Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Ceann Comhairle for selecting this Topical Issue matter, which is an important and urgent issue. It is not important to the Minister for Health, Deputy Simon Harris, because, once again, he has not bothered to turn up. I know he does not turn up to Topical Issue debates and I do not know how to get him to turn up. I have been elected to the Dáil for over three years. I have tabled a number of Topical Issue matters on this issue and the Minister has never once turned up. The Ministers of State, Deputies Finian McGrath, Catherine Byrne and Jim Daly, have come to the House, but never the Minister, Deputy Harris. He does not respond to the letters we send, requests to meet Oireachtas Members or letters signed by a number of Oireachtas Members from across the mid-west region.

This is a crisis. The Minister should be ashamed of himself, not just for not turning up to address my Topical Issue matter, which I can live with, but because he allows what is happening in the emergency department in University Hospital Limerick to continue day after day. Today 81 people were on trolleys and 1,400 were recorded as being on trolleys during September, the highest number ever recorded in any month since records began. It is an increase on last year, despite the Government spin. I wish the Minister of State, Deputy Finian McGrath, and the other Minister of State would stop laughing while I am speaking. There was a 57% increase in trolley numbers for September this year on last year. This is an ongoing crisis. There is a story in the Irish Independenttoday about a woman was left on a trolley for 105 hours. These stories happen every single day of the week.

The Minister does not have the decency to come to the House to answer questions. It is not just that he is missing the debate today; he has missed every debate for which this has been selected as a Topical Issue matter. He has never been here once. He was at a Fine Gael gig when the party was electing its party leader. Obviously, that was more important to him than talking about the hospital in Limerick which is at crisis point. People in Limerick deserve better than what they are getting from the Government. There is no proper intervention.

The Government talks about plans. The Minister of State read out a list of statistics. The statistic is that the hospital in Limerick is at crisis point. People in the hospital are dying unnecessarily. They should not be on trolleys but there are no beds available for them. The Government should be ashamed of itself. The fact that the Minister has not bothered to come to the Chamber is shocking. The Minister of State will read out a script. I will quote from a previous reply in May 2017, when concern was expressed by a nursing union that at least 24 people would be on trolleys from the get go, a concern we shared. He rubbished the union and what I said. At the time he said, "The CEO of the UL hospital has confirmed that there is no basis for any suggestion that 24 patients will be accommodated on trolleys in the new emergency department." We would almost wish the figure was just 24. There were 81 people on trolleys today and on three separate days in recent weeks. In September, 1,400 people were on trolleys.

The Government has not intervened. There are no proper step-down or primary care facilities. General practitioners are not being funded. The Government has spoken about building extensions, but the 60-bed extension will not be in place for at least a year. The winter months will, unfortunately, result in more overcrowding than during the summer months. There are historic numbers of people on trolleys. I know older people who will not go to hospital and families who are stressed. When they get access to hospital the service they get is very good, but the problem is entering the hospital in the first place.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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On the problem you raised about the Minister for Health not being present, it is entirely in order for a Minister of State from the relevant Department to take a Topical Issue matter. However, if a Deputy is unhappy, he or she can make contact with my office and we will always try to arrange for the Minister and Deputy concerned-----

Maurice Quinlivan (Limerick City, Sinn Fein)
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I appreciate that, but it is frustrating that the Minister has not come to the House on this issue for three years.

Finian McGrath (Dublin Bay North, Independent)
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I welcome the opportunity to address the House on the issues raised by Deputy Quinlivan. I want to stress that I never rubbished anyone's arguments about Limerick hospital. I understand the issue and apologise on behalf of the Minister, Deputy Harris, who was unable to attend this debate.

I wish to acknowledge the distress overcrowded emergency departments cause to 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% and the number of emergency department admissions increased by 1.7% compared to the same period last year. The emergency department at University Hospital Limerick, UHL, is one of the busiest in the country. As such, the hospital and CHO mid west were identified as one of the nine focus sites requiring additional investment, focus and support last winter.

