Alan Dillon (Mayo, Fine Gael)
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I express my gratitude to the Ceann Comhairle for selecting this crucial topic for discussion. It certainly holds significant importance for the people of Mayo. There is an urgent need to extend the emergency department and advanced medical assessment unit, MAU, at Mayo University Hospital, MUH. I emphasise the increasing need for action to support the capital investment programme for healthcare services at MUH. The people I represent deserve improved healthcare services that meet their needs in a timely and efficient manner. The current emergency department at the hospital is running at full capacity and the rising number of patients seeking care is straining its resources. This has resulted in extended wait times, overcrowding and a decline in the quality of service.

Within the HSE's capital plan, the executive has outlined provisions to facilitate the expansion of the existing emergency department. This includes a ground-floor extension aimed at introducing seven essential new assessment and treatment spaces. In addition, there are plans for a first-floor MAU. This will go a long way by providing ten additional assessment spaces dedicated to unscheduled care and auxiliary services. At present, we are informed the HSE design team is advancing through the stage 2b design report. Despite these plans, the timeline is not aligned to the urgency of our situation. The Taoiseach visited the hospital in June. There was a commitment to submit the extension plans to the planning authority by September, yet we are in mid-November and these vital plans have not materialised. This is unacceptable. I appreciate the Minister of State, Deputy Butler, is taking this on behalf of the Minister, Deputy Stephen Donnelly, but the people of Mayo certainly deserve better. I strongly appeal to the Minister for Health to take immediate and decisive action to ensure we have a prompt submission on these critical plans to the planning authority.

The proposed emergency department goes beyond physical space; it represents a lifeline for people who need access to critical healthcare. The seven new assessment and treatment spaces and the advanced MAU will be crucial in addressing the capacity challenges the emergency department currently faces. While I accept the approval process must adhere to the public spending code, it is really important that we look at expediting the submission. It is really important. The Government must look not just at MUH, but all hospitals that are facing similar challenges. We must prioritise projects as a matter of utmost importance and hold the HSE to account in relation to them. The health and well-being of the people of County Mayo must not be jeopardised any longer and this situation cannot be overstated. Will the Minister of State provide a more specific timeline for the submission of essential plans to the planning authority?

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for his question. The annual capital plan sets out the planned health infrastructure investment within a given year throughout the country. Capital investment has a critical role to play in enabling and enhancing service provision and in driving the reforms set out in Sláintecare. A number of projects for MUH are included in the 2023 capital plan. Funding has been allocated in 2023 to progress these projects. I do not like having to say this, but it is fact that management and administrative grade staff in the Fórsa trade union in the HSE commenced industrial action on Friday, 6 October. As a consequence of this industrial action, members in these grades are not engaging with political forums or processes, so the information provided in this response is the most up-to-date the Department can provide. The Deputy might therefore be further advanced with respect to the answer than what I have to tell him, given he lives locally and will have on-the-ground information.

The projects include building works associated with the replacement of the existing CT scanner. Proposed works include the construction of an extension to house the new CT scanner and construction work is under way. Electrical upgrades are to be delivered under multiple phases. Phase 1c is under construction and submissions are to follow for phases 2 and 3. The hospital sterile services department reconfiguration and upgrade is currently under construction and is expected to be completed by the end of 2023 or early 2024. The projects the Deputy is most concerned about are a new ground-floor extension to the emergency department, the reconfiguration of the existing emergency department and a new MAU. It is proposed that these projects will lead to seven new assessment and treatment spaces in the emergency department. A new first-floor medical assessment unit will also be constructed to provide an additional ten assessment spaces for unscheduled care and ancillary services. This project is at the design feasibility stage. I contacted the office of the Minister, Deputy Stephen Donnelly, last night to see whether any further information on timelines could be provided, but it just was not available.

In conjunction with the capital projects in MUH, there are other significant projects in County Mayo that will assist with capacity issues. One is the development of a new community nursing unit, CNU, in Ballina. The Ballina CNU capital proposal was completed by the service area and submitted to HSE estates. The submission is going through a process of further validation around projected costs and ensuring it meets population requirements. This will be submitted to the next national capital and property steering committee for review in quarter 1 of 2024. A new CNU is also proposed for Belmullet. A capital submission is being prepared by the service area to follow the same process as in Ballina. Both of these projects are currently at appraisal stage. The Deputy will understand this is part of the 2016 plan to reconfigure 90 CNUs across the country. I understand 43 are complete, with 47 more to be completed. The delivery of capital projects is a dynamic process and is subject to the successful completion of the various approval stages.

The Department is working in conjunction with the HSE to finalise the capital plan for 2024. Once finalised, it will be submitted to the Minister for Health for approval prior to publication, in line with established procedures.

The number and cost of projects competing for inclusion in the annual capital plan invariably exceeds the funding available. The HSE has developed detailed and robust systems and procedures to appraise, manage and deliver infrastructure projects that are aligned to the public spending code.

Alan Dillon (Mayo, Fine Gael)
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I thank the Minister of State for the response. I want to acknowledge all of the work she has been doing within her portfolio in supporting older people and mental health. I accept that she was given a script today but the background to me raising this matter in the Dáil is the lack of a progress report from the HSE up to 6 October. We are now in mid-November and still there is no update on this. It is disappointing that the Department of Health could not have furnished a more up-to-date outline of the situation with regard to these capital projects.

The HSE is aware of the necessity of facility upgrades at Mayo University Hospital, MUH, but yet again it has failed to take the required steps to expedite construction. For me and for Members of this House, holding the HSE to account is really important. The executive's inaction is, at times, unjustifiable. The urgency of this matter is stark when one looks at the alarming number of patients who spend more than 24 hours on trolleys at MUH and that was underscored in 2023 when the latest figures were released. There is a pressing need for a new ward block within MUH and we must vigorously campaign for the realisation of that. A recent HIQA report outlined deficiencies within the facilities and held that the need for a 75-bed ward block at the Mayo site was unquestionable. This is one of the long-term actions that the management within MUH presented as a valid solution, particularly in the context of addressing the shortage of single, en-suite rooms in MUH.

Mayo deserves access to quality healthcare services in a timely and efficient manner. I ask the Minister of State to relay to the Minister for Health the need for immediate action to address this issue.

Mary Butler (Waterford, Fianna Fail)
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I certainly will go back to the Minister and relay to him the concerns raised by Deputy Dillon. Departmental officials are considering all available opportunities to improve on the pace of delivery of capital health projects. This process is currently underway and includes consideration of the use of modern methods of construction to deliver rapid build.

In March this year changes to the public spending code aimed at enhancing National Development Plan, NDP, delivery were introduced. These changes seek to streamline the appraisal and approval of major projects, with infrastructural guidelines due to issue shortly.

As Deputy Dillon will be aware, a five-year allocation out to 2025 of €5.65 billion has been provided to the Department of Health as part of the review of the NDP to support projects and programmes throughout the country. As everyone here understands, the early stages of all capital projects are the slowest. Once construction starts, it generally happens very quickly. That said, I will certainly bring Deputy Dillon's concerns back to the Minister. We are facing into the winter again now and the last thing we want to see is patients, particularly older people, on trolleys.