Maurice Quinlivan (Limerick City, Sinn Fein)
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I stood in this Chamber six years ago, in May 2017, with a different Minister of State sitting opposite, when we in the mid-west region were looking forward to the imminent opening of the new emergency department in University Hospital Limerick, UHL. None of us was naive enough to believe it would solve all the problems in the hospital, or even in the emergency department, but we were led to believe there would be a major change. The Irish Nurses and Midwives Organisation, INMO, expressed concerns at the time that up to 24 people would be left lingering on trolleys every single day at UHL. The Minister of State who sat that day in exactly the same seat in which the Minister of State, Deputy Noonan, is sitting tonight rubbished what I and the INMO were saying. The union was saying 24 people would be on trolleys at UHL. Moving forward to 2023, there have, on average, been 100 people on trolleys every day for the past month.

We have had the worst year ever and we are going to have the worst month ever. We will probably end up with 20,000-plus people on trolleys at UHL. These are people who have been assessed as being in need of a bed but there is no bed available for them. I was in the hospital recently visiting people and it is absolutely chaotic. I saw trolleys smashing into each other and trolleys on hallways, in storerooms and everywhere else. Staff are working as best they can in these absolutely overcrowded conditions. It is so bad at the moment that one will see medical devices, bandages and other equipment all over the hospital, in wards and corridors. It is no exaggeration to say that every month in the years since the Minister, Deputy Stephen Donnelly, took office, the numbers have worsened. Given the crisis and the impact on citizens, it would have been helpful if the Minister had come to the Chamber to hear at first hand what is going in at UHL. However, he has done the same as the previous Minister for Health, Deputy Harris, who also ducked the issue and did not come to the House. I have been raising this matter on the Topical Issue Debate since 2016. In my maiden speech in the Dáil, I spoke about the situation at UHL. I have raised it under Questions on Policy or Legislation and every other way in which I could raise it. Yet, here we are with no concrete answers and no solutions.

People are really frustrated and at their wit's end. There is a sense that nothing will be done. The hospital staff are doing an absolutely amazing job. It is clear from HIQA reports and internal hospital reports that there simply are not enough staff. The Minister of State is well aware that if people are waiting on trolleys for a certain number of hours, some will die. That is probably happening every day in our hospitals. It is an indictment of the Government. There is no sense from the people I speak to in Limerick and the mid-west region that their concerns are being taken on board and the issue is being treated with the severity and urgency that is needed. We talk about long-term plans but there is nothing in the here and now.

We have just come out of a summer in which we had the worst figures for the number of people on trolleys in June, July, August and September, and we are now facing into what probably will be the worst three months, which means we will probably tip over the 20,000 figure. That is an absolute scandal and everybody in government should be ashamed of themselves. They have not grasped the issue with the severity and urgency that are needed. I am interested to hear the Minister of State's response. In fairness to him, it is not his fault and it is not his Department, but he probably will read out the same statement I have been listening to for the past five, six or seven years. It is deeply frustrating, not just for me but for the people who are lingering in the hospital and for their family members who are distressed. I am sure this issue is raised with every Deputy in the mid-west region. I am contacted every day by people who are at their wit's end because there are just too many patients presenting to our hospital. This all goes back to the reconfiguration of the three hospitals in 2009, which was a catastrophic mistake.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I wish to clarify something before the Minister of State responds. When a Member tables a Topical Issue, the protocol or procedure is that the Department to which it is addressed makes contact with the Deputy and indicates whether a Minister or Minister of State from that Department-----

Maurice Quinlivan (Limerick City, Sinn Fein)
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In this case, in fairness to the Department, I was alerted that the Minister of State, Deputy Noonan, would be here. I raised this issue with the Ceann Comhairle after the previous occasion on which there was no Minister or Minister of State from the Department of Health present.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Did Deputy Quinlivan agree that the Minister of State, Deputy Noonan, would take this matter?

Maurice Quinlivan (Limerick City, Sinn Fein)
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Did I have any choice in it?

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Deputy could have said he was not going to proceed with the matter today because he would prefer to have the Minister for Health or a Minister of State from that Department respond.

Maurice Quinlivan (Limerick City, Sinn Fein)
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The last time I did that, I was told it would not be facilitated and I could take it or leave it. It was not the Minister of State, Deputy Noonan, taking the matter in that instance.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Departments are not the arbiters of whether Deputies must take or leave it.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I hope I will get to raise the issue again and there will be somebody from the Department to respond.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Deputy should talk to my office about that.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Ceann Comhairle.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Minister of State, Deputy Noonan, is very welcome and we are glad he is here to deal with this matter.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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Generally, a Minister or Minister of State is on Front Bench cover on a given day and will take a range of questions, whether Commencement matters or Topical Issues, during that day. I am glad Deputy Quinlivan was contacted and informed the matter would not be taken by the Minister for Health or one of the Ministers of State from that Department. This issue of who responds to questions has been raised before. It is important that there be clarity for Deputies who bring forward issues, all of which are serious and important. I respect that Deputy Quinlivan has been raising this particular issue in the Dáil for some time.

