Maurice Quinlivan (Limerick City, Sinn Fein)
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I want to put it on the record that I always thought that when a Minister could not come to a Topical Issue debate it was because he or she was not available. The Minister for Health just walked through the Dáil Chamber less than one minute ago so that is disrespectful. We always gave Ministers a bye if they were carrying out other important business but the Minister for Health walked past us there. It is not good enough and that is no disrespect to the Minister of State, Deputy Feighan, who is here in his place. That shows a disregard for Members and for the House.

I will return to the matter I want to raise. If this report was available at the time I could have raised it prior to the general election in 2020. I am speaking of the report of the independent review of unscheduled care performance. It is quite a damning report and I hope the Minister for Health can address why it was not published before. It took a freedom of information request for this report to be made available. The report reviews emergency care in nine of our hospitals. The report refers to unsafe treatment caused by overcrowding and staff shortages and it was completed prior to the Covid-19 pandemic when staff shortages dramatically increased due to the spread of the virus. Its findings highlight a level of dysfunction at the heart of the HSE, with some hospital staff members stating that they did not know who was in charge. Many of the issues that were highlighted remain. The accident and emergency department wait times in 2022 look like they will reach pre-Covid levels with more than 51,000 patients already waiting longer than 12 hours in accident and emergency departments this year. Some 13,000 people have already waited more than 24 hours for admission. These are incredible figures when one considers the research report by the Royal College of Emergency Medicine in the UK that there is, on average, one excess death for every 67 patients who stay in an accident and emergency department for eight to 12 hours.

I have a particular concern about the plight of patients and staff at University Hospital Limerick, a hospital that continues to have huge numbers of people treated on trolleys and in corridors. Almost 1,600 people have been treated on trolleys there every month of 2020 to date. Despite the best efforts of the wonderful but overworked staff there, the issues of long wait times and treatment on hospital trolleys continue unabated. I spoke to a senior staff member at the hospital today who gave me a shocking first-hand account of how tragically challenging the jobs of staff there have become. The member of staff contacted me in desperation about how difficult the work environment they are facing is. I have no doubt that people are dying unnecessarily due to these failures. Yesterday evening there was only one electrocardiogram, ECG, available across the three wards in the accident and emergency department. Apparently all the other machines were broken. That is one ECG to cover three wards, the triage area and the resuscitation sections. That is a scandal. These are important but basic pieces of equipment that should be readily available to staff. It is a major hospital and the fact that just one ECG is in operation for the accident and emergency department is simply not good enough for me or for the people of Limerick. This is a critical issue but on a more basic level, staff members told me today that there is often a challenge to get blankets and pillows for patients who are waiting. The healthcare staff do their best. Staying in hospital is a worrying experience and even the provision of this as an iota of comfort seems to be a cause of difficulty.

I am from Limerick and these patients could be my friends or family members; they are not simply statistics. The hospital zones are so full that in zones A, B and C of University Hospital Limerick yesterday, trolleys were two-deep in hallways, meaning that patients being moved had to either walk or be transferred through back doors so as not to interfere with those people lingering in the hallways. It is worth remembering that zone C is a Covid area so infection is widespread because people are next to each other.

We would all agree that the Minister for Health has an abundance of challenges facing him but he seems to be getting nowhere fast. I have appealed to him, and I do so again, to expedite the construction of the 96-bed unit at University Hospital Limerick. While it will not solve the problems of the hospital it would be an important signal to the people of Limerick that they are not being ignored and that the Government is committed to rectifying the problems at University Hospital Limerick. Reducing accident and emergency department waiting times is just one part of the puzzle. It needs to be done but it needs to be done as part of wider health reforms. We can invest in GP capacity to reduce hospital admissions and we can increase capacity in staffing numbers in our hospitals. These things take investment and we need to see this Government commit to this major investment.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I welcome this opportunity to address the House on the issue raised by Deputy Quinlivan. The health sector is facing significant challenges in providing emergency care while also managing Covid-19. I acknowledge that this is causing distress to patients, their families and front-line staff. I welcome the release of the report of the independent review of unscheduled care performance under the Freedom of Information Act 2014 following an application to the Department from the Irish Patients' Association. The terms of reference of the report were finalised by the HSE following discussion with the Department, and it was published in June 2019. The review across nine hospital sites was conducted during 2019 by an independent review team, including external management expertise from the National Health Service Scotland, the Scottish Government and National Health Service England.

