Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I thank Senators for the opportunity to discuss the HIQA review of urgent and emergency healthcare services in the mid-west. We continue to be fully committed to deliver the highest quality healthcare services nationwide, including at University Hospital Limerick and across the mid-west region.

I take this opportunity to acknowledge the hard work, expertise and consideration that HIQA invested in producing its recent review and the advice it gave me.I also acknowledge the significant work undertaken by the ESRI, which contributed important research relating to the future bed requirements for the mid-west, which greatly informed HIQA's advice.

We can all agree without hesitation that the people of the mid-west deserve access to responsive, safe, urgent and emergency care in a safe and timely way. Much has improved in Limerick over the past 12 months. To add to that, I was delighted to open the first of two new 96-bed blocks at UHL last month. Those beds were very much needed. The opening was important not just for Limerick but for the entire mid-west region. The bed block has already had a positive impact on capacity and reducing overcrowding. Since its opening, we have seen days this month such as last weekend where UHL reported on the HSE figures, which are our standard for measuring, nine, five and seven people on trolleys. On the same day last year, those numbers were 80, 75 and 59, respectively. The 96-bed block has had a major impact on trolleys in Limerick. It is not a universally perfect picture by any means but the difference in what is experienced in Limerick in the past number of weeks since the bed block opened is considerable. The average trolley number in the two weeks before the bed block opened was 54, while the average trolley figure for the two weeks after that was 20. As I look at the difference at random between my first pages of trolley figures and my most recent pages of trolley figures from January, we are looking at figures in Limerick of 72, 77, 57, 88, 91 and 69. If I look over the past number of days, the numbers are seven, six, 13, 30, 27 and 28. A figure of 28 people is too many but it is a very considerable difference and improvement and it reflects the trajectory we know we need to see. When I look at all the hospital trolley figures every day, there was a lot of red in January while there was far less red in the past seven or eight days. In Limerick, it really does come down to beds because it has made extraordinary improvements in all its processes, particularly in the emergency department.

We know that in large part this is because of the implementation of the excellent report of the independent investigation by retired Chief Justice Frank Clarke into the tragic death of Aoife Johnston at UHL in December 2022. It identified several factors that contributed to delaying treatment and to Aoife's death. My thoughts continue to be with her family. I was so grateful to have the opportunity to meet with them this year. The report highlighted particularly severe pressures that night in the emergency department and the HSE established a structure to oversee the implementation of the 17 recommendations made by the report immediately after it was published in September 2024. Work to close out that implementation has concluded and was shared with the Department last month. The outcomes from the report contribute to an improved patient safety situation in the HSE mid-west region and across the healthcare system in Ireland generally because other departments are learning from the experience in Limerick. It has transformed their processes generally in the emergency department but also in other parts of the hospital since December 2024.

Regarding the HIQA review, in 2024, my predecessor Stephen Donnelly requested HIQA to conduct a review of urgent and emergency care in the mid-west with the primary objective of ensuring safe, quality acute care. As part of that review, HIQA was asked to consider the case for a second emergency department in the context of population changes in recent years and ongoing pressures across the mid-west. That final report was submitted by HIQA and published at the end of September 2025. As Senators are aware, the report presents three options and advices for me as to how best to address the capacity gap. They include the expansion of capacity at UHL on the Dooradoyle site, option A; the extension of the UHL hospital campus to include a second site in close proximity under a shared governance and resourcing model, option B; and the development of a model 3 hospital in HSE mid-west providing a second emergency department for the region, option C. More than anything else, as Senators are aware, the report clearly identifies that the lack of sufficient acute inpatient beds in UHL and the mid-west region is the core issue that needs to be addressed urgently, and that is my priority.

In addressing the issue, we continue to increase capacity as we try to increase capacity generally. A total of 278 beds have opened in acute hospitals since January 2020, including two 16-bed rapid-build units delivered in December 2024 and June 2025 and the 96-bed block, which I opened last month. A total of 236 of those 278 beds are in UHL. We can see the impact on patients waiting on trolleys.

