Verona Murphy (Wexford, Independent)
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Before I call Deputy Quinlivan, the Cathaoirleach Gníomhach, Deputy Jen Cummins, has a big birthday tomorrow. It is a zero one. We will not ask which one, but "Happy Birthday, Deputy," in advance.

Jen Cummins (Dublin South Central, Social Democrats)
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Thank you very much.

Maurice Quinlivan (Limerick City, Sinn Fein)
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First, I wish to put on the record my disappointment, to put it mildly, that there is nobody here from the Department of Health. The Minister for Health is not here and neither are any of the junior Ministers. I do not believe they are all abroad. The could be here. They will be here in the morning as well. It shows utter contempt for the people of Limerick.

This is an important day, 30 September. It is the end of September, which has been the worst month ever for people on trolleys in University Hospital Limerick since we started counting figures.

In my maiden speech in 2016, I spoke about University Hospital Limerick. Here we are again.

Today, as the Minister of State will be aware, the HIQA report on emergency healthcare in the mid-west was published. At the outset, I welcome the publication of the report, one that we in Sinn Féin requested. We have waited a long time for it. I thank HIQA and the ESRI for their diligence in compiling it. The report has presented three options to the health Minister in terms of addressing the capacity at University Hospital Limerick: the expansion of capacity at UHL; extending the UHL campus to include a second site under shared governance; and an additional model 3 hospital in the HSE Mid-West, providing a second emergency department. While I agree the first two options are the quickest in terms of addressing the immediate capacity challenges, I would urge that these be advanced in conjunction with the third option, namely, the development of an additional model 3 hospital in the mid-west region.

The report has verified that the core issue impacting healthcare delivery in the mid-west is inpatient capacity deficit, both in UHL and across the mid-west.

It goes on to note that this capacity deficit, coupled with the ever-growing demand for services, presents a risk to patient safety. In the legacy of the inexcusable decision by previous Governments to downgrade the facilities at St. John's, Ennis and Nenagh, this is where we find ourselves.

The HIQA report that we are discussing was commissioned by a previous Minister for Health following the inquest into the tragic and untimely death of young Aoife Johnston at UHL. Her tragic death occurred on an evening when the capacity challenges at UHL were evident. Despite her death and the following inquest, these capacity deficits have continued unabated. Already in 2025, over 18,000 people have been treated on trolleys and in corridors. All 18,000 of these people were deemed in need of a bed. It is worth remembering that they are friends, neighbours and family members. They are people who have been deemed in need of a hospital bed yet no bed is available for them. Last year, a record 23,203 people were treated in this unacceptable manner, and that number will be exceeded in 2025. Indeed, since 2011, when Fine Gael came into government, there has been a more than 500% increase in the number of people being treated on trolleys at UHL. The Taoiseach at the time said he would end the scandal of people on trolleys.

The people of Limerick and the wider mid-west deserve much better than they are getting. The staff at the hospital deserve better from Government Departments. The staff do a very good job at the hospital when they can, and I have witnessed this myself on numerous occasions. They do so under very challenging working conditions, where they navigate between trolleys packed together in hospital corridors. Some 2,386 people were treated in these conditions in September alone. This is the highest number of any month ever. It will be part of the Government's legacy. If we are hitting these record numbers in September, many people, including senior medical staff, are seriously concerned about what the winter months will be like for both patients and staff.

Today's publication is welcome. It points towards recognition of the problems caused by Fianna Fáil and Fine Gael Governments’ failure year after year to take the needed actions when it comes to UHL. I have a concern about Government underfunding of the health service capital plan in the national development plan. I am concerned that despite this report and the obvious need for additional services in the mid-west, the Government will not plan to deliver an additional model 3 hospital. UHL desperately needs more capacity and it needs it now. The mistakes made when St. John's, Ennis and Nenagh were downgraded cannot be repeated. I urge the Minister for Health to act urgently in advancing all the options outlined in HIQA's review. This review has provided the clinical underpinning to the solutions offered by my party, Sinn Féin, and healthcare managers in the mid-west. I look forward to discussing this further.

Alan Dillon (Mayo, Fine Gael)
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I thank Deputy Quinlivan for the timely opportunity to address the House on capacity at University Hospital Limerick. I am taking this matter on behalf of the Minister for Health, Deputy Carroll MacNeill, who sends her apologies that she cannot be here to provide an update on the measures that are being taken to alleviate overcrowding.

Since the Deputy last raised a Topical Issue on this matter in July, the work to increase capacity and alleviate overcrowding at UHL has continued at pace. In May 2024, HIQA was requested to undertake an independent and expert review of urgent and emergency healthcare services in the mid-west by the then Minister for Health. The priority for this work is ensuring safe, quality acute care. HIQA has today published this review and the Minister for Health briefed the Government on the report this morning. She also placed on the record of the House during Questions on Promised Legislation her points regarding this publication.

