Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Ceann Comhairle for selecting this important issue for discussion. On 21 April, the Irish Nurses and Midwives Organisation, INMO, recorded a figure of 126 patients on trolleys awaiting admission at University Hospital Limerick, UHL. That was the highest number of patients on trolleys ever recorded at any hospital in Ireland. Of the patients, 65 were in the emergency department, with the remaining 61 in ward overflow areas. The number was triple the next-highest figure on the day, recorded at St. Luke's General Hospital, Kilkenny, where 40 people were awaiting admission. Today, the INMO recorded a figure of 113 people on trolleys. Last January, a figure of 111 people was recorded. That was a record at the time. There is a serious bed capacity shortfall in the mid-west region. We simply do not have enough beds and the pressures associated with Covid-19 have exacerbated the problem. Figures of 126, 113 or 111 patients awaiting admission were never previously recorded.

In the past two years, 98 additional new beds were provided at UHL. In the past decade, more than €100 million has been invested by successive Governments in delivering key infrastructural projects at the hospital. In 2015, a €40 million critical care block providing 12 intensive care beds, a 16-bed high dependency unit, a 16-bed acute cardiac care unit, a step-down cardiac facility and a day cardiology unit was delivered. In 2015, a €24 million state-of-the-art accident and emergency unit was opened. Early in 2020, a €21 million 60-bed modular unit came into use. Funding of €43 million was recently approved by the board of the HSE to deliver 96 new beds at UHL and it is anticipated construction will commence next year.

Despite the provision of this extra capacity and the recruiting and funding of additional consultants, doctors, nurses and medical staff, UHL still experiences the worst overcrowding of any hospital in the State. These overcrowded conditions are dangerous for patients, as well as the doctors, nurses and staff who work extremely hard in the most challenging of environments. There is a need for a collective and immediate response from the Government and the HSE to take control of this extremely serious situation. There is a need to immediately bring into place a short-term, medium-term and long-term solution to this serious issue. HIQA carried out an unannounced visit to UHL in recent weeks and its report is awaited.

To the credit of the Minister, Deputy Donnelly, he visited Limerick last February and spent two days engaging with patients, medical personnel and the executive management team. I understand he received a presentation from hospital management in respect of the need to provide an elective-only hospital in the region. I strongly support the proposal to build an elective-only hospital to cater for patients outside of UHL. It is my understanding that UHL has had discussions in the past year with the University of Pittsburgh Medical Center, UPMC, which has 40 hospitals globally, including five sites in Ireland. An elective-only hospital needs to be prioritised for the mid west ahead of any other region because of the shortage of beds in the system. I understand that 83% of patients in UHL are there for emergency care, while the remaining 17% require elective procedures.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to address the House on the issue raised by the Deputy. I am replying on behalf of the Minister, Deputy Donnelly. I thank the Deputy for the constructive way in which he outlined the situation and acknowledged that €100 million has been invested in the past ten years. More capacity has been put in place but UHL still recently recorded the highest ever number of patients on trolleys, at 126. I have answered questions on this topic in the Dáil and the Seanad and I have discussed it with the Minister, Deputy Donnelly, who is acutely aware of the issue. As the Deputy stated, the Minister travelled to Limerick and spent two days there. He is aware of the situation.

I acknowledge the distress that overcrowded emergency departments cause to patients and their families, as well as front-line staff working in very challenging conditions in hospitals throughout the country. We are seeing a welcome reduction in the number of Covid-positive patients in hospital, with current numbers less than a third of the peak numbers seen in late March. However, the ongoing presence of Covid-positive patients, the continued requirement to provide separate Covid and non-Covid pathways and staff absences due to Covid are continuing to put pressure on the capacity and operation of hospitals, including emergency departments, across the health system.

University Hospital Limerick has reported that it is continuing to deal with record volumes of patients attending the emergency department. The hospital recorded a 10% increase in attendances in the first quarter of the year compared with the same timeframe in 2019. In the short term, UHL is working to ensure that care is prioritised for the sickest patients. As part of its escalation plan, additional ward rounds, accelerated discharges and identification of patients for transfer to UL Hospitals model 2 hospitals are all under way.

