Hospital Overcrowding

As the Minister of State is aware, the mid-west region has been underfunded for decades by successive governments. We are now left cruelly exposed as winter approaches and the hands and tools of staff who need to deliver vital services are tied. The Minister of State will be aware that the HSE met with local representatives from Limerick, Clare and Tipperary and what it told us was stark. The feedback from the briefing yesterday was beyond concerning. They presented the public representatives, including myself, with a situation of impending catastrophe, with a strong suggestion that this winter there is a high chance of avoidable deaths at University Hospital Limerick. They do not say that lightly. They outlined that they are expecting up to 400 presentations at the UHL emergency department every single day of the winter, with presentations expected to exceed 102,000 people by the end of 2026. These are incredible figures. UHL is at 125% capacity already and simply cannot deal with the number of people presenting there. We are utterly exposed come wintertime. The HSE outlined how, at the same hospital, very few elective surgeries are taking place because it does not have the capacity or staff. In the 21st century, to have a hospital that caters for such a large population suspending necessary procedures is outrageous. The issue of overcrowding and capacity remains a significant concern for staff and patients. Overcrowding and capacity challenges have been found to be partly responsible for numerous deaths at the hospital in recent years, as the Minister of State knows. The present situation is a risk to patients and causes massive stress for staff. Both Fine Gael and Fianna Fáil have failed to take any meaningful action on the issue of overcrowding. Indeed, with members of those parties as Minister for Health the issue has got worse, not better. This is not bluster - it is the sad reality. The numbers are not coming down in any significant way. In 2021, for instance, 12,106 people were on trolleys, while last year 22,473 people were treated on trolleys in hospital corridors. I acknowledge that this is a slight reduction on the record high of 23,202 patients on trolleys in 2024. However, the HSE in the mid-west has not received any additional staff since late June and many vacancies remain unfilled across the service. The HSE spoke of a dire need for acute beds. If we were to triage our health service in different regions, it is fair to say that healthcare in the mid-west would be in need of immediate resuscitation. The tools and long-term solutions were presented to the Government over a year ago. They were presented in the three recommendations of the HIQA report on emergency care in the mid-west region. Those recommendations, which the Government has committed to implementing, are: the significant expansion of acute inpatient beds at Dooradoyle; extending the UHL campus by adding a second site nearby; and developing a new hospital in the mid-west region featuring a second emergency department. A year later, we still have no clarity as to whether we will even get a second hospital with acute beds. This is a dereliction of duty. Of the three recommendations, the establishment of a new hospital in the mid-west offers the best hope long-term to ending the deplorable state of emergency care in the mid-west. This is a long-term fix. However, we urgently need to see a fix for the here and now. We have no confirmation of any new hospital acute beds being delivered. The Minister for Health should hold an immediate meeting with the HSE to address this looming crisis in our region. We need a proper plan for the coming winter. We are all deeply concerned that this winter will be catastrophic for our region. To implement the HIQA recommendations, we need a medium-term plan for three to five years. Like most, I am not sure what that plan is or what is going to happen. The Minister for Health, Deputy Carroll MacNeill, needs to intervene personally. She should meet with the HSE as a matter of urgency. She should also meet and update Oireachtas Members in the mid-west region on her plans for the region on a regular basis.

I thank the Deputy for the opportunity to discuss the actions taken since the HIQA review on urgent and emergency healthcare services in the mid-west region. I am taking this issue on behalf of the Minister for Health, Deputy Jennifer Carroll MacNeill. I acknowledge the issues that Deputy Quinlivan is raising on behalf of his constituents, who are also constituents of mine. I am very aware of the issues he is raising. I want first to 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, who do their very best for their patients. HIQA did identify a significant inpatient bed capacity deficit as the central challenge facing urgent and emergency care in the region. The Minister for Health remains focused on ensuring that the recommendations arising from HIQA’s assessment are implemented in a timely and co-ordinated manner. The report sets out three potential options, as Deputy Quinlivan has already indicated. Option A is to expand capacity at the UHL site in Dooradoyle; option B is to extend the UHL campus to include an additional adjacent site; and option C is to develop a model 3 hospital in the mid-west, providing a second emergency department. The Minister for Health accepted this advice and the Government approved a blended approach to progressing all options in December 2025. At UHL, work is already under way on option A. Two new 16-bed units are now in place, alongside the new 96-bed block which opened last October. A further 16-bed unit is due for completion by the end of this year. Contracts for a second 96-bed block were recently awarded and a design team has been appointed for a further 66-bed block. This investment is not just for Dooradoyle. Capacity across Ennis, St. John's and Nenagh hospitals will also be expanded, with an additional 114 beds planned by 2031. Overall, 420 additional beds are planned for delivery across the mid-west between 2024 and 2031. In March, acting on the direction from the Minister for Health, the HSE secured a 44-acre site in Raheen, just 2 km from University Hospital Limerick, to progress option B. This site provides a significant opportunity to provide meaningful additional capacity and health services to the people of Limerick, Clare and Tipperary in the mid-west. Importantly, the site sits on a direct corridor linking it to the main hospital campus, providing strong connectivity and operational advantages for future service integration. The location represents a unique strategic opportunity. It provides sufficient scale to accommodate significant future healthcare development while maintaining close operational links with the existing model 4 hospital. It creates the opportunity for a campus approach to healthcare provision, allowing services to be expanded and reconfigured in a way that supports both immediate needs and long-term growth across the region. Securing the site was an essential first step. The focus now is turning to the next phase. To that end, the Minister established the mid-west health planning board in July 2026 and appointed Mr. Sean O'Driscoll as chair. The board held its first formal meeting in September and is overseeing the development of a service and infrastructure plan for the region, to be finalised within nine months. That plan will inform decisions on the services and facilities to be developed at Raheen and across the wider mid-west. The HSE will subsequently develop an implementation plan to advance the board's work. The challenges facing the mid-west will not be resolved by one intervention alone. However, we are acting on HIQA's advice by expanding capacity across the region, securing the Raheen site for future development and developing a strategic plan for the longer term. The Minister for Health remains firmly focused on delivering these measures, so that patients throughout the mid-west can access safe, high-quality and reliable healthcare. I have run out of time but I will address the winter plan after Deputy Quinlivan's next contribution.

