Maurice Quinlivan (Limerick City, Sinn Fein)
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The Minister for Health is not present. In saying this, I mean no disrespect to the Minister of State, Deputy Jim Daly. I said this to him in March in respect of a similar topic when he came in to deputise for the Minister. I understand the Minister for Health is very busy and I have no problem with that but he has never once come here to address one of my Topical Issue matters. Normally all of the issues I raise are related to University Hospital Limerick. Can the Leas-Cheann Comhairle, Ceann Comhairle or Minister of State, Deputy Jim Daly, raise my concern with the Minister so he might try to get here himself the next time one of my Topical Issue matters is selected for discussion? By March, I had tried to get him in here 13 times.

Obviously, there have been more occasions since then. It is quite disappointing that this hospital has the worst crisis in the State and has the highest number of people on trolleys every day, yet the Minister has been unable to appear on even one occasion. I understand that he is busy but he cannot have been unable to attend on every occasion it has been selected as a Topical Issue. It is simply not good enough.

To be honest, I have lost count of the number of times I have submitted a Topical Issue on this matter. There is an issue in the hospital every day and every week. The full capacity protocol is used every day in Limerick even though it is supposed to be a temporary emergency measure. That means staff are under huge pressure and elective operations are cancelled. A number of them were cancelled this week. There have been 166 people on trolleys already this week. There were 46 on Monday, 63 on Tuesday and 57 on Wednesday. However, I am astonished that I am obliged to ask the Minister for Health today, and the Minister of State might convey this to the Minister, to explain why there were not enough staff to feed patients in the emergency department in Limerick's largest hospital last week. It is a crazy and outrageous situation.

On Monday I was contacted by somebody who works in University Hospital Limerick. That person stated there was only one attendant providing food for over 90 patients in the emergency department for the previous four days and, as no staff cover was available, some patients could not get food or even a cup of tea. The agreed figure for such staffing at the hospital is a minimum of three. This is inexcusable. Today there are 57 people on trolleys in the hospital. That is more than the number of patients on trolleys in 17 other hospitals across the State combined. Can the Minister explain this situation? I hope he or his Department will contact the hospital management immediately to ask what is happening. What additional funding will be provided to ensure there are enough staff to feed the patients at least?

Jim Daly (Cork South West, Fine Gael)
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I thank the Deputy for raising the important issue of the challenges arising in University Hospital Limerick and, on behalf of the Minister, Deputy Harris, I welcome the opportunity to address the House on this issue.

The emergency department in University Hospital Limerick, UHL, 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 emergency department at UHL in 2017 compared with 2016. I acknowledge the distress overcrowded emergency departments cause to patients, their families and front-line staff working in very challenging working conditions in hospitals throughout the country. Behind every trolley number there is a patient in need of effective, timely and compassionate care from the health service. That is why the Government is committed to breaking the cycle of overcrowding in the health service. As emergency department attendances continue to rise, those departments are under increasing pressure to meet the new level of demand and ensure the provision of timely, safe and effective care for patients. A considerable number of patients presenting to the emergency departments are frail or acute patients who often require admission.

With regard to the claim that some patients are not being fed, the University Limerick, UL, hospital group has advised that except for one catering attendant who is currently on leave there is a full catering staff complement. UL hospital group has advised that it is managing this deficit from its relief pool. At times there may be unscheduled sick leave that could create pressures on the service but full catering is available to all patients who are not fasting due to medical reasons.

As regards patient experience, the House will be aware that overcrowding at the UHL emergency department has been a concern for some time. The emergency department is frequently working above capacity using the 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 emergency department at UHL, which opened in May last year. The new facility is triple the size of the old emergency department and immeasurably improves the experience of patients in terms of their comfort, privacy and dignity. Furthermore, against a background of increasing demand for unscheduled care services, an extra €30 million was made available nationally to respond to winter pressures in 2017, with a further €40 million being provided in 2018.

To conclude, the UL hospital group has assured me that full catering is available to all patients who are not fasting due to medical reasons. Regarding the overcrowding, I am acutely aware of the current situation and I am monitoring it closely. The Department, the HSE and UL hospital group are carrying out measures to improve the situation.

Maurice Quinlivan (Limerick City, Sinn Fein)
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The Minister of State said the UHL emergency department is frequently working above capacity. It is doing that every day. The emergency measure has been in place every day this year and was in place every day in 2017 so it is not frequently but daily. That leads to elective surgeries being cancelled and extra beds being put into wards, which is not safe. When this measure was introduced by the HSE a number of years ago in consultation with the nurses, the nurses expressed huge concern but they were told at the time that it would be an emergency measure. However, it is used every day in Limerick and that is not good enough. It is not true to say in the House that it is frequently used as it has been used every day this year and every day in 2017.

The Minister of State mentioned the new emergency department. It is a good facility but, as I highlighted previously in this Chamber when the Minister of State, Deputy Finian McGrath, was in attendance as the Minister, Deputy Harris, did not turn up again that day, the nurses were concerned about the proposal to have 24 people usually on trolleys in the new department. The Minister, Deputy Harris, rubbished that and said it would never be the case and would never happen. The hospital in Limerick would almost be happy if there were 24 people on trolleys because the number is far more than that every day.

I wrote to the Minister last January seeking a meeting with him to discuss ways to reduce the overcrowding problem in the hospital because it is abundantly clear that his plan for our local hospital is failing miserably. I have yet to hear back from the Minister. University Hospital Limerick is in a terrible state. It is constantly overcrowded and operations are being cancelled all the time. It is unfair to make nurses, doctors and staff work in such pressurised, overcrowded conditions and even worse to make sick patients lie on trolleys for days waiting for a bed. How does the Minister expect to attract nurses home from places such as Australia to work for lower wages and in far worse conditions? I was proud to stand with the nurses outside the hospital a number of days ago. The full capacity protocol is being used every day despite it being designed only for emergencies.

The Minister might refer back to me on my questions this time, although I was told previously that he would and he did not. What plans does he have for the 96-bed extension? When will it be built? Is there any progress on speeding that up? The last we heard is that the plans might be ready in 2019 but we need the building work to start.

Jim Daly (Cork South West, Fine Gael)
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I will relay the Deputy's concerns to the Minister, Deputy Harris. To address the issue of the Minister not being present, it is a very fine balance. I appreciate the Deputy's frustration and I am not saying this to be argumentative but to illustrate the challenges the Minister faces daily in getting the balance right between trying to deal with the issues and engaging with the parliamentary process. The House places many demands on the Minister's time, as do the Seanad and the committees, as well as the pleas for hearings from numerous lobby, interest and advocacy groups and representative bodies. The Minister, like every Minister, has to make a judgment call between the amount of time to spend actively engaging one-on-one with complaints and issues and actually dealing with the problems behind the scenes, such as by meeting with UL hospital group, the management and getting one's head around the issues that exist. That is a continuing balance. I can assure Deputy Quinlivan it is not a snub to him. Diary challenges are always difficult, and they are probably more challenging for the Minister for Health than for other Ministers.

With regard to the emergency department in UHL, I wish to reassure the people who are using the facility that there is a full catering service available at the hospital. I believe the Deputy emailed the management about it and he probably should engage more proactively with the management.

Maurice Quinlivan (Limerick City, Sinn Fein)
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They came back to me ten minutes before this debate.

Jim Daly (Cork South West, Fine Gael)
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That is something he could do with the management as a public representative, as the Minister does not manage the UHL or, indeed, any of the acute hospitals throughout the length and breadth of the country. That is done by the HSE and the management team in place. I will relay the Deputy's concerns to the Minister and make him aware of the issue.