Maurice Quinlivan (Limerick City, Sinn Fein)
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The number of people who lingered on trolleys in University Hospital Limerick, UHL, last month was 1,561. The figure for the same month last year was 1,498, so the Minister for Health is again breaking records, though not in a good way. The question I wish to put to him, which the Minister of State, Deputy Peter Burke, might relay given the Minister's absence, is a simple one. I want to know what the Minister is going to do to address the crisis in both the immediate and longer terms. I fail to understand what he has done on this issue since becoming Minister in 2020. In 2021 there were 12,106 people on trolleys waiting for care in UHL. However, by 2022 the number had grown to 18,012. The numbers have got worse and worse under the Minister's watch and he and his Government colleagues seem to have no appetite to address them with any sense of urgency. It is worth stating these figures and remembering they are not just statistics. Each of these people and their family members have had to go through the stress of presenting themselves to the hospital to be left waiting on a trolley for days at a time, in some cases. This can only compound the stress and anxiety of a hospital visit.

The Minister has spoken of more capacity to come in UHL. I welcome that construction has begun on the 96-bed unit and that more is scheduled to be done. However, that work must be speeded up. As usual, the facilities are coming too late for many patients at UHL and too late for the hard-working staff of the hospital who work in challenging and often difficult conditions, yet continue to deliver for their patients. I called on the Minister and his predecessor many times to expedite the construction of the initial 96-bed unit and many times they have failed to do that.

The January 2023 trolley figures were less than those of January 2022 because the UHL management team initiated an internal incident procedure that alleviated some of the pressure on the hospital. However, as soon as it was lifted the numbers shot back up again, as expected. The hospital presentations in the last week of December 2022 were not presentations that came out of the blue. They had been predicted, yet there were no steps taken to manage them in advance. We knew there was going to be a problem around December and January. The winter plan was announced far too late and over the course of the winter crisis of December and January we saw 45,000 hospital appointments cancelled across the State. This is an incredible number and just like the high numbers of people being treated on trolleys, it demonstrates there are massive capacity issues in our hospitals. Of the 45,000 cancellations, some 7,656 were appointments for children.

The Taoiseach, who is a former Minister for Health, visited UHL earlier this month. I appreciate him doing this because it was something I had called for many times. However, he came and left with no commitments as to how he and the current Minister will end this crisis. It is not just capacity in the hospital that is needed, though that is needed urgently. There has also been a failure to increase capacity in primary and community care. If such capacity was in place, hospital overcrowding and mass outpatient cancellations could be avoided. Capacity issues are rife across hospital services. There are children with mental health challenges who have been waiting years to be seen by child and adolescent mental health services, CAMHS. People who need elective procedures are being informed that they will be waiting years for procedures to address issues such as cataracts.

As the Minister of State is standing in, I advise him that across the State we need at least 800 additional hospital and community recovery beds to be put in place this year. The planning and procurement need to happen now and to be speeded up. The people of the mid-west need to see results now. It was only last month that 11,000 people protested in Limerick about the dire state of the health service in the mid-west region. How much longer do people in my city need to wait to see this Government supporting them and ensuring they receive safe and timely health care when they visit our local hospital?

Peter Burke (Longford-Westmeath, Fine Gael)
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I am taking this Topical Issue matter on behalf of the Minister for Health, Deputy Stephen Donnelly, who has been concerned for some time about the congestion experienced in the emergency department at UHL, which has led to long patient experience times and patients waiting on trolleys for admission. According to the HSE’s TrolleyGAR, there were 470 patients counted on trolleys at 8 a.m. in February 2023. This represents a 25% reduction on February 2019 when it was 629 patients and a 6% reduction on February 2022 when it was 500 patients. There were just under 80,000 attendances at the emergency department in Limerick in 2022. This is up 12% compared with 2019 and is 13% higher than the average for the period 2017 to 2021. This makes UHL the second busiest emergency department nationwide.

There has been, and continues to be, substantial investment in capacity in UHL. This includes a 42% growth in workforce since the end of 2019, the opening of an additional 98 acute inpatient beds and a 19% increase in budget in 2022 compared with 2019.

The Minister met with the hospital group management and elected Oireachtas Members from the mid-west on 11 January this year to discuss the emergency department situation in the hospital and future developments. The hospital crisis management team was convened in January to de-escalate UHL and took various actions. Extra staff, including nurses and doctors, were asked to present for duty, with additional consultant and support staff working over the weekends to effect discharges. A medical assessment unit, MAU, at Nenagh hospital has been operating seven days a week as a temporary measure since 7 January and will continue over the coming weeks. Additional surge beds opened in Ennis, Nenagh and St. John’s hospitals. Outpatient appointments for UHL were cancelled during the first week of response. Sanction was given for the use of bed capacity in private hospitals in the region and outside the region. These actions brought about a significant reduction in trolley numbers.

