Maria Byrne (Fine Gael)
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The Minister of State is very welcome to discuss this important issue. I will share time with my colleague, Senator Conway. Senator Ahearn sends his apologies. He has his own very strong views on the issue of overcrowding in University Hospital Limerick.

From my own experience and from hearing from people in Limerick, I know that there are great concerns. Only today, I spoke to a man who has been in hospital for three weeks. He is seriously ill and has a lot of underlying health conditions. When he first went into University Hospital Limerick, he spent at least three days on a trolley. He is still in the hospital three weeks later. He is very grateful for the care and attention he received once he got into the hospital but spending three days on a trolley when one is very sick is not acceptable. He is just one example of the many people who are waiting on trolleys.

There are no visitors allowed at the moment. Visits are very restricted unless somebody is very seriously ill, a child or a confused patient. That is a result of Covid. The number of people with Covid is increasing, as we are all very aware. There were 97 Covid patients in University Hospital Limerick yesterday, which is a really high number. That is adding to the troubles. My concern is that people are going into the hospital and waiting on trolleys. As I said, the care they receive is excellent but there is also the matter of the safety of the people working in the hospital. They are working under very difficult conditions. I have been speaking to patients and to staff. I know there was to be a Health Information and Quality Authority, HIQA, investigation. I am concerned that the Taoiseach said that there would be a HIQA investigation but that the Minister for Health said that he would consider it. That needs to be clarified.If there is to be a visit to the hospital, this should not be recognised or announced. The people who will be carrying out this inquiry will have to go and see for themselves, unannounced.

Victor Boyhan (Independent)
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Hear, hear.

Martin Conway (Fine Gael)
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Hear, hear. Gabhaim buíochas leis an gCathaoirleach Gníomhach agus leis an Aire Stáit, who is very welcome to the House. I agree with the sentiments of my colleague, Senator Byrne, who, like me, has been inundated with people’s views on what is happening in Limerick. It is not at all attractive and is not something we can stand over.

In spite of the great work being done by the nurses, clinicians and consultants on the ground, a problem remains and I cannot really work it out. Some €40 million was spent on building a state-of-the-art, brand new accident and emergency department in 2014. A modular unit was then deemed necessary because the overcrowding persisted and €22 million was made available by the then Minister for Health, Deputy Harris, in 2017 to build a 62-bed modular unit on the grounds of University Hospital Limerick. Despite this, the numbers on trolleys at UHL are the highest in the country. They range from 80 to 100 depending on the day of the week. On Mondays and Tuesdays, the figure is usually over 90. The problem then seems to dissipate somewhat towards the end of the week because discharges and so forth run relatively smoothly.

We must ask what the management situation is in University Hospital Limerick. Are management clinicians on duty at weekends? I suspect not. Are people on duty at the weekend who are in a position to sign discharge documentation for people? I suspect not. I suspect we are dealing with a management issue, from both a front-door perspective in the hospital and a back-door discharge perspective.

A commitment has been made to have an independent inquiry and we are told it is to be carried out by the Health Information and Quality Authority, HIQA. It is not ideal that HIQA is carrying out this inquiry given that it has already stated it does not consider that there is an issue in University Hospital Limerick. Really and truly, it should be an independent inquiry. If it is to be carried out by HIQA, let it be HIQA but let us get on with it. I want a timeline from the Minister of State for when the inspection and inquiry will start and conclude. Will the recommendations be published and acted upon?

Mary Butler (Waterford, Fianna Fail)
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I welcome this opportunity to address the House on the issues raised by Senators Byrne, Conway and Ahearn. Senator Ahearn cannot be present and I acknowledge that he has also raised this issue previously.

I acknowledge the distress that overcrowded emergency departments, EDs, cause to patients, their families and front-line staff working in very challenging conditions in hospitals throughout the country. Senator Byrne spoke about the case of an elderly gentleman who spent three days on a trolley. That is just not acceptable to anyone and is definitely not good enough. On top of extremely high emergency department attendances, the health sector is also under significant pressure from Covid-19, as was mentioned.

Yesterday there were 1,308 Covid patients in hospital, 83 of whom were in UHL. The emergency department in Limerick is one of the busiest in the country, with over 76,000 attendances in 2021, up 16% compared with 2020 and 7% compared with 2019. However, the numbers of patients waiting on trolleys for admission in UHL in 2021 were 4.7% lower than in 2020 and 35% lower than in 2019.

