Maria Byrne (Fine Gael)
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I thank the Minister of State, Deputy Butler, for being here on behalf of the Minister for Health, Deputy Donnelly, to discuss this important issue. University Hospital Limerick, UHL, is in the headlines again today. It is the most overcrowded hospital in the country, with over 80 people waiting for a bed. There are approximately 670 people waiting for a hospital bed across the country but Limerick has the highest number of such patients and is consistently in that position.

When the CEO of UHL, Ms Collette Cowan, and her team led by Professor Lenihan, appeared before the Joint Committee on Health in September, they spoke about the proposal for an elective hospital for Limerick. The Taoiseach admitted in the Dáil that this proposal needs to be considered. A report commissioned by UHL referred to the need for extra beds for Limerick. It is estimated that 302 additional beds are needed in Limerick and the wider mid-west region, across six hospitals. UHL is having to deal with a growing population and is constantly in the news. We must think of the workforce there as well as the patients. Those attending the hospital want to be treated in a safe and compassionate manner. They deserve timely treatment and should not have to wait for hours to be seen or to get a hospital bed. I want to pay tribute to the staff who work so hard.

I am aware that the Minister for Health was not supportive of this proposal in the past. However, when he visited the hospital recently he gave a commitment to Ms Emer Martin, the CEO of St. John's Hospital, that he would consider its proposals. When Deputy Harris was Minister for Health, he made a commitment to consider locating an elective hospital at St. John's Hospital in Limerick. St. John's Hospital has 99 beds currently. It is a nightingale hospital but there is huge potential to add on to it. The original proposal was for 120 beds but this has been increased to 150 beds. The proposal is for so-called replacement beds which would allow for procedures to be carried out in the hospital. It is an old-style hospital but the proposed new extension would make an enormous difference. There is also a proposal from University of Pittsburgh Medical Centre, UPMC, for a new hospital which means, in effect, that there are two proposals on the table.

An elective hospital is needed for Limerick and the mid-west. The people of the mid-west deserve better. The day on which the Minister for Health visited UHL was a particularly quiet one but if he was there today he would see over 80 people waiting for a bed in the hospital. Obviously when there are so many people waiting on beds, elective surgery appointments have to be cancelled because of the overcrowding. It is just not right that the people of the mid-west are disenfranchised in this way. An elective hospital is badly needed. This has been acknowledged by the Taoiseach and I understand it has been discussed at Cabinet. Something needs to happen quickly. The weather has been very mild up to now and we have not really had cold winter weather yet. I dread to think what we will face in the mid-west in terms of overcrowding and people not being able to receive the attention they need at UHL.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Maria Byrne for raising this important issue and for her continued advocacy for health services in the Limerick area. The cross-party Sláintecare report in 2017 articulated a new vision for healthcare in Ireland, including the provision of elective-only hospitals to provide protected capacity for elective care. This policy has also been informed by a number of subsequent policy documents and Government decisions including the 2017 Sláintecare report, the Sláintecare implementation strategy of 2018, the 2018 National Development Plan, the programme for Government in 2020, the Sláintecare implementation strategy and action plan up to 2023, as well as the new national elective ambulatory care strategy agreed by the Government in December 2021.This new strategy aims to change the way in which day-case scheduled procedures, surgeries, scans and outpatient services can be better arranged to ensure greater capacity in the future and help to address waiting lists at a national level.

The development of additional capacity will be provided through dedicated, stand-alone elective hospitals in Cork, Galway and Dublin. The elective care scope of service will be provided in two phases commencing with day cases, diagnostics and outpatients, and then by inpatient treatment. On this basis, the elective care centres, ECCs, will be designed to provide sufficient capacity to facilitate future phases, including some elective inpatient capacity, thereby providing a sustainable and strategic response to cater for the highly dynamic landscape of healthcare policy and practice.

It is important to note that the locations chosen will allow for new facilities of a size and scale to implement a national elective care programme that will tackle waiting lists on a national basis. This means the new facilities will be designed to maximise their capacity and, in doing so, will operate to meet the demands of as wide a catchment area as possible, extending beyond existing and future health areas, including Limerick and the mid-west.

The locations were chosen in line with good practice, which suggests that in order to maximise economies of scale, dedicated, stand-alone elective centres should be as big as is reasonably possible to meet identified demand while providing appropriate population coverage. Locating the new facilities in Cork, Dublin and Galway will enable the provision of a national service that aims to maximise the coverage of the ECCs as far as is reasonably possible. A central point of introducing these new facilities is not that they will only benefit the subset of the population that sits within their direct catchment, but, rather, that the introduction of this new delivery capability into the public healthcare system will benefit the whole population, including those who do not fall within the immediate geographical catchment. An additional elective facility in Limerick would have a minimal impact on population coverage relative to the significant increased investment to build and operate.

Nonetheless, I am conscious of the desires expressed by the Senator and I take on board her point that there are 80 people on trolleys today in Limerick. The Minister for Health, Deputy Stephen Donnelly, was in Limerick the week before last and discussed this matter with local representatives and the senior management team at St. John's Hospital. As the Senator will know, we are fully committed to the continued improvement of the elective care system in Ireland and have been impressed to see innovative care solutions developed locally, such as the Reeves day surgery unit at Tallaght University Hospital, which has succeeded in significantly reducing day surgery waiting times for patients.

As well as the strategic intervention under the national programme for elective care, the Minister will consider any similar proposal by University Limerick Hospitals Group to deliver elective day care in the shorter term.

Maria Byrne (Fine Gael)
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I thank the Minister of State for her response, although I am disappointed that is a standard response. I am not blaming her for that. As the Minister stated in the report, he only met the team ten days or two weeks ago. The issue of an elective hospital was highlighted in the report commissioned by UHL and its CEO, Professor Cowan, and Professor Lenehan reiterated that when they were before the joint committee. It has been called for by many of the top people in the mid-west as an overall solution.

All hospitals are overcrowded. Elective hospitals are proposed in Dublin, Cork and Galway but that will not solve the problem in the mid-west, which has the worst overcrowding. People are waiting for days on trolleys. I am not exaggerating as I know somebody who waited five days recently before getting a bed. It is totally unacceptable. There is a need for an elective hospital in the mid-west. I would like the Minister of State to take the message back to the Minister that he needs to listen to the people of the mid-west. This is a very serious issue.

I know meetings were held with the senior teams of St. John’s Hospital and UHL. The Minister needs to wake up and listen because the people of the mid-west deserve better.

Mary Butler (Waterford, Fianna Fail)
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It is important to note that the locations chosen will allow for new facilities of a size and scale to implement a national elective care programme that will tackle waiting lists on a national basis. This means the new facilities will be designed to maximise their capacity and, in doing so, will operate to meet the demands of as wide a catchment area as possible, extending beyond existing and future health areas, including Limerick and the mid-west.

As well as the strategic intervention under the new national programme for elective care, the Minister has said he will consider any similar proposal by the University Limerick Hospitals Group put forward to deliver elective day-care in the shorter term. When the Minister was there recently, the sod was turned on a new development. I understand this development will take up to two years and I appreciate the challenges that are there, but progress is being made.

I assure the Senator that he remains committed to the continued improvement of the elective care system in Ireland. I have just come from the Dáil where a similar question was raised about the proposed hospital to be located in Cork. As part of this, the Minister will keep an open mind to any considered proposal brought forward as to how elective day care can be delivered in the shorter term for the Limerick area.