Martin Conway (Fine Gael)
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I move:

“That Seanad Éireann:

acknowledges: - the unprecedented level of spending on health in 2023; more than €24bn has been committed to our health services nationally;

- that total health expenditure has been increasing steadily over the last decade;

- the significant investment in the UL Hospitals Group;

- a number of capital projects have been completed at UL Hospitals Group since 2020; in total, the UL Hospitals Group has received €94.81m in National Development Plan funding for the completion of these projects, namely:

- Croom Orthopaedic Hospital:

- new rapid build ward – Covid-19 National Action Plan: provision of 24 bed Rapid Build Ward (all single rooms) as part of the Covid National Action Plan; longer-term, these beds will address the bed capacity deficit in the mid-west, including the future provision of a Theatre Department where construction was completed in 2020: an investment of €20.66m by the State;

- Orthopaedic Surgical Unit Development: a Theatre and CSSD fit-out including a link to St. Anne’s Ward and lifts (excludes refurbishment of St. Anne’s Ward) under the Pandemic Plan, with construction completed in 2021; an investment of €14.69m by the State;

- Ennis General Hospital:

- Outpatient Department (OPD) equipping: the equipping of new OPD, including provision of X-Ray Room and other diagnostics where the main construction was completed in 2021 and the X-ray project completed in 2022; an investment of €1.29m by the State;

- Redevelopment (Phase 1b): Phase 1b of the redevelopment of Ennis General Hospital consisting of the fit-out of vacated areas in the existing building to a Local Injuries Unit where construction was completed in 2022; an investment of €2m by the State;

- Limerick University Hospital (UHL):

- reconfiguration of vacated Emergency Department (ED): reconfiguration of recently vacated ED to create a Medical Short-Stay Unit where construction was completed in 2020; an investment of €3.86m by the State;

- New Ward Block: the provision of a 60 bed ward block where construction was completed in 2020; an investment of €21.67m by the State;

- Modular New Build Thrombosis and Coagulation/Medical Social Work Department/Speech and Language/Occupational Therapy: modular new build to accommodate Thrombosis and Coagulation / Medical Social Work Department and Speech and Language / Occupational Therapy; a reconfigured 14 bed High Dependency Unit – Covid-19, the construction of which was completed in 2020; an investment of €4.61m by the State;

- New Rapid Build Ward – Covid-19 National Action Plan: provision of 24 bed Rapid Build Ward (all single rooms) as part of the Covid-19 National Action Plan, including longer-term beds to address the bed capacity deficit in the mid-west, the construction of which was completed in 2020; an investment of €12.77m by the State;

- new Modular Covid-19 laboratory: construction of a new modular Covid-19 laboratory to manage testing, the equipment and the team are currently housed in the Clinical Education and Research Centre building which needs to return to education within the Pandemic Plan, with construction completed in 2021; an investment of €4.05m by the State;

- Lift Replacement Programme: lift replacement (4 Lifts), the construction of which was completed in 2022; an investment of €1.11m by the State;

- Nenagh Mid-Western Regional Hospital:

- Ward Block extension and refurbishment programme: to ensure compliance with HIQA standards, includes 16 single rooms and 4 double rooms, where phase 1 was completed in 2018 and phases 2 and 3 were completed in 2020; part-funded by the Friends of Nenagh Hospital by €0.64m and an investment of €7.07m by the State;

- Accident and Emergency Department (A&E): completion of a new A&E Department in 2017; an investment of €24m by the State;

- additional 96 Bed Block: currently under construction 96 single ensuite rooms with associated access links overhead to the existing renal dialysis and EDs as an extension to the existing hospital facilities at UHL; an investment of €93.42m by the State;

- other incidental works within the UL Hospitals Group include:

- Neonatal upgrade works at University Maternity Hospital Limerick (UMHL); an investment of €5.41m by the State;

- fire alarm and emergency lighting upgrade works; an investment of €8.10m by the State;

- Blood Sciences Project in UHL; an investment of €4.27m by the State;

- Radiology Department upgrade works, including the provision of a second MRI at UMHL;

- Theatre Suite and CSSD redevelopment works at Ennis Hospital;

- redevelopment works to provide two replacement theatres and supporting facilities at Ennis Hospital;

- future works where commencement is imminent, including the relocation of UMHL;

further acknowledges: - the significant investments at Ennis General Hospital, Croom and Nenagh and the recent opening of several Primary Care Centres in the region;

- the serious difficulties experienced over the last couple of months in the UHL ED;

- that this problem has existed over several years; welcomes: - the apology from the CEO and management for the stress caused to patients, their families, and staff at the hospital;

- the new protocols at Ennis General Hospital designed to alleviate pressure at UHL ED; and calls on the Government, following on from a recent meeting with Oireachtas Members representing the mid-west region, and UHL CEO and Senior Management: - to extend the protocols in existence at Ennis to St. John’s and Nenagh to further alleviate the pressure at UHL ED and to fast-track the proposed second and third 96 bed blocks to address capacity issues;

- to revisit the decision not to provide an elective hospital in the mid-west region;

- to accelerate the start date of the new surgical clinic proposed for Limerick City;

- to explore the possibility of relocating Shannon Doc at the UHL campus to help assist non-referral presentations at the ED.”

I will be sharing time with my colleague with my colleague Senator Maria Byrne.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.

Martin Conway (Fine Gael)
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I welcome the Minister, Deputy Stephen Donnelly, to the Seanad this evening. His presence to address this critical Private Members' motion speaks volumes of his commitment to this issue. It is a critical for us in the mid-west. For some years people in the mid-west have suffered considerably as a result of the overcrowding in the emergency department at University Hospital Limerick. It is very appropriate for Fine Gael to use its Private Members' time to highlight the challenges and difficulties faced by people throughout the mid-west at the accident and emergency department but also to look to the future and identify what needs to be done. In many ways it is a campaigning motion. The Minister is fully aware of the issues and challenges. He has visited the emergency department on a number of occasions. He has seen the positives but has also seen the negatives.

The motion acknowledges the apology by management at University Hospital Limerick for the experience people have faced at the accident and emergency department, not just in recent weeks but for some years. That apology is important. It states a lot. It states that people understand the trauma, difficulties, challenges and stress that people face.

This evening's debate is about solutions. There are a number of very clear solutions to the problem. No instantaneous solution would resolve the problem outside capacity building, but a number of things can be done. The first thing that the motion proposes is that the Minister would seriously and genuinely reconsider providing an elective hospital for the mid-west. While we very much welcome the three elective hospitals announced for Cork, Galway and Dublin, we believe because of the problems with lack of capacity, the mid-west should have been one of the regions for an elective hospital to be located. That said, I believe a fourth elective hospital would be appropriate. We do not want to take an elective hospital from any of the three locations identified, but we believe that the Government should consider Limerick for an elective hospital.

