Kieran O'Donnell (Limerick City, Fine Gael)
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I raise the need for an elective hospital in Limerick. It is already Government policy that Cork, Galway and Dublin will get elective hospitals, and it is completely illogical that Limerick and the mid-west are not included. There are a couple of reasons for that. I have been a public representative of Limerick for many years. We have the highest number of people going through the emergency department, ED. In 2021, Limerick had the highest number of patients going through the ED in any one year, while it is predicted that almost 80,000 people will go through it this coming year. Furthermore, we have the lowest number of open beds per 1,000 of population of any region.

Cork, Galway and Dublin all have private hospitals. We have no private hospital at the moment, even if we will have one in the future. The lack of an elective hospital is illogical given Limerick has been the place with the highest number of people on trolleys over a recurring period. Thankfully, the numbers today are down. Nevertheless, while they are not at their highest level, they are still high.

This is pretty straightforward. The Taoiseach has stated in recent days that he now believes that the case for an elective hospital in Limerick is compelling.

I want to see about getting a process under way. An elective hospitals oversight group has been established to progress the elective hospitals in Cork, Galway and Dublin. I want to see the Minister for Health now direct it to start scoping for an elective hospital for County Limerick. This is the process I want to see around that. We have University Hospital Limerick, UHL. St. John’s Hospital in the heart of the city has a proposal in at the moment. It is already an elective hospital, in many ways. It has a proposal in to increase the number of beds from 90 up to 150. UPMC has also brought forward a proposal for an elective hospital. This needs to be scoped. I want an agreement in principle from Government that it will now make a Government policy that Limerick will have an elective hospital. Part of that has to involve the consideration of what St. John’s Hospital can bring to the table. We need to evaluate the UPMC proposal as well.

The process, which I have looked through, is very straightforward. The Government and the Minister for Health need to direct the elective hospitals oversight group, which has joint governance under the Department of Health and the HSE, to now include the scoping out of an elective hospital in Limerick along with what it is doing in Cork, Galway Dublin. Otherwise, it is incomplete. I would certainly question the methodology that was used that gave rise to elective hospitals in Cork, Galway and Dublin and none in Limerick. It is illogical to me. We have to move to the next step.

The Taoiseach came out and firmly stated that he now sees the compelling need. He said he will go to the Minister for Health to fast track it. I am now putting forward what the process is, which is that the Minister for Health instructs the elective hospitals oversight group to start the scoping exercise as to what form the elective hospital in Limerick will take. When it goes to the elective hospitals oversight group, however, it should be Government policy that there will be an elective hospital in Limerick.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this Topical Issue matter today, which I am taking on behalf of the Minister, Deputy Stephen Donnelly.

As the Deputy is aware, the cross-party Sláintecare report in 2017 articulated a new vision for healthcare in Ireland, including the provision of elective only hospitals and providing protected capacity for elective care. This policy has also been informed by a number of subsequent policy documents and Government decisions including the 2017 Sláintecare report, the Sláintecare implementation strategy and the national development plan in 2018, the programme for Government in 2020, the Sláintecare Implementation Strategy and Action Plan 2021-2023 and, finally, the new national elective ambulatory care strategy, which was agreed by the Government in December 2021.

This new strategy aims to change the way in which day cases, scheduled procedures, surgeries, scans and outpatient services can be better arranged to ensure greater capacity in the future and help to address waiting lists at a national level. The development of additional capacity will be provided through dedicated, stand-alone elective hospitals in counties Cork, Galway and Dublin.

The elective care scope of service will be developed in two phases commencing with day cases, diagnostics and outpatients, and then by inpatient treatment. On this basis, the elective care centres will be designed to provide sufficient capacity to facilitate further phases, including some elective inpatient capacity, thereby providing a sustainable and strategic response to cater for the highly dynamic landscape of healthcare policy and practice.

It is important to note that the locations chosen will allow for new facilities of a size and scale to implement a national elective care programme that will tackle waiting lists on a national basis. This means that the new facilities will be designed to maximise their capacity and, in doing so, will operate to meet the demands of as wide a catchment area as possible, extending beyond existing and future health areas including the mid-west. The Minister, Deputy Stephen Donnelly, is conscious of the desires expressed by Deputy O'Donnell for a dedicated elective hospital in Limerick.

