Maurice Quinlivan (Limerick City, Sinn Fein)
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I mean no disrespect to the Minister of State, Deputy Collins, but I would have hoped a Minister from the Department of Health would have come in. The last time I had a Topical Issue at least I was told it would be the Minister of State, Deputy Collins, which I appreciated. I had a Topical Issue on crime but nobody from the Department of justice. I want to put that on the record. I will write to the Ceann Comhairle about it because it is bad road to be going down. We are trying to raise important issues to us and we do not get that chance often. It is important that a Minister from the line Department comes in. Again, I mean no disrespect to the Minister of State, Deputy Collins. The Minister of State is from my own county and I know him for a number of years.

The capacity issues of University Hospital Limerick continue unabated and they risk patient safety. In each year since the Fine Gael-Fianna Fáil Coalition was established in 2020, the trolley numbers at University Hospital Limerick have got steadily worse. Already this year, we have seen 12,998 people treated in this manner. In 2024, it was 23,203 people. In 2023, it was 21,400 people and the previous year, it was 18,012 people. The coalition parties have failed again and again to address the capacity issues at University Hospital Limerick. Indeed, since Fine Gael entered government in 2011, there has been a 585% increase in trolley numbers in my local hospital.

Each of those left on a hospital trolley in a hospital corridor is somebody who has presented to the hospital and has been assessed and deemed in need of a hospital bed and yet no bed is available to them. The people of Limerick and the mid-west region deserve much better. The staff at University Hospital Limerick deserve much better. It is not good enough that 1,899 people were treated in June this year in conditions that are devoid of privacy and dignity. For the record, June saw 233 more people treated on trolleys than in June 2024.

Despite this issue being raised on so many occasions in this Chamber for more than five years by me and despite it also being raised on so many occasions by consultant doctors, patient advocacy groups and nurses' organisations, there is no real progress being made.

Last week I had the pleasure of meeting with the members of the Irish Nurses and Midwives Organisation, INMO, the nurses' union. They highlighted how often their members were asked to care for multitudes of patients - numbers that are clearly not safe or acceptable. Nurses, doctors and other medical professions at University Hospital Limerick do their best, in most cases, in the most challenging of circumstances, but they are exhausted. The hospital struggles to retain nursing staff. Who could blame these nurses departing for jobs in places such as Australia and Dubai? Once there, they have job security, a lesser ratio of patients per nurse and accommodation options near their place of work. In Limerick, the average rent is €2,400 per month, and beyond the affordability of many nurses.

We are halfway through the year and already 13,000 people have been treated on trolleys in one hospital. This is an utter disgrace and a complete abandonment of the people of Limerick and the mid-west. A Government that is serious about addressing the obscene nature of the overcrowding in UHL, which has caused the cancellation of elective procedures and excessive emergency department wait times, would have said that the number is far too high. Indeed, I would suggest that such a Government would have taken robust action to stem the tide of increased numbers.

Over recent years, we have had commitments to build two 96-bed units, each of which may deliver an additional 48 beds. While I welcome any increase in capacity, it is simply not good enough. It is not enough when you consider that UL Hospitals Group itself advises a minimum of 400 beds is needed to deal with the capacity. Even that number does not consider the projected population growth in the mid-west region.

This is a crisis. It happens every day and needs an emergency response. Too often, there has been the tragic avoidable loss of life at University Hospital Limerick with the issue of overcrowding deemed a contributing factor. One thinks of the loss of young Aoife Johnston. We are 12 months on from the publication of the Clarke report into Aoife's avoidable death and since then, the capacity challenges at UHL have only worsened.

Last October Sinn Féin brought forward a motion in the Dáil, in part on the establishment of an additional model 3 hospital in the mid-west region.

Verona Murphy (Wexford, Independent)
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The Deputy will get to come back in a second time.

Maurice Quinlivan (Limerick City, Sinn Fein)
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The Government did not oppose that motion and we await a response from HIQA.

Niall Collins (Limerick County, Fianna Fail)
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I thank Deputy Quinlivan for giving me the opportunity to address the House on capacity at University Hospital Limerick and provide an update on measures that are being taken to alleviate overcrowding. Reducing emergency department overcrowding and reducing waiting lists is a priority for this Government. Many patients are still waiting too long for hospital appointments and treatments. UHL has one of the busiest emergency departments in Ireland. Presentations totalled 87,194 in 2024.

Between January and June this year, emergency department attendances at UHL were 9% higher than in the same period last year. Despite this, the daily average of patients counted on trolleys at 8 a.m. during this period is down 3% compared with the same period in 2024. However, too many patients are being treated on trolleys at UHL. More capacity is required but this must also be supported by a range of reforms across health services in the region.

There has been ongoing investment in additional capacity at UHL in recent years. UHL’s annual budget spend has increased from €265 million in 2019 to €507 million in 2024. A package of wide-ranging reform measures is also being implemented. These measures are aimed at capacity and reform of the health system in the region, including increased staffing levels. Staffing at UHL has grown by 48%, an increase of 1,337 whole-time-equivalent staff, from 2019 to May 2025.

More beds are needed in the hospital and across the mid-west region. Through Government investment, 140 new beds have opened in UHL since 2020. This includes the successful delivery of two fast-tracked 16-bed inpatient blocks which opened in December 2024 and in June this year. More new bed blocks are being developed which will provide up to 292 additional beds by 2028. This includes two 96-bed blocks, the first of which is expected to open in September 2025.