We also feel very strongly about the need for the second and third 96-bed units that have been discussed and identified as a priority. The Minister and the Taoiseach very kindly engaged with both Opposition and Government Oireachtas Members from the mid-west about three weeks ago. During that discussion everybody agreed that there was a serious lack of capacity in University Hospital Limerick. The way to address that is by building capacity. We very much welcome the beginning of construction of the 96-bed unit that is under way at the moment. I hope it will be delivered on time - whatever about within budget. We want the UL Hospitals Group to submit its plans for a second and third 96-bed block. Once those plans have been submitted to the Government, it needs to be turned around in a matter of weeks. By the end of quarter 2 or quarter 3 or certainly by the end of 2023, there should be a Government commitment to the second and third 96-bed blocks. Everybody agrees that capacity is an issue. If capacity is an issue, let us deal with it and let us have a Government commitment that funding will not be a problem and that it will be delivered as quickly as possible.

The third element of the motion that we feel very strongly about is the surgical unit, which has received Cabinet approval.I thank the Minister for his ongoing commitment, particularly in the provision of a surgical unit. He has seen the benefit of the surgical unit in Tallaght University Hospital and that it has alleviated significant pressure on the hospital's emergency department, ED. We believe the same will happen in Limerick but we want the surgical unit built as a matter of urgency. Whatever needs to be done to deliver that as quickly as possible needs to happen. This motion articulates and supports that position.

The fourth thing we want to see happen relates to Shannondoc. We believe Shannondoc should be located on the grounds of UHL simply because 50% of presentations at UHL are not referrals. They are people who turn up because they cannot access a GP in time and panic. They are not blue-lighted nor are they referred. On that basis, we want Shannondoc located on the grounds of UHL so that non-referrals that come to the hospital can be redirected to Shannondoc. In such a scenario, if it is identified they need to attend the accident and emergency department, they can be facilitated with a referral letter and, if not, they can be dealt with by Shannondoc.

These are four proposals we in Fine Gael believe will deal incrementally with the situation at the ED in Limerick. They are not a panacea that will solve all the problems but taking those four steps would be a significant move forward in that regard.

Overall, the reconfiguration that took place in 2009 put the cart before the horse. The facilities had not been equipped or developed before the reconfiguration happened. Had the facilities been in place, we probably would not be here discussing this issue now, but that is history. What we must deal with now is how we move forward. This motion is important and it is important we discuss it in the Seanad. I sincerely hope it receives all-party support because it is critically important to the people of Clare, Kerry, Limerick and north Tipperary. I acknowledge that the Minister, Deputy Donnelly, has come to the Chamber to address this motion, which speaks volumes.

Maria Byrne (Fine Gael)
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I second the motion. I thank the Minister for coming here to address this all-important motion. I acknowledge the amount of investment - up to €98 million over recent years - put into the University Limerick Hospitals Group. While many parts of the hospital are working, there are parts that are not. I know the Minister is well aware of this and that he has visited the hospital. I acknowledge, as did Senator Conway, that when the management of UHL came before the Committee on Health, they apologised to people - the staff, the people who have visited the hospital, patients and their families - and that must be acknowledged.

As Senator Conway outlined, this has been going on for an awfully long time. I come from Limerick city, which is the third largest city. We have the main hospital and the level 2 hospitals - St John's Hospital, and Nenagh and Ennis hospitals. Croom Hospital is also part of the UL Hospitals Group. I know protocols have been put in place recently and that Mallow hospital has been used. There have been enhancements at Ennis Hospital. I understand some of the protocols put in place at Ennis have helped in the reduction of trolley numbers at UHL. However, as the third largest city, we deserve better than what is going on in terms of delivery to the people of the mid-west. Senator Conway spoke about the elective hospital but we also need, in addition to the accident and emergency unit, an enhanced trauma ward and an enhanced minor injuries unit so that when people attend the emergency department who do not necessarily need to be there, they can be treated and looked after in the enhanced unit.

The Government recently sanctioned the elective clinics, which is an issue I have raised with the Minister before. That needs to be accelerated, as does the delivery of the 98-bed blocks. We also need to see staff being recruited along with this because there is no point in building units if-----

Mark Daly (Fianna Fail)
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I have been informed the Minister is required to attend a vote in the Dáil Chamber.

Maria Byrne (Fine Gael)
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There was an article in the newspaper yesterday that stated Limerick had the highest trolley numbers. While I acknowledge the number has come down, we are still at the top of the list. We have the top med-tech and biopharma companies. We have a lot of companies that are relocating. I was at the launch of the rebranding of Legato as one of the top and fastest growing healthcare companies.Many companies are locating operations in the mid-west. A large number of them are doing so because they are involved in the area of healthcare, which is top of the agenda.

In the context of primary, secondary and tertiary care, we need our health authority restored to the city of Limerick as a matter of urgency. We need a full trauma centre, which should be based at UHL, as well as the accident and emergency unit. We need full capacity in the oncology centre. We need to be top in terms of the cancer care strategy because the oncology unit, which is a fantastic unit under the UL Hospitals Group, needs to be a leading centre, especially in light of the number of experts based there. Those experts need departments at St. John's, Ennis and Nenagh. I read the consultants' letter. While they say it would not be efficient to restore full accident and emergency units, better use needs to be made of those hospitals. We need to look at those hospitals to see how we can deliver better services to the people of Limerick, Ennis, Tipperary, Kerry and the mid-west in general.

Limerick needs to be chosen as a centre for major healthcare resources and initiatives. This would tie in with the research between those healthcare companies that are on our doorstep and the expertise in the hospital. I read the letter from the 87 consultants. They are extremely concerned. At the weekend, 11,000 people marched through the streets of Limerick. This shows that people are very worried about the future of the hospital.

To go back to our asks, we need the provision of the 96-bed blocks and the elective clinics to be accelerated. We cannot wait for this to happen in two or three years. We need to find a building, kit it out and start carrying out these procedures. Many people had their appointments cancelled in the recent months because the accident and emergency department was overcrowded and it was a case of all hands on deck.

We have four asks. If the Government supports those asks and takes action in respect of them as soon as possible, we will see a fully restored healthcare system that people are not afraid to use. My big fear is that people are staying at home because they are afraid to go to hospital.

I pay tribute to the staff. They have worked in very difficult circumstances. When the emergency was called on 4 January, people came in from home and put their shoulders to the wheel. We have to keep that going forward. The Government needs to be seen to support the people of the mid-west and to show leadership. The Minister put the crisis management team into the hospital, but we need to see delivery going forward.

Victor Boyhan (Independent)
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I welcome the Minister and thank him for coming to hear about these issues at first hand. It is the first time he has heard them, but it is good that he is here. It is always important that we are courteous and respectful to Ministers. The Minister is part of a tripartite coalition Government made up of Fianna Fáil, Fine Gael and the Green Party. These are not new issues for any of these parties involved. I presume they have been discussed by those parties at length. None of this should be a surprise.

I thank Senators Conway and Maria Byrne and their party colleagues for bringing this issue to our attention. It is always important that we shine a light on matters of this nature. I am conscious of the arithmetic in this House and the vast numbers on the Government side. One of the real challenges for parliamentary democracy is that the Opposition is so small and the vast number of Members on the other side have collaborated on everything. They have power but they also have responsibility. They have to shoulder that responsibility in the context of things that do not go well as much as they do when it comes to things that do go well. That is an important point. When they have such power collectively within Parliament, it is right that they should be questioned. All we have available to us is that we can shine a light on an issue. At the outset, I thank the those who put this important motion together.

