Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

The whole purpose of this is a patient safety issue. I have to correct a few things. Let me go through the patient safety issues. The whole approach is to try to make Limerick have enough capacity to have the same flow as other well-run hospitals like Waterford. Limerick is now an extremely well-run hospital. In the last 12 months, Ian Carter, Catherine Peters and Sandra Broderick have brought in really meaningful changes. All of the teams working there, all the consultants and all of the nurses deserve credit. The hospital is a different place in terms of how it is run and it is having a major impact on patient safety.

What do we do? We do a range of different things all the time and not just at Limerick. We are trying to decant as much as possible from the acute hospital so that people who are acutely unwell can get the best care there. So, we are doing a couple of different things. We are moving as many outpatient appointments as we can to primary care facilities. I met one of the ENT consultants, Joe Hughes, who is now running his clinics in the primary care centre in Newcastle West. That is exactly the sort of commitment to Sláintecare that we are seeing from consultants there. He does not need to do his surgery in the hospital, requiring people to incur parking costs and other different challenges. He can do that in Newcastle West. That is one of the many things we are asking people to do differently that is happening in the mid-west.

We do have an elective flex, not just in Limerick but in every hospital in every season not just in the winter season. We do that to account for a couple of different things. There is always a Christmas-winter flex and then we have to intersect when the flu season will hit; it changes every year. This year the flu season is likely to hit really hard in the two weeks over Christmas; normally it is a little bit later. We need to adjust and adapt to that. For anyone who has not yet got their flu vaccine, I encourage them to please do that. Even if they are not going to get the flu, even if they are not at risk, they can stop its transmission. From the experience of the southern hemisphere, we know that this will be a hard flu and an early flu. I am asking people to get the flu vaccine because that is the single biggest thing people can do to contribute to their loved ones' well-being and help the healthcare staff in Limerick. There are opportunities there.

We always flex. There has been a change in October and November this year. They do it all the time, but there is no change to the electives in St. John's. The electives are still continuing at St. John's and that is the model we have in Limerick to enable continuing elective procedures. We are also opening a surgical hub there to do elective procedures and take away the pressure, again to take away a thing that should not be happening in acute hospitals but can happen elsewhere.

Why do we do it? Why do we have an elective flex? I hope there is not a single person in this room who would think it is acceptable to bring in an elective surgery into an overcrowded hospital thereby creating danger to the people already there and to the person who is coming in potentially for very sensitive surgery. We need to try to do it somewhere else or at a different time. We should not bring people into an already overcrowded hospital. Our first priority has to be patient safety and the well-being of the hospital.

That is why it is so important that all the reforms I have been trying to push through since January in terms of weekend work, weekend rostering and weekend discharging are to make sure that we have a safe patient flow and that we do not have people backed up on trolleys on Mondays and Tuesdays. That is not just in Limerick but in every part of the country. All those reforms need to sit together to have a hospital that has a good flow all the time. Is it possible? Yes. The hospital in Waterford has had no people on trolleys in the last five years and it does not cancel elective surgeries. Why? It is because it has its patient flow absolutely tip top. When I look at the trolley numbers every day, Limerick is the only place that I will give a pass to in terms of being in the red because I know it has an acute bed capacity issue. It is not down to its processes. It is an acute bed capacity issue.

It is absolutely clear that Limerick is persistently better on trolley numbers, whether it is counted on the INMO figures or the HSE figures. I might get this slightly wrong but they are two very different things. The INMO figures count the people who are in the emergency room generally. The HSE figures count the people on trolleys. They are slightly different ways of counting. More people are self-referring to the hospital in Limerick than in any other region and so those numbers will always be much higher. However, we need to look at the trend regardless of which one we count by. The trend is persistently lower. I have to end this idea that Limerick is the worst hospital in terms of its emergency department.

