catchment area of 400,000 but it does not have the bed capacity or staffing to deal with that.

As Deputy Jan O'Sullivan noted, whole-time equivalent rates in the mid-west are 14% lower than the national figure. This leads to an increase in the standardised mortality rate in the mid-west. It is a shocking indictment of the health service that there is such disproportionality between one area and another. It comes down to retention and recruitment of staff across all hospitals in the region but also arises from deployment of consultants and medical staff across the model 2 and model 4 hospitals in the region. There is also a deficiency in funding primary care to allow patients to come out of hospital as quickly as possible and the funding of community intervention teams to assist discharge.

Tom Neville (Limerick County, Fine Gael)
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I am very much wearing the green jersey today in backing up the statements from my colleagues across the political divide, particularly as they relate to capacity. I have had personal experience of the workings of the hospital with a person close to me in the past couple of months and I commend the staff on the exemplary work they are doing under pressure. The pressure is felt in the accident and emergency department in particular as bed capacity has not been built behind it. I welcome the initiative to build a 96-bed unit at the hospital. It is long overdue. While it is being designed and built before operation, there will be a shortfall. I ask the Minister of State about the possible use of modular units in Limerick to address that shortfall. I have put down parliamentary questions about that and been told there is an ongoing broad assessment. I have not been given any specifics relating to University Hospital Limerick so I would be grateful to receive clarification in that regard.

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister, Deputy Harris, I thank the Deputies for raising this very important matter. Let me start by recognising that this Government has approved a record level of capital investment in health at €10.9 billion over the next ten years, which will provide for a major enhancement of the capacity of our health services to meet demand in the coming years. Within this context in February of this year the Department of Health published the health service capacity review, the findings of which now provide the evidence base for capacity decisions. This report concludes that if the required reforms are implemented, nearly 2,600 additional acute hospital beds will be required by 2031.

As a first step towards implementing this recommendation, the Minister has asked the Department to work with the Health Service Executive, HSE, to identify the location and mix of beds across the hospital system that can be opened and staffed this year and in 2019. The HSE is continuing to work on a submission in this regard, with the aim of formulating an evidence-based plan for increasing bed capacity nationally that will form the basis of discussions with colleagues in government on the financing of this important programme of work.

Deputies Jan O'Sullivan, Harty and Neville have specifically raised concerns about the plans as they relate to University Hospital Limerick.

The need to address bed capacity at University Hospital Limerick, UHL, is recognised by all stakeholders. As the Deputies will be aware, a new emergency department was opened at University Hospital Limerick on 29 May 2017. The €24 million development aimed to provide University Hospital Limerick with increased capacity for emergency medicine to meet the demands of population growth and changing service models and to improve efficiency targets. In addition, 17 new short-stay beds were opened in December 2017 as part of winter measures aimed at alleviating pressure on the emergency department and meeting the growing demand for services in this period. Looking forward, the national development plan includes provision for a 96-bed replacement ward block at University Hospital Limerick. The Minister, Deputy Harris, can confirm that the HSE capital plan for 2018 includes funding to progress the design phase of this project. In the meantime, the HSE is also considering a submission by University of Limerick hospital group to develop a modular inpatient facility at University Hospital Limerick which will have capacity for up to a further 60 beds. A decision on this, as part of the broader work being brought forward by the Department of Health and the HSE to increase bed capacity in advance of this winter and throughout 2019 will be made as soon as possible.

We all acknowledge that the challenges we face are significant. Therefore, importantly, this focus on increasing capacity will be matched by forthcoming reforms as set out in the all-party Sláintecare report. This work will be overseen through the establishment in the Department of a Sláintecare programme office, the publication of a detailed Sláintecare implementation plan and the appointment shortly of an executive director for the Sláintecare programme office. I know we have a long road ahead of us, but this is a journey of reform and strengthening of our health services. I will come back in on some of the issues the Deputies raised.

Jan O'Sullivan (Limerick City, Labour)
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I regret that the Minister, Deputy Harris, is not here but I thank the Minister of State for her reply. In the context of what she has just said about the fact that work that can be done in advance of this winter is to be identified, I urge that our region be prioritised in respect of both the modular unit and the opening of extra beds. It is quite clear we come out on top of the trolley list constantly. Furthermore, when we talk about the inequality in the provision of acute medical staff, we have the statistics. We are not just talking about unfilled posts; we are actually talking about unallocated posts. In other words, the region simply is not allocated the equivalent number of posts as other regions. We are therefore asking that the mid-west region be prioritised so we do not have to put people through an absolutely intolerable winter, with elderly people lying on trolleys for hours and hours waiting to get beds. The staff do wonderful work, as Deputy Neville said, but they cannot move people if they do not have beds into which to put them. I therefore ask the Minister of State to prioritise our region.

Michael Harty (Clare, Independent)
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The issue, in a broader sense, is that the mid-west is actually competing with Galway and Cork for services. The Saolta west group and the southern group are, I think, getting a disproportionate amount of resources compared to the mid-west, and this is a fundamental issue which is leading to overcrowding in our hospitals. Regarding the Minister of State's reference to the Sláintecare report, it has been published for over a year, but there has been no Government response to it. In the Sláintecare report reference is made to how these issues can be tackled on a national basis, though I am of course particularly concerned about the mid-west. The failure of the Government to respond to Sláintecare is most regrettable. The issue really amounts to beds and staffing. We need more step-down beds in our model 2 hospitals, we need modular units in the regional hospitals and we need enhanced community intervention teams, but we also specifically need more diagnostics. Patients are waiting in hospital for inordinately long periods to get diagnostics, particularly scanning. Unfortunately, our scanning units work on a five-day basis, nine to five, but people require them on a 24-hour basis. We need to look at all these aspects which feed into the issue of overcrowding in Limerick because it is a multifactorial issue. Limerick, unfortunately, is a black spot in respect of bed capacity and overcrowding. As Deputy O'Sullivan said, there are 53 people on trolleys in Limerick today, in the middle of summer, and that is completely unacceptable. There is a specific issue which relates to the mid-west which must be addressed.

Tom Neville (Limerick County, Fine Gael)
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I thank the Minister of State for her update on this. Obviously, it is imperative that we get moving on this as quickly as possible, particularly before the winter. Deputy Harty has outlined the statistics as of today, but the statistics were much higher last winter, when there is more demand on services. I have communicated the correspondence from Dr. Gerry Burke to the Minister, Deputy Harris, and am awaiting feedback on it from the Minister. There are modular units going into South Tipperary General Hospital. Perhaps it would be an idea to try to speed this up in order that something could be done in conjunction with Tipperary to try to get this into Limerick before the winter. It takes 26 weeks to build these units off-site. Obviously, there are planning permission issues as well, but all that can be dealt with off-site. Twenty-six weeks is three months, so we still have time to try to get this in before winter kicks in. I would be very grateful if that could be considered.

Catherine Byrne (Dublin South Central, Fine Gael)
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I again thank all the Deputies who spoke very passionately of their concerns about University Hospital Limerick with facts and figures. I assure them I have taken a number of notes and what I have missed I will get tomorrow from the Official Report. I assure them that I will raise their concerns, including the point about the modular units, as soon as I can with the Minister, Deputy Harris. The point about the modular units may be of significant help in the coming months. I will also raise with the Minister the request that the mid-west be prioritised, particularly coming into 2019 with some more units becoming available, whether it be through modular units or opening up some of the beds in the units that are not available. I will raise all these points with the Minister as soon as I can.