As Senator Maria Byrne rightly stated, let us cut to the chase. There are four asks here. I am of the view that the Minister, everybody in government and those on all sides of the House want to see these implemented. However, there is the reality of how they are going to be implemented in a timely manner, and how they are going to be implemented in accordance with the wishes of the medical practitioners, all of the hospital staff and the management structures that are in place, and to the satisfaction of patients and their families, which is an ongoing challenge.

The other issue is resources. This is not a blame game. We all know what the problem is. We need to assess, in a positive way, how we are going to get out of the mess at UHL, and we need to look at hospitals that are somehow outperforming others. We need to compare like with like, although I acknowledge that no two hospitals are the same.

I thank the 87 consultants who highlighted this matter in The Irish Times. The story also appeared in other newspapers. Today, I received a back issue of the Limerick Postfrom a member of Fine Gael in the west who said that he knew this was coming up and that I might have a look at it. The article in that newspaper was more or less about the same letter,. However, I thought it was interesting to look at the local angle taken in theLimerick Post, a publication with which I am not familiar. What the consultants said was extremely concerning. We all have to be worried about it, particularly in the context of issues relating to overcrowding and the relentless demands on services for many years. Much of this involves having adequate resources, and that is where the Government comes in.

I am sometimes amazed, in my observations of the Dáil and Seanad, at how Government Members come into the Houses and are highly critical of something, and rightly so. However, they are in government; they have got to get solutions and they have to work together. It is too easy to hang the Minister or somebody else out to dry. They are in government. As stated, it is a tripartite coalition Government. They have to take the good with the bad, put their shoulder to the wheel and lead. We are called upon as politicians to be responsible and to lead.

I want to touch on a few points, in particular the issue of care, dignity and respect for the patient. People are vulnerable. It is unacceptable that people have to wait days and days on trolleys. We are hearing stories from Ennistymon and other hospitals. The Limerick Post reports people sitting on trolleys for three to four days. I am aware of the case of a woman whose daughter, who is 19 or 20, was admitted to the hospital in Ennistymon with heavy bleeding and gynaecological problems. She was not offered the opportunity to wash or take a bath for four days. That is the reality. The woman and her daughter spoke to me this morning and asked me to raise the matter here. They thought I might be embarrassed and would not want to do so. Why would I be embarrassed? Four days on a trolley and she was not provided with washing facilities or supports. That is clearly not satisfactory. I could go on with a litany of issues.

The reality is that the consultants involved have highlighted the issue. They have put pen to paper and they have said there are grievances, shortages and issues. However, there is a bit of hope. The consultants' letter states:

The recent Deloitte report clearly outlines the disparity in support and resourcing. We welcome the recent engagement of the Taoiseach and Minister for Health and their acknowledgement that UL Hospitals group require specific support to build additional bed capacity to serve the demographic demands.

It is positive that they welcome and are open to engagement. They want dialogue, they want to get on with it and they want to do what they are trained to do, which is to provide these services. The letter also states that they are “calling on the Minister for Health to bring this about through engagement with the clinical stakeholders and allocation of adequate resources.”

That is it. That is the gist what my colleagues are saying. I support them. I look forward to discovering how we might do it. The real focus in these four asks is whether the Minister has the resources to act on them in the short, medium and long term. How does he propose to get the resources? Can he expedite his vision, his plan and his commitment? What positive messages can he send out, not just to these consultants, who are only part of the picture, but also to the people in the region and the patients? How are we going to move matters on and fix the problem?I thank the Minister and I thank the proposers of this Private Members' business.

Lorraine Clifford-Lee (Fianna Fail)
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Cuirim fáilte roimh an Aire agus roimh an rún ó Sheanadóirí Fhine Gael maidir le Grúpa Ospidéal Ollscoil Luimnigh. Molaim an Seanadóir Conway agus an Seanadóir Maria Byrne, go háirithe, as an gcur síos a rinne siad ar an rún agus ar na fadhbanna agus as a gcuid moltaí féin freisin. Is maith an rud é go bhfuil deis againn an t-ábhar an-tábhachtach seo a phlé. Tá a fhios agam gur údar imní ar leith é seo do mhuintir an réigiúin. Tá a fhios agam freisin go raibh mórshiúl i Luimneach an tseachtain seo caite inar ghlac na mílte duine, idir óg agus aosta, páirt ann. Eisíodh figiúirí inniu a léiríonn go raibh UHL ar bharr an liosta maidir le plódú i mí Eanáir. Ní staitistic mhaith í seo don réigiún. Tá an ceart ag muintir Luimnigh agus an Chláir, agus gach duine eile a úsáideann an t-ospidéal seo, a bheith buartha faoi sin.

Tá an-chuid infheistíochta déanta ag an Rialtas agus glactar le seo. Tuairiscíodh go dtógfar bloc nua le 96 leaba agus tuigim go dtabharfaidh an tAire sonraí faoi seo i mí Aibreáin. Beidh sé seo ar an dara bloc breise anseo agus tabharfaidh sé faoiseamh maidir leis an mbrú san ospidéal. Is maith an rud é sin. Cuireann sé sin leis an infheistíocht atá le feiceáil cheana féin sa ghrúpa ospidéal seo. Tá a fhios agam go bhfuil an tAire ag tabhairt mórtas áite do leapacha breise agus infheistíocht sláinte sa réigiún freisin. Tá a fhios agam go leanfaidh sé leis an idirphlé agus leis an gcumarsáid le hionadaithe an réigiúin. Táim buíoch as an deis an rún seo a phlé.

Paul Gavan (Sinn Fein)
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There are 78 people on trolleys at UHL this morning. So the number is running at more than twice the level of the next nearest hospital and three or four times the level of most other hospitals. The Minister will know that 12 years ago Enda Kenny declared, "I'll end the [scourge] of patients on hospital trolleys". That promise was posted all across the country. It was a key electoral promise that went a long way to securing two seats for Fine Gael in Limerick City.

In 2011 - Fine Gael's first year in power - there were 3,500 patients on hospital trolleys in UHL. Last year - 11 years later - 18,000 patients were on trolleys in UHL. So during Fine Gael's 11 years in government the number of patients on hospital trolleys had multiplied by five times. That is its record. You would think that there would be some acknowledgement of these facts somewhere in this Fine Gael motion, especially as 11,000 people came out on to the streets of Limerick a week ago but no. In a truly surreal move, the motion barely references the crisis. There are 946 words in this motion and you have to read down as far as the 774th word before there is a reference to "the serious difficulties experienced over the last couple of months."

Crucially, the motion in no way explains how we got to this point of crisis. Thankfully, 87 doctors who work in UHL were kind enough to publish a letter reminding us of how we got here and it states:

The origins of this ongoing crisis date back to the poorly resourced reconfiguration of hospital services in the midwest in 2009. The 640 beds to support this were never delivered.