Throughout November - I will happily call it out - Galway, St. Vincent's at the edge of my constituency in Dublin, and Cork have been persistently worse in their hospital trolley figures than Limerick and they do not have the same bed issues that Limerick has. For the benefit of Senators from the region I will outline the figures. Yesterday, Wednesday, at 8 a.m. there were 28 people on trolleys in Limerick on the HSE figure. There were 42 in Galway. On Tuesday, there were 27 in Limerick, 50 in Galway and 35 in St. Vincent's. It is persistently worse in other hospitals. We have to get away from the idea that Limerick is the most dangerous place and the most under pressure; it is not actually. This is as a consequence of two things. First is the greatly improved processes and second is the new bed block. We need more beds, there is no question about that. However, the other hospitals have more to do and they do not have the same presentation pressures, demographic pressures or capacity pressures. It is important to put that in context. In particular, I compliment the management there on the extraordinary work they do.

Am I committed to it? Every morning at 11 o'clock, there is a trolley call with the CEO and other senior management of the HSE, the regional executive officers and hospital managers - it depends on who is there. Owing to Cabinet meetings and everything else, just twice this week I joined the call in the background and listened to the specific nuances going on in each hospital. I do that because I recognise that there are some hospitals like St. Vincent's and Cork which have had an up-and-down experience over the last month where they are just not landing it and just not getting it right persistently. Some other hospitals might be under a flu pressure or an RSV pressure for a day or two and then recover. They are all slightly different issues. It helps me track the delayed transfers of care. It helps me track what is happening in the community and the beds the patients are going to.

One of the really important investments we are making is the additional investment in Ennis and Nenagh. We have 81 beds in Ennis and our plan is to put in another 48, a 50% capacity increase. We have 62 in Nenagh and an additional 27 coming. I think St. John's has 95 with an additional 42 coming. It is as much about the service delivery in those different hospitals to try to do everything we can to avoid the need for people to come to UHL unless they are seriously unwell or have been in a trauma situation. However, for routine treatment, for outpatient appointments, for elective processes, we do not want them to be in Limerick in the same way that we do not want them to be in other acute hospitals. We are across this.

We have an urgent bed capacity issue. I ask for all Senators' support that when we put in planning applications they do their best to make sure we minimise objections to those applications so that we can get the best out of the site that we can, that we push as hard as we can on that site, that we deliver an option B as close as possible to that and that we look intelligently with all of the best information we have about how to approach the option C construct and how we do that with optimal site location, optimal clinical location and optimal hospital size, recognising that we are learning more and more about better hospital efficiency over time from our international experience and from our own learning here.

There is a real commitment to the people of the mid-west from the hospital management, from the people who are working there, from everybody here and from me. I am invested in this on a day-to-day basis. Over the weekend, I get a text at 8 a.m., 2 p.m. and 8 p.m. every single day of my weekend every single weekend so that I can track exactly where every hospital is and so I can see if a hospital is going into difficulty. Am I committed? I promise Senators that I am. I know exactly what is going on to the best that I can in the 29 hospitals at any given time.

Last weekend, at one point I think there were 57 people on trolleys in 29 hospitals and that increased over Sunday night into Monday and Monday night into Tuesday. So, I really do know. Limerick is doing really comparatively well. It might not feel like that for people who are in Limerick today. It has the seventh longest wait times of all the hospitals but not the longest wait time. It does not have the worst hospital trolley presentations and that is because of the work of the people in Limerick and because of the 96 beds. My priority is to deliver more beds as quickly as possible and to put in all the supporting architecture to make sure we can bring people out of Limerick. We are genuinely committed to this.

We will prioritise A and B coming up to Christmas and we will all look together at the opportunities for option C in the new year. The Senator is right that I did not say those things at the meeting yesterday; I was not correctly quoted. We will look at option C intelligently and in a paced way in the new year when we have done what HIQA has asked us to do for the people of the mid-west, our commitment being in respect of option A and B and putting real teeth to that.