I would say to Deputy O'Donnell that the locations were chosen in line with good practice, which suggests that in order to maximise economies of scale, dedicated, stand-alone elective centres should be as big as is reasonably possible to meet identified demand while providing appropriate population coverage. Locating the new facilities in counties Cork, Dublin and Galway will enable the provision of a national service while aiming to maximise the coverage of the elective care centres as far as is reasonably possible.

A central point of introducing these new facilities is not that they will only benefit the subset of the population that sit within their direct catchment, but rather that the introduction of a new delivery capability into the public healthcare system will benefit the whole population, including those who do not fall within the immediate geographical catchment.

An additional elective facility in Limerick would have a minimal impact on population coverage relative to the significant increased investment to build and operate. The Minister expects to bring an update to the Government very shortly and the preliminary business cases will be published when approved by the Government. I hope that when they are published, the significant and material benefits for the people of Limerick and the mid-west will be evident.

Kieran O'Donnell (Limerick City, Fine Gael)
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I have two issues. I mean no disrespect to the Minister of State, Deputy Rabbitte, but I would like to have had the Minister, Deputy Stephen Donnelly, in the Chamber today. He is the Minister with primary responsibility; he should have been here.

Second, I wholeheartedly disagree with the Minister for Health's comment that an additional elective facility in Limerick would have minimal impact population coverage relevant to a significant increased investment to build and operate. From what I can see, other jurisdictions that have the elective hospital cannot even decided on a site. They are openly arguing. We have options on the table, namely, St. John's Hospital and UPMC, maybe with both working together. In my view, that subject has to be looked at.

The bottom line here is that this is a Government decision. This is at variance with what the Taoiseach said publicly both in the Dáil and outside. He said there is a need for an elective hospital unit. The case is compelling. This particular response seems to completely ignore the fact that we have had a performance management unit in UHL for the last number of months. We have the highest number of patients presenting to the emergency department in the country. We had 80,000 this year. Second, our ratio of emergency department attendees-to-bed ratio is by far the highest in the country. The case is, therefore, compelling. I have looked at the process. Under the Sláintecare national elective ambulatory care strategy, the elective hospitals oversight group was challenged with basically scoping out the elective hospitals in Cork, Galway and Dublin. It needs to be directed by the Minister for Health, in line with the commitment from the Taoiseach, to now include Limerick as well.

Our system in Limerick is under enormous pressure. The recently published Deloitte report stated that we will need 300 additional beds by 2026. At the moment, we need 200. We have 96 being built; we need another 90 more or less straight away. There are options on the table that would effectively involve an enhanced elective hospital at either St. John's Hospital or UPMC on the ground very quickly.

I very much want the Minister for Health to take up this issue now and have discussions with the Taoiseach in terms of what the Taoiseach said publicly. We need to get this elective hospital for Limerick included as Government policy and get the scoping from the elective hospitals oversight group under way.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this important issue. As I said in my opening remarks, I am conscious of Deputy O'Donnell's desire for new elective facilities in the mid-west. However, I would stress to him that the new facilities that are planned for the three locations in Cork, Dublin and Galway should be considered as national assets that will introduce a new delivery capability into the public healthcare system, which will benefit the whole population to the greatest possible extent.

I am conscious of the remarks made by the Taoiseach earlier this week in response to a proposal for elective facilities in Limerick. I fully agree with the Taoiseach that progressing the elective hospital route is the way to go. We are taking all steps to fast track this proposal within the current rules. By introducing new capacity, we can tackle waiting lists in the long term and free up hospital capacity in the existing wider public hospital network. To conclude, I would note again that I hope Deputy O'Donnell will see the clear benefits that Limerick, the mid-west and the country as a whole will see through the development of these new world-class elective hospitals.

Kieran O'Donnell (Limerick City, Fine Gael)
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Can I just say-----

Bernard Durkan (Kildare North, Fine Gael)
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I am sorry. The Deputy cannot-----

Kieran O'Donnell (Limerick City, Fine Gael)
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I welcome the comments from the Taoiseach in the Minister of State's response. It is something we will be following up on.

Bernard Durkan (Kildare North, Fine Gael)
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We cannot set a precedent; I am sorry about that. If the rules change we will accommodate that.