I welcome the opportunity to address the House on this issue. The Minister for Health has been concerned for some time about the congestion experienced in the emergency department, ED, at UHL, leading to long patient experience times and patients waiting on trolleys for admission. There were just under 80,000 attendances at the ED in Limerick in 2022, which is up 12% compared with 2019 and is 13% higher than the average for 2017 to 2021. There continues to be a high level of ED presentations in 2023, with more than 59,000 attendances between January and September of this year. I have supplementary information to hand that the Deputy may not have. I can provide it to him after the debate. The figure of 59,000 represents an 11% increase on the same period in 2019. More important is that the attendance figures for patients aged 75 or over have increased by 30% compared with 2019.

There continues to be substantial investment in capacity in University Hospital Limerick, including 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 medical assessment unit, MAU, pathway for 112-999 patients in Ennis and Nenagh hospitals was extended to St. John’s Hospital on 4 August 2023. This initiative allows for patients meeting the clinical criteria to be treated at the MAUs in St. John's, Ennis and Nenagh hospitals. The extension of the 112-999 MAU pathway to St. John’s Hospital means that all three of the UL Hospitals Group MAUs can now treat patients referred by GPs, ShannonDoc and National Ambulance Service, NAS, paramedics. A key element is the telephone referral from the 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.

As part of last year’s national winter plan, there was a bespoke, site-level plan for Limerick. While the winter plan officially ended at the end of last winter, many of the plan initiatives continue to be implemented. The local plan focused on local needs and it builds 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 diagnostics for both urgent and emergency attendances in the emergency department, and for GPs, and the enhancement of GP out-of-hours supports; and the recruitment of administration staff and the creation of the performance management office to drive the ongoing service improvements in UL Hospitals Group.

The Minister for Health, Deputy Donnelly, asked the HSE to develop a new approach to urgent and emergency care, UEC, planning to reflect the year round demands on emergency departments, including UHL. The approach to planning urgent and emergency care is twofold, which is the delivery of an operational plan for UEC for 2023, recently approved by the Government, and the delivery of a three-year multi-annual UEC plan, which is expected to be submitted to the Government this autumn. The Department of Health is working with the HSE to ensure that the UEC operational plan initiatives are fully implemented.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State. With the greatest respect to him, as I said earlier, I am deeply disappointed the Minister for Health or a Minister of State from the Department of Health are not here. It is really important and I do not believe the Minister has grasped the severity of the situation in Limerick, which is ongoing. We are facing a crisis. I have been in the hospital recently. The trolleys are smashing off each other because there is no way to get around. The porters there have told me that people who have a need to be resuscitated and are on a hospital trolley in UHL cannot be moved. If the porters are not able to move them people will actually die. They cannot be moved because there are too many people there. The porters are human, and they know these people. Sometimes it is their neighbours or friends, and often it can be family members.

We need some sort of an intervention from the Minister. The people from the mid-west region have not really heard from the Minister on this issue as much as he should be doing. Everybody understands that the capacity issue is a problem. Everybody everybody understands this happens if one merges three hospitals together. We were supposed to end up with a centre of excellence. In 2009, however, we never got the resources or the staffing that we were supposed to get. We are now dealing with the legacy of this. It is all catch-up.

There is stuff we can do in the moment. Some of the Minister of State's colleagues spoke previously about housing adaptation grants. I would bet my house there are people in UHL tonight who cannot leave because a housing adaptation grant has not been approved for them. It is simple stuff. The Minister said he would do whatever he could do, but that proves he will not. There are nursing home problems, there are issues with home care package that are approved but nobody can do them because the Minster will not pay or retain the staff properly.

Nurses, and especially the foreign nurses who come here, are doing a fantastic job. Some of them stay for five years but they are also actively targeted to go back to Australia or different places. Sometimes they are being offered a free car or offered free accommodation. We need to do something to make sure the staff actually stay. It is also well known that we are short 64 non-consultant doctors in UHL. There is no urgency around doing that.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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The Deputy made an important point with the connection between home care packages and that a significant proportion of the patients are over the age of 75. The Deputy is correct that we are talking about people's lives and that these are real and significant challenges.

I will give a supplementary response on the emergency department performance at UHL. I will provide a copy to the Deputy when I conclude. The Government is committed to addressing the issues at UHL. Significant resources have been invested in UHL in recent years. This has led to an increase in UHL's workforce of 34% - or 963 whole-time equivalents - since the end of 2019. The Minister for Health recently opened new theatres, wards and clinical areas at Croom Orthopaedic Hospital, which includes the development of an ambulatory trauma service that facilitates transfer of trauma patients from UHL for surgery and recovery, improving patient flow and emergency department congestion.

Part of the solution for UHL is additional beds, and 98 new inpatient beds have opened in UHL since the start of 2020. Work on the new 96 single-bed patient block commenced in September 2022. Construction is expected to take two years to complete. Pending planning approval, the next step is the development of the second 96-bed block, and this will continue. The Department regularly seeks assurance regarding the appropriate escalation of measures for emergency department overcrowding.

Reform of service delivery as outlined in Sláintecare is vital to deal with the increased demand. This includes the expansion of community care and other measures providing people with the care they need outside of the emergency department, improving patient flow and discharge from hospital with more support packages and nursing home supports. Increased funding is being provided for additional GP access to diagnostics in primary care allowing for patients to be referred directly for X-rays or scans in the mid-west. More than 1,400 of these scans are being completed each month.

The matter of emergency department performance is under constant review by the Department of Health through ongoing engagement with the HSE. I assure the Deputy that the Government and the Minister are committed to improving emergency department performance.