The medical assessment pathway for 112 and 999 patients has commenced at both Ennis and Nenagh hospitals. The new pathway allows stable medical patients meeting agreed clinical criteria to be treated in model 2 hospitals. A key element is a telephone referral from a treating paramedic to the receiving MAU doctor, which ensures that the right patient is brought to the MAU. This pathway facilitates patients receiving medical treatment in a hospital closer to their home, assists in reducing patient presentations to emergency departments and helps to release ambulances more quickly to respond to other emergency calls. Those 112 and 999 patients who do not meet these clinical criteria will continue to be transported to the emergency department for assessment and treatment. The medical assessment units in Ennis and Nenagh hospitals treat patients referred by GPs, Shannondoc and now National Ambulance Service paramedics. It is envisaged that similar measures will be introduced at St. John’s Hospital in the near future.

In addition to the national winter plan, there are bespoke site-level plans, including for Limerick. The local plans focus on local needs and build on integration between the community and acute hospital services. UHL’s plan includes measures such as the recruitment of extra staff, including but not limited to two whole-time equivalent emergency medicine consultants, additional emergency department registrars and discharge co-ordinators to target patient flow; improving access to diagnosis for both urgent and emergency attendances in the emergency department and for GPs; the enhancement of GP out-of-hours supports; the recruitment of administrative staff; and the creation of a performance management office to drive the ongoing service improvements in the University of Limerick Hospitals Group.

The Minister, Deputy Stephen Donnelly, has asked the HSE to prepare longer-term unscheduled care performance improvement plans for all our emergency departments, including that at UHL. The Department of Health is working with the HSE to ensure winter plan initiatives continue to be implemented.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State for his response. After what I have heard, I am not convinced that the situation will improve anytime soon, unfortunately. I assume the figures were supplied by the Minister or the Department of Health. I notice he is using different figures from those he used when he sat on this side of the House. I will use the same figures we have all used over the years, which are the Irish Nurses and Midwives Organisation, INMO, figures. The trolley figures in Limerick have not reduced at all, unfortunately. I wish they had. We know they are not just figures; these are people we know. They are often family members, relatives or neighbours. They are often elderly people and are often in distress.

The knock-on effects of the capacity challenges can have a real impact on patients. At UHL, this is most profoundly seen in the outpatient waiting lists. As of 26 January this year, there were 29,027 adults on waiting lists, of whom 5,787 had been waiting for 18 months or longer. Heartbreakingly, there are 4,055 children on outpatient waiting lists at the hospital, of whom 668 have been waiting for 18 months or longer for their appointments - these are children. The time is long past for this crisis to be solved. The reports of last year - the HIQA inspection, which was a damning inspection of the hospital, and the Deloitte report - showed an array of issues and problems that need to be addressed at the hospital as a matter of urgency. However, I see nothing in the response this morning.

The emergency department does not have the capacity to cater for the current volume of presentations. We all agree on that. However, this was predicted when we closed down the accident and emergency departments in Ennis, Nenagh and St. John's hospitals. The powerful letter signed by 87 consultants in relation to inpatient care in UHL noted that there are, on average, 240 presentations a day at the emergency department, which is designed to facilitate a maximum of 190 presentations. That is the problem. What message does the Minister of State have for the people of Limerick and the mid-west region who desperately want to have an emergency department at their local hospital that is fit for purpose and to get the respect and treatment they deserve?

Peter Burke (Longford-Westmeath, Fine Gael)
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As I mentioned in my opening statement, significant resources have been invested in UHL over recent years. The workforce at UHL has increased by 42%, or 1,161 whole-time equivalents, since the end of 2019. It is accepted that a key part of the solution for Limerick is additional beds. Work on a new inpatient block at UHL has commenced, with the Minister, Deputy Stephen Donnelly, breaking ground on this development. The project consists of a four-storey, 96-bed acute inpatient ward and renal dialysis unit. It involves a total capital investment of just over €90 million. In addition, 98 new inpatient beds have been opened in UHL since the start of 2020. This includes a 60-bed modular ward block, which was established to provide a rapid-build interim solution to begin to address the bed capacity issues at UHL.

The Department regularly seeks assurance regarding the appropriate escalation measures for emergency department overcrowding. The HSE performance management and improvement unit continues to lead an intensive engagement with hospital in response to the Minister's concerns about the hospital. The engagement with the University of Limerick Hospitals Group and the local community healthcare organisation in the mid-west supports and oversees the implementation of rapid improvements and services in the region. These measures include a renewed focus on hospital avoidance, patient flow and discharge planning, and regular and frequent assessments of patients with long stays in hospital.

Reform of service delivery, as outlined in Sláintecare, is vital to deal with the demand. This includes the expansion of community care and other measures, providing people with the care they need outside the emergency department, and improving patient flow and discharge from hospital with more home support packages and nursing home supports. The matter of emergency department performance is under constant review by the Department of Health through ongoing engagement with the HSE. I assure Members that the Government and the Minister for Health are committed to improving emergency department performance.