Jan O'Sullivan (Limerick City, Labour)
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It is quite clear that the situation at University Hospital Limerick is intolerable. There were 81 patients on trolleys last Monday, the joint highest number ever. That figure was also reached in April and July and we are not even close to the winter which people are dreading. I want ministerial and Government responsibility to address this issue to be taken, first to acknowledge that there is inequality in the allocation of resources for the mid-west region. Deputy Kelly gave the figures today during Leaders’ Questions. The region is under-resourced for the provision of beds and staff across the spectrum. That needs to be acknowledged and addressed. When the numbers of staff were increased in recent months, the region did worse than others which are much better resourced. That has to be acknowledged, accepted and acted on. Owing to the embargo in effect on recruitment, although the Minister described it this morning as control measures, there are 100 nursing posts unfilled, as well as several doctor and ancillary posts. It has come to my attention this week that there are people employed as home helps who are waiting to have their contracts renewed, while others who have been interviewed have not been told that they will offered work. There are patients who could leave hospital if they received support at home and get out of beds which are urgently needed in the emergency department. All beds in the region should be opened and staffed, including in geriatric and lower tier hospitals. Wherever there are beds, they should be opened and resourced to take the pressure off University Limerick Hospital. We are talking to people in their eighties. What they are going through in the emergency department is intolerable. A second MRI scanner which is urgently needed should be provided. We should have progress in providing the 60-bed modular unit and the 96-bed unit. We need all of these actions urgently.

Michael Harty (Clare, Independent)
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The situation in Limerick is disgraceful for patients and staff. It has a knock-on effect on recruitment and retention. Working in the conditions in Limerick burns staff out and they become disillusioned. That is one of the reasons for the problems in recruitment. To have between 60 and 80 patients awaiting admission is intolerable. They are mostly elderly people with complex needs. The longer they stay in the casualty department on a trolley the longer their stay in hospital will be and the poorer their outcomes. That has been scientifically proved. What is happening in Limerick is adding to the torture and problems these patients are suffering.

We are waiting for the 60-bed modular unit to be provided. If everything goes well, it will be available by the end of next year. However, the 90-bed unit is as far away as ever. Unfortunately, there is a suspicion that the national children’s hospital will soak up the funding for the 90-bed unit and that it will not be delivered for many years. There is a need for immediate recognition that what is happening in Limerick is unique to the region. As Deputy Jan O’Sullivan said, there is unique under-resourcing and a lack of beds in Univeristy Hospital Limerick. It is 20% down on the number of beds it should have for the catchment area that it serves and 20% down on the number of staff, nurses, consultants and other health professionals, it should have. This is leading to long waiting lists and long delays.

The most immediate problem is the provision of an MRI scanner. I visited six patients from my practice in the hospital a few weeks ago. Four of them were sitting on beds bored to death waiting for scans and a consultation with other doctors, while down the corridor there were 70 patients on trolleys waiting for admission. There is a huge problem in the provision of diagnostics, staff and beds.

David Stanton (Cork East, Fine Gael)
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I welcome the opportunity to address the House on the issues raised by the Deputies. I speak on behalf of the Minister for Health, Deputy Harris, who cannot be here and sends his apologies. He acknowledges the distress overcrowded emergency departments cause for patients, their families and front-line staff working in very challenging conditions in hospitals throughout the country. The number of patients attending emergency departments continues to increase year on year. For the first eight months of 2019, the number of patients attending hospital emergency departments increased by 2.9%, while the number of emergency department admissions increased by 1.7% compared to the same period last year.

University Hospital Limerick is one of the busiest in the country. As such, the hospital and community health organisation mid-west were identified as one of the nine focus sites which required additional investment and support last winter. In University Hospital Limerick there was a 13.3% increase in trolleys in the year to date in August 2019 compared to the same period last year, while there was a 5.9% increase in August 2019 compared to the previous month. It is acknowledged that this is unacceptably high and the Health Service Executive, HSE, is working actively with the University of Limerick Hospital group to ease congestion in the hospital, with the focus on facilitating transfers to level 2 hospitals, assistance provided by rehabilitation units and community health organisation, CHO, services and the prioritisation of diagnostics to aid inpatient discharges.

The health service capacity review, published last year, highlighted the need for a major investment in additional capacity. Progress has been made in increasing capacity in University Hospital Limerick. The average number of open inpatient beds increased by 4% between 2017 and March 2019. Since 2017, an additional 25 beds have opened in University Hospital Limerick, including eight as part of last year's winter plan. A capital budget of €19.5 million has been approved for the provision of a modular 60-bed inpatient ward block at University Hospital LimerickL, with funding of €10 million allocated in 2019. The new modular block will include three wards comprising 20 single occupancy rooms with en-suite facilities, two of which will provide full isolation facilities and care and treatment for patients from admission to discharge. The HSE has advised that the enabling works are complete and that the main contractor is commencing work. In addition, the national development plan includes a 96-bed replacement ward block at University Hospital Limerick. Capital funding was provided in 2018 to progress the design phase of the project.

