Paul Gavan (Sinn Fein)
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It is always nice to see the Minister of State but I have to be honest, I am more than disappointed that, once again, the Minister for Health has decided not to turn up. I do not know if the Minister of State is familiar with the Coen brothers movie of 2001, "The Man Who Wasn't There". It is a great movie - the Coen brothers always deliver. Perhaps they should write a sequel, "The Minister Who Wasn't There." Frankly, I can only assume it is because of embarrassment that he has, for the second time now, declined to come to the House for a Commencement matter to talk about University Hospital Limerick, UHL. Equally, I have to share with the Minister of State that my colleague, Deputy Quinlivan, is having exactly the same experience regarding Topical Issues.It is particularly disappointing this week because, as the Minister of State may know, a new record was set with 130 patients on trolleys last Monday. Just when we thought it could not possibly get any worse, it continues to do so. I do not know whether he has seen the video posted by the Sunday Worldof the emergency department. We can see patients stacked up in the corridors, one on top of another, right the way through, outside the emergency department and inside. We can see doctors and nurses frantically trying to calm down patients who are in obvious distress because of the fact they are completely stranded without a bed.

The record of the Government is, frankly, appalling with regard to the failures at UHL. There is a record of 12 years of Fine Gael failure in government with regard to UHL. I assure the Minister of State that the people of Limerick will not forget this. It beggars belief as we head into another winter that we are said to have worse figures again this year. Last year. 18,000 patients were on trolleys at UHL. We are already set to beat that appalling record this year. In October, as of last Monday, there have been 1,632 patients on trolleys. The same time last year there had been just over 1,200. There has been a 30% increase on patients on trolleys.

The Minister of State will really appreciate that the trouble with figures is that they do not give any insight into the pain, distress and lost lives. We know from research conducted in the UK that for every 82 patients on trolleys for more than eight hours, there is one death. We can take it from this that each day, at least one life is being lost unnecessarily in UHL. This week there was a telling interview with the INMO official, Mary Fogarty. In exasperation, she called for a halt to all elective procedures because of the impossible conditions that her members, the nurses, are put under at UHL. The same extends to healthcare assistants, porters and all of the other vital staff in the hospital.

This is compounded by the fact that the Minister for Health was thrown under the bus by the Minister for Finance just two weeks ago in the budget, with a large deficit for the health system and a freeze on recruitment. As healthcare assistants decide to leave UHL, they will not be able to be replaced. I know some of them who have left because of the appalling conditions there. How on earth will we get through this winter? Last winter the system entirely collapsed. Shannondoc collapsed and the whole system collapsed. I was going to ask the Minister for Health, and I hope the Minister of State will have some answers on his behalf this morning, what particular interactions is he planning to make sure we do not have a repeat of this crisis as we head into another winter.

I remind the Minister of State that we have been told by the HSE that the 96-bed unit promised to be delivered next year will not be ready until 2025. This will only deliver an additional 48 beds because 48 existing beds will be phased out. Even when we have this unit, which is at least two winters away, there will still be a large deficit in beds. We are 200 beds short. This is a failure of planning and a failure of capacity. It is always at the expense of the people of Limerick. I look forward to the response from the Minister of State.

Neale Richmond (Dublin Rathdown, Fine Gael)
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I greatly appreciate the opportunity to reply to Senator's matter. It is always good to see the Senator, regardless of the seriousness of the nature of the debate. This should be reflected.

As the Senator alluded to, the Minister for Health has been concerned for some time about the congestion experienced in the emergency department at UHL, leading to long patient experience times and patients waiting on trolleys for admission.

There were just under 80,000 attendances at the emergency department in Limerick in 2022, up 12% compared to 2019 and 13% higher than the average of 2017 to 2021. There continues to be a high level of presentations in 2023, with more than 59,000 attendances between January and September of this year. This represents a 11% increase on the same period in 2019. Crucially, the attendance figures for patients aged 75 or over has increased by 30% compared to 2019.

There has been, and continues to be, substantial investment in capacity in UHL, including the opening of an additional 98 acute inpatient beds, and a 19% increase in budget in 2022 compared to 2019. Ennis and Nenagh model 2 hospitals and St. John's model 2S hospital are also playing a key role in delivering high-quality patient care in the wider mid-west. Further funding of €5.2 million was allocated this year to medical assessment units in these three hospitals, which now operate 12 hours a day, seven days a week. These units provide earlier treatment, allowing patients to avoid the emergency department, and they ensure community referrals. In addition, the medical assessment unit pathway for 999 patients in Ennis and Nenagh hospitals has been extended to St. John’s Hospital since 4 August.