Bed capacity is being further expanded throughout the region through the acute hospital inpatient bed capacity expansion plan. This will deliver 572 new inpatient beds in the region by 2031, including 24 new beds at Nenagh Hospital, 48 new beds at Ennis Hospital and 42 new beds at St. John’s Hospital in Limerick. In addition, 25 virtual ward beds are operating at UHL.

In May 2024, the Health and Information Quality Authority, HIQA, was requested to conduct a review of urgent and emergency care in the mid-west region. The primary objective of this work is to ensure safe, quality acute care in the region. As part of this review, HIQA was requested to consider the case for a second emergency department in the context of the population changes in recent years and the ongoing pressures at UHL. HIQA published the terms of reference for this review in August 2024. A preliminary briefing was received at the end of February. This preliminary briefing was published in March by the Minister for Health. A final report is expected in September 2025. The Minister will then consider the findings of the report to ensure that the appropriate actions are taken to ensure safe urgent and emergency care that is both safe and of high quality. I would like to reassure the Deputy, and all patients and people in the mid-west, that this Government is fully committed to improving health services in the region.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State, but it does not give me any confidence. In the last line of his response he said, "I would like to reassure the Deputy, and all patients... in the mid-west, that this Government is fully committed to improving health services in the region." I have received the same reply since 2016 when I first started raising this nine years ago. The fact remains that we have record numbers of people attending University Hospital Limerick, with June of this year having the highest June number ever. The Government's plan will not address this issue.

I am not sure if the Minister of State is aware that the second 96-bed unit that he mentioned has been referred to An Coimisiún Pleanála. That means we will face at least a two-year delay on that one. I would like to know what the Government intends to do in the interim as we plough through the An Coimisiún Pleanála delay on that. People are entitled to object to planning applications if they want but this will cause chaos in Limerick because we were depending on this 96-bed unit being delivered sooner than that. This will potentially add two years on to that. What will the Government do in the interim to solve the problem we have?

The sum total of the Government's plan to solve the crisis is to introduce a few additional beds, which is not really good enough. It is talking about 2028, in three years' time and potentially two years later than that. In Limerick city and county, where the Minister of State lives, the people he and I represent cannot wait that long. We need immediate action that treats the situation with the urgency it deserves. In recent weeks an average of 100 people per day have been on trolleys and the hospital is simply not designed for that. We have had a new emergency department since 2017. It was never designed properly for the numbers presenting to the hospital. The UL Hospitals Group advises that a minimum of 400 beds are needed and even that number does not consider the projected growth of population in the mid-west region which we all know will grow exponentially. The figures the Government is offering are dramatically short of what is needed in University Hospital Limerick. I do not get any comfort from the response the Minister of State gave and the people in Limerick and the mid-west will not get any comfort either.

Niall Collins (Limerick County, Fianna Fail)
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There is no doubt that when people get through the emergency department at UHL, the care and treatment they receive up the house and in their journey through UHL in the main is very good and very high quality.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I agree.

Niall Collins (Limerick County, Fianna Fail)
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That needs to be acknowledged and put on the record. Very often, the political narrative around UHL dismisses the very fine work that is going on there at all levels by porters, nurses, doctors, senior house officers, consultants and those at administration level. Of course, there have been some very unfortunate high-profile individual cases which have been in the news. They should never have happened but unfortunately they did happen. However, in the main people get great treatment and care at UHL.

I do not agree with Deputy Quinlivan when he says there has been no progress.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I said no recent progress.

Niall Collins (Limerick County, Fianna Fail)
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I have outlined the significant investment and the significant progress that the Government has made over recent years, particularly since Fianna Fáil returned to government in 2020 by almost doubling the operational budget, increasing the workforce by well over 1,000 and increasing bed capacity. There has been a robust response. The Deputy said there has not been a robust response. I would argue that he is wrong. There has been a robust response. When Sinn Féin people discuss UHL, I never hear what their proposals are. The Deputy has not outlined here today and I have never heard him outline previously what Sinn Féin would do in government about UHL.

Maurice Quinlivan (Limerick City, Sinn Fein)
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We had the last Dáil motion on UHL which was passed.

Niall Collins (Limerick County, Fianna Fail)
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Sorry, I have the floor. Sinn Féin describes the problem and provides a commentary on the problem, which is fine and we are all well able to do that. What would Sinn Féin do differently? How would it resource it differently?

Maurice Quinlivan (Limerick City, Sinn Fein)
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We are the only party that actually called for-----

Niall Collins (Limerick County, Fianna Fail)
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Sinn Féin has never outlined a detailed proposal.

Maurice Quinlivan (Limerick City, Sinn Fein)
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Yes, we have

Niall Collins (Limerick County, Fianna Fail)
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It will not take An Coimisiún Pleanála two years to reach a decision on the second 96-unit block.

Verona Murphy (Wexford, Independent)
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That concludes the question. I thank the Minister of State.

Niall Collins (Limerick County, Fianna Fail)
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The delivery time for decisions through An Coimisiún Pleanála has drastically fallen, thankfully.

Verona Murphy (Wexford, Independent)
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I thank the Minister of State.

Niall Collins (Limerick County, Fianna Fail)
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I passed UHL recently; it is a massive building site.

Verona Murphy (Wexford, Independent)
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The Minister of State is way over time.

Niall Collins (Limerick County, Fianna Fail)
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There is huge investment going on there.

Verona Murphy (Wexford, Independent)
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We have to move on.

Niall Collins (Limerick County, Fianna Fail)
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A lot has been done and I accept that more needs to be done. It is incumbent on everybody to point out the positives of it as well.

Verona Murphy (Wexford, Independent)
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We are way over time and the Minister of State is out of order.

Niall Collins (Limerick County, Fianna Fail)
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There are challenges there, but there are plenty of positives.