Dee Ryan (Fianna Fail)

Cuirim fáilte roimh an Aire. As the Minister knows, the people of Limerick, Clare and Tipperary have lived with crisis conditions in our acute hospital system for more than a decade. What the HIQA review has done, bluntly and unmistakably, is confirm in black and white what patients, families, clinicians and communities have been saying for years - that the mid-west’s acute hospital infrastructure is not fit for purpose, not matched to the population we serve and not resourced in line with national norms.

Last night, along with Oireachtas colleagues from across the region, I met with her to discuss the report and the action required in its aftermath. I acknowledge at the outset her engagement, her openness and her commitment to progressing solutions. Acknowledgment of the problem alone will not rebuild public trust in the mid-west. We now need decisive and visible action to restore public confidence - action that shows the people of the mid-west that this Government will deliver the acute hospital capacity that our region critically needs.

The figures are stark. UHL remains the busiest emergency department in the country, with 83,000 attendances up to 16 November, a 10% increase on the same period last year. It also has the highest acuity of any model 4 hospital in the country. This means that patients attending UHL are sicker and more unwell than those attending other hospitals. As a result, UHL has recorded the highest number of admissions nationally to date - 25,915 admissions nationally to date. Behind these statistics are real people and real suffering. The memory of Aoife Johnston and Eve Cleary and the testimony of families like that of Niamh McNally just yesterday must be front and centre in our minds. Their experiences and those of so many others are a constant reminder that delays in procuring hospital beds at UHL are not abstract problems; they are matters of life and death. Every day that we fail to deliver meaningful solutions increases the risk to people right across our region.

The geographical realities make the challenge even sharper. Over 40% of Clare's population lives more than an hour from an emergency department. The west Clare municipal district, the largest municipal district in Clare by population, is also the furthest from an emergency department. It is not just inconvenient; it is dangerous. I recognise and thank the staff - our nurses, doctors, hospital staff and management who continue to work tirelessly to provide safe care in difficult conditions. Their commitment is extraordinary. We have seen improvements. I acknowledge the impact that the new 96-bed block has had on trolley numbers since the Minister opened it last month. Indeed, for the first time in recent memory, Limerick was designated green last weekend, as the Minister stated, because the trolley numbers have fallen so low. We are, however, at 35 today on the HSE trolley watch and at 98 on INMO, which is more than double any other hospital in the country, even with those improvements. We must be honest - the new block has not ended corridor care. It is not capable of addressing the scale of the crisis before us alone.

The problem is bigger and deeper than that single block. That is why the HIQA report matters. It is why the decisions that the Minister takes now will shape healthcare for the mid-west for a generation. We urge the Minister to place herself in our shoes and imagine that she, her family and all her loved ones are in the catchment area for UHL and be ambitious for us. I welcome her commitment to option A, maximising capacity at the existing Dooradoyle site, and option B, identifying a site for a co-located acute bed facility. They must progress urgently and in parallel. I also welcome the Minister's confirmation that she will be bringing a detailed and fully costed report on those options to Cabinet prior to Christmas. That is the seriousness that this moment requires. I appreciate too that she is examining option C and looking at what the long-term sustainable hospital capacity for the mid-west may look like. I appreciate that this requires further time and consideration. That is prudent and necessary. At the same time, as I raised with her last night, we cannot simply wait for medium-term and long-term solutions. That is why I asked her last night for a UHL site-specific winter plan, as I had previously done in this Chamber over many months before the summer.

As I referenced last night, the HSE mid-west region has implemented a seasonal adjustment plan, postponing non-essential procedures. This is normally implemented in November and December and it is to keep the hospital beds free for the emergency department, but it was brought into force in October of this year. That means we have had a reduction in non-essential procedures from a maximum of 20 cases admitted per day to a maximum of ten admitted per day and the majority of those ten are reserved for oncology and in line with cancer treatment protocols. I ask the Minister, in advance of next winter, if we could have a site-specific UHL winter plan. I acknowledge that her plans, which we look forward to hearing next week, on localising services across the region will indeed help us to manage those challenges. The public needs to see movement. We need to see that the Government understands the scale of the crisis and that this Government is willing to match the investment with action. Let this moment be the turning point. Let it be the moment we acknowledge past failings, face the realities outlined by HIQA, and commit fully, visibly and without delay to delivering a modern acute hospital system worthy of the people in the mid-west it serves.