Dee Ryan (Fianna Fail)
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An tAire Stáit is welcome to the Chamber, and I thank him for coming to take this matter. I raise this matter once more. It is the number one priority for people living in Limerick and a huge concern for people across the mid-west, including in Limerick, Clare and Tipperary. It came up at more doors than housing in Limerick during the general election campaign. That is how sincerely people in Limerick feel about the issue. If the Minister of State lived in Limerick, he would feel this way too.

To recap, there are 450,000 people across Limerick, Clare and north Tipperary. The University Hospital Limerick, UHL, group is the hospital group which operates the region with one accident and emergency department. It is the only hospital group in the country that operates with just one accident and emergency department to serve its population. We have had chronic overcrowding for the past 15 years. We have had record high numbers of patients on trolleys. Just this morning, UHL is again the hospital with the most patients on trolleys in the country. The HSE's population profiles show that more than an average number of amount of people living in the mid-west would be classed as extremely disadvantaged, very disadvantaged or disadvantaged. I will say that again. We have higher than average levels of people in the normal population in the country classed as extremely disadvantaged, very disadvantaged or disadvantaged. We know that there is a correlation between poverty and complex health needs, and, therefore, a greater number of presentations to accident and emergency departments.

I acknowledge the progress that has been made, particularly during the term of the previous Government when staffing numbers were increased by approximately 100,000 healthcare workers across the UHL group. The first 96-bed block is due to open in September, and we are very much looking forward to that. The Minister has been to Limerick and has had a tour of the facility. The second 96-bed block that was commissioned is under way. A total of 16 rapid-build beds were put in place in December last year and a further 16 have been committed to. I understand they will go in this summer. The former Minister, Stephen Donnelly, announced last November a further 84 beds.

This all sounds like great news, and I know and understand that these measures will help to alleviate the problem. However, they are not helping in the here and now. We are already very worried about this winter. We have the highest level of patients on trolleys across the country. The majority of people presenting to accident and emergency departments are elderly people. If an elderly loved one in my family has a slip or a trip and has to go into the accident and emergency department, he or she will be facing a much longer wait, with less frequent access to care, than any other person in the country. That is simply not fair. The people of Limerick and the mid-west are very worried.

I received notice from the office of the Minister last Friday that the HIQA report into accident and emergency care across the mid-west region, commissioned by the previous Minister has been delayed. It was expected to be presented to the current Minister in May and published when she was ready to publish it. I appreciate that the Minister has a lot of important and pressing healthcare matters on her plate. However, my question is that regardless of the recommendations of the HIQA report - and I note that the programme for Government committed to putting more beds into UHL - what actions is the Minister preparing for this winter, as we face into another seasonal surge in illness and as we anxiously anticipate higher than ever trolley numbers?

Christopher O'Sullivan (Cork South-West, Fianna Fail)
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I thank the Senator for raising this issue, which I am taking on behalf of the Minister for Health, Deputy Carroll MacNeill. I know how important University Hospital Limerick is to the people of the region. Clearly, it is a matter the Senator is passionate about and acutely aware of. She has presented her case well, especially her analysis of why there is a higher number of presentations at UHL, which is clearly the case.I will do my best to lay out the situation nationally and specifically that of University Hospital Limerick. A key priority of the Minister is to provide a seven-day health service to the public. Progress has been made over recent bank holiday weekends to ensure patients receive the care they need in a timely and efficient manner throughout the week. Services again undertook significant work in the week preceding the June bank holiday weekend to maximise discharges and patient flow, which was the key factor in ensuring most sites had sufficient capacity to meet demands over the bank holiday weekend. This resulted in 55% fewer patients waiting on trolleys at 8 a.m. over the June bank holiday weekend compared with the St. Brigid’s Day bank holiday weekend this year. Out of the total 29 acute hospital sites with 24-7 emergency departments, seven sites maintained a level of zero patients waiting on trolleys at 8 a.m. throughout the weekend, Saturday to Monday, inclusive. A number of sites continue to consistently achieve good operational grip, avoiding congestion and maintaining patient flow, such as Connolly Hospital, MRH Tullamore and UH Waterford. However, on Tuesday, 3 June, UHL reported 49 patients on trolleys at 8 a.m., making it one of eight sites in red status. From January to May 2025, attendances at UHL's emergency department were up 8% compared with the same period in 2024, and it is ranked highest nationally for overall emergency department attendances and admissions. The Senator eloquently outlined why that may be the case. The impact this has on patients and their families is something this Government is deeply committed to addressing.

In preparation for winter 2025, a large and ongoing programme of work is under way focusing on increasing capacity and improving patient flow. Crucially, more than 100 new beds are due to be opened at UHL in the coming year, while 16 beds completed construction at the end of May 2025 and are anticipated to open in quarter 3. The first 96-bed ward block is expected to complete construction in quarter 3 of 2025 and expected to be opened as soon as possible once completed. It remains to be seen whether that will happen in time for the winter. This additional capacity will be vital as we head into the winter period. Furthermore, a 16-bed unit was completed in December 2024, already contributing to increased capacity at the hospital. Enabling works for the second 96-bed block at UHL are progressing. A planning application was submitted for the second ward block in March 2025.

To enhance patient flow and avoid unnecessary emergency department presentations, several key interventions are being implemented. The medical assessment units at Ennis and Nenagh hospitals have had extended evening service hours since October 2024, providing additional weekly capacity for 34 and 22 patients, respectively. The virtual ward at UHL can now accommodate 25 patients. Work is under way to operationalise an emergency department in the home, EDITH, service at UHL. Community rehabilitation units in Ennis and Nenagh are already operational. The HSE CEO has explicitly asked regional executive officers to continue implementing seven-day working and extended hours across all services relevant to improving patient flow. This includes ensuring senior decision-makers are rostered on-site over weekends and in the evenings, leveraging the benefits of the public-only consultant contract which provides for rostered work from 8 a.m. to 10 p.m. Monday to Friday and 8 a.m. to 6 p.m. on Saturdays. Work continues to enhance discharge processes to support patients prior to 12 p.m. seven days a week. The urgent and emergency care operational plan 2024 provides a comprehensive framework covering hospital avoidance, emergency department operations, in-hospital care delivery and discharge management. That sets out some of the plans in place to try to increase capacity at UHL prior to the winter months.

Dee Ryan (Fianna Fail)
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I appreciate the Minister of State coming to the House to give me that information but, with the greatest respect to him and the Minister, I have heard all of this before. I know all of those figures and about all of those initiatives. Other than the extension of the medical assessment unit hours in Ennis and Nenagh, they are not specific to UHL. What is the Minister considering for this winter? I am not hearing about short-term interventions specifically for UHL, that the Minister is considering a temporary reopening of accident and emergency departments in Ennis or Nenagh, that she will assign additional staff to the UHL emergency department, or that she is planning on installing more temporary beds. We need a specific UHL emergency department winter plan and we need it now.

Christopher O'Sullivan (Cork South-West, Fianna Fail)
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I completely understand Senator Ryan's frustration and concern. This has gone on for too long in UHL. We have heard the stories and examples of long waiting times on trolleys. It is not good enough. There needs to be urgent action. I also mentioned the 100 extra beds due to come online in the coming year. I hope that will alleviate some of the pressure. The Senator mentioned the medical assessment units in Ennis and Nenagh. They should alleviate some of the pressure. There are other innovations nationally, only where appropriate, with types of virtual triage. That sometimes prevents extra numbers presenting to accident and emergency departments. That can be looked at. I will express the Senator's frustrations directly to the Minister and ensure she is aware of the need for a UHL-specific action plan.