Dee Ryan (Fianna Fail)
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Cuirim fáilte roimh an Aire Stáit. It is great to have him in the Chamber and I thank him for coming to discuss the matter I have raised, which is the chronic shortage of accident and emergency capacity in the mid-west. The situation at University Hospital Limerick is simply unacceptable. The 420,000 people in Limerick, Clare and north Tipperary must rely on one overcrowded and under-resourced emergency department. This morning once again, UHL has the highest number in the country of people sitting on trolleys awaiting beds. The people of the mid-west are fed up. We are fed up with the dangers our loved ones face. We are fed up with the intolerable situations and conditions that our nurses, doctors and other hospital staff are working in. We are fed up with constantly hearing for more than a decade that we have the worst hospital overcrowding in the country.

As I stand here, I am conscious of the heartache and suffering of families affected by this crisis. In particular, we cannot discuss emergency department overcrowding without remembering Aoife Johnston, whose tragic and avoidable death at UHL must be a wake-up call.

UHL is a model 4 hospital. There are nine model 4 hospitals in the country. They are top-of-the-range hospitals, with expertise and facilities to cater for large catchment areas. Is the Minister of State aware that every other model 4 hospital in the country has at least one model 3 hospital with a 24-hour emergency department supporting it? Is he aware that UHL stands alone in the country as the only model 4 hospital without a second emergency department in its catchment area supporting it? Is he aware that, of the five hospitals with increased trolley numbers in the country, UHL was the only one that saw a further increase last year and not a decline in its numbers?

I acknowledge the progress made in the term of the previous Government. The first of multiple new bed blocks - a 96-bed block - is under construction on the UHL campus and there for all who are passing to see, with further bed blocks planned and in design. Perhaps the Minister of State will be able to provide us with an update on it. Recruitment has commenced for when the new bed blocks are ready to open, which is welcome.

A surgical hub for elective procedures has been commissioned and given the go-ahead for Limerick. We have seen a 41% increase in staff numbers at UHL since 2019, and a 44% increase in the budget has been given to UHL to deliver services to the people of the mid-west. While these investments are very welcome and much needed, the demographics and population growth projections tell us they will not be enough on their own. I ask the Minister of State to convey to his colleague, Jennifer Carroll MacNeill, an invitation to come and witness the crisis for herself and to hear directly from the management and staff in UHL about how bad things are.

I have one more question for the Minister of State this morning. What immediate strategies is the Minister planning to ease pressure on the emergency department in UHL, which, regrettably, is a factor for us every day of the week and not just at weekends?

Jerry Buttimer (Cork South-Central, Fine Gael)
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I thank Senator Ryan for raising the matter of the emergency department in University Hospital Limerick. In the previous Seanad, the Leas-Chathaoirleach raised it continuously. Senator Ryan is correct, in that it is completely unacceptable. For those of us who do not live in the catchment area, it is beyond belief as to how we are continuously in a place where concern is expressed by Members and others about the hospital.

In discussing this matter, we remember Aoife Johnston. I thank Senator Ryan for remembering her this morning.

It is important to recognise that UHL has experienced high levels of congestion again this winter, with a peak of 91 patients on trolleys in the middle of January, as per the HSE TrolleyGAR figures. As Senator Ryan rightly said, the impact on patients and their families is way too high and we cannot allow this to continue.

On 18 February, the Minister for Health brought a memo to the Government regarding the situation set out in the report on urgent and emergency care this February, specifically on the spike in trolley numbers nationally after the bank holiday weekend. The Minister briefed the Cabinet on recent trends in poor patient flow and the build-up of inpatient congestion over weekends. Patient flow must be carefully managed seven days a week. The number of patients admitted and discharged must be kept balanced to avoid congestion, which results in patients waiting on a trolley for a bed.

Ensuring that sufficient numbers of senior decision-makers are rostered to discharge patients throughout the entire week, including evenings, weekends and public holidays, is fundamental to managing patient flow. The public-only consultant contract, introduced in March 2023, provides for evening, extended out-of-hours and Saturday rostering. Attention must now focus on realising the benefits of this contract to increase access to services in the evenings and at weekends.

