Paul Gavan (Sinn Fein)
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I wish to put on record that I am more than disappointed that the Minister for Health is not present. He has bottled it because he knows he has no answers to the issue I will raise in respect of University Hospital Limerick, UHL. I am interested to hear the response of the Minister of State who is from Limerick. He may be aware there is considerable divergence between the official HSE figures for the number of admitted patients on trolleys and the figures as counted by the Irish Nurses and Midwives Organisation, INMO. During a debate in the Seanad on Wednesday, 1 February, the Minister, Deputy Donnelly, said there were just eight patients on trolleys in UHL that morning. He went on to say, "In the past week the average has been about six." However, figures from the INMO show there were 78 people on trolleys in UHL on the morning of 1 February. In the week before that, there were between 44 and 65 patients waiting for an in-hospital bed. Mary Fogarty, the INMO assistant director of industrial relations, told the Limerick Post that the Minister's figures have no basis in reality. She went on to say:

We were at the hospital on Thursday, February 2, and established that his figures are absolutely wrong. I have no idea where the Minister got the figures but there were 77 people on trolleys when we were there.

The Minister of State knows Mary Fogarty. I spoke to her yesterday. She described the HSE figures as bizarre and confirmed that the INMO figure is taken at 9.20 each morning. As the Minister of State will be aware, the HSE figure is taken three times a day and claimed there were eight patients on trolleys at 8 a.m. on the morning in question. It is simply not credible for the Minister, Deputy Donnelly, to state there were eight patients on trolleys at 8 a.m. on 1 February when the INMO tells us there were 78 patients on trolleys at 9.20 a.m. It should be borne in mind that Mary Fogarty spoke directly to staff in the emergency department to verify those figures.

The Minister of State need not take her word on this issue, however. Ger Kennedy of SIPTU, who represents the support staff in the emergency department, also confirmed to me that the HSE figure is nonsense. I put it to the Minister of State that 11,000 people did not take to the streets of Limerick to protest about the chronic crisis in capacity in staffing because of eight people being on trolleys.

The reason this is so serious is that implicit in the statement of the Minister, Deputy Donnelly, is a belief that there is no crisis in respect of patients on trolleys in UHL.I would be interested in hearing the Minister of State's position. While I know he has a script to read, it is too important a matter. I want to know whether the Minister of State acknowledges that the INMO figures are correct. I want to know whether the Minister of State acknowledges there is a massive crisis with patients on trolleys in University Hospital Limerick. I ask this because, frankly, when the Minister was sitting in that seat two weeks ago, he said quite the opposite. He stuck to the figure of eight patients that the HSE gave. The Minister of State and I both know those figures are absolute nonsense. There is a difference in how the figures are calculated, but in no way do they go anywhere near closing the gap between the two figures, which are eight patients and 78 patients. By the way, if one looks at the figures over the last month, it will show that a significant gap is always there. There are gaps of 40, 50 and 60 between the INMO and the HSE figures.

It is worth exploring this topic. We know if that if a patient is in a cubicle in the emergency department in UHL, and he or she is still on a trolley, mind, that person will not be included in the HSE figure. Is the Minister of State happy with the exclusion of those people from those numbers? We know the INMO also counts patients placed on wards, corridors or chairs elsewhere in the hospital who are waiting for admission to a bed. However, the HSE figures the Minister quotes excludes those people again. What is the Minister of State's opinion on that? Does he think people who are on trolleys who are not in the emergency department should be excluded? Clearly, the Minister for Health does. I remind the Minister of State that previous Ministers for Health, such as the Minister of State's colleague, James Reilly, were happy to accept those INMO figures. Indeed, when Deputy Stephen Donnelly was in opposition, he was happy to quote the INMO figures. However, he has been in constant denial here on not just one but two occasions in the past month. To be frank, I believe that is why the Minister for Health is not present this morning, because he would have no answers in relation to this crisis. The people of Limerick want to know at the very least whether the Minister for Health understands there is a chronic crisis in UHL. He was in denial here two weeks ago. I hope the Minister of State will give me a positive answer and that he will be very clear that he accepts those INMO figures.

Kieran O'Donnell (Limerick City, Fine Gael)
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I am taking this Commencement matter on behalf of the Minister for Health, Deputy Stephen Donnelly. The Senator and I are colleagues in Limerick and I am fully aware of this issue. Senator Gavan will know that I, along with colleagues, have looked to highlight the issues at UHL with overcrowding. I intend to explain the difference and then I will deal with the more local, substantive issues.