Planning for winter 2019-20 has commenced. The Department of Health has been engaging actively with the HSE in planning for winter 2019-20. In that respect, the HSE has been asked to consider actions and initiatives over and above non-funded actions, building capacity and the options available to it to alleviate the expected overcrowding. The Department expects to receive a draft winter plan in the coming weeks. I will bring the Deputies' other points to the Minister's attention.

Jan O'Sullivan (Limerick City, Labour)
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We need more than just the Minister, Deputy Harris, acknowledging the problem. We need him to take action. One simple action would be providing the €6.5 million required for a properly functioning MRI scanner, which would address the issue of patients occupying beds and waiting for scans for which others could be in the hospital. No other region has such an inadequacy. There is a need for a particular focus on the region, given that it is clear it is under-resourced and underfunded. The health system is supposed to be fair to everyone, no matter what part of the country people live in, but we do not currently have this in the mid-west. That is the strong, factual point we are making. We have made it repeatedly and need a response. The extra beds need to be delivered as quickly as possible. One action that could be taken in respect of the 60-bed unit is ensuring the recruitment of staff alongside the resourcing of the building in order that when it is open, it will be ready and able to be staffed and occupied immediately. They are practical steps that could be taken, but we need to pull out all the stops to ensure the winter will not be terrifying for people who are ill.

Michael Harty (Clare, Independent)
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The issue in Limerick is much wider than the emergency department. It appears in the emergency deparment, but the problem is not confined to it. Rather, it is much wider within the hospital. There is a need for an expansion of the number of consultant staff in the hospital and ophthalmology services. One can wait three and a half years following the diagnosis of a cataract to see a consultant, not to mention waiting for a surgical procedure. In urology, one can wait six months for an investigation when one has symptoms that indicate a high likelihood of cancer. There is only one endocrinologist in the mid-west for 400,000 people, which diminishes the treatment of diabetes, in particular, and all other endocrinology problems. Ear, nose and throat, ENT, treatment is a case in point, where there is a significant problem. Limerick Regional Hospital has lost its recognition for higher professional ENT training since 2014. One can wait an inordinate length of time just to have one's tonsils removed or grommets put in one's ears. One of the issues that needs to be resolved is the devolution of services to model 2 hospitals within the mid-west, particularly in Ennis, where two modular theatres should be provided to allow for the provision of day care services. I refer to ENT day care services, in particular, which are essential to relieve the pressure on Limerick Regional Hospital.

David Stanton (Cork East, Fine Gael)
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I thank the Deputies for raising this important matter and acknowledge their knowledge and expertise in the area.

The Minister for Health acknowledges that attendances at emergency departments are growing year on year and that the health service capacity review indicates that Ireland has among the highest acute bed occupancy rates in the developed world. Deputy Harty is correct that it is widely agreed that an important part of the solution in Limerick is the provision of beds, other services and staff. In the past two winters an additional 25 beds were opened in Limerick, including eight as part of the winter plan last year. The new emergency department that opened in May 2017 provides modern, safe and fit-for-purpose facilities which meet the expectations of patients and their families, while at the same time providing high quality accommodation that better protects privacy and dignity. In addition, the new 60-bed ward block was established to provide a rapid build internal solution to the hospital capacity issue in response to the health service capacity review carried out by the Department of Health. University Limerick Hospital group has welcomed the commitment in Project Ireland 2040 to build a new 96-bed ward over the emergency department and a design team has been appointed for the project.

Improving timely access for patients is part of Sláintecare. Building on the progress made in recent years in the area, the Sláintecare action plan for 2019, published by the Department of Health, includes a specific work stream on access and waiting lists. In addition, many of the other service reforms and enhancements included in the action plan will support timely access to care for patients in the coming years. Progress has been made in implementing the Sláíntecare action plan access actions for this year.

We all acknowledge, including the Minister, that the challenges we face are significant. It is the Minister's firm belief, however, that all Deputies want to find the right patient-centred, evidence-based, results focused and sustainable solutions to the challenges facing the health service. Investment alone will not deliver the health service to which we all aspire, but neither will reform or productivity improvements on their own. All three actions, including the provision of additional capacity, as Deputy Harty pointed out, must be delivered in tandem if we are to stand any realistic chance of meeting healthcare needs in the coming decades.