Denis O'Donovan (Fianna Fail)
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In the absence of the Minister, Deputy Flanagan, we will allow the Minister of State, Deputy Catherine Byrne, to take this Commencement matter as well. We will let Senator Conway off as long as he does not keep us all day.

Martin Conway (Fine Gael)
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I am happy to co-operate. I welcome the Minister of State to the House. The situation in emergency departments in many hospitals was particularly acute over Christmas and the post-Christmas period. University Hospital Limerick, UHL, is facing constant challenges. It seemed to be in crisis management mode for most of last year. The difficulties at the hospital reached an unprecedented level earlier this month. According to some commentary, there are concerns about the management of the hospital, which is located in the Dooradoyle area of Limerick. I do not know whether these issues relate to the management, the management structure or the management system. I would like clarity on this aspect of the matter. I know that the Minister, Deputy Harris, and the Ministers of State, Deputies Catherine Byrne and Jim Daly, and the other people are doing their very best to deal with this issue by allocating resources and managing change.

I welcomed the investment of over €20 million in the new accident and emergency department at UHL. I would have expected that things would have improved with that investment. I have noted commentary by the Taoiseach and the Minister in recent times to the effect that there are management challenges at the hospital. I think the people of the mid-west have a right to know what those management challenges are. What is being done about them? Are they being addressed? What are they? Are they causing bed blockages? Are there human resources issues or structural issues? It is really not good enough to comment that there are management challenges at a time when people are on trolleys for between 48 and 72 hours, as has happened in recent weeks. I would like clarity on what the management challenges are. I would also like to know what is being done about them.

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister, Deputy Harris, I thank Senator Conway for raising this important matter today. It is unacceptable that patients, especially the elderly and the vulnerable, have to wait on trolleys for long periods of time. The accident and emergency department at University Hospital Limerick, UHL, is one of the busiest in the country with approximately 67,000 attendances annually. Demand for accident and emergency department services at the hospital continues to increase. The number of accident and emergency department attendances at UHL in 2017 represented a 6% increase on the 2016 figure. In recognition of this high demand, funding of €24 million was provided for a new accident and emergency department at UHL which opened in May of last year. The new facility is three times larger than the old accident and emergency department. It has improved the patient experience in respect of comfort, privacy and, above all, dignity. The Minister for Health visited the accident and emergency department for its opening last year. I know he was impressed with the accident and emergency department, particularly its pod-based design, the aim of which is to streamline patient pathways.

Notwithstanding this significant investment, the accident and emergency department at UHL continues to face challenges. There are many patients on trolleys in the department each day. Late last year, the Minister for Health met the director general of the HSE, the chief executive and the clinical director of the hospital group and the head of the HSE special delivery unit to discuss the situation in the accident and emergency department at UHL. At his request, the hospital has submitted an accident and emergency department performance improvement plan, which sets out in detail how performance will be improved. The plan is currently being implemented. In December 2017, there was a 4.9% decrease in trolley numbers at UHL compared to December 2016. We expect to see this incremental improvement continue in 2018.

In order to alleviate overcrowding pressures this winter, 17 new surge capacity beds opened in the old accident and emergency at UHL in September 2017. These beds will be converted into a medical short-term unit in 2018. In addition, Limerick has been in receipt of access to 13 additional transitional care beds and four additional home care packages every week since the start of October. These supports will continue until the end of winter in March. UHL was chosen as a pilot site for a national HSE programme which is designed to improve patient flow across acute hospitals and the wider health service. This programme aims to develop and assist different approaches to the improvement of patient flow.

I reiterate that the Minister of Health is acutely aware of the current situation at UHL and is monitoring the situation closely. The Department of Health, the HSE and the University of Limerick hospital group are carrying out measures to improve this situation. We must bear in mind that behind every trolley number is a real patient who needs effective, timely and compassionate care from the health service. I assure the Senator that the Government remains committed to driving this type of improvement in all accident and emergency departments in the country. I will be happy to respond to any other issues the Senator may wish to raise.

Martin Conway (Fine Gael)
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I know the Minister of State has responded on behalf of the Minister, Deputy Harris. With due respect to the senior Minister, this answer does not address the specific question I asked. Is there a specific difficulty with the management of the emergency department at UHL, as has been alluded to in media reports lately? Is there an issue with the structure of the management? Is there a human resources issue with the management that is of concern? I know that the nurses and the staff on the ground are run ragged. They are doing their very best. They provide an incredible service to patients in UHL. I am concerned. I would like to know whether there is an issue with the management. Does the Minister have confidence in the management team that is running UHL?

Catherine Byrne (Dublin South Central, Fine Gael)
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I cannot answer the personal and direct question about the management. I assure the Senator that the Minister is fully aware of the situation at UHL and is monitoring it closely. In light of the concerns raised by the Senator, I will certainly speak to the Minister again about this issue. Perhaps he will be able to reply directly to the Senator on the specific concerns about hospital management which have been raised this morning and which he and the Taoiseach have previously spoken about. I will pass on the Senator's message to the Minister.

John O'Mahony (Fine Gael)
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I think that is a good compromise.

Martin Conway (Fine Gael)
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I thank the Minister of State.