On enabling works, I have seen it myself in the second 96-bed block at UHL and a further 84 inpatient beds planned at UHL are under way. Those projects, including the 32 rapid-build beds and the first 96-bed block, will increase the bed capacity by up to 308 beds by 2028. Since 2020, we will have had 572 new inpatient beds across the region to 2031. I know these are lots of numbers and it is hard to imagine but the most striking thing for me was to stand in the soon-to-be-opened 96-bed block and look down and see the second 96-bed block about to be developed. The reason it did not happen at the same time was related to some of our outdated rules regarding procurement and infrastructure guidelines, which the Minister, Deputy Chambers, will be bringing measures to Cabinet next week to change.

Other really important initiatives include the acute virtual ward for 25 patients, which went live last year. We want to extend that to 40 patients. That is like 40 beds. It is 40 people who can be at home under the care of Limerick in the bed or on the couch, properly monitored remotely. It is working well in Limerick and St. Vincent's and we are expanding that across five more hospitals. It really works well. We have had very good outcomes and would like to see more of that. The Limerick surgical hub will open in the summer of 2026. We will begin recruitment for that in advance. It is very important. The idea is to pull out as much work that does not have to be in the hospital, such as elective and other day case procedures, to free up capacity for other things.

Staffing has grown by 53% since 2019, including 300 more whole-time doctors, including consultants, 571 more nurses and midwives and 163 more health and social care professionals. All of those improvements show our commitment to increasing capacity and de-escalating the pressure experienced in the UHL emergency department more broadly.

I compliment the work of the regional clinical director Dr. Catherine Peters, the overall regional executive officer Sandra Broderick and the patient council, all of whom have done extraordinary work on changing processes in Limerick. Limerick has the lowest proportion of public-only consultant contracts and is working with the 2008 contract holders in an excellent way to ensure there are more people working at weekends. They are discharging better at the weekends, have the highest presentations and are discharging and rostering the best at the weekend. They really have taken every possible step and what they need are more beds and more acute capacity. That is very clear.

I have met with the patient council and will meet it again. Last night, I met a cross-party group of Senators and Deputies to discuss the next steps of the review and outline my thinking for them. I thank them sincerely for their collaborative work. Everybody here simply wants to improve services for the people of the mid-west, whom they represent and to whom I have a major obligation. My intent, as I said to Senators and Deputies last night, is to bring a memo to the Government before Christmas to do a number of different things. One is to show how we are going to bring forth options A and B, particularly in the context of the new infrastructure guidelines that I hope will be approved by Cabinet next week. That is a really important enabler for us. The reason we did not do two 96-bed blocks at the same time related to the infrastructure guidelines and how difficult and slow they have been in the past, so this is an important enabling change and I need to see how that intersects with our plan for option A in particular. We need to get as much out of the Dooradoyle site as we can while exploring and delivering the other options. My intent is that the memo before Christmas will deal with options A and B together and set out a really substantial plan for how we can increase not just infrastructure capacity in Ennis and Nenagh, recognising that there are many more beds. I have should have spoken to that earlier. There are an additional 48 beds that are going into Ennis on top of the 81 that are there. That is a very considerable expansion. There will be something of a similar order in Nenagh. There will also be more radiology and other medical facilities such as disinfection facilities.

What we have not fully explored, and what I have asked the HSE to give me, is a plan for how we can deliver more services from Ennis. I am talking about cancer treatments that can be delivered closer to home after the patient has had the major diagnosis and the treatment plan in the acute hospital. What more can we do to deliver services? My intent is to bring forward a memo dealing with those three things in particular and to agree a process for how we will address option C, which needs to take a longer term approach to and analysis of what the perfect size for a hospital is and how that is best governed. We have a genuinely clean slate here and we are learning so much about the perfect hospital size in terms of efficiency, governance and clinical integration. The mid-west is a big opportunity for genuinely good thinking on that, bearing in mind what we have learned from the very important work of the infrastructure accelerator task force, which has been working with the Department of public expenditure and reform for the past six months or so.We have a major project of work. In my mind, I divide it into two sections: prior to Christmas dealing with the priority area of delivering acute capacity, which is what HIQA has said is necessary, so that must be our priority, and then the in the early part of 2026 having a proper structure that enables us to consider all of the factors about how we will deliver capacity for the longer term in the mid-west.