Maurice Quinlivan (Limerick City, Sinn Fein)
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I mean no disrespect to the Minister of State but the senior Minister for Health really should be here when we are talking about University Hospital Limerick, UHL, because it is a massive issue, as she will be well aware. I raised this issue in the previous Dáil whenever I could and I also raised it with the Tánaiste last week. There seems to be a problem in our hospital. One always knows there is a big problem when the nurses ask for someone to do something. They have asked the Health Information and Quality Authority, HIQA, to do an inspection. I reiterate my support for that call. That needs to be done as a matter of urgency. There is an ongoing crisis with trolleys and waiting. Everyone tells me that once they get through the emergency department and into the hospital, the staff are fantastic and that they get a very good service. They are very pleased with that but families are being put under stress. The past year has been very difficult for people. As a result of Covid, families cannot visit or be with people in the hospitals.

I want to put some information on the record. The figures this year are stark. In January, there were 949 people on trolleys in the middle of a pandemic; 914 in February; 1,059 in March; 1,020 in April; and 420 in May to date. This is off the scale, even compared to last year when many people did not go to the emergency department because of the pandemic. Today might be considered a good day in that only 35 people are on trolleys but that is 35 families who were affected. One day last week, there were 75 people on trolleys.

We need an intervention. A modular unit was recently opened. It was supposed to be a panacea that would help fix the issue. It did not do so. We did not expect it to. There is a 96-bed unit in progress. We need to know where it is at. Is it going to be expedited? We were all shocked to hear the HSE's recent statement that only half of those beds would be delivered, rather than 96 new beds. We need to make sure we get the 96 new beds. The amalgamation of the three hospitals, those in Nenagh, Ennis and Limerick, is at the root of this problem, which has been ongoing for a number of years. It needs to be addressed.

Kieran O'Donnell (Limerick City, Fine Gael)
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I want to address two aspects. The Minister of State will probably be aware that we have had consistently high trolley numbers in Limerick over the recent period. There is an historic issue. There was a consultant's report from Teamwork a number of years ago, which stated that we should get at least 138 additional beds. To date, we have got approximately 98 additional beds, including a 60-bed modular block. These are all single-person bedrooms, which makes them very important in the fight against the Covid virus. They certainly kept the incidence rate in the hospital and, by extension, the rate among people in Limerick, down. What plans have been put in place to reduce the number of people on trolleys, which has been, on average, 54 this month? Planning permission for a 96-bed block has been granted to the HSE. The project is due to go out to tender and a preferred bidder will probably be in place by the end of the year. We must ensure this is approved by the HSE board and included in the Government's capital programme so that we can start to build next year with a view to completion by early 2024. Will the Minister of State give us an update on the status of that 96-bed block so that we can reach that critical number of 136 or more? I believe we need more because of Covid and because of the correct move away from Nightingale wards towards single-bed rooms, such as exist in the 60-bed block. This four-storey block of 96 acute beds is to be built over the existing dialysis unit in the hospital. Will the Minister of State give us an update on that? We want to see not only the 98 beds, including the 60-bed block, but also this 96-bed block being built as quickly as possible.

Mary Butler (Waterford, Fianna Fail)
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I welcome this opportunity to address the House on the issues raised by Deputies Quinlivan and O'Donnell. I have heard both Deputies raise similar issues on many occasions. I acknowledge the distress that overcrowded emergency departments cause to patients, their families, and the front-line staff working in very challenging conditions in hospitals throughout the country. I also acknowledge the work of staff and their commitment to ensuring the uninterrupted provision of emergency care throughout the pandemic.

The emergency department at UHL is one of the busiest emergency departments in the country, with 65,824 presentations in 2020. As both Deputies have mentioned, over the past number of weeks, the hospital has experienced considerable demand for inpatient beds. This is attributed to a sharp increase in overall emergency department attendance, particularly among those aged over 75 who present with higher acuity, and to increased lengths of hospital stay. The number of presentations between January and April this year was 22,202, an increase of 10.1% on the same period last year. The attendance of those over 75 has increased by 16%.

Additionally, while attendance and admission numbers have now returned to pre-pandemic levels, the continued requirement to provide separate Covid-19 and non-Covid-19 pathways presents an additional challenge to patient flow in all hospitals, including UHL.