The Government is committed to ensuring that every necessary measure is taken at UHL to ensure the smooth running of the hospital. UHL is being supported by a large ongoing programme of work to increase capacity in terms of staffing and beds. For the information of Members, the budget for UHL has increased by €224 million, or 84%, from €265 million in 2019 to more than €489 million last year. Staffing has increased by 43% since December 2019, including 62 more consultants, 192 more doctors and 442 more nurses and midwives. Between 2020 and 2023, €90.6 million in capital investment was assigned to UHL. A total of 166 new acute beds have opened in the mid-west region since January 2020, including a 16-bed unit delivered in 2024. The Government is providing for increased capacity, with a new 96-bed block due by the middle of this year and a second new rapid-build 16-bed unit later this year.

Enabling works are under way for a second 96-bed block at UHL and a further 84 inpatient beds are planned through the acute hospital inpatient bed capacity expansion plan. Overall, 582 new inpatient beds will be delivered in the mid-west region between 2020 and 2031. Other measures to alleviate congestion include the extension of opening hours for medical assessment units and the delivery of a new surgical hub.

On the question Senator Ryan raised about other hospitals in the area and emergency departments, opening hours have already been extended from 8 a.m. to midnight at the medical assessment units, MAUs, in Ennis and Nenagh hospitals and the waiting list action plan for 2025 will reduce waiting times for patients. In September 2021, the average time on the list in the mid-west was just under 16 months. By January 2025, the length of time waiting improved to less than six months.

I thank the Senator again for raising this matter. It is of great concern and something that we must continue to be vigilant about and work on, ensuring that we deliver for patients and staff in the mid-west. I apologise that the Minister was not here to take this Commencement matter.

Dee Ryan (Fianna Fail)
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I thank the Minister of State for the update. I acknowledge the extensive investment the mid-west received in the course of the previous Government. When I heard the Minister of State call it all out for us, it sounded very impressive, but the mid-west was already at a significant disadvantage in terms of hospital care and the efforts made thus far have not yet brought it to a par with the rest of the country. Without a second emergency department in the region, I fear UHL will remain overwhelmed and the situation may worsen as our population ages and grows.

Senator Dee Ryan: I thank the Minister of State for the update. I acknowledge the significant investment the mid-west has received in the course of the previous Government. It is extensive. When I hear the Minister of State call it all out as he has just done it sounds very impressive but ew were already at a significant disadvantage in terms of hospital care. The efforts made those for have not yet brought us to a par with the rest of the country. Without second emergency department in the region I fear you H will remain overwhelmed and the situation may worsen as the population ages and grows.While patient flow improvements are necessary and while we need more consultants to adopt the new roster, these measures alone, however, will not address the reality of a lower number of ED beds per capitain the mid-west than any other place in the country. I stand ready to support the Minister of State and the Minister in government but I wish to get an update on the HIQA report that was commissioned last year by the then Minister, Stephen Donnelly, on accident and emergency capacity in the mid-west. I wish to discuss the matter further at the next opportunity.

Jerry Buttimer (Cork South-Central, Fine Gael)
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I thank Senator Ryan for raising the matter and she is right that investment alone will not solve the problem. A wholehearted, collaborative approach around management, investment and patient flow is needed. She is correct; the people of the mid-west deserve access to responsive, urgent and safe emergency care. It is about the combination of increased capacity and reforms, which the Government is aiming to deliver.

More beds and more investment at UHL are important and critical. The Senator made reference to the HIQA report. As she rightly said, the Government has asked HIQA to lead a review into urgent and emergency care in the mid-west, including consideration of the need for a second emergency department. The Government expects the HIQA interim report shortly, with a final report due some time around May of this year. The Minister for Health, along with the Government, will fully consider the HIQA report when it becomes available and the Minister will take any action that is deemed necessary to ensure, again, the quality and the safety of delivery of further and future urgent and emergency care services for the people of the mid-west.