As part of last year’s national winter plan, there was a bespoke, site-level plan for Limerick. While the winter plan officially ended at the end of last winter, many of its initiatives continue to be implemented. The local plan focused on local needs and builds on integration between the community and acute hospital services. It includes measures such as the recruitment of extra staff, including, but not limited to, two whole-time equivalent emergency medicine consultants, additional emergency department registrars and discharge co-ordinators to target patient flow. The plan also includes improving access to diagnostics for urgent and emergency attendances in the emergency department and for GPs, and the enhancement of GP out-of-hours supports. The plan also includes the recruitment of administrative staff and the creation of the performance management office to drive the ongoing service improvements.

The Minister asked the HSE to develop a new approach to urgent and emergency care planning to reflect the year round demands on emergency departments, including in UHL. The approach to planning urgent and emergency care is twofold. It comprises the delivery of an operational plan for 2023, approved by Government in July, and the delivery of a three-year multi-annual plan, expected to be submitted to Government in the coming weeks. The Department of Health is working with the HSE to ensure that the operational plans are fully implemented.

I share the frustration of the Senator, as do all representatives regardless of whether they are from Limerick. The images we saw posted by the Sunday Worldwere absolutely harrowing. I was doing my leaving certificate in 2001 and I do not remember that particular Coen Brothers movie. I do remember the video posted in recent days. It was absolutely shocking. It is a requirement for the Government to react to it and to continue to increase the level of investment.

To be quite factual with regard to many of the recruitment changes that have happened as part of the budget, no one was thrown under the bus. Throwing out such slurs does not add to the debate on serious matters such as this. Health funding was increased in the State. It is always reviewed. Many of the positions identified for additional recruitment have not yet been filled. All of these issues remain under review. At the top of the priority list for anyone is to ensure the delivery of care and support for everyone in the country, particularly those in Limerick and the wider mid-west.

Paul Gavan (Sinn Fein)
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I thank the Minister of State. I appreciate the fact that he has gone to the best extent he can in giving me a response. I acknowledge this. I have a couple of key fundamental problems with the response. The measures taken to date are not working fully enough. Conditions continue to get worse and, in fairness, the Minister of State has acknowledged this with regard to the horrific video we have both seen.

When the Minister for Health was last in the Chamber, he was in denial about the INMO figures. This is fundamentally a massive problem. If he does not accept the INMO figures, which he was happy to accept when he was in opposition, then he really does not understand the extent of the crisis. In February, he insisted there were eight patients on trolleys when in fact the INMO figure was 78 patients on trolleys. The feeling of people in Limerick is that this is a Minister who does not understand the depth of the problem and has failed so far to get to grips with it. What I want to understand in particular is what additional steps he will take, for example, to utilise private hospitals if required to ensure the ongoing daily crisis in UHL is halted for the sake of the patients and their loved ones who, even as we speak, are struggling on trolleys again this morning.

Neale Richmond (Dublin Rathdown, Fine Gael)
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As I mentioned, significant resources have been invested in UHL in recent years. I want to outline some of what has been invested in and is onstream. We saw an increase in the workforce in UHL of 36%, or 966 whole-time staff, at the end of 2019. Recently the Minister opened new theatre wards in clinical areas in Croom Orthopaedic Hospital. This includes the development of an ambulatory trauma service to facilitate the transfer of trauma patients from UHL for surgery and recovery, improving flow and reducing congestion.

A key part of the solution for Limerick is additional beds. Work on the new 96 single bed inpatient block commenced in September 2022. This additional bed capacity for the midwest is expected to be operational in mid-2025. Pending planning approval, the next step in the development of a second 96 bed block will continue. The Department regularly seeks assurance regarding the appropriate escalation measures for the emergency department. We have seen increased funding provided for additional GP access to diagnostics in primary care, allowing for patients to be referred directly for x-rays or scans. In the mid-west, more than 1,400 of the scans are being completed each month. These are all part of the many solutions required to address what is an extremely acute regional problem for Limerick and the mid-west.