According to provisional HSE TrolleyGAR data, there was a 70% increase in patients waiting on trolleys to date in the UHL emergency department in September 2019 compared to the same period last year. In September 2019, there were 897 patients counted on trolleys in UHL, a 28% increase compared to the previous month. It is acknowledged that this is unacceptably high and the HSE is actively working with the UHL group to ease congestion in the hospital, with a focus on facilitating transfers to level II hospitals, assistance from rehab units and community health organisation 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 on increasing capacity in UHL. The average number of open inpatient beds increased by 4% between 2017 and March 2019. Since 2017, an additional 25 beds have been opened in UHL, 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 UHL, with funding of €10 million allocated in 2019. The new modular ward will include three wards comprising 20 single occupancy rooms with en suite facilities, two of which will be full isolation facilities and will provide care and treatment for patients from admission to discharge. The HSE has advised that the enabling works are complete and the main contractor is commencing work. In addition, the national development plan includes a 96-bed replacement ward block in UHL and capital funding was provided in 2018 to progress the design phase of the project.

Planning for winter 2019-2020 has also commenced. The Department has engaged extensively with the HSE in regard to planning for this. In that respect, the HSE has been asked to consider actions and initiatives over and above non-funded actions and to look at the building capacity and options available to them to alleviate the expected overcrowding. The Department expects to receive a draft winter plan in the coming weeks. In the context of planning and preparing for the challenges of the winter period, the Department and HSE have been considering a comprehensive approach to the current high level of delayed transfers of care. However, recognising the urgency of the situation, approval was provided to the HSE to begin actions immediately to the value of €5 million in 2019. As part of these measures, the HSE released a significant number of funding approvals with the NHSS this month, bringing the waiting time for the release of funding back to four weeks.

Maurice Quinlivan (Limerick City, Sinn Fein)
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The Minister of State read the same thing he read to me before. The 96-bed unit to which he referred has been talked about for a number of years. There is no update on that, apart from what he said. We are all well aware of the project. It will not alleviate the current problem.

The 60-bed modular unit is very welcome, but it will be more than a year before it can be used by patients. What immediate action will the Government take? That has not been addressed. What will it do for the 81 people who are on trolleys today? There will probably be a similar number on trolleys tomorrow and every other day in October. I hope that is not the case, but it seems likely.

I hope the Minister of State will pass on my concerns to the Minister for Health, Deputy Harris, as he stated he would. The Minister should come to the House to apologise to the people of Limerick and the thousands of patients who suffered on a trolley in the past year. This year, there will be a record number of patients on trolleys. The 2018 levels have already been exceeded. The Minister should also apologise to the nurses and other hospital staff who daily run up and down corridors apologising to patients for the way they are treated in emergency departments. It should not be the role of hospital staff, who deliver the best care they can, to apologise to people. Rather, the Government should do so. The Minister should be in the Chamber to address this issue, as I have requested on several occasions, and to apologise to the people of Limerick. I hope he will take that step.

I do not know what are the plans of the Government. I have not heard anything about extra funding for step-down facilities, homecare packages or immediate access. The Minister of State referred to the modular unit. As I pointed out, it will not be ready for a year, while the 96-bed unit is so far into the stratosphere that we will probably never see it being built. It was supposed to be constructed several years ago but it was not delivered.

I believe the Government has no interest in the hospital. Fianna Fáil decided to merge the three hospitals in the mid-west region in spite of being told that these problems would arise. In fairness, nobody expected the scale of the increase in admissions to the hospital, but that is what happened and the Government has not intervened. Ministerial intervention is needed on this issue. If the Minister is not up to it, he should go.

Finian McGrath (Dublin Bay North, Independent)
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It must be acknowledged that attendances at emergency departments are growing year on year and that the health service capacity review indicates that Ireland has among the highest rates of acute bed occupancy in the developed world.

It is widely agreed that additional beds are a key part of the solution for Limerick. Over the past two winters, an additional 25 beds were opened in Limerick, including eight beds as part of the winter plan 2018-19. The new emergency department which opened in May 2017 provides a modern, safe and fit-for-purpose facilities that meet the expectations of patients and their families while providing high quality accommodation that better protects privacy and dignity. In addition, the new 60-bed ward was established to provide a rapid-build interim solution to the bed capacity issue at University Hospital Limerick and in response to the health service capacity review by the Department. The UL Hospitals Group welcomed the commitment in Project Ireland 2040 to build a 96-bed ward block over the current emergency department. A design team has been appointed to the project.

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

All Members acknowledge that the challenges faced in this area are significant. However, it is my firm belief that we all want patient-centred, evidence-based, results-focused and sustainable solutions to the challenges currently facing our health services.