I welcome the opportunity to address the House on this important issue, which has been raised by Senator Gavan. Although both the HSE's TrolleyGAR and the INMO's trolley watch counts provide daily reports on the number of patients waiting on trolleys for admission in acute hospitals, there are notable differences in their inclusion criteria. The HSE's TrolleyGAR is a count of all emergency department patients who are waiting to be admitted to an inpatient bed and for whom an appropriate bed space is not yet available. The definition of an appropriate bed space agreed between the HSE and the INMO is that it must have a bed, curtains, access to bathroom facilities and oxygen and suction facilities, must have a named consultant and nursing team assigned and the patient must be on a documented pathway of care. As such, TrolleyGAR includes patients waiting on trolleys in the emergency department and in wards but does not include patients in designated surge capacity beds, which are recorded and reported separately by the HSE. It is my understanding that it does not include people in cubicles. It is our understanding that the INMO may include some surge capacity beds within their trolley counts. There is a definition. I likewise had a look at the figures. In the last two days, the TrolleyGAR recorded Limerick at the figures of 26 and 18. respectively. I do not know what the INMO's figure was this morning because it was not up, but it was 90 yesterday, it was 80 on Tuesday and it was 77 on Monday.

For me, it is a matter of how they are counted, as well as about treatment. I would prefer for someone to be treated in a cubicle than for them to be on a trolley, but it is about dealing with overcrowding in UHL. Whatever metric is used, there is still overcrowding. We have looked to address it through the new emergency department. Some 98 additional acute beds have gone on-site in the last two years. In last three years, there has been a 60-bed acute ward, plus an additional 38 units have been put in during Covid-19. There is a 89-bed acute bed ward that is under construction at the moment. We are looking to get another 96 beds. There is a new consultants' contract coming in.

The numbers went up by a great deal between January and February. That is because electives were restarted and we need to do electives. What I would like to see and what we need to look at - and I hope this will happen under the new contract - is for there to be consultants on duty. There are now 11 consultants in the emergency department. Can we have a mechanism where there is a consultant who is on duty at later times, perhaps up to 12 midnight? Furthermore, will there be discharges over the weekend?

The point is, however, that whatever metric is used, there is overcrowding in UHL. I am conscious of that for the patients and their families who come in. It is something I acknowledge. I am committed to working with the Government, with the Minister for Health, Deputy Stephen Donnelly, and the Taoiseach in order that we get the numbers of trolleys down. Whatever count that is being used, the numbers are too high.

Paul Gavan (Sinn Fein)
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I thank the Minister of State. The point is that the divergence between these figures is such that the HSE figure is simply incredible. I have a huge concern that twice in this Chamber over the past month, the Minister for Health rejected the INMO figures. He insisted there were just eight people on trolleys on 1 February when he was here and he told me that I did not have my homework done. It turns out that he has just written a note to say that he cannot attend school today. The fact he is not here is an absolute disgrace and he has bottled it. I feel sorry for the Minister of State because the fact is that everyone in Limerick knows the INMO figures are correct. Everyone knows there are more than 100 patients on hospital trolleys. Members of all parties have acknowledged it over the last couple of weeks in this Chamber. Yet, the Minister for Health is in absolute denial in relation to this issue. It is hugely disrespectful to the INMO. It is hugely disrespectful to SIPTU, to the front-line workers there in the hospital and at the very least, the Minister needs to come into this Chamber and correct the record and acknowledge that he is fundamentally wrong when it comes to the numbers of people on trolleys in UHL.

Kieran O'Donnell (Limerick City, Fine Gael)
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I acknowledge the phenomenal work being done by front-line workers. I acknowledge the difficulties being experienced by patients who are presenting in UHL. Staff are doing their utmost. We have a capacity issue and we all accept that. The Minister for Health, Deputy Donnelly, is fully aware. These are two different metrics. If someone presents to UHL, I would prefer for them to be in a cubicle to be treated than to being on a trolley or waiting. That, by definition, makes sense.

I have spoken to the Minister for Health many times on UHL. He is fully aware of this and he is fully committed to getting the trolley numbers down, by whatever metric is used. The issue for us in Limerick and in the mid-west is that the hospital requires additional bed capacity. Equally, we need to look at other ways we can improve the patient flow through the hospital itself. I will take the point the Senator has raised back to the Minister, Deputy Donnelly. However, I utterly refute any question that the Minister is not committed to UHL, because at this stage I have spoken to him on countless occasions about the issues in UHL. He has visited it and he is fully committed, as is this Government, to getting the additional capacity into UHL in order that we can reduce the numbers of people on trolleys who present at the emergency department.

Paul Gavan (Sinn Fein)
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There have been 12 years of failure from Fine Gael on this issue.