That is a fact that needs to be said and acknowledged by both Fine Gael and its sister party, Fianna Fáil, that implemented the disastrous reconfiguration. The result of that reconfiguration cannot just be seen in the HIQA and Deloitte reports but as Mr. Ger Kennedy, who is a SIPTU representative who represents those workers in hospital told me today, it can be seen across the graveyards in the counties of Limerick, Clare and Tipperary because we know from medical research that was carried out in the UK that of the patients who spend more than eight hours in an emergency department on a trolley, one in 67 of them will die.

Martin Conway (Fine Gael)
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If Sinn Féin goes into government will it open the 24-hour accident and emergency unit in Ennis?

Paul Gavan (Sinn Fein)
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I did not interrupt the Senator.

Martin Conway (Fine Gael)
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I just asked a question.

Paul Gavan (Sinn Fein)
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I do not think that it is funny-----

Martin Conway (Fine Gael)
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No.

Paul Gavan (Sinn Fein)
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-----when I am referring to people who died. Hundreds of deaths have happened across Limerick and the mid-west and the Senator wants to crack a joke. Seriously?

Maria Byrne (Fine Gael)
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Senators, no interruptions please.

Martin Conway (Fine Gael)
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Who cracked a joke?

Paul Gavan (Sinn Fein)
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It is not good enough.

Maria Byrne (Fine Gael)
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Senators, please show respect for the speaker.

Paul Gavan (Sinn Fein)
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It is gas because there will be enough of the Senators to speak afterwards if they want to make statements.

Martin Conway (Fine Gael)
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Withdraw that statement.

Paul Gavan (Sinn Fein)
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I will not withdraw it.

Martin Conway (Fine Gael)
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On a point of order, where did Senator Gavan come up with the point that this was a joke? I never made a joke. I asked him a simple question. If Sinn Féin goes into government will it open the 24-hour accident and emergency unit in Ennis? That is a simple ask.

Paul Gavan (Sinn Fein)
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It is pathetic.

Maria Byrne (Fine Gael)
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Senator Gavan, please continue.

Paul Gavan (Sinn Fein)
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I thank the Acting Chairperson.

Martin Conway (Fine Gael)
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We need a few facts.

Paul Gavan (Sinn Fein)
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I am giving the facts. In fact, I am giving the facts that were supplied by the doctors who actually work in UHL and who refer to "the chronic under resourcing of the region".

To be frank, what I am seeing here this evening is Government politicians pretending to be in opposition when Senator Conway and Senator Maria Byrne voted for each and every budget for the last number of years in this Chamber, and each one of those budgets resulted in "the chronic under resourcing", to use the words of the doctors in UHL. Those are the facts of the matter.

In terms of dealing with the crisis as it is today, I have a few points to make to the Minister. Shannondoc collapsed at Christmas, which he knows. I appreciate that he arranged a meeting for us after Christmas but when I asked a simple question about how many missed calls were not picked up, its manager could not tell me. Shannondoc does not even count the amount of missed calls in an essential service. How can that be? The number of healthcare assistants who were allocated to the emergency department was 26.6 in 2017 when it was due to deal with 170 patients a day, which has since gone up to 250 patients a day. Does anyone want to hazard a guess at how many additional healthcare assistants were allocated by management? It is a round figure; it is zero. Can the Minister explain that to me?

Stephen Donnelly (Wicklow, Fianna Fail)
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That is not true.

Paul Gavan (Sinn Fein)
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No, it is true.

Stephen Donnelly (Wicklow, Fianna Fail)
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It is not.

Paul Gavan (Sinn Fein)
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In fact, I spoke to the SIPTU representative today who told me that there is not 26 healthcare assistants, HCAs there at the moment but only 22.

Stephen Donnelly (Wicklow, Fianna Fail)
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No.

Paul Gavan (Sinn Fein)
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I have given the Minister the facts.

Martin Conway (Fine Gael)
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Let us deal in facts.

Paul Gavan (Sinn Fein)
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The Minister might also explain why it has taken a month for the CEO to respond to the three unions that work in UHL to agree to meet them after the changes that were made at the beginning of January. How does that make sense?

The Minister might explain why doctors who published previous letters said, themselves, that a witch hunt was conducted by the management team, not to deal with the issue that these doctors raised, but to find out who publicised the issues. I wish to make clear that I have no confidence in the senior management team in UHL and I believe that the Minister has a duty to act in that regard.

On the future configuration, I cannot believe that after two and half years in government, the Minister cannot tell us definitively whether we need an elective or model 3 hospital. The motion states: "to accelerate the start date of the new surgical clinic", but the Minister does not have a date for the surgical hub. So, in two and half years, we have seen further failures.

I ask the Acting Chairperson for more time on account of the long interruption, and I think my request is only reasonable.

Maria Byrne (Fine Gael)
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Yes.

Paul Gavan (Sinn Fein)
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We need to see urgent action in terms of decisions by the Government, which are based on clinical advice. In the short term, because of the crisis, I am clear that we need to see accident and emergency units reopened in Nenagh General Hospital, St. John's hospital in Limerick and Ennis General Hospital while we figure out what resources are needed and quickly action those items. We have had 11 years of Fine Gael failures and their pretending to be in opposition is not going to save them. The people of Limerick are outraged by what has happened UHL.

Garret Ahearn (Fine Gael)
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I thank my colleagues, Senators Maria Byrne and Conway, for bringing forward this motion.

As the Minister knows, this matter is the biggest issue in the region of counties Clare, Limerick and Tipperary. It has been the biggest issue for the last couple of months. I listened to what was said by Senator Boyhan. He was very critical of previous Governments so he must have forgotten that he was a member of a political party where the leader of that party was the Minister for Health in a Government the Senator has criticised.

We, as a Government, have massively invested in health over the last number of years. There has been no shortage of investment in health by this Government or previous Governments involving Fine Gael. We have seen success in the health service and other parts of the health service in other areas of the country. Trolley numbers have been an ongoing issue in UHL and we hear about it every winter. The Minister has put forward a winter plan and plans are in place for when there is a surge but it always seems to be the case that Limerick has the highest trolley numbers.While we have invested in hospitals - we have had big investment in Nenagh and a 40-bed modular unit built in my town, Clonmel - the part the people cannot understand is how a 40-bed modular unit can be built in Clonmel and the trolley numbers there come down after it has been built whereas 60 beds are provided in UHL and the trolley numbers there are still going up. The people I speak to in Tipperary, Limerick and Clare cannot understand that. That is not the Minister's fault or the Government's fault. We are putting in more beds and in one hospital it is working and in another it is not. We need to be honest about why it is working in one place and not in the other. It is as simple as that. It is not complicated. These are not simplistic and populist lines that it is completely the Minister's fault and so on. It works in my home town, Clonmel, but it is not working in the whole of the Limerick region.

