2026-05-12

The medical board at University Hospital Limerick has, as the Minister of State is aware, warned that the risks to patient care at the hospital remain intolerable and unacceptable. I have spoken countless times in this Chamber over the past decade of the challenges faced by patients and staff at University Hospital Limerick, UHL, and I welcome the intervention of Prof. Devlin of the UHL medical board. Dr. Alan Watts, a consultant in emergency medicine and a member of the board as well, said on the Live 95 FM radio station in Limerick, "There are people on a trolley in the emergency department who should not be there." He said that they should be in a bed and that corridor care is not adequate healthcare. Today, there were 101 people being treated on trolleys and in hospital corridors at UHL. This strips them of their privacy and dignity, yet despite this and despite UHL consistently having the highest number of patients on trolleys in the State, there seems to be no immediate actions being taken to address this crisis. Those who read about the trolley crisis may believe that it only pertains to those in the emergency department. It does not. A walk through the hospital's zones is a walk past numerous trolleys scattered across wards. I have seen this myself. Professor Devlin also has stated that "there are trolleys in corridors all around the hospital". This is a crisis, and it requires a crisis intervention. I am sure the Minister of State will talk about some of the investments and additions that have been made in the last number of years at UHL and the wider mid-west region. There are commitments to open additional beds in Ennis, St John's Hospital and in Nenagh hospital by 2030 or 2031 but we need immediate intervention to tackle the ongoing risk to patient safety caused by the overcrowding at UHL. Put simply, recent Governments have failed to curb the crisis in healthcare at University Hospital Limerick. The new bed unit opened in October last year. While very welcome, it has only reduced the numbers being treated on trolleys by approximately 2%. While any reduction is welcome, this leaves on average 94 people on trolleys every single day in UHL to date this year. The new surgical hubs that could alleviate some of the pressure at UHL will now open at the end of the year and not this month as originally planned. Not only that but the HSE has advised me that it will receive only 50% of the funding needed and that level of funding will struggle to achieve half of the planned 20,000 annual procedures. Will the Minister of State intervene in this issue and speak directly to the Minister, Deputy Carroll MacNeill to make sure that we get the 100% funding that we need? I have been advised by staff and patients at UHL that the MRI machines are often not working, which leaves patients taking up beds for longer than is necessary as they wait for their slot for MRIs that work. It is really appalling that in a modern hospital already plagued with overcrowding that such necessary equipment is often broken. The next additional 96-bed unit at UHL is scheduled to open at the end of 2029. It was announced years ago and yet there has been no urgency to swiftly progress it. UHL is not receiving the support that it needs. For instance, if we compare UHL with University Hospital Waterford, despite UHL having double the number of people presenting at the emergency department, University Hospital Waterford has more consultants than UHL. This is a clear demonstration of years of underfunding for the mid-west region. We have a commitment from the Minister that the three recommendations in the HIQA report will be implemented and yet no board of management has been established to deliver this commitment. The HIQA report, which was published on 30 September 2025, stated the mid-west needs 500 acute additional beds. Some 224 days later, the delays in progressing these recommendations is systematic of the lack of urgency, as usual, where UHL is concerned. A project board needs to be established swiftly to deliver these projects. The challenges at UHL stem from bad decisions taken in the 2000s that ignored the concerns raised at the time about capacity. The board at UHL has called for a suspension of staff ceilings and other staffing restrictions in the mid-west. This call needs the Minister of State's support, and we need to ensure that all resources requested are made available to contribute to the ending of the disgraceful situation at UHL.

I thank Deputy Quinlivan for the opportunity to discuss the challenges and the ongoing developments to support University Hospital Limerick and our health services across the mid- west region. I am taking this debate on behalf of the Minister for Health, Deputy Carroll MacNeill. I acknowledge that there are significant challenges at the UHL site, which are having an impact on patients, staff and families in Limerick and the mid-west region. I also recognise the dedicated and hardworking staff at UHL and throughout the health services in the region and I accept that the numbers on trolleys are too high. The Government is working and is committed to addressing the challenges facing acute care across the mid-west. Investment in the hospitals in the region has increased from €370 million in 2019 to €763 million in 2025. The budget for UHL has increased from €265 million to €569 million in the same period. Staffing at the university hospital has grown by 57% to 4,422 whole-time equivalents, WTEs, since December 2019, which is an increase of 1,608 WTEs from 2,814. This includes 319 more whole-time equivalent doctors, including consultants, 616 more nurses and midwives, as well as 199 more health and social care professionals. The Minister for Health, Deputy Carroll MacNeill, has been advised by the HSE that recruitment of clinical front-line staff at UHL and throughout the region can continue as normal. Baseline implementation of the safe staffing framework has been funded in UHL. The framework was implemented on a phased basis between 2022 and 2024 in the emergency department and all 22 medical and surgical wards. More must and will be done. The Government is fully committed to delivering the highest quality care in the mid-west. We have carefully considered all of HIQA’s recommendations following its review of urgent and emergency care in the region. The Minister, Deputy Carroll MacNeill, has listened carefully to the determined advocacy of people, healthcare professionals and public representatives across the mid-west. She has visited the region on a number of occasions and will continue to listen. The Minister remains focused on ensuring the recommendations arising from HIQA’s assessment are implemented in a timely and co-ordinated manner and that people in the mid-west have access to safe, high-quality and reliable care. HIQA’s review identified three potential options for the region, namely, option A, expand capacity at the UHL site in Dooradoyle; option B, extend the UHL campus to include an additional adjacent site; and option C, develop a model 3 hospital in the mid-west to provide a second emergency department. In December, the Minister for Health received Government support to progress a blend of all three options. Work to progress option A is being rapidly advanced, including the delivery of a new 96-bed block at Dooradoyle in October 2025. There is also ongoing work to deliver a second 96-bed block and planning is under way for additional 16- and 66-bed blocks. The ESRI projected that between 299 and 503 additional beds will be required across the mid-west by 2040 compared to 2023 levels. Under existing plans, we will deliver 420 additional beds by 2031, with 128 of these hospital beds already delivered at UHL. The second 96-bed block is getting under way, along with an additional 82 beds to be delivered. Furthermore, the 420 beds include 48 additional beds planned for delivery in Ennis Hospital, 42 for St. John’s Hospital and 24 for Nenagh Hospital. To progress option B, the HSE has acquired a 44-acre site in Raheen, just 2 km from UHL. This site provides a significant opportunity to provide meaningful additional capacity and health services to the people of the mid-west. The Minister visited Clare in the mid-west yesterday and met the public, patient advocates, healthcare professionals and public representatives from the region. The Minister has requested the HSE to deliver additional health services locally at Ennis, Nenagh and St. John’s hospitals where it is safe and appropriate to do so. The next step is to establish a project board to progress options B and C and develop a comprehensive strategic plan for the organisation of services and investment in the mid-west to ensure a balanced, sustainable and region-wide model of care. The Minister for Health is committed to advancing the establishment of the project board before the summer Dáil recess. I assure the Deputy, the people of the mid-west and all public representatives that the Government will continue to pursue all measures to increase capacity and improve service delivery at UHL and across the entire region. I will bring to the attention of the Minister the two points the Deputy brought up about the surgical hub and the MRIs.