University Hospital Limerick was included in the independent review of unscheduled care conducted in 2019. The quality and patient safety team at UHL has developed a number of quality improvement pathways to ensure the recommendations of this review are enacted.

The Department of Health continues to work with the HSE and the National Treatment Purchase Fund to identify ways to quickly improve access to care, including through increased use of private hospitals, funding weekend and evening work in public hospitals, funding "see and treat" services, providing virtual clinics and increasing capacity in the public hospital system.

It is accepted that a key part of the solution for Limerick is additional beds. The new 60-bed modular ward block at UHL is a significant step in addressing this, and provides modern, single-room inpatient accommodation with improved infection prevention and control capabilities, as well as patient flow throughout the hospital. This follows two separate rapid-build projects which delivered 38 beds under the Government national action plan in response to Covid-19.

Medium-term plans for Limerick include provision for a 96-bed ward block at UHL. The evaluation of tenders received has been completed and the awarding of a works contract was approved by the HSE board on 25 March 2022. The capital and estates department of the HSE will now be engaging with the successful bidder. It is anticipated that it will likely take 24 months from commencement to complete the construction phase, with a further eight to nine weeks required to equip and commission the new block for use by the hospital. In the longer term, the plan for UHL, and nationally, is to enable more patients to be seen in the community wherever possible.

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State. The Sláintecare plan recommends that three elective-only hospitals be built - one each in Dublin, Cork and Galway. Given the continuous overcrowding at UHL and the compelling case that has been put to the Minister, Deputy Stephen Donnelly, by the executive management there, Government policy clearly needs to change. Priority must be given to delivering an elective-only hospital for the mid-west. I want to establish what the Minister's position is on the provision of that hospital. It is of critical importance that it be prioritised and that every effort be made by the State to fast-track its delivery. I have sought an urgent meeting with the Taoiseach and the Minister and I understand that request is with the Taoiseach's private secretary. When the Minister of State reports back on this debate, will she raise this issue with the Taoiseach and the Minister?

The HSE and the Minister need to examine an enhanced role for the model 2 hospitals in Ennis and Nenagh and for St. John's Hospital. There is a need to build additional bed capacity at Ennis General Hospital by adding new wards and extending the opening hours of the medical assessment unit and the minor injuries unit, which was recently refurbished at a cost of €2 million. Private hospitals played an important role during the Covid crisis and their services should now be contracted to cater for elective patients at UHL and deal with the extraordinary waiting lists for procedures.

I understand a number of initiatives are being rolled out in the mid-west to divert older people away from the emergency department at UHL. The integrated care programme for older people, ICPOP, is being rolled out, with a hub in St. Joseph's Hospital in Ennis, as well as the pathfinder initiative. In the context of her responsibility for services for older people, will the Minister of State update the House on those initiatives?

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I take on board all of the points the Deputy has raised regarding the proposal to build three elective-only hospitals, his comments on UHL and the enhanced role for the model 2 hospitals located in that particular community healthcare organisation. The health service capacity review 2018 was clear on the need for a major investment in additional capacity in both acute hospitals and community services, combined with a wide-scale reform of the manner and location of the provision of health services. Since January 2020, more than 800 additional acute inpatient beds have been provided nationally on a permanent basis.

However, even with all the extra capacity in Limerick, it clearly is not enough. I provided details in my reply about the number of new beds, as the Deputy acknowledged. The most important thing we can do for people, especially older people, is to ensure they can get care in their community. The ICPOP teams are fantastic in supporting older people, ensuring the first step is not always the emergency department and providing wrap-around support in outpatient services.

I note the Deputy's request for a meeting with the Taoiseach and the Minister. I will feed that suggestion back to them. All the Deputy's points have been really well made. I recognise and respect the sincerity with which he has made them. I will speak to the Minister on his behalf.