Management needs to step up in that regard. I thank the Minister for the meeting we had. A couple of weeks ago we had a meeting to which he invited all public representatives and Oireachtas Members from all parties, and the Taoiseach came in on it, to have an open, frank discussion. The Minister was there with the management staff from UHL. It was a long meeting and was very frank, and it needed to be. The Minister will know that I brought up in my contribution the fact that HIQA did a report on UHL a year and a half ago and it was very critical of the management of UHL. I got a response two weeks ago from the CEO of UHL to questions I asked. I asked her what her view was on the HIQA report, if she had made any changes on the back of the report and what she had done about the criticism of the management within UHL. Her response was that the inspectors came on a bad day. That is utterly unacceptable as a response. What sort of confidence does it give the people in Limerick, Clare and Tipperary when the head of the hospital says the reason a critical report was done was just that the inspectors came on a bad day? It is just not acceptable. Other people can stand up here and say it is the Government's fault, the Cabinet's fault or the Minister's fault. There is a management issue if people cannot answer a simple question about a report that was done a year and a half ago. They have not prepared even a genuine bluff answer; it was just that they came on a bad day.

This is a massive issue for us in the region. That is why this motion has been tabled. People need the confidence they can go to a hospital and get the care they deserve. People in Clare, Limerick and Tipperary have made decisions not to go to a hospital simply because they believe it is in their best interests for their health not to go to a hospital. That is a crazy situation to be in.

I will make one last point. It seems the opening of Ennis Hospital to the ambulance service carrying out triage and sending patients to Ennis Hospital rather than University Limerick Hospital has been quite successful. The Minister might be able to answer this in his contribution. I know they are assessing that and will make a decision on the back of that, but Nenagh hospital needs to be opened up for that too. I believe that would relieve some of the pressure, certainly for that area of north Tipperary.

I thank my colleagues for tabling the motion and thank the Minister.

Annie Hoey (Labour)
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I thank the Fine Gael group for tabling this. A lot of what I will cover has come from party colleagues of mine in Limerick or people I know in Limerick who have contacted me to discuss some of the issues they are concerned about. I also have correspondence from a student who got in touch. I ask the House to bear with me as I jump from one device to the other because the people contacted me in different ways.

My colleague, Councillor Conor Sheehan, who is a Limerick city north representative, outlined to me why UHL is 50% more overcrowded than every other acute hospital. I spoke about this last week so I am sorry if we go over a similar topic again. Councillor Sheehan said he believes that this is primarily a matter of resourcing and that the hospital is underfunded and understaffed, with fewer beds per capitathan the six other acute hospital groups. He said this has been highlighted over a number of years by many Members of both the Upper and the Lower Houses. My party colleague Deputy Alan Kelly has spent years talking about Nenagh, St. John's and Ennis hospitals and the impact this would have, and we are seeing the result of the closure of all these facilities now. There are figures suggesting UHL is possibly 50% more overcrowded than other hospitals. Many of us would probably agree that when St. John's Hospital, Nenagh General Hospital and Ennis Hospital were downgraded, UHL never got its fair share of resources to create the centre of excellence that was promised. That was demonstrated by Dr. Gerry Burke, who was the clinical director. I believe he met with all Oireachtas Members based in the mid-west in, I think, 2019. His research shows that five of the hospital groups had 25% more hospital doctors, 27% more consultants, 50% more health and social care professionals and 7% more nurses and midwives than UL Hospital Group and that ULHG needed 130 more doctors, 120 nurses and 200 health and social care staff to bring it up to the same level as the five other hospital groups. I know some work has been done since that meeting.

Stephen Donnelly (Wicklow, Fianna Fail)
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When was that?

Annie Hoey (Labour)
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It was in 2019. Those were the figures at the time. I think Dr. Burke said at the time that the hospital needed an additional €40 million a year. I do not know if the Minister has figures to hand as to how close the figure has gone to €40 million since 2019 or if it has gone over €40 million. My colleague, Councillor Sheehan, said he does not believe anything will change until the resourcing issue is dealt with and that it is important the Government, the HSE and the Department of Health officially accept there is a funding and staffing deficit at UHL. He has outlined that about €40 million over three years will be needed to tackle overcrowding and to bring ULHG up to the same standard as the other five hospital groups. Beaumont Hospital in Dublin serves a similar population and a similar catchment area, but the difference in the number of doctors, nurses and administration staff is remarkable and does not seem to make sense. I am speaking of only one Labour Party councillor in the area, but there is a whole Labour Party councillor team in Limerick. I do not want to forget the rest of my colleagues, all of whom have called for the opening hours-----

Lorraine Clifford-Lee (Fianna Fail)
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The Senator will be in trouble if she-----

Annie Hoey (Labour)
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I know. I should start ticking everyone off. All of them have called for the opening hours of Ennis and Nenagh hospitals and St. John's medical assessment unit to be extended from the current hours of 8 a.m. to 6 p.m. to divert more non-critical patients away from the emergency department in UHL.

Friends of mine or people I know in Limerick have got in touch with me about other matters. This is not directly related to accident and emergency but I think it is related to UHL and other areas. One person highlighted that Limerick has no 24-hour sexual assault treatment unit and no Saturday unit, which means it can operate only when the other clinics are closed, which in turn means, in practice, that someone who has been sexually assaulted may have to wait 12 hours without eating, drinking, changing clothes or moving until the clinic opens. Someone got in touch to say they felt that was an issue in the region.

Someone else got in touch to say the lack of community mental health services in the region is an enormous problem. What is there is predominantly psychiatry, waiting lists and short appointments. There is the length of time it takes medications to work and wild over-reliance on medications that are barely at placebo levels of efficiency, which have made what is there seem pointless to many people and exacerbated the crisis. The child and adolescent mental health services, CAMHS are a disaster, as we know, and there is nowhere for a distressed person to go except into an accident and emergency department, which is obviously part of the issue in the region. This person also said the services are not equipped to deal with dual diagnoses - neither, to be fair, are a lot of the services - which is ridiculous and needs to be addressed as a matter of urgency. Addiction is a symptom of distress. There is a severe need for holistic services all under one roof in the community. There are waiting lists in the order of months or a year for anything at the moment.

Another person got in touch to say people need proper community care alternatives to hospital emergency departments. There has to be a stronger co-ordination between community care facilities and hospitals to ensure step-down beds - we spoke about this last week and have spoken about it many times - are available in the community for speedy discharges and to ensure home help is readily available for people.

A recently qualified doctor in the region got in touch with me to say she knows people are not coming into UHL accident and emergency department when they need to do so because of fear. She knows that is costing lives, and that is heartbreaking.

Maria Byrne (Fine Gael)
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Are Senators Carrigy and Lombard sharing time?

Micheál Carrigy (Fine Gael)
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Yes.

Maria Byrne (Fine Gael)
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Is that agreed? Agreed.

Micheál Carrigy (Fine Gael)
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I welcome the Minister. I am speaking in support of my colleagues regarding what has turned out to be an extremely serious issue. It has been highlighted by the Senators from Tipperary, Clare and Limerick. Whatever has to be done should be to be done in order to address it.

If I might digress for a moment, I wish to put a number of issues relating to my area on the record. Longford does not have a general hospital. The main general hospital that serves the people of Longford is located in Mullingar, where excellent care is provided. We do have St. Joseph's campus, however, a facility with which the Minister will be familiar. Among the issues I wish to highlight is the fact that until recently there was only one palliative care bed on St. Joseph's campus. I have raised this matter on a number of occasions since I was elected. A second bed has been added while the development relating to the new configuration at the campus is taking place. However, the figures show that a greater need exists. We should not have a situation where there would not be a bed available to allow a person to pass away in their home area. A 20-bed unit is being developed in Tullamore, but I want additional bed space to be provided at St. Joseph's.

