Martin Conway (Fine Gael)
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The Minister of State is very welcome to the House. It is my first time speaking here since his appointment. I warmly congratulate him. His expertise in his area was well recognised in the previous Oireachtas. I have no doubt he is going to make a significant impact in the coming months and I wish him the best of luck. I stand with Senator Dee Ryan on the issue that has dominated politics and healthcare in my region of Clare and the entire mid-west area for the last number of years. In spite of the tens of millions of euro invested in UHL, capacity being increased and the budgets made available, we still have an average of about 100 people a night waiting on trolleys in UHL. Before the last local elections the Minister made an announcement that HIQA was going to be asked to do a capacity review on the ED provisions in the mid-west region. That review is ongoing. It is a year and a half since the announcement, which was in May 2024. It is now almost October of 2025 and we do not know what HIQA has recommended about additional capacity for emergency department provision in the mid-west. It is not good enough that it takes HIQA a year and a half to carry out a review when most of us know what the answer is, namely, that we need an additional emergency department in the mid-west region. What I want to know is very simple. When are the Minister and HIQA going to publish the findings of the review into accident and emergency care in the mid-west? It is needed. We are heading into a winter where it is going to be very serious and we need a pathway and a framework for moving forward.

Dee Ryan (Fianna Fail)
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I echo Senator Conway's call for the publication of that review. We in the mid-west are very eager for it to come out, to see what the recommendations are and for the Minister to take action on it. Actioning it is key. We would like to hear what provisions she is making for further capital investment in healthcare in the mid-west region in the coming budget.

In my Commencement matter I also asked if the Minister could update the House on what provisions she is making for this winter. We have seen significant long-term capital investment in the mid-west, as my colleague rightly points out, since 2020. There is the 96-bed block in UHL, which I believe will be opening next month, and a second 96-bed block under way. There is also a surgical hub at the site of the old Scoil Carmel up in Punch's Cross. There is also the completed first phase of a community nursing unit in St. Camillus Community Hospital with a second phase under way. We are, therefore, seeing significant capital investment but that is not going to get us past this winter. My question to the Minister is what immediate actions can she take to bolster the healthcare provision in accident and emergency in UHL this winter. I will tell the story of a gentleman I am aware of. This 79-year-old gentlemen had a first fall in April, spent 24 hours on a trolley in accident and emergency, contracted pneumonia and was twice in the high-dependency unit over a period of weeks. He has been back twice and on a midweek night in September of this year that gentleman spent 24 hours on a chair. It is shocking. It is shocking what the people of the mid-west are going through, so what can the Minister do for us this winter?

John Cummins (Waterford, Fine Gael)
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I thank Senators Conway and Ryan for their question, which I am taking on behalf of the Minister for Health. I also thank Senator Conway for his kind words, which are much appreciated.

On the topic at hand, the final report of the review of urgent and emergency care in the mid-west region is due to be submitted to the Minister for Health by HIQA very shortly and published soon thereafter. I will take a moment to explain the sequence of events since May 2024 when the Minister requested a review of urgent and emergency care within the mid-west region with the primary objective of ensuring safe, quality acute care. As part of this review, HIQA was requested to consider the case for a second emergency department in the context of the population changes in recent years and ongoing pressures at the ED at University Hospital Limerick.

The terms of reference, which were published in August 2024, stated, "... a final report will be provided to the Minister in Summer 2025 ..." and a more specific timeframe of the end of May was agreed. HIQA submitted an interim briefing on 28 February, which was published on the Department of Health website in March. It provided a progress update on the various streams of the ongoing work programme. HIQA next wrote to the Minister for Health in May 2025 to update on the timeline for completion of its report. Overall, the HIQA work on the review of urgent and emergency healthcare services in the HSE mid-west region has progressed very well and the work streams undertaken by HIQA to inform the advice to the Minister had been completed. A critical dependency for completion of the final report from HIQA is the input from the national and regional demand and capacity projections being undertaken by the ESRI for the Department of Health. The first of these three ESRI reports, on projections of national demand and bed capacity requirements for public acute hospitals, was published on 28 May. The second report, on future capacity requirements for GP services, was published on 18 June. The third report, on future capacity requirements for older persons' care, was published on 30 June. The ESRI is due to publish a further regional analysis very shortly. It is these analyses and projections that are obviously feeding into the report which is being compiled for the Minister and will feed into the question of whether a second ED in the mid-west region is warranted. It should be with the Minister very shortly and she has committed to publishing it thereafter.

I know full well the pressures within the mid-west region and University Hospital Limerick, but it is important to say there has been significant funding and investment in the region and the hospital in recent years. From 2019 to 2024 there was an increase from €265 million to €507 million. There has been an increase in the staff ratio by 50%, with 57 more whole-time equivalent doctors, including consultants, 576 more nurses and midwives, as well as 155 more health and social care professionals. Senator Ryan mentioned the 96-bed block, which is due to open imminently, and the second 96-bed block, for which some enabling works are already under way. They will have a positive impact, but it is true that patient flow within University Hospital Limerick is very important when it comes to managing ED admissions and ensuring people are not on trolleys. I will make a couple of further comments in my closing remarks.

Martin Conway (Fine Gael)
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I thank the Minister of State. He is just delivering the message and we appreciate that, but it has taken a year and a half and we still have not had this HIQA report published. Were it to recommend an additional ED in the mid-west, between site purchase, planning, design, QS work, construction and fit-out it would be 2035 before we see another emergency department. That is not good enough for the people of Clare, Limerick and Tipperary who find themselves in a difficult situation on a trolley in an ED for days, like the 79-year-old my colleague spoke about. We need to get real. We need to get urgent. We need to put a bomb under this whole process because it is simply too long. It is not good enough and people are suffering.

Dee Ryan (Fianna Fail)
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I thank the Minster of State for coming to see us this morning and delivering that message. I agree with him on acknowledging the significant investment that has been made in recent years. I also acknowledge the huge work being done by the newly appointed regional executive of HSE Mid West, Sandra Broderick, Bernard Gloster, head of the HSE, and indeed the Minister, who has focused on weekend discharging. I wish the CEO of the hospital, Ian Carter, the very best in the work he is doing, which we are hearing is bearing fruit. However, unfortunately we are fighting fire when in the mid-west when it comes to healthcare. We have only one accident and emergency department to deal with all the issues that occur in the entire region, including the ones that can be foreseen or projected in terms of age groups and the ones that are unforeseen, like accidents. We are under immense pressure so we need additional focus from the Minister to get us through this winter.

John Cummins (Waterford, Fine Gael)
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I thank both Senators for raising this important matter. I can assure them on the investment flow that has gone into University Hospital Limerick. There is a significant focus. I know the importance of the review informing future investment. I come from Waterford in the south-east region where a hospital serving a population catchment of over 600,000 has had zero trolleys for the last three years because of very clinical bed management and patient flow through that acute hospital. The former CEO of University Hospital Waterford, Grace Rothwell, has been appointed as the national director for acute hospitals and will assist the new executive in University Hospital Limerick to ensure patient flow and bed management in order that we get the benefit from the additional 140 beds that have been provided to University Hospital Limerick over the last number of years. There is further significant investment to go into the region to ensure that we no longer have patients on trolleys because that is unacceptable. However, there does have to be better management of the flow, notwithstanding the excellent work that is done by staff on the ground day in, day out. I will take the comments back to the Minister.

Martin Conway (Fine Gael)
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I thank the Minister of State.

Dee Ryan (Fianna Fail)
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I thank the Minister of State.