2025-12-10

I thank the Minister of State from being here. She is from the relevant Department, and I appreciate it. That should be the norm in this House. It used to be. An exceptional piece of journalism was published last week by the Limerick Leader. The front page article spoke about the catastrophic failures in University Hospital Limerick, UHL, which we have discussed in the House. No other topic have I discussed more in my political career. The picture on the front page shows four young women. I compliment the journalist, Ms Sandra Quinn, and the Limerick Leader for what they put out. Sometimes a visual says more than words. The story is about Ms Aoife Johnston and Ms Niamh McNally, both 16, Ms Eve Cleary, 21, and Ms Leona Cusack, who was 33. They all died because of what is going on in UHL. I will say something of the Government with all the positivity I can. I know what I am talking about. I have spoken about my family in the Dáil on numerous occasions. I have spoken about my dad, the anniversary of whose passing was two days ago. He did not want to go into UHL. I have spoken about my neighbours and friends. I spoke recently about a situation where I had to ring and somebody in the HSE told me once I got on the motorway to go to Portlaoise hospital, which I did. That was an emergency and the patient got fantastic service. The Government has a huge decision to make. In fairness, the Minister, Deputy Carroll MacNeill, has said she will make that decision next week. She met mid-west Deputies and Senators two weeks ago. Unfortunately, for some reason, Deputy Sheehan and I were not invited so I must raise the issue on the floor of the Dáil. The HIQA report was not necessary, but we have it because Mr. Gerry Burke, who was the former lead clinical consultant in UHL, did all the statistics ten years ago. The situation has only got worse. Even in terms of the HIQA report, the census data is out of date. We are totally discriminated against. If you look at the south east, which the Minister of State is very familiar with, there are three model 4 hospitals in Waterford, Wexford and Kilkenny. There is also one in south Tipperary. We have one. That is not sustainable. The idea that the people in Clare, Limerick and north Tipperary have only one accident and emergency for 450,000 people is insane. The only decision that can be made next week, along with option A of the 96-bed block and option B of building a 100-bed unit nearby, is to make the decision long term. We need ambition to have a model 3 or model 4 hospital in the mid-west. Anything else will continue this discrimination and I will not be part of another generation of politicians who stand up in this House and accept that. It is discrimination. My phone was ringing all weekend about cases in Limerick. Despite the new 96-bed block, the numbers there are 110 on trolleys and 31,000 on waiting lists. We have a worrying situation where consultants, because of the working conditions, are leaving. I urge the Minister of State to give the Christmas news everybody in Tipperary, Limerick, Clare and even parts of north Cork want to hear and that is that we will do all the short- and medium-term planning and we will look again at the pathways regarding minor injury units and open them up as well as open up community services but for God's sake, we need another hospital in the mid-west. It is as plain as the nose on my face. Any other decision is discrimination and is totally wrong. I will be the first person to stand up and congratulate the Minister of State if she delivers it.

I thank Deputy Kelly for the opportunity to address the House on the discussion around the need for a new model 4 hospital in the mid-west region. I also thank him for his ongoing advocacy in relation to University Hospital Limerick. I have stood across the floor from him many times over the past five and half years discussing health matters, and he has been very consistent. I want to put that on the record. In May 2024, HIQA was requested to conduct a review of urgent and emergency care in 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 the region and with the ongoing pressures at UHL. HIQA submitted its final report to the Minister, and it was published on 30 September this year. As the Deputy will appreciate, the reports and analysis supporting this review are extensive. There was substantial stakeholder engagement, regulatory inspections, a national policy review, data analysis review and international evidence reviews. The Minister and I acknowledge the substantial work undertaken by all those who both conducted and took part in this review, including the expert advisory group which included a wide representation of relevant experience. In summary, HIQA’s analysis found the inpatient bed capacity in the region needed to be increased to meet current and projected demand for patients requiring more complex or specialist healthcare. I acknowledge UHL is still the busiest hospital, with a 10% increase in attendance this year compared to the last year. I had a conversation with senior management this morning and they are on track to receive 100,000 attendees to the emergency department this year. Mitigation pieces are in place regarding senior clinician decision-making and de-escalation of the emergency department, with a good length of stay averaging at four and half days. Thankfully, mortality is static and currently in line with every other hospital. I recently visited the mid-west region to discuss mental health and I compliment the mental health teams. The CAMHS teams there have turned around the complete waiting list and are now operating much better. I also visited University Hospital Limerick and met with the regional executive officer, Sandra Broderick, and senior management. I visited the new 96-bed block and I am delighted to say it is open, which the Deputy has welcomed publicly. The second one will be up and running as soon as possible. However, this does not solve the short-term issues. This morning there are 32 people on trolleys in UHL - three in the emergency department and 29 moved to wards. This is similar to other areas. In Galway, there are 51, in Cork, there are 39, and in the Mater, there are 27. Certainly, every focus has been put in place to try to reduce that. Going back to the HIQA report, it presents three options, as the Deputy knows, with the expansion of capacity at UHL on the Dooradoyle site, which is option A; the extension of the UHL hospital campus to include a second site in close proximity, which is option B; and option C, which is the development of a model 3 hospital in HSE Mid West. The Minister has accepted the report and the advice from HIQA. Along with her officials, she is considering the comprehensive and detailed reports and advice provided by HIQA and will report back to Government before the end of the year. The ESRI has projected the number of inpatient beds to meet the projected 2040 demand will need to increase from between 299 and 593 beds compared with 2023 capacity levels.