I am deeply concerned by a part of the Minister of State’s response. He said that, “Under existing plans, we will deliver 420 additional beds by 2031”. He also said that 128 of those beds have already been delivered at UHL but HIQA said in September, when it knew these beds were there, that 500 beds were needed. That is what it said. I spoke to senior officials in the hospital before I came here tonight. I am deeply concerned about that. I am deeply concerned that the mid-west has been left behind for years. We do not just need a small plan to go forward but an intervention. We must realise the mistakes we made in the past. People have been abandoned for years. As I said, Waterford has more consultants than UHL, but we have double the number of people presenting. The staff have been left in an impossible situation where presentations in January and February of this year have increased by 14%. The Government is not planning an extra 14% in its plans. It is actually talking about 300 beds when HIQA says 500 beds are needed. That is a concern. People deserve to be treated properly. When people come to a hospital, they need to be seen, including those presenting at UHL. The people I talk about on trolleys are people who are deemed to be in need of a bed, but no bed is available for them. At UHL, since 2022, we have had 93,000 people on trolleys. I have been at the hospital recently. I am sure the Minister of State has been there as well with relatives and friends. As Professor Joe Devlin said, there are trolleys everywhere. They are all over the place. People are being treated in corridors. Unfortunately, I overheard people’s diagnoses and people in stress. I heard people talking to doctors and nurses, who are doing their very best in an overcrowded situation. The answer is very disappointing. The Minister needs to get involved as a matter of urgency to appoint and get that board up and running. It is 224 days since the HIQA report was published. We need to get that board up and running. We need all three recommendations implemented. We must end the scandal of people in Limerick and the mid-west on trolleys.

I thank the Deputy for raising this important matter and the concerns raised by the UHL medical board. Like the Deputy, I am local TD in Limerick and I am fully aware of the concerns raised. The Government is fully committed to driving significant improvements to the health service at UHL and across the mid-west. As the Deputy stated, UHL is one of the busiest emergency departments in Ireland. Increasing levels of activity in 2026 have attendance up 11% in January to March compared to the same period in 2025. Despite these attendances and a related rise in waiting times, we have seen some improvement in compliance but there are too many instances of prolonged patient waiting times. There are too many people on trolleys. I accept that. It is a capacity issue, as the HIQA report stated. The Minister for Health and the Government are focused on increasing bed capacity. Staff numbers in UHL have grown by 50% since December 2019. As I stated, the Minister of Health has been advised by the HSE that recruitment of clinical front-line staff at UHL and throughout the region can continue as normal. That is an important point to make people aware of. More than 53,000 patients attended the three mid-west injury clinics - St. John's, Ennis and Nenagh hospitals - during 2025. Those clinics do great work. The acute virtual ward went live in UHL in July 2024. This has been scaled up to now provide 40 virtual beds, assisting in freeing up hospital capacity. The surgical hub is expected to be in operation by the end of the year, as the Deputy referenced. This will increase theatre capacity and reduce day cases and the low-complexity surgical waiting list in the region. It will make an enormous difference. The purchase of the 44-acre site at Raheen represents a significant milestone and provides an opportunity to plan for delivery of healthcare in Limerick and the region for current and future generations. Obviously, the Minister is committed to advancing the establishment of the project board before the summer recess. That project board will look at all aspects, including capacity and everything else that is required in the region. It will look at all aspects when it comes to options B and C. Option B is to look at additional capacity and the expansion of the UHL campus to include an additional adjacent site. Option C is to develop a model 3 hospital in the mid-west to provide a second emergency department. I concur with the Deputy that it is very difficult for patients coming to UHL with the waiting times and trolleys. I join with him in expressing gratitude to the staff in UHL and the entire region for the fantastic work they do. The Government and the Minister for Health are absolutely committed to ensure that we continue to provide further investment in required staff to meet capacity requirements for UHL, Limerick and the entire mid-west region in delivering health services.