I thank the Minister of State. We all agree that more than one intervention is needed. Where is the urgency? I did not hear any urgency in the Minister of State's response. I am deeply concerned about the feedback I received from the HSE yesterday, and I put my concerns on record. The Government should not say in January or February that it was not aware of the scale of the crisis or the challenges our hospitals face. Will the Government remove barriers and instruct the HSE to allow the University Limerick Hospitals Group to employ the additional staff it urgently needs? I understand there are also 80 private beds readily available in a particular area. Will the Government commit to allow UL Hospitals Group to buy these as an interim measure as we work our way through the imminent winter? The situation at University Hospital Limerick is well documented. I can tell the Minister of State from experience that the conditions many face at the hospital are devoid of dignity and privacy. Too often, it is our most senior citizens left in the corridors. These are people who built our State, worked hard and raised families. In their latter years, they should be able to expect treatment and comfort when they go to their local hospital. I would like to say a bit about the staff. They are often forgotten about when we rightly focus on patient care. The healthcare staff on the ground, the porters and doctors, do their best for patients. They do not want patients in hospital corridors. It impedes their work. I was proud to stand in solidarity with healthcare workers last Wednesday as they took industrial action. The mid-west health planning board has not even decided that the mid-west needs another hospital. That is outrageous; it is bonkers. I see no plans in the here and now. I urge the Minister of State to use all the resources available to him to ensure all necessary resources are in place at University Hospital Limerick for this winter. The Department should allow the vacant jobs to be filled. As I said, no posts have been filled in our hospital since June. There is a blockage on filling them. Will the Minister fast-track the delivery and implementation of all three HIQA recommendations and immediately confirm that the mid-west will be getting new acute beds and a new hospital? That has not been confirmed yet and the new board does not seem to know what it is doing in that regard. We have zero time to lose on this. We need an intervention from the Minister, Deputy Carroll MacNeill. She needs to meet all of us but she needs to meet the HSE as a matter of urgency. Winter is coming and we are all deeply concerned. Every Member of the Dáil and Seanad who attended the meeting was really upset when they came out of it.

I thank Deputy Quinlivan again for his contribution. As stated earlier, I am taking this matter on behalf of the Minister for Health, Deputy Carroll MacNeill. The Minister for Health fully recognises the significant and sustained pressure on urgent and emergency care across the mid-west, particularly at University Hospital Limerick, and acknowledges, as I do, the fantastic work of the staff. It is obviously all about the care of the people in the mid-west. There has been investment in increasing the capacity of the region. In addition, we are looking at increasing patient flow, supporting timely discharge and maximising available hospital and community capacity. This includes increased access to diagnostics, step-down capacity and virtual wards to enhance community care. We need stronger pathways across acute, community and step-down care, helping people avoid hospital and to appropriately leave hospital safely once acute care is completed. To assist with this, following a recent tender competition by the HSE, a bespoke national panel arrangement was established for the provision of short-stay therapeutic beds, with 125 beds available to the mid-west region. The range of supports includes access to community-based, therapy supported beds for acute hospital patients, with hospitals approaching the nearest panel provider subject to availability. I will make two further points. The mid-west planning board should be allowed to do its work. It is due to report to the Minister. On the point the Deputy made about the winter plans, the Department and the Minister have been engaging with the HSE senior leadership team-----

Will there be acute beds? We do not know.

These are short-stay therapeutic beds. They are step-down beds, and 125 such beds will be available in the mid-west region. The Minister for Health, with her team of senior Department officials, will engage with the senior leadership team in the HSE on the winter plans more generally, with an emphasis, as would be expected, on the issues in University Hospital Limerick and the mid-west. We remain very much committed to increasing capacity, as required and as recommended under the HIQA report, while also looking at immediate issues in the here and now for winter planning for University Hospital Limerick and the mid-west region overall.