There is an issue whereby MIDOC GP CLG went into administration just before Christmas. This issue was made known to the Minister recently. A new contract with the doctors has not been agreed. A temporary contract is in place, but we need to have a permanent contract sorted out immediately. I hear talk to the effect that it will hopefully be in place by the end of March. That is not acceptable. I am aware that the matter does not come fully within the Minister's remit. However, we need to progress the negotiations with the doctors and get the permanent contract in place in order to provide the people in my home county with certainty as to the fact that the service will be available. We had an issue a number of weeks ago where a locum was not available and people were referred to Mullingar to access MIDOC service there. I do not think that is acceptable.

There is also the issue of the radiology department. We have a fantastic radiology department that needs to be upgraded. We should not have a situation where people go to Mullingar when we have the service available in our county. If we want to reduce the large number of patients in accident and emergency departments, we should upgrade the facilities that we have.

I take this opportunity to extend an invitation to the Minister. Councillor Peggy Nolan, who the Minister knows well and who is a fantastic advocate for the hospital, and I would like him to come and meet us in order that we can show him the fantastic facility we could have if we got investment and additional resources.

Tim Lombard (Fine Gael)
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The Minister is more than welcome. We are having a very interesting debate about the UL Hospitals Group and where matters stand. The first line of the motion is really important. It is amazing that €24 billion is being spent on health. That is the core issue: we are now putting as much money as is required into the health service.

I will speak openly about what we have in my part of the world. We have the best medium-sized hospital in the world , namely, Bantry General Hospital. The management of the hospital have worked on its potential in the past few years. There are 17 house doctors, six consultants and an overall staff of 300 at this hospital that is located in a remote area. The biggest factor that comes into play is confidence. When there is a bad story about Bantry, staff do not want to go there because they are of the view that it is being talked down. This is no longer about money; it is about trying to get staff into the system, building confidence and making sure that said confidence is built in order staff will follow the approach that has been adopted. Unfortunately, a really important aspect of this debate is that if people continue to talk down both the health service and the those on the front line and the work that they do, then staff will not come to a particular district or hospital.

If we are talking about remote locations, we have to look at Bantry. It is what it is, but it is a fantastic location. We need to start talking up what is being done. Twenty four billion euro is an amazing amount of money to put into the health service. Capital development has come through. The unemployment rate has fallen below what was a 20-year record. We need people. The only way to attract people is to build confidence and start talking up what we have done. That is what we need to do. We are making the investment. We are going have a world-class health service in a matter of years. It takes time to build a service. If we continue to talk it down, unfortunately, people will not go into it.

Maria Byrne (Fine Gael)
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Go raibh maith agaibh. I ask the Acting Leader to suspend the House until after the vote in the Dáil.

Martin Conway (Fine Gael)
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We will suspend proceedings until after the vote in the Dáil.

Maria Byrne (Fine Gael)
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Is that agreed? Agreed.

Seán Kyne (Fine Gael)
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I welcome the Minister. I acknowledge my colleagues, Senators Conway, Byrne and Ahearn, for tabling this comprehensive Private Members' motion. It is unusual to have such a specific regional topic brought before the Houses. It is important to acknowledge that, because the Fine Gael group decided to use its slot, which comes up every number of weeks, to highlight a specific hospital in a specific region. It is also important to highlight the issues of concern in University Hospital Limerick and in Ennis and Nenagh, as Senator Conway has done in the Joint Committee on Health. It is a very important topic, which is why we are discussing it. It has generated a lot of publicity in recent months for the wrong reasons. I pity the staff, who work in difficult circumstances in all of our hospitals but particularly in hospitals that are under pressure and have been in the headlines in recent months, as Limerick has been. There are fluctuations at different times in different hospitals, but it is unusual for there to be such a prolonged period of problems as there has been in Limerick. It is unfair on both the staff and the patients and puts pressure on them. Unfortunately, I have even heard of people in Galway who have decided not to attend hospitals because they are listening to true stories about the pressure Limerick is under. That is a concern I have.

The motion lays out the comprehensive investment that has taken place in Limerick over a number of years and in the associated hospitals in Ennis, Croom and Nenagh. It is important to acknowledge the investment that has taken place because there has been an accusation that members of Government voted for budgets. Certainly, in the case of Fine Gael, we have voted, since 2011, for budgets and capital plans that have allowed for investment, and that has to be acknowledged. However, there is a need for more beds and more capacity such as the 60-bed ward that was completed and opened. There is a need for additional investment, as highlighted. I note too the reference to the reconfiguration of the vacated emergency department. That was done in Galway and the additional ten beds have improved the situation there. Looking at that example and at other hospitals, the provision of small numbers of additional beds, where it can be done and they can be staffed safely, improves the situation. However, there is clearly a need for additional capacity and additional beds in Limerick, and I commend the Senators on their contributions.

In the case of the Saolta hospital group, we can see the difficulties general and community hospitals and nursing homes have in finding staff. Despite international trawling, the last notice I received showed 13 empty beds in Áras Mhic Dara sa Cheathrú Rua. Tá fadhbanna ansin ó thaobh na ndeacrachtaí atá ann chun altraí a fháil don ospidéal agus don ionad sin agus sa Chlochán, áit a bhfuil easpa foirne freisin ó thaobh altraí. Tá spás, airgead agus leapacha ann ach nach bhfuil Feidhmeannacht na Seirbhíse Sláinte in ann altraí a fháil. It is a staffing and recruitment difficulty in terms of being able to get nurses. For example in Clifden, County Galway, they put out a specific call for staff. There were a number of expressions of interest and a number of people called to interview.Five were offered jobs. One accepted a job offer but would not be available until 2024. That is one specific regional hospital in Galway. It goes to show the difficulties in recruiting. Once upon a time, it was the case in this country that there were no jobs. Now there are jobs available across a variety of sectors but it is difficult to recruit people. We need to continue looking out for international nurses to fill those vacancies because it is hugely important that they are filled. The situation has a knock-on effect on the emergency department and the discharge of patients. That knock-on effect puts emergency departments under pressure, of which we have seen many example. The HSE has stated that we must learn from both success and failure. Which hospitals have performed well this year? I know not all hospitals are the same, but which hospitals have performed well in recent months and what lessons can they give to other hospitals that are having difficulties? University Hospital Waterford has been mentioned as a successful example. What is the hospital doing that explains its success? Is it a management issue or a capacity issue? Why are other hospitals, such as University Hospital Limerick, falling down? I again commend my colleagues on bringing forward this motion.

