Joe Carey (Clare, Fine Gael)
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I thank the Ceann Comhairle for selecting this important issue for debate. Overcrowding at the accident and emergency department at University Hospital Limerick, UHL, continues to be a major problem. In the past two months alone, a staggering 900 patients at the hospital have been placed on trolleys, the highest number recorded in the country. There are many contributory factors to this, including that some surgical theatres and consultants are not available seven days a week, but the major issue is a lack of acute bed capacity in the region. In fairness to management at UHL, it has put forward two projects to boost significantly bed capacity, namely, a 60-bed modular unit and a new 96-bed block proposal.

The 60-bed modular unit was recently granted full planning permission by Limerick City and County Council. It is extremely regrettable, however, that this vital project has been stalled because of a planning objection on the part of a resident of Dooradoyle in Limerick. This project is of critical importance to healthcare provision in the mid-west region, servicing counties Clare, Limerick and north Tipperary, as it will improve patient flow throughout the hospital, patient comfort, patient safety, privacy and patient dignity. It is outrageous that one individual can hold up a project of such importance. I have taken this matter up with the Minister of State with responsibility for planning, Deputy Damien English. It is my view that strategic projects such as this should be lodged directly with An Bord Pleanála. While I have no wish to deprive people of the right to appeal against planning decisions, it makes sense to give An Bord Pleanála the right to deal directly with applications for major public service projects as such an approach would streamline the process and allow people have their views considered without compromising the public interest.

What is the Minister of State's position on this project? With winter almost upon us, what contingency plans are in place to deal with the severe overcrowding at UHL? More can and must be done with the smaller hospitals in the region, including at Ennis and Nenagh and St. John's. Does the Minister of State agree with this? What plans does he have to involve these hospitals more?

Tom Neville (Limerick County, Fine Gael)
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I support Deputy Carey's comments on the smaller hospitals or sister hospitals of the University Limerick hospitals group in the mid-west. We have been told to use these facilities, particularly the injury clinics. If I injure myself playing a match, the first place I will think of is UHL in Dooradoyle. We do not know what specific services are provided by the other hospitals, whether St. John's, Ennis or Nenagh. A major communications strategy needs to be put in place to ensure these facilities are used to their capacity to try to take the heat off the emergency department in Dooradoyle. I have asked for such a communication plan before. It is now paramount this is done, given where we are. I welcome that the Government is moving on the 96-bed unit project in conjunction with the hospital group. I understand it is at design stage and I hope it will soon proceed to tendering. I would like an outline of the design timelines for the project.

As for the modular unit, everyone has a right to appeal and to object - I have no problems with that - but with this process we are looking for something so urgently that I echo Deputy Carey's sentiments that the likes of this should go straight to An Bord Pleanála. I mean no disrespect to the council, on which I sat for a number of years, but this is a strategic project that warrants a streamlining and fast-tracking of deadlines. We are talking a number of months. As Deputy Carey said, 880 people were placed on trolleys in UHL in June and use of the hospital's emergency department increased by 17% in the past year, and is ramping up all the time. I would like to hear the Minister of State's comments on this and I will follow up on them afterwards.

Finian McGrath (Dublin Bay North, Independent)
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On behalf of the Minister for Health, Deputy Harris, I welcome this opportunity to address the House on the issue raised by Deputies Joe Carey and Tom Neville. I commend Deputy Joe Carey on his great work on health in County Clare and Deputy Tom Neville on his support for services throughout Limerick.

The Government is committed to breaking the cycle of overcrowding in our health service. Emergency department overcrowding has been linked to many adverse outcomes, such as longer wait times, worse patient outcomes, treatment delays and growing staff and patient dissatisfaction. The emergency department in University Hospital Limerick is one of the busiest in the country, with approximately 67,000 attendances annually. Demand for ED services at the hospital continues to rise, with an increase of 6% in ED attendances in UHL in 2017 compared with 2016.

The Department of Health undertook a health service capacity review in line with the commitment in A Programme for a Partnership Government, the findings of which provide an evidence base for future capacity decisions. If reforms are implemented, the report concludes that nearly 2,600 additional hospital beds will be required by 2031. The national development plan provides for the full 2,600 beds by 2028, three years ahead of schedule. The national development plan announcement earlier this year includes provision for a 96-bed replacement ward block at University Hospital Limerick. The HSE has provided capital funding in 2018 to progress the design phase of this project. Further funding will be considered in the context of the capital allocation for health, having regard to the availability of funding and the level of contractual commitments already in place. Subject to funding and the successful completion of the planning, design and tender phases, it is currently anticipated that construction is unlikely to commence before 2021.