The report notes that the nine hospitals accepted the inspection visits with good grace, openness and a desire to learn, and that this is a great testament to their acceptance of the huge need for learning and change. During the course of the review the team witnessed many incidents of outstanding practice and excellent patient care and was reassured by the many good things it saw happening. The team also observed many areas that it felt needed to be improved. The report contains significant findings in areas such as: patient experience times; executive leadership; and appropriate care settings. It also gives clarity on: care provision; patient flow; and the normalisation of full capacity protocol. The report makes numerous site-specific recommendations and 30 consolidated recommendations across four themes, covering: leadership and governance; emergency departments and assessment; patient flow; and operational grip. It highlighted the following: the need for better access to routine diagnostics at weekends; the need for more senior decision-makers on-site on evenings and at weekends; and the need for more health and social care professionals working at weekends. The HSE has advised that the arrival of the Covid-19 pandemic in March 2020 required it to respond to the extraordinary challenges posed and in doing so resulted in the implementation of structures and initiatives to address many of the issues and recommendations that were identified in the draft report.

The report has remained in draft format since January 2020 and close-out of the review process to include factual accuracy checks and response from the nine sites reviewed was never completed. The Government has increased health service current funding from €15.3 billion in 2018 to €19.4 billion in 2021, and €20.4 billion this year.

We permanently funded 1,146 acute hospital beds in budget 2021 and more than 800 have opened. Significant funding was provided for additional staff, home help hours, alternative care pathways and community services. It is critical that the funding is used in a manner that has a demonstrable impact on the challenges facing the healthcare system, particularly in relation to overcrowding in healthcare settings. Key to this outcome is an emphasis on alternative options to emergency department attendance and a focus on improving the patient experience in the emergency department.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State for the response but it is not good enough for the people of Limerick or most of the hospital staff. I am a Deputy for Limerick. The report referred to nine hospitals. I am sure the Minister of State was just handed his response and read it out. It did not even mention University Hospital Limerick. One would imagine, since I am the Deputy for that constituency, that the response would refer to that hospital. That is deeply disappointing. The workers at the hospital did Trojan work through the Covid pandemic. They need to hear support from central Government and that their concerns are being heard. Calls have been made for a HIQA inquiry into the level of overcrowding in University Hospital Limerick. I have yet to hear whether one will be commissioned.

In a recent reply to a question, the Minister stated that the current congestion in our emergency departments is due to constrained bed capacity, the high number of patients with Covid-19, and increased numbers of delayed transfer of cases. I accept these are important elements, but the report of the independent review of unscheduled care performance shows that the issue in emergency departments preceded the Covid-19 pandemic. It is important to restate and put on the Dáil's record the report by the Royal College of Emergency Medicine that there is an average of one excess death per 67 patients who stay in emergency departments for eight to 12 hours. People are clearly dying unnecessarily in our emergency departments, including in University Hospital Limerick, due to waiting and overcrowding.

Covid is a factor but it has grown old as an excuse for the Minister to hide behind. The problems existed well before Covid. Covid added to them and the Minister's inaction has compounded them. Unfortunately, people in Limerick believe nothing will change while the Minister, Deputy Donnelly, is in charge. The fact he walked through the Chamber literally one minute before I spoke speaks volumes about his interest in our hospital. His speech, which I am sure was crafted for the Minister of State, did not mention Limerick either.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I agree with the Deputy that emergency department overcrowding is a serious issue that needs to be addressed. The Deputy referred to increased attendance in recent weeks. The Covid pandemic put enormous pressure on the system which has resulted in unacceptable delays. It appears the recommendations in this report can be part of the solution to delays in emergency departments. As I outlined in my opening comments, significant additional funding has been provided to the health service in recent years. However, funding alone is not the solution. I agree with the findings of the report that management, leadership and operational grip are important drivers of performance and should get the same level of attention as part of a solution as capacity, staff and enhanced community services.

The Minister, Deputy Donnelly, is due to meet with the chair of the HSE board and members of the executive management team to discuss emergency department performance and the actions required to bring about a sustained improvement across all emergency departments. Deputy Quinlivan has raised the issue of the hospital in Limerick. I will bring it to the Minister's attention. He will discuss this with the chair of the HSE board and members of the executive management team. I will specifically ask for Limerick to be included.