The University Limerick Hospitals Group has reported that it is continuing to deal with high volumes of patients attending the UHL emergency department, a pattern that has been sustained over a number of months and is being replicated around the country.

UHL is working to ensure that care is prioritised for the sickest patients. As part of its escalation plan, additional ward rounds, accelerated discharges and identification of patients for transfer to UL Hospitals Group model 2 hospitals are all under way. There has been continuing substantial investment in UHL and the wider hospital group in recent years to address capacity issues, including a new emergency department that opened in 2017. This was referred to by Senator Conway.

Since the start of 2020, 98 new beds have opened at UHL. This included a 60-bed modular ward block, which became operational in November 2020, established to provide a rapid-build interim solution to begin to address the bed capacity issues.This also included a 24-bed single-room block which functions as a dedicated haematology oncology unit, and a temporary 14-bed single-room block designated for confirmed and suspected Covid-19 patients, initiated in May 2020 under the national action plan in response to Covid-19.

The winter plan for 2021 to 2022 was published on 15 November. It builds on the significant investment in last year's winter plan and the additional capacity delivered in health services in 2021. The winter plan aims to address the significant combined challenges faced by the health service over the winter period and recognises that a whole-system response is required across primary, community and acute care. The scale of these challenges and the demands our health system faces require both a plan and an associated system of governance and accountability. The winter plan sets out the national, area and site level leadership and governance arrangements that are in place.

The matter of performance in hospital emergency departments is under constant review by the Department through ongoing engagement with the HSE. The situation is still very distressing. There is a situation where patients are in the emergency department on trolleys. Yesterday, there were 83 people in the hospital who have Covid. The most important thing we can do is to improve throughput in the hospital so that when a person is deemed well enough, he or she is discharged. We have put substantial investment into step-down beds, transitional beds and home care. The most important thing is that we can transition people through hospitals as quickly as possible.

It is very distressing for families, patients and staff when there are high numbers on trolleys, and I know this is happening daily in Limerick.

Maria Byrne (Fine Gael)
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I thank the Minister of State for her response. The staff work very hard but staff morale is at an all-time low. It is a question of safety for the staff and the patients. Once most patients get into the system, they have an excellent experience, but it is about getting into the system. It is not acceptable. As Senator Conway said, there has been a lot of funding and new beds, but there is a problem and it needs an independent investigation to see what that problem is. It needs a fresh pair of eyes looking at the situation. Realistically, this cannot continue. I know other places have engagement with private hospitals, as we had during Covid, so they can use other beds or transfer patients. I believe there needs to be an outsider looking in to find new ways of doing things.

Martin Conway (Fine Gael)
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Over the past decade, anything the senior management team in Limerick Hospital has looked for, it has got. The Government has stood up to the plate on each and every occasion when a request has gone in, even to the stage of committing to build a new 96-bed unit, which I believe has gone out for tender and which will in real terms create 48 beds. That is happening. Everything the team has looked for, it has got, so I want to know where the problem is. The only way we are going to find that out is by somebody going in, drilling down, asking the hard questions and challenging people as to what is going on. At the end of the day, it is taxpayers’ money but, much more importantly, there are people who are very sick, sitting on trolleys. That is something none of us here will defend and nobody within the health service should defend. That is why questions have to be asked but they need to be answered.

Mary Butler (Waterford, Fianna Fail)
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It is accepted that a key part of the solution for Limerick is additional beds. The new 60-bed modular ward block at UHL is a significant step in addressing this and provides modern single-room inpatient accommodation with improved infection prevention and control capabilities. This follows the completion of two separate rapid-build projects delivered under the Government's national action plan in response to Covid-19, which provided an additional 38 inpatient beds on site at UHL. Furthermore, Project Ireland 2040 includes provision for a 96-bed replacement ward block at UHL. This project has now been tendered in line with public procurement requirements, with tenders returned on 3 February. This tender evaluation process is under way and it is hoped to progress this process in the coming weeks with a view to seeking HSE board approval for the award of the works contract. If that can be escalated as quickly as possible, it would have a major impact.The Department and the HSE will continue to work with local hospital management to further improve patient experience in UHL.

Both Senators raised HIQA and an investigation. I will bring that to the Minister's attention on the Senators' behalf.

Erin McGreehan (Fianna Fail)
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Before we move on to the next Commencement matter, I warmly welcome two Galwegians in the Visitors Gallery, Councillor Alan Cheevers and his good friend Frank Owusu, who is a community activist. They are very welcome to Seanad Éireann.