Aisling Dolan (Fine Gael)
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I welcome the Minister to the House to speak about the issue of emergency departments, which is crucial across many areas. I thank Senators Conway and Maria Byrne for bringing forward the motion. There is pressure on emergency departments. Senators have raised issues, particularly in respect of University Hospital Limerick. I want to speak specifically about the Saolta University Health Care Group area in CHO 2, which includes Portiuncula University Hospital, Roscommon University Hospital and University Hospital Galway. There are three issues, the first of which is capacity in our emergency departments, how space is used within hospitals and how hospitals are trying to manage. The second issue is the reduction in the number of nursing beds, the step-down facilities that hospitals can use when community intervention teams are coming to help people discharge. The third issue relates to GPs in the community.

The Minister will be fully aware that the catchment area of Portiuncula University Hospital contains almost 400,000 people. It is based in east Galway but covers an enormous area. It is the hospital for Athlone, a town of more than 20,000 people. It also covers counties Roscommon, Westmeath, Offaly and Tipperary, as well as Galway. It experienced its worst ever January for the number of patients on trolleys. The hospital, based in Ballinasloe, has close to 1,000 staff. I fought hard in 2019 to secure a meeting with the then Minister for Health, Deputy Harris. At that meeting, we were able to move forward a project of the senior clinical team in Portiuncula for a 50-bed ward block. Funding was allocated to move that project on to the next stage. The ward is now under construction. People in Portiuncula can see that the new ward is under construction, which is wonderful, but the process started back in 2019. It should have started five or six years earlier. The new ward is now under construction but the hospital does not have any additional beds right now. There are 13 single beds. Enormous pressure has been put on services. The hospital is converting the outpatient department to allow for eight single en-suite rooms. It will also have two additional rooms. Staff are trying to make these changes within the hospital but the hospital dates back to the 1940s and contains multi-bed wards and so on. One can only imagine the situation. There is, however, an amazing team there who have been striving for years to cope.

The general manager and the senior clinical team at the hospital have now applied for ten additional bays in the emergency department. That submission has gone from Saolta on behalf of Portiuncula University Hospital to the Department. The Minister will be looking at the issue with the HSE and its new interim chief executive, Bernard Gloster.

It is crucial that we consider capacity issues, modular construction or the building of some type of additional accommodation around emergency departments. There is enormous pressure here. The emergency department in Portiuncula University Hospital cannot cope with the pressure, which is the result of Covid-19, respiratory syncytial virus, RSV, and the other viruses that are circulating.

The Minister will also be fully aware of the other challenge in my area, that is, our older population. It is a regional area. It does not have a large, city-centre, urban population. We are spread out and managing a more regional, sparse and widely dispersed population. The population is older and has different needs. The challenge is the reduction in the number of nursing home beds available in the Saolta area. I am sure the Minister is aware that we have lost nearly 150 nursing home beds. Small nursing homes in Roscommon and east Galway have closed. Areas such as Kiltormer and Dysart have been affected. These were small nursing homes and I understand there are issues in respect of their feasibility. I am asking for innovation around how we support nursing homes that have beds available as step-down facilities. We cannot lose more beds in an area that is struggling so much at the moment. We simply cannot lose more beds. Is there any type of co-operation model within smaller independent nursing homes? I know there are also larger corporate entities. I am asking about how we look at this. I urge the Minister to come up with some other solutions around nursing homes and how we access those beds.

I also raise the issue of GPs. I thank the Minister. We worked hard with the Minister of State, Deputy Rabbitte, on the issue before Christmas. We had meetings with GPs in our area and €436,000 was allocated, with the support of the Minister and the Government, to help GPs in that area. The money provided Westdoc facilities for GPs all around the Ballinasloe and south-east Galway area. We hope that will relieve the pressure on hospitals and emergency departments. It is crucial that the access to diagnostic services that has been provided for GPs under the winter service plan can be continued.

There are phenomenal multidisciplinary teams in Roscommon University Hospital. The National Ambulance Service, as it has in Ennis hospital and University Hospital Limerick, is looking at how to identify patients on the basis of their level of need and considering whether Roscommon University Hospital can support those patients. It is important that there is a referral for these medical assessment units.

The Mayo Roscommon Hospice Foundation is wonderful. The Minister attended its Roscommon palliative care unit in November 2021 and we had a wonderful launch. The facility is due to open shortly. The staff are being trained there in the coming weeks. There will be an additional eight beds. Staffing will come from Roscommon University Hospital to allow the hospice to operate. Like many other things, it has taken too long. I know there are many challenges involved, but we need access to those beds. It will be crucial for that to happen in the coming weeks. The staff will be trained and we need the facility to open shortly.

I also ask that consideration be given to Sacred Heart Hospital and that 50-bed unit. It is all about capacity. I know that the brand-new chief executive of the HSE will be working hard to consider how to provide immediate capacity.

To conclude, there is €24 billion in the budget. The Minister has a lot of support. There has been a 17,000-strong increase in staff. We have nearly 140,000 staff in the Minister's area. Three is so much we can do. We need to consider immediate access to additional and modular accommodation and the expansion of emergency departments.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Senators who tabled the motion and those who have spoken during the debate. This is a constructive motion. I have listened carefully to the ideas that have come forward in respect of what needs to be done. I share the concerns that have been raised about some aspects of urgent and emergency care in the mid-west. Those concerns do not only apply to the mid-west. There are concerns in Cork, Galway, parts of Dublin and Letterkenny. There are concerns around the country. However, we are talking specifically about the mid-west and University Hospital Limerick. I want to say clearly that having people on trolleys and waiting for ward beds for long periods after admission is unacceptable. The numbers in Limerick have been far too high, particularly in respect of those who are waiting for a long time and particularly when it comes to elderly people or patients who are more frail or sick. It is unacceptable. It is not something that our healthcare providers want. It is not something that anyone in the Oireachtas wants.

I have visited University Hospital Limerick several times. I have been in the emergency department several times. I have met patients and their families. I have been in many emergency departments around the country because I wanted to see and hear first-hand what was happening, what was working and what was not working, and what was being experienced.What we are seeing in Ireland is being seen across Europe. We had three particularly bad days several weeks ago. Some of the high numbers over the winter are due in part to the unprecedented combination of Covid-19, flu and RSV, which is causing emergency department pressures, not only in Ireland but also in some of the best resourced and best-run healthcare systems in Europe. We need to be conscious of that context. However, regardless of the pressures this or any winter, it is simply unacceptable to see this number of patients waiting on trolleys for admission to hospital. It is not a new problem but it is a problem we must and can solve.

I met with the emergency department, ED, task force earlier today and we discussed various ways this can be addressed, not as a winter issue but in terms of access to urgent and emergency care. Last summer the figures were far too high. As I said to the ED task force, my Department and the HSE, this is not about solving a winter problem. This is about ensuring we have an urgent and emergency care service that gets people the care they need throughout the year. We will do additional things in the winter when we are dealing with the extra pressures.

Demand for care, including urgent and emergency care, is growing. We know that. While our public health service and governments have tried to respond to this for many years, there has been a deficit in capacity. Our public health providers have been trying to respond to growing demand without the toolkit or firepower they needed in terms of beds, diagnostics, workforce, community care and many other things. What are we doing about that? This Government is responding in a completely unprecedented way in fundamentally increasing the capacity of our public health services. We have added nearly 1,000 hospital beds, more than 360 community beds and 65 critical care beds, and we have increased the HSE's workforce by more than 17,000 people. That is thousands of additional nurses, doctors, dentists, healthcare assistants and many other healthcare providers. It is not enough. We are addressing deficits that have been building up over many years, but we are addressing them and we are doing so more quickly. We are building capacity in the system more quickly than it has ever been done.

