Timmy Dooley (Fianna Fail)
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I thank the Minister of State for attending to address this important issue. If I look through my files from the long number of years I have been in the Houses, one of the issues that has arisen most often is that of the state of play at University Hospital Limerick, or Limerick Regional Hospital as it was previously known. Notwithstanding significant investment over the years, the situation has deteriorated and continues to deteriorate. Those of us who believed in the reorganisation of the hospital structure in the region took a fair amount of political heat at the time for doing what we believed was the right thing – focusing attention and developing a hospital that was best in class and best in practice and reached a high standard. Unfortunately, that has not happened.

There has been significant investment in the hospital's new accident and emergency unit and a new ward block, but demand continues to outstrip the services the hospital provides. I do not know whether this is due to bad planning or the poor use of its facilities, but something is amiss. The population in the mid-west region has not exploded or done anything other than what was expected over a prolonged period. Last Thursday, the number of people on trolleys in University Hospital Limerick's accident and emergency unit was 126. That was the highest ever in a hospital in the history of the State. Today, that number is 111. Yesterday, it was 113. Cork University Hospital had the next highest number yesterday at 63. That is a huge number and should not be that high. I suspect if we did not have the situation in Limerick, the people from Cork would be crying blue murder.

This is not just about numbers, which the Minister of State knows as a hard-working, on-the-ground politician. She knows that, behind every number and statistic, there is an individual or family and there is heartache. As the trolley numbers continued to increase in recent weeks, the level of heartache and pain brought to my door by people who were looking out for a loved one was at an all-time high. Hand on heart, there is nothing that I can say to them that I believe would solve their problems.

I have reached a point where I think that the only appropriate response is to bring in an external and independent review team. I do not mind where they come from, but I will say where they cannot come from, namely, the hospital, the HSE or the Department of Health. I want a thorough investigation, audit, analysis or whatever you want to call it, and it needs to be done by someone who is entirely independent of the various vested interests. I am not casting aspersions on any individual or group, but I will not have confidence in repeating anything I hear from the Minister of State, the Department or the Minister, with the greatest of respect to them, unless and until it is supported by a document prepared by a group of management consultants without any connection to the hospital, the HSE or the Department. If that requires going outside the State, it is the least we can do. Last Thursday, the figure was 126. Yesterday, it was 113 and today it is 111. I do not know what the figure will be tomorrow but I am sure it will peak again. We owe it to the families and the people who are affected. With the best will in the world, we like to say that if people are on death's door, they will be treated in the accident and emergency department and if people are only a little sick, they have to wait a little longer. That does not wash anymore because the truth is that when I talk to nurses and doctors on the ground, they tell me privately that it cannot be guaranteed that they are able to deliver care that will save the lives of individuals. That is a serious situation to be in. We need to get to the bottom of this. I keep being reassured there is no shortage of money or planning. There is, however, a shortage of solutions to a problem that has been around for a very long time and which predates the time in office of the Minister of State and, indeed, that of her predecessor.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator for the opportunity to address the House on this matter on behalf of the Minister for Health, Deputy Stephen Donnelly. I fully understand how important University Hospital of Limerick, UHL, is to the people of the mid-west and, indeed, that it is adequately resourced and staffed. In that regard, this Government, along with the Department of Health, is fully committed to improving patient services and having patient-centred care in Limerick. That commitment is reflected in the unprecedented level of funding that is being targeted right across the health service in budget 2022.

The UL Hospitals Group has reported that it is continuing to deal with record volumes of patients attending the UHL emergency department. In addition, waiting times for scheduled appointments and procedures remain significantly affected by the Covid-19 pandemic. While ongoing work continues to positively impact on waiting times and improve pathways to elective care, our acute hospitals, including UHL, continue to be impacted by operational challenges arising from Covid-19.

The Minister for Health fully acknowledges the distress overcrowded emergency departments and delays to elective treatment causes to patients, their families and front-line staff working in very challenging conditions, not just in Limerick but in hospitals throughout the country.

