Joe Carey (Clare, Fine Gael)
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I thank the Ceann Comhairle for selecting this important issue for debate. Last Friday I attended a briefing at University Hospital Limerick, UHL, given by Professor Colette Cowan, Professor Paul Burke and their team. UHL experienced severe overcrowding in 2018. It is a longstanding issue which is not going away. It must be addressed. Management has put forward a number of proposals which need the support of the Department of Health and the Minister for Health. A lack of bed capacity is a major issue at UHL. The proposal to build a 60-bed modular unit at UHL now has the benefit of planning permission. Originally there was an objection lodged with An Bord Pleanála but that has since been withdrawn. It is a shovel-ready project. It now requires €40 million to construct it. Following discussions with the Minister, Deputy Harris, I am very confident this essential project will be given funding in the not too distant future. Will the Minister of State confirm this to be the case? Once funding is confirmed and the green light is given to the project, management is very confident that the project can move forward and will be in place for winter 2019.

In the more immediate term, it is important the winter admissions plan being put forward by management in Limerick is responded to positively. This proposal includes bringing ten additional beds into use, extension of the MAU to a 24-7 service and the establishment of a 24-7 surgical admissions unit which would facilitate direct referrals to it. These initiatives will reduce the overcrowding issues at the emergency department.

I welcome the recent opening of a second emergency department surgical theatre at UHL on Sundays. It is an issue I raised in the Chamber a number of weeks ago. I have raised it repeatedly. It is a welcome development. Management has also put forward the need to open up a second surgical theatre in the emergency department on Friday, Saturday, Sunday and Monday. I support that proposal and I ask the Minister of State to support it as well.

Timmy Dooley (Clare, Fianna Fail)
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I welcome the Minister of the State. As with Deputy Carey and other Members of the Oireachtas, I had an opportunity to meet senior management and staff at the hospital in Limerick in recent days. While they are coping to the best of their ability, they are under enormous pressure. The new accident and emergency department at the hospital, which was opened to much fanfare, has seen a very considerable increase in admissions in the past number of years. It has grown steadily since 2014. Notwithstanding the state of the art facilities in the accident and emergency department, the bed capacity behind it is not adequate or appropriate to meet the growing demands and needs of the region. Part of the issue is demographics and part of it has to do with the way in which reconfiguration was, rightly, accepted by the region. It has put an intolerable burden on the staff and, more particularly, on the patients who present and who are left for an inordinate amount of time waiting in unacceptable conditions. There was a very clear belief that the 60-bed modular unit can be brought on board quickly if the funding is put in place. However, it will still take some time to build. We have not yet entered into the difficult winter period of the winter vomiting bug and other stresses on the health services which will result in increased numbers of patients presenting and, therefore, increased chaos in the accident and emergency department. Even in advance of that, we still have 60 to 70 people per day on trolleys. It is not acceptable.

A number of initiatives can be taken quickly. We need an urgent response from the Department in terms of putting the moneys aside. My understanding, and that of other Members who were at the meeting, is that proposals are coming from the hospital and if they are not already with the Department they will be within the next number of days. To alleviate the really short-term issues, we need funding to open an additional ten beds, which I understand can be done with some reorientation within the hospital. A second trauma theatre at weekends would mean that lots of the work that presents over the weekend would get treated and dealt with over the weekend and it would take away the pressure on Mondays. The acute medical assessment unit should be moved from an 8 a.m. to 8 p.m., Monday to Friday unit to a 24-7 unit. The acute surgical admissions unit needs to be open on a 24-7 basis. It will ensure we do not have peaks and troughs and that work can be progressed more evenly throughout the week so we do not see this spike on a Tuesday. That is the kind of work that needs to be done. I hope that, notwithstanding the additional funding that has been provided to the Department as a result of the recent budget, we can see those short-term funds made available to address the immediacy of the crisis and then work towards getting the additional bed capacity through the modular unit that is proposed. Hopefully we can then move to the long-term situation where the 100 beds that were planned and proposed for the hospital come on board.

Catherine Byrne (Dublin South Central, Fine Gael)
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I thank the Deputies for raising the matter. I will read the statement I have been given by the Department of Health. It may not answer some of the questions that have been asked by the Deputies so I will make sure the Minister, Deputy Harris, receives them.

On behalf of the Minister, Deputy Harris, I welcome the opportunity to address the House on the issues raised by Deputy Dooley and Deputy Carey. The Government is committed to improving access to our health service. The emergency department in UHL is one of the busiest in the country, with nearly 54,000 attendances this year to the end of September. Demand for emergency department services at the hospital has continued to rise this year with an 8% increase in emergency department attendances at UHL compared with the same period last year.