The Minister and the Government are concerned at the significant challenges being experienced in Limerick and the wider mid-west, and the impact this is having on patients and their families in the region. I thank the hard-working front-line staff at the hospital, who continue to deliver excellent care for patients every day. The Minister and her officials will now consider the reports and advice provided, including the three options that were identified. The Minister will report back to the Government on these considerations. As the Deputy will appreciate, the reports and analyses involved are extensive and involve a stakeholder consultation, regulatory inspections, data analysis and international evidence reviews. I acknowledge the substantial work that has been undertaken by all of those who conducted and took part in this review.

HIQA’s analysis finds that inpatient capacity in the region needs to be increased to meet current and projected demand. The report identifies three options, including expanding capacity at the Dooradoyle site, extending the UHL hospital campus, and developing a model 3 hospital and, consequently, a second ED for the region. The HIQA review notes that real improvements are continuing to be made at UHL and across the mid-west. This work of improvement and reform will go on while the HIQA findings are being considered.

As the Deputy is aware, 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 starting to receive patients this week. This increase in capacity will go towards reducing the number of people waiting on trolleys. The opening of this new 96-bed block will be a major boost to increasing capacity at UHL. I know it will be welcomed by all the people of the mid-west.

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. I would like to reassure the Deputy and all patients in the mid-west that substantial work is ongoing to improve healthcare services in the region.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I am conscious that, while we debate tonight, there are 133 people on trolleys in UHL today. When I speak on this issue in the Dáil, I am always mindful of the families who have lost loved ones in UHL due to this issue of excessive overcrowding. Unfortunately, the report has come too late for them.

I know the Minister of State is not the Minister for Health or in a health Department, and he probably just read out his response. He has probably never been in University Hospital Limerick in his life.

The 96-bed unit will open on Friday for the first 24 patients, followed by 24 on Monday, 24 on Tuesday and 24 on Wednesday. That is welcome, but it will not have a significant impact in the hospital, where senior staff tell me it will reduce by 17 the number of people on trolleys for the day. The University Limerick Hospitals Group says it needs a minimum of 400 beds to deal with capacity. This does not take into account the factor of population growth, so it will probably need more than that.

Today must be remembered as a positive day for the mid-west but the three options that are on the cards need to be taken simultaneously. We need to increase capacity in the hospital. We have to be careful when we talk about increasing capacity because we have a plan to move maternity services across and there is no space to do both. Either we are doing one or the other, and we can do part of this under option A. Option B is for additional capacity near the campus, which I would also support. We can do both and, in fact, we could start them tomorrow. We should also start tomorrow on option C, which is to deliver what everyone says we need, knows we need and will tell you we need, which is a new model 3 hospital in the mid-west region. That is what we need to deal with the issue of capacity.

The people of Clare, north Tipperary and Limerick have suffered enough. They have been abandoned for years and years. There is no plan. The Minister of State talked about a second 96-bed unit. At the moment, that is with An Coimisiún Pleanála, so we can imagine when that will be built and when it will have any impact on the situation in UHL. As I said, we are here on 30 September following the worst month ever in the history of the UHL trolley crisis. The Government should be ashamed of itself.

Alan Dillon (Mayo, Fine Gael)
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We are all in agreement that the people of the mid-west rightly deserve access to responsive urgent and emergency care. The HIQA review was published today. It has an extensive range of findings across the healthcare service in the mid-west. I would be interested to hear what the Deputy disagrees with in the HIQA report.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I did not disagree with anything.

Alan Dillon (Mayo, Fine Gael)
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I would be interested to hear if there is anything in the report that he disagrees with.

It will be given full consideration and all the findings-----

Maurice Quinlivan (Limerick City, Sinn Fein)
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We just want the three recommendations implemented as fast as possible.

Alan Dillon (Mayo, Fine Gael)
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-----are under way to determine the future direction of the services in the region. It is important to also highlight UHL's annual budget spend has increased from €265 million in 2019 to over €507 million in 2024. A package of wide-ranging reform support measures also is being implemented. It is important these measures are aimed at both capacity and reform of the healthcare system in the region. Increased staffing levels are also being prioritised. Staffing at UHL has grown by 32%, an increase of 1,465 whole time equivalents, since 2019 to August 2025. Other measures and reforms to alleviate congestion include the extension of opening hours for the medical assessment unit in the model 2 hospital in the region and the new surgical hub, which is expected to be operational by quarter 4 in 2026.

These are real steps being taken to ensure patient flow through ensuring sufficient staff and decisions are available for UHL seven days a week. I am sure many of these improvements and those identified within the HIQA report will make a real impact on the delivery of healthcare services in the mid-west.