There is much talk about recruitment crises and finding it hard to get healthcare professionals. That is true across the world, and in some hospitals and specialties it is also true in Ireland, but in fact this year will be the fourth year in a row of record recruitment into our public health service, the HSE. We need to recognise the level of Government commitment to the matter of public resources and the response of the HSE in hiring people.

In the context of today's debate, I have engaged extensively with the University Limerick Hospitals Group about the pressures being dealt with there. Many Senators were at a meeting I convened for Oireachtas Members with the hospital group, which the Taoiseach also attended. It was an important and constructive meeting and I took a lot away from it.

We know that part of the solution is more capacity in the hospitals and, critically, in the community. I will talk first about the capacity that has already been invested in UHL and the UL hospital group. As per the motion, a new emergency department was put in place in recent years. We have heard calls for more beds. What does not get covered very often is that, since Covid-19 started, there are 150 additional beds in the group, 132 of which are in UHL. The workforce and consultants in UHL have said they need more beds. We agree. We have already added 132 beds. I also turned the sod recently on another 96-bed block. That is a lot of additional beds. The leadership in Limerick has said more staff are needed. Again since Covid, the workforce in UHL has increased by 1,000 healthcare professionals. That is a huge increase.

I apologise, I do not know what the protocol is. I can keep going for a few minutes, but when the bell stops, I will have to go to the Dáil to vote. I apologise to the Chair and Senators.

Jerry Buttimer (Fine Gael)
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That is fine.

Stephen Donnelly (Wicklow, Fianna Fail)
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The budget has increased by 20%. In 2019, the hospital budget was €265 million. It is now €315 million. There has been a large increase of money, workforce and beds. In the emergency department, extra emergency medicine consultants have been sanctioned. Under the safe staffing framework for emergency departments, 21.5 additional whole-time equivalent nurses have been sanctioned for UHL and 19.5 of those nurses have already been recruited. Senator Gavan pointed out, at least technically correctly, that UHL did not receive any increase in the number of healthcare assistants for the emergency departments. What the Senator did not say is that the reason UHL did not get any more healthcare assistants is that it was already at the high level other hospitals aspire to. When the ratio was increased, it turned out that UHL was already at or above the increased ratio and was already at the safe staffing level, which is clearly an important part of this. We have invested across the group. There is a new injury unit in Ennis Hospital. A state-of-the-art complex was opened in Croom in 2021.

The motion calls on the Government to do more to alleviate the pressures we face today. It is all well and good for us to say we have added a lot of capacity, but critically it is not enough as patients are still, at times, receiving a level of service that is not acceptable to any of us. We have to keep going. The motion calls on the Government to continue to invest and we are doing exactly that.

The National Ambulance Service has a protocol we are aware of that was put in place for the medical assessment units in Ennis Hospital. I am delighted to be able to say it will be in place in Nenagh hospital in the coming weeks and we will also roll it out shortly thereafter in St. John's Hospital.

Martin Conway (Fine Gael)
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That is great news. Well done.

Stephen Donnelly (Wicklow, Fianna Fail)
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That is actively happening and consideration will be given to future capacity, including the two 96-bed blocks. I was talking to the HSE about that earlier today.

I have more information I can come back to on another day, but I will wrap up. The core message is that we will continue to invest in UHL and in the hospital group. We will continue to invest in the workforce and in beds. We are putting a surgical hub and much more capacity in place. The other part of this is that we need changes to working practices, to patient flow through the hospitals and to integrated care pathways between the hospital and the community. Many of those changes are also required. We need both. We have seen the team in UHL respond in recent weeks and drive down the number of patients on trolleys. There were eight patients on trolleys in UHL this morning. In the past week the average has been about six. The team has responded well and we need to acknowledge that.

I will finish there. I thank colleagues and will now have to leave to vote in the Dáil.

Martin Conway (Fine Gael)
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As the Minister is about to leave, I acknowledge and thank him. We are delighted to hear the protocols will be extended to both St. John's and Nenagh hospitals because that was one of the significant requests in our motion. We now know that element of the motion will be actioned. That is fresh news. The healthcare community in the mid-west will welcome it this evening.

On my behalf and that of Senator Byrne, I thank the House for its support for this motion. It is a critically important motion. While we are in government and are supportive of the Government, our job is also to hold the Government and the Minister to account and bring the Minister to the Seanad to explain and give details to the House about what is happening. That has happened here this evening. The Minister for Health, Deputy Donnelly, the senior Minister, has been here.He attended the briefing for all Oireachtas Members in the mid-west a couple of weeks ago. He has visited UHL and did the official sod turning on the 96-bed block that is now under construction. That speaks volumes. I have absolutely no doubt whatsoever in the Minister’s sincerity in working with all stakeholders to resolve this problem.

To sum up, our motion has delivered the extension of the protocols to both St. John’s and Nenagh. Senator Maria Byrne, the Fine Gael group and I are delighted with that news this evening. We want to see the other two 96-bed blocks fast-tracked. I think there is a commitment here that will happen. I encourage the senior management team in UHL to advance its plans as quickly as possible and get them to the Government. I think they will find that the Government will not delay in sanctioning the money.

We will see the surgical unit happen. I want it to happen as quickly as possible. That has proved its worth in Tallaght. It has responded to the crisis in Tallaght in a positive way and I believe it will do the same in Limerick.

On the elective hospital, we have not got the type of clarity we would like on that issue. Hopefully, we will in due course and the Government will see the logic and rationale behind the elective hospital and the need for it to contribute to dealing with the capacity issue in the mid-west region.

Process and management in UHL is critical. Progress has been made and we have seen that with the dramatic reduction in the trolley numbers. The process change has to continue.

Marches and protests have happened – all of that. People are entitled to do that and I support and welcome it. However, if there are alternative governments proposing, we need to know exactly what they will deliver if they go into government. Will we see a reversal of reconfiguration? Will we see the opening of a 24-hour consultant-led accident and emergency service in Ennis and Nenagh? This Government is not promising that because the clinicians do not support it; the clinicians do not believe it would be safe. Hard questions now need to be asked of Opposition Members. Is this what they are proposing? Are they promising the electorate that we will see a 24-hour consultant-led accident and emergency service in Ennis and Nenagh? If that is the case, they should come out and say it. We will start asking them the questions that need to be asked. The people need to know if that will happen. If that is what they are promising, that is well and good. Let us go to the people and have that discussion. However, you cannot have it every way and you cannot have it both ways. They have to say precisely whether they will open level 3 hospitals in Nenagh and Ennis. Perhaps that is what they will do. These questions have to and will be asked.

Overall, the Seanad is supporting what we are trying to achieve in this motion. We had good news this evening. It is an excellent motion. I thank all Members across the House and all parties for participating in it. I commend the motion to this House.