Victor Boyhan (Independent)
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I welcome the Minister of State, Deputy Feighan, back to the Chamber.

Maria Byrne (Fine Gael)
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I thank the Minister of State for coming back to the Chamber to discuss this all-important issue. I would like him to make a statement regarding the recent HIQA report on University Hospital Limerick. It is a damaging, concerning, disappointing and shocking report. I have been raising the issue of UHL in this House, as well as with the Minister for Health, for a long time. I raise issues every week. While there are positive things that happen there, this report is damaging. It is important that the Minister acknowledges the concerns around the hospital.

I welcome that the visit was unannounced. I had been calling for this, because I believe that in an unannounced visit we can get the true sense of the issues within the hospital. I have written to the Minister seeking the terms of reference of the independent group that he is asking to look at the hospital and the issues present there. I believe that this report should inform what the independent group looks at.

The report outlined many disturbing facts and concluded that UHL was mainly non-compliant with all HIQA standards. That is most frightening. Throughout the report, it can be seen that of the many examinations that took place, none of them concluded that the hospital was compliant. There have been recent reports of patients going missing. There are not enough neurological nurses, which I have highlighted in the House in the past. I was told that three were sufficient but I believe that eight are required.

Some solutions have been suggested, including the provision of 100 beds. However, Professor Lenihan said the other evening that they need more than 200 beds to bring the hospital up to standard. More than 200 patients have been waiting for over four years for appointments for diabetes. These issues are not helping the overcrowding conditions.

During Covid-19, 98 extra beds as well as 11 extra critical care beds were provided but that has not been enough. Improved access to special infection prevention, supporting staff with education and training, improving clinical audits, activity within the emergency department and staffing levels are all issues that were highlighted in the report. I believe the Minister for Health and his Department can no longer bury their heads in the sand and ignore the crisis any further. Doing so will be a reflection of the fact that, at the moment, his concerns do not seem to be around overcrowding in UHL.I really believe it is the worst hospital in the country in that respect. On one day alone last month, there were 126 people on trolleys. Standard 6.1 states: "Service providers plan, organise and manage their workforce to achieve the service objectives for high quality, safe and reliable healthcare." The report concluded that UHL was non-compliant in this matter as staff shortages were always present and staff deficits varied between 17% and 33%.

With regard to the quality and safety dimension, the report found that UHL was also non-compliant on the two national standards that were assessed. Furthermore, UHL was found to be non-compliant regarding service users' dignity, privacy and autonomy, which is highly disturbing as patient confidentiality is crucial in all healthcare settings. The hospital was also found to be non-compliant in the service provider's ability to protect service users from the risk of harm associated with design and delivery of healthcare services. The conclusion of the report states that while it was the second busiest emergency department in 2021, UHL had the second lowest bed stock compared with other model 4 hospitals in Dublin, Cork and Galway. Another point that was highlighted is that elective hospitals in other areas are being progressed. In Limerick that is certainly not the case.

It is deeply concerning that there has not yet been a single comment from the Minister on the report. Undoubtedly the crisis is dangerous, not only for the people of Limerick and the mid-west but also for the staff. That is the really frightening part. I have been speaking to some of the staff and morale is on the floor. The report from last Friday needs to be considered in a serious light and taken as part of the independent review the Minister is ordering. The issues need to be addressed. Limerick and the mid-west deserve a better standard of healthcare, not only for the patients and their families but for the staff working there as well. I look forward to the Minister of State's reply.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I welcome the opportunity to address the House on this important issue raised by Senator Maria Byrne. I also welcome the publication of HIQA's report of the unannounced inspection of the emergency department at University Hospital Limerick against the national standards for safer better healthcare. Four national standards were assessed as part of the HIQA inspection, two standards in each of the two dimensions of capacity and capability, and quality and safety. HIQA judged that UHL was partially compliant against one standard and non-compliant against the remaining three standards.