Despite the difficulties of the past two years, work is being done by the UL Hospitals Group to address these issues. Elective activity is reviewed daily in line with the hospital’s escalation plan, based on capacity and on the clinical need of patients. This includes elective patients coming in for time-critical investigations and procedures. UHL has also advised that it is undertaking additional ward rounds, accelerating discharges and identifying patients for transfer to model 2 hospitals. In addition, all patients who present to the emergency department with minor injuries at this time, such as suspected broken bones, cuts, bruises and sprains, are being redirected to the injury units in Ennis, Nenagh and St. John’s for treatment whenever clinically appropriate.

In recent years, there has been significant investment in UHL to address capacity issues, including a new emergency department that opened in 2017 and a new 60-bed modular ward block which provides modern, single-room inpatient accommodation with improved infection prevention and control capabilities as well as patient flow throughout the hospital. This follows the completion of two separate rapid-build projects which provided an additional 38 inpatient beds on site at UHL.

Further to that investment, Project Ireland 2040 includes provision for a 96-bed ward block at UHL. The evaluation of tenders is complete and the award of a works contract to the successful tenderer has been approved by the HSE board. The HSE will now be engaging with the successful bidder in the coming weeks with a view to the award of contract being finalised during the second quarter of 2022.

While acknowledging the difficulties faced by patients attending UHL, it is important to note that significant work is being done and every effort is being made to improve the situation at UHL. The Department will continue to closely monitor the situation in conjunction with the HSE.

It would be remiss of me not to acknowledge the front-line workers in the emergency department. They see the queues and acknowledge the issues. There were 121 trolleys occupied last Thursday, 60 of which were in the emergency department, and the other 61 were dispersed throughout the hospital to accommodate patients awaiting admission. That is no way that anybody with expertise wants to manage an emergency department. It must also be acknowledged that while there is substantial ongoing investment, there was chronic underinvestment for many years. This is not about numbers; it is about getting it right now.

Timmy Dooley (Fianna Fail)
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I appreciate the Minister of State's upfront and frank appraisal of the situation. I accept that the 2040 project is there and 96 beds have been promised. I know the hospital will move quickly and I hope those beds can be provided even more quickly. However, something needs to happen in the interim. It is not enough to say that every effort is being made. I am not having a pop at the Minister of State but it is not acceptable to say every effort is being made and we will do our best because that does not cut it with the people who see the numbers rising every day as the situation develops.

The 2040 project and the moneys included in it will take two to three years to take effect. A staffing cohort will have to be put in place. That is a futuristic solution for people who are suffering today and will be for the next 12, 18 or 24 months. We need an urgent intervention. We need to sweat the asset at it stands and, unfortunately, I do not see that happening. It has not happened to date and that is why I want an independent expert review. We can all learn from experts and get a better understanding of a situation and learn to better manage the problem. The Minister of State and I know full well what the problem is, as do the people on the trolleys and their families. Quite frankly, the solution to resolve the problem right now is not there. The solution is designed for the future. As is always the way with the Department, it suggests there is a solution for the future, population will grow, etc. What we want is decisive intervention now that gives some chance of a dignified medical response to people from the region who have no choice but to attend the accident and emergency unit.

Anne Rabbitte (Galway East, Fianna Fail)
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I again thank the Senator. I am all for a decisive and independent external review. I am all for leaving the vested interests of the HSE, management, the Department of Health and the hospital group outside the door. That is absolutely my position. However, that does not solve the issue for the 111 people on trolleys today. I believe there must be triaging of the issue. I compliment the management within the hospital group for what it has done with the facilities at Ennis, Nenagh and St. John's hospitals. I also compliment the hospital group for what it has done on elective procedures. However, there is a substantial problem with the emergency department in UHL. One consideration we must address is whether we have the consultants who can triage the patients who are coming through the doors of the hospital. We need to do that work now. We must examine whether we have the people on the ground who can make the decisions to move the trolleys along. I agree with the Senator. I will bring what he said to the attention of the Minister.