Maurice Quinlivan (Limerick City, Sinn Fein)
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I want to put on the record that I have written previously to the Ceann Comhairle about the Minister or Minister of State responding to Topical Issue debates. I mean no disrespect to the Minister of State, Deputy O'Donnell. My understanding has always been that if the Minister was not available, we would be advised of it in advance or a Minister of State from that Department would come to the House. I wrote to the Ceann Comhairle on the previous occasion this happened. It was on the same issue and here we are again.

Kieran O'Donnell (Limerick City, Fine Gael)
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I am on duty for all of the Topical Issue debates and it is nothing in particular.

Maurice Quinlivan (Limerick City, Sinn Fein)
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No disrespect is meant to the Minister of State.

Kieran O'Donnell (Limerick City, Fine Gael)
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I appreciate that.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I want to put on the record that no disrespect intended to the Minister of State, Deputy O'Donnell. I will be writing to the Ceann Comhairle again. We should have received notification that neither the Minister nor a Minister of State from the Department of Health would be here. This is the second time in a row this has happened to me.

As the Minister of State is aware, on Friday, 23 June, HIQA published its report of an unannounced inspection that took place at University Hospital Limerick on 21 and 22 February. Its previous report, following a visit on 15 March 2020, was damning. Of the four major categories, that report found the hospital to be partially compliant in one category and non-compliant in three. Last week's report is an improvement but things could not have been any worse. Some actions have been taken to address the failings found in the June 2020 report but the report is of concern with regard to patient safety and dignity. In the 15 subcategories listed in last week's report, University Hospital Limerick was found to be fully compliant in only one area, substantially compliant in seven areas, partially compliant in five areas and, worryingly, non-compliant in two areas.

One of the positive aspects of the report is with regard to the staff at UHL. The patients spoken to by HIQA were extremely complimentary about the staff. I thank the staff for the incredible work they do, often in a difficult environment. For those who have relatives, friends and families attending the hospital, the feedback will come as no surprise. In the main the staff are professional, courteous and kind, and this is no easy accomplishment when we consider the overcrowded working conditions in which they operate. The challenges facing UHL staff was noticed by the patients, who remarked to the report authors that there were not enough staff and the staff were overworked. The staff can do only so much. There are not enough of them to cope with demand in the hospital. The hospital remains significantly short of non-consultant hospital doctors, with the University Limerick Hospitals Group acknowledging that a further 68 are needed.

The HIQA report found that on 21 February the emergency department was over capacity by three times the recommended number of patients who can be assessed safely. By 11 a.m. on that day there were 121 patients in the emergency department, which has an intended capacity of 49 people. An additional 72 people were being accommodated on trolleys and chairs. While this is no surprise to many, it is an atrocious situation to have an emergency department operating at 153% of its safe capacity. The day of inspection, 21 February, was a Tuesday and not a Saturday or Sunday when a large influx of presentations might be anticipated. The HIQA report found that on the day of inspection, 60% of attendees in the emergency department were still there after six hours, 48% were there after nine hours and 20% were there after 24 hours. At 11 a.m. on the day of infection, the hospital was not compliant with any of the national key performance indicators set up by the HSE for emergency departments.

The report went on to note, as I have highlighted many times in the Chamber, that the persistent overcrowding is not only an affront to patient dignity but is dangerous and places challenges on staff in ensuring the cleanliness of clinical areas in the hospital, the separation of patients and limiting the spread of infection. Overcrowding at the hospital is not a new phenomenon. The hospital has operated an emergency protocol every day this year apart from two days. As the INMO stated in response to the report, we need to see a laser-like focus from the Government and the HSE on tackling the overcrowding crisis once and for all. Can we expect a response from the Minister for Health whenever he turns up?

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank the Deputy for raising what is a significant issue for the people of Limerick and the mid-west and for all of us who represent them in the Oireachtas. I welcome the opportunity to address the issues in the HIQA report. As the Deputy is aware, in February, HIQA inspected University Hospital Limerick against the national standards for safer and better healthcare. The inspection assessed compliance with 11 national standards. The inspection team visited several clinical areas throughout the hospital, including the emergency department, the trauma ward, and the acute medical unit.

While more has to be done, there have been some improvements. A geriatric medical unit has been established in the emergency department for those aged over 75 years. There has been recruitment of additional staff, including two emergency department consultants, bringing the complement to 11, and 20 non-consultant hospital doctors. There has also been recruiting for nursing and other areas. A total of €6 million has been provided to deal with issues raised in the previous HIQA report. Many of the initiatives have been in place only since January. There have been some improvements and HIQA would like to see a lot more.