The inspection focused particularly on the important issues of patient flow and inpatient bed capacity in the hospital; respect, dignity and privacy for people receiving care in the emergency department; and staffing levels in the ED. As Minister of State, I am concerned about the significant risk to service users identified in the report. I am pleased that the Minister, Deputy Stephen Donnelly, recently requested the HSE to appoint an expert review team to work with hospital management to improve ED performance at UHL. In addition, the Minister also requested the HSE to prepare short-term and longer term unscheduled care performance improvement plans for all our emergency departments, including UHL.

The compliance plan agreed by UHL with HIQA to bring about compliance with the relevant standards contains short-term, within three months, medium-term, within six months, and long-term, within three years, actions. The Department of Health is working with the HSE to ensure the ED performance improvement plan for UHL and the expert team review operate in concert with the compliance plan included in the HIQA report.

In addition, UHL also commissioned Deloitte to review and advise on unscheduled care and patient flow in the hospital. The expert team will consider the outputs of this work in its review. Both Deloitte and the HSE expert review team are due to submit reports which are expected to help identify potential mitigations for the problems outlined in the HIQA report.

It must be recognised that University Hospital Limerick continues to deal with record volumes of patients attending its ED.There were more than 76,000 attendances at the emergency department in UHL in 2021, up 16% compared with 2020.

There continues to be substantial investment in UHL to address capacity issues, including a 28% increase in the workforce since the end of 2019 and the opening of an additional 98 non-ICU acute beds. To deal with this increased level of presentations, reform of service delivery as outlined in Sláintecare is vital. This includes the expansion of community care and other measures to provide people with the care they need outside emergency departments. We are working to improve patient flow and egress from hospital by providing more home care packages and nursing home supports. Investment of €1.1 billion was allocated in budget 2021 to expand capacity, increase services and support reform. That level of investment has been maintained in budget 2022.

Maria Byrne (Fine Gael)
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I thank the Minister of State. While I acknowledge there has been significant investment and expansion of services, it is not enough. This report has made that clear. I am disappointed that the Department has not acknowledged that services need to be expanded further. I acknowledge the Department is awaiting the expert report but it is not right that the people of the mid-west are subjected to these conditions. It is the most overcrowded hospital in the country.

There are many good things about the hospital. It has won several awards in different areas. Not all the departments are affected by overcrowding - I do not want the story to go out that they are - but the emergency department is a significant concern and needs to be attended to. The Minister must acknowledge straightaway that these issues need to be dealt with because the situation is at crisis point. It is very deflating for staff, families and patients to hear other patients saying they are afraid to go to the hospital. That is the most frightening statement a person could make. That needs to be acknowledged by the Minister.

The Department and the HSE cannot afford to put their heads in the sand any more. There has been significant investment but there is a need for an independent group to see what is working right and what is not working, bring the two together and deliver a report. Any such report must not sit on a shelf, however; it needs to be implemented.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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As I stated, I am concerned by the findings in respect of patient safety in the HIQA report. However, I believe the report provides an important opportunity for a renewed focus on the capacity and capability of UHL and on the quality and safety of the emergency services it delivers to the people of the mid-west. The Senator has articulated those issues extremely well. HIQA reviews are essential in ensuring that the resources required to underpin patient safety are optimised and that learning is shared across all hospitals and the health service generally. A strong quality and safety culture is associated with a responsive health system that listens and learns to improve services.

The Department regularly seeks assurance regarding the appropriate escalation measures for emergency department overcrowding. As I mentioned in my opening statement, significant resources have been invested in UHL in recent years. This has seen an increase in its workforce of 28%, or 796 whole-time equivalents, since the end of 2019. In addition, 98 new beds have been provided since the start of 2020, including a 60-bed modular ward block that was established to provide a rapid-build interim solution to begin to address the bed capacity issue at the hospital and to improve patient flow. A further 96-bed block is currently in planning for the hospital.

The performance of hospital emergency departments is under constant review by the Department through ongoing engagement with the HSE. I assure Members that the Government and the Minister are committed to driving improvement in emergency department performance. I again thank the Senator for raising these concerns. They will be brought back to the Minister and the Department.