I thank the Minister of State for her response and I acknowledge the improvements that have happened in UHL in the past couple of years. However, we have serious issues when it comes to staffing and high-level consultants as regards attracting them, given the situation the hospital is in. Politics has failed the people of the mid-west on this issue. I am not going to start blaming certain parties but politics has failed across this House. Consultants helped drive the agenda to close the units in Ennis, St. John's and Nenagh. Then, they disappeared off the face of the earth and were never found again. Politics now has to come back and fix it. This Chamber has to fix it; the Minister of State's Department has to fix it. We cannot fail the people of the mid-west continuously as we head into Christmas again, with people who live alongside me afraid. We cannot fail the families of these four poor women and others. I could give the Minister of State hundreds of examples of issues there. The Minister of State spoke about the volume of beds required, which I absolutely accept but how in the name of God can we create those beds without creating a new hospital? I am not even arguing for Nenagh, Ennis or wherever; I just want a decision that we need a new hospital in the mid-west - an access point with beds and critical infrastructure. We cannot go on the way we are. We need that ambition and I am afraid this is being choreographed, that the decision being made next week will be options A and B but not C. I have no issue with option B as long as that decision to create another 100 beds has a hospital wrapped around it in years to come. The Minister for public expenditure is from the Minister of State's party. I urge the Ministers for Health and public expenditure, Deputies Carroll MacNeill and Chambers, in the next week before the Cabinet decision is made - it has to be made because the Minister has promised it - that this decision will be long term and that we will create a new model 3 or 4 hospital in the mid-west to end the discrimination and fear. There are people who will not go into UHL because of the fear they have and the situation we have been left in.

I thank the Deputy for that. The Minister will update her Cabinet colleagues before Christmas on her considered response. I acknowledge the fact the Deputy appreciates there is work going on to increase capacity and additional funding has been provided. UHL's budget has increased from €265 million in 2019 to €507 million in 2024. I will also touch on the two rapid build 16-bed units opened in December 2024 and June 2025, respectively, and the 96-bed block that was opened in October 2025, which the Deputy spoke about, to provide an additional 128 beds in the region, since the ESRI assessment of capacity in 2023. This has already helped reduce the number of people waiting on trolleys, notwithstanding the pressures all hospitals are currently facing due to the increased presentations by people sick with the flu. A second new 96-bed block is in progress at UHL and a third 16-bed block is planned for 2026. Bed capacity has been further expanded throughout the region, through the acute hospital inpatient bed capacity expansion plan, including 24 new beds at Nenagh Hospital, 48 new beds at Ennis Hospital and 42 new beds at St. John's Hospital. It is expected that there will be at least an additional 420 beds in the region by 2031. Other initiatives for the region include the acute virtual ward for 25 patients, which went live in UHL in July 2024. I will also touch on the staff, especially those working in the emergency department with the constantly increasing presentations every day. They are the front line and do a phenomenal job. However, I take on board every word the Deputy said. I know people are waiting in anticipation for the Minister's response. She has said she will bring it to the Cabinet before Christmas and I will speak to her after this debate to let her know about the Deputy's strength of feeling. Everyone accepts and acknowledges that there is not enough capacity of acute hospital beds in the region at the moment. I thank the Deputy again for his advocacy.