We have seen the time patients are in the emergency department decrease by approximately an hour but it is still way off what we would like to see. The report stated the fundamental issue is capacity. This is borne out by the fact the acute medical unit and the acute surgical assessment unit were re-established. What the report states is they have not worked to date. A total of 55% in the acute medical unit were waiting for an inpatient bed, as were 25% of those in the acute surgical assessment unit. More particularly, 24% of those presenting to the emergency department will be admitted to inpatient beds but 45% of those in the emergency department were awaiting admission.

A total of 40% of people in the ED are awaiting admission, which shows the capacity constraints. We have looked to address that, as the Deputy will be aware. The 60-bed modular block has been built and a further 38 beds went in during Covid, bringing the total to 98. A 96-bed block is under construction and is expected to be in operation in early 2025 and a further 96 beds on top of that second block are being advanced. The Minister has given approval for UL to advance the design of that project alongside the existing 96-bed block. Between them, that is nearly 200 beds, which will make a huge difference.

The HSE, in conjunction with UHL, has developed a compliance plan and makes reference to a number of aspects within it. In the acute medical unit in Nenagh, there will be a doubling of the beds, from six to 12, bringing the overall figure from 32 to 38 between the hospitals in Ennis, Nenagh and St. John's, at 18, 12 and eight, respectively. An acute medical assessment unit will have been relocated alongside the ED by October, and there has been a request for a review of the acute surgical assessment unit by the same month.

The Deputy spoke about compliance. That comes down to the compassion and kindness of the staff for patients, and HIQA was glowing in that regard in its review. It is going to review the space, with a view to providing an additional 16 nurses and a further five-----

Catherine Connolly (Galway West, Independent)
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I thank the Minister of State but his time is up. He will have a chance to come back in.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State. I am on record as saying I acknowledge that work is being done at the hospital, with a 96-bed unit being built as we sit here. Nevertheless, that will deliver only 48 additional beds, as the HSE itself has stated. Single-occupancy beds would be the better way, not least because our hospital has suffered over the years from infections and cross-contamination, so that would be useful. Two other 96-bed projects are in the ether but we do not know their status. I do not believe the Government has at its heart the ability, willingness or will to solve the problem at University Hospital Limerick. The overcrowding has been going on for years. The UL report stated the hospital needed 302 additional beds, not 96 or 48, by 2030.

The slow delivery we are seeing means we are condemning the people of Limerick and the wider mid-west to suffer overcrowding in the hospital for years to come, with no plan whatsoever to get us out of the situation we are in. There is a crisis in home care and people in hospital have been occupying beds for days while simply waiting for an MRI scan. These issues can be resolved. We all know about them, and families, friends and nurses will have told us about them. Consultants have rung my office in despair, asking me whether I can somehow speed up an MRI scan because they cannot seem to get it done themselves. All that nonsense is going on while we wait for the units to be built. There are three 96-bed units and I assume all of them will equate to 48 beds fewer in the system. As I said, that is good but it will not deal with the capacity. The number one issue relates to the catastrophic mistake made to close the emergency departments without delivering a centre of excellence in our local hospital, and we are all suffering the consequences of that in Limerick and throughout the wider mid-west.

I ask the Minister for Health, who might listen to the debate or read the Official Report, and to whom I will write about this, to intervene personally and speed up the process. This cannot keep going on the way it is.

Kieran O'Donnell (Limerick City, Fine Gael)
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The Deputy can be in no doubt the Government considers dealing with the issues at UHL a top priority. The Minister will go to Limerick on Friday and visit Croom hospital and UHL, specifically because the priority is being directed very much towards the latter. Improvements have taken place. The medical assessment units are now open seven days a week and an additional six beds will go in. Furthermore, a report commissioned by the hospital group itself yesterday referred to 300 beds, and the more beds there are, the better. The HIQA report states there is a shortage of 200 beds. There is the 96-bed block and HIQA is saying it is split 52:48, although I think that is a moot point.

HIQA stated in the report that it would like to see something done immediately with some of the existing wards to improve their quality, and that is something I am going to pursue with UHL along with the Minister. Moreover, the 96-bed block on the grounds of UHL is under construction, while the second 96-bed block will be located directly beside it. UHL will carry out some works on that as part of the current 96-bed blocks and then will put forward design and planning to the Minister to proceed with the second 96-bed block. Between them alone, that is 192 beds, with the second 96-bed block expected to have been finished by 2027.

When I read the report, I see a lot of things need to be done, including the additional recruitment of staff. There are now ED consultants there between 8 a.m. and 8 p.m. midweek, and 8 a.m. to 1 p.m. at the weekend. I would like to see whether we could increase those hours under the new contracts. Fundamentally, the Government is utterly committed, as am I as a Limerick City Deputy, to ensuring we get sufficient capacity into UHL.