Given the current pressures on our hospital emergency departments, the Department of Health has engaged with the HSE to identify the location and mix of beds across the hospital system which can be opened and staffed this year and into 2019. A proposal from the HSE, which identifies approximately 600 additional acute beds and 290 additional residential care beds to be phased in between 2018 and 2020, is under consideration in the Department. These proposals include a 60-bed modular unit at University Hospital Limerick.

Therefore, while I understand the Deputies' wish to have a clear response today on the provision of additional beds in UHL to alleviate the ongoing pressures on the ED, I must await the outcome of the processes currently under way. These include matters which are being considered in the context of the 2019 Estimates process. I will convey the Deputies' sensible concerns and suggestions to the Minister.

Joe Carey (Clare, Fine Gael)
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I thank the Minister of State. Ennis hospital is a vital cog in the wheel here, and I believe more could be done in Ennis to try to reduce the burden on UHL. I welcome the fact that Clare County Council recently granted planning permission to the hospital group to develop a new outpatient department just off the Kilrush Road in Ennis. We need to see further investment in Ennis hospital, particularly in surgical theatres, and an expansion in the opening hours of the medical assessment unit and the minor injuries clinics.

I know the Minister has a view that smaller hospitals can play a bigger role. Does the Minister of State support that position? Will he convey the opinion being expressed here this evening that the smaller, model 2, hospitals in the region need to be better resourced in order that they can play a bigger role?

Tom Neville (Limerick County, Fine Gael)
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I reiterate that we need this project to proceed as quickly as possible. From what I hear, dates are being shifted out all the time. The Minister of State is saying today that it will commence in 2021. We need to get this moving faster. I ask that we find a way to fast-track this process. I ask that the person who is appealing the decision to grant planning permission for the project, An Bord Pleanála and the Minister sit down, iron out their differences and come up with a solution so that we can move this forward. People are lying on trolleys under bright lights and having their privacy compromised. I have had phone calls this weekend in respect of some specific cases. Some people have been on trolleys for three or four days. We have been dealing with this for a considerable period.

On diagnostics, I also suggest that we move beyond the nine to five, Monday to Friday model. This has happened in the private sector where people move to weekend shifts and are remunerated and paid bonuses and shift allowances accordingly. We need to start thinking differently in this regard. It is getting too serious.

I pay tribute to the staff in University Hospital Limerick who are working under extreme pressure. A total of 67,800 people attended the hospital's accident and emergency department last year. I understand the new facility will deal with the most acute cases and those who have reached the end of the admissions process for whom staff are trying to get beds. I commend the staff and management because a large number of people have passed through the hospital. It is essential that we get the project through as soon as possible.

Finian McGrath (Dublin Bay North, Independent)
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Again, I thank the Deputies for raising this very important issue. They made many points which I strongly support. For example, I agree with Deputy Joe Carey on using Ennis general hospital to take some of the burden. He also raised issues regarding the medical assessment unit. As to whether I agree that smaller hospitals can play a bigger role in dealing with this issue, I absolutely agree, and I will convey that view at Cabinet and to the Minister for Health.

Deputy Tom Neville spoke of speeding up the process, fast-tracking the project and An Bord Pleanála. This is something on which we have to act. I agree that it is not acceptable to have patients on trolleys for two or three days. We need to be more proactive and think differently. That is very important when we are planning and designing the health service.

The health service capacity review indicates that Ireland has one of the highest bed occupancy rates in the developed world, at 94%. That is significantly ahead of the OECD average of 77%. This is why the Government has approved a record level of capital investment in health - €10.9 billion over the next ten years. This will provide for major enhancement of the capacity of our health services to meet demand, the issue raised by the Deputies. However, increasing capacity alone will not address the challenges faced by the health system. Investment and reform must go hand in hand. The Sláintecare implementation strategy, which was recently published, provides the framework for how our health service reforms can be realised across primary and social care, as well as acute care. We have now commenced the implementation of the Sláintecare programme.

We all acknowledge that the challenges we face are significant. Of that there is little doubt. However, it is my firm belief that all of us here want to find the right solutions. I have heard some of the Deputies' suggestions but solutions have to be patient-centred, evidence-based, results-focused and sustainable in order to deal with the challenges facing our health services.