Preparations and planning for winter 2018 and 2019 are well advanced in the hospital and at local level. The Department of Health is working with the HSE to ensure the most effective response to the winter challenges to unscheduled care provision within available resources. As part of budget 2019, an additional €10 million in funding is being provided in 2018 to prepare for and manage the expected peak in demand for health services in the winter ahead. The funding will focus on initiatives to enable the hospital system to de-escalate before Christmas.

The Minister, Deputy Harris, has requested the HSE to provide for a significant increase in the provision of social care and other measures to support the patient’s journey home in the first quarter of 2019 in response to the expected surge in demand after the Christmas period. A further €10 million in funding is being made available in 2019 to increase acute bed capacity in line with the recommendations of the health service capacity review.

Increasing capacity is a priority for the Government. The Department of Health is in discussion with the HSE in the context of the national service plan 2019 to identify the sites for investment and the associated number of beds, as part of an agreed capacity programme for 2019. The selection and opening of beds on specific sites in 2019 and future years will be considered as part of the annual Estimates and service planning process and subject to financial, operation, human resource and policy considerations and priorities. Increasing capacity is both part of the short-term and long-term solution. The national development plan announcement earlier this year includes provision for a 96-bed replacement ward block at UHL. 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 level of contractual commitments already in place. Subject to funding and the successful completion of the planning, design and tender phases, it is anticipated that construction is unlikely to commence before 2021.

Investment in capacity and reform must go hand in hand. We have commenced implementation of the Sláintecare programme of reform, providing the framework for how health service reforms can be realised across primary and social care as well as acute hospital care. I know that has not answered many of the questions put by both Deputies, but I will return to the matter.

Joe Carey (Clare, Fine Gael)
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I pay tribute to the University Hospital Limerick, UHL, staff, who work under extreme pressure. Attendances there at the emergency department, ED, have increased by 18.5% over the past four years, while it is projected that approximately 71,000 people will visit that ED this year alone. Will the Minister of State convey the outcome of this debate to the Minister for Health, Deputy Harris? It is important that he confirms funding support for the 60 bed modular unit and that he confirms he supports the winter admissions plan put forward by management at UHL, which includes ten additional beds, a 24-7 medical assessment unit, MAU, a 24-7 surgical assessment unit and a second ED surgical theatre for weekends. These initiatives will help address the severe, chronic overcrowding at UHL, and it is important that the Minister of State conveys these sentiments to the Minister and that he responds to us.

Timmy Dooley (Clare, Fianna Fail)
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I thank the Minister of State for her response but, unfortunately, it falls well short of what is required. I do not think she needs me or anyone else in this House to tell her the level of crisis that is felt in the mid-west because of the massive level of overcrowding, even during the summer period, which is normally relatively quiet. The infrastructure there is wholly inadequate to meet the demands and needs of the people. I will be back here next week looking for more answers, and what I need to hear is not about what will happen in 2021 but rather what will happen in 2019. I want to hear that funding will be made available to ensure that by the time we get to September 2019, the modular unit is well under way. Prior to that, however, from the very beginning, we need ten extra beds, the second trauma theatre at weekends, the 24 hour acute MAU and the acute surgical admission unit on a 24-7 basis. It will not solve the problem but it will have a meaningful impact. It will allow the staff to give reasonable treatment to people who present and it will give a general expectation to those patients that they will be treated in a timely manner and with dignity and respect.

Catherine Byrne (Dublin South Central, Fine Gael)
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I see from both of the Deputies' contributions the frustration and seriousness of what they have spoken about. Unfortunately, I am not privy to some of the meetings that were held before I was asked to take this Topical Issue matter. As I outlined, however, the preparation and planning for the 2018-19 winter is well under way in hospitals at local level, the objective of which is to ensure the most effective response to the winter challenges to schedule care provision of any available resources. It is acknowledged that attendances at accident and emergency departments grow year on year, and the health service capacity review indicates Ireland has among the highest acute bed occupancy rate in the developing world, which is why we must invest in more beds in 2019.

We acknowledge the challenges we face are doubtless significant, but I firmly believe all of us in the House wish to find the right solutions for patient-centred, evidence-based results, focusing on sustainable solutions to challenges facing the health service. I assure both Deputies that in my capacity as Minister of State in the Department of Health, I will convey their frustration and serious concerns to the Minister as soon as I speak to him, which I hope will be sometime this evening.