The winter plan provided several hospital avoidance measures to support UHL. These include the appointment of a dementia adviser, recruitment for enhanced community care in the south of the city and west Limerick and additional capacity in Nenagh and Croom hospitals.

It is acknowledged that acute bed capacity shortages in the mid-west are a major contributor to overcrowding at the emergency department in UHL. The provision of 98 additional beds in the hospital over the past year has been a significant step in addressing this. These include a new 60-bed modular ward block, providing modern, single-room inpatient accommodation. As well as improving patient experience in terms of comfort, privacy, and dignity, it also improves infection prevention and control capabilities, including better isolation of patients, where necessary. The remaining 38 beds were provided through the completion of two separate rapid-build projects delivered under the Government national action plan in response to Covid-19.

Both Deputies asked about the 96-bed replacement ward. I am pleased that funding has been provided in the 2021 HSE capital plan for a 96-bed replacement ward block at UHL. Following receipt of the final grant of planning permission in early March 2021, the design team have now commenced detailed design and preparation of the procurement documents for this development. It is planned to have the project tendered and a preferred contractor selected by the end of 2021. The construction period from contractor appointment will be approximately 18 months. As we know, all capital development proposals must progress through a number of approval stages in line with the public spending code, including detailed appraisal, planning, design and procurement, before a firm timeline or funding requirement can be established.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State for her response. I will come back on the 96-bed unit. Our concern is that the HSE recently told us that there will not be 96 additional beds, but 48. This will not address the problem we have. Unfortunately, there are more than 48 people on trolleys in UHL every day, which is a national scandal. I agree with the call from the INMO for HIQA to investigate the hospital. That should be done as a matter of urgency. I thank all the staff in the hospital, who have done a really good job. I refer to the consultants, the nurses, the porters, the kitchen staff and everybody else in that hospital. Unfortunately, I have family members there myself. It is very difficult for families. We cannot continue like this. We cannot continue having to come into the Dáil every week to talk about a service that should be delivered to everybody. Everybody is equal but there is a sense in the mid-west that we are not equal. The three hospitals announced the other day are to be situated in Galway, Cork and Dublin. Limerick was forgotten about again. There was no vaccination centre in Limerick; it was in the Radisson Hotel in Clare. The new one is to be located in Patrickswell, which is welcome but, again, Limerick feels left out. I hope this will be addressed.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank the Minister of State for her response. I seek clarification of a number of points. First, after the 96-bed block has gone to tender and the preferred bidder is in place, will the Government support its approval by the HSE board? We can get that block started in January and then built. It will be a significant build of 18 months of thereabouts. Second, will a plan be put in place now to determine how to reduce the number of people on trolleys? This month's average of 54 is too high. In that context, I acknowledge the fantastic work being done under difficult circumstances by the staff at UHL. People get great care there.

Our region has an historical issue. The 60-bed block has made a major difference, as has the 38-bed block, but we need the 96-bed block. We may even need further beds in future, but the 96-bed block must be got under way as quickly as possible.

Mary Butler (Waterford, Fianna Fail)
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I have with me the response from the Minister's office. To be clear, Project Ireland 2040 includes provision for a 96-bed replacement ward block at UHL. Funding for this design work has been provided for in the 2021 HSE capital plan. Following receipt of planning permission in early March, the design team has commenced work on the detailed design and preparation of the procurement documents for the development. The Department of Health and the HSE will continue to work with local hospital management to improve the patient experience in UHL further.

It is accepted that the national development plan provides for the recommended 2,590 additional beds. Compared with the number of beds available at the end of 2019, an additional 834 beds have been provided on a permanent basis. The Programme for Government: Our Shared Future commits to continuing investment in our healthcare services in line with the recommendations of the health service capacity review.

I will take the Deputies' comments on board. It is no secret that University Hospital Limerick has been plagued for a long time with a large number of people on trolleys. We hear about it in the House on a weekly basis. The provision of the 96-bed replacement ward will make a significant difference. As Deputy O'Donnell pointed out, though, it must happen very quickly. I will bring the Deputies' concerns to the Minister.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Minister of State's assistance in these matters is appreciated.