Hospital Overcrowding: Motion [Private Members]

I move: That Dáil Éireann: notes that: — the Irish Nurses and Midwives Organisation recorded 12,274 patients without a hospital bed in September 2026, the worst September on record, including 1,994 at University Hospital Limerick (UHL) and 1,008 at Cork University Hospital (CUH); — the number of recorded emergency department experiences lasting more than 24 hours increased from 33,843 to 36,410, up 7.6 per cent, and for patients aged 75 and over, the number exceeding 24 hours increased from 10,019 to 12,106, a sharp increase of 20 per cent; — recruitment restrictions, unfilled essential posts and delays in offering graduates permanent jobs are undermining patient safety and winter preparedness; and — there is a significant bed deficit across our hospitals as acknowledged in the Government's Acute Hospital Inpatient Bed Capacity Expansion Plan 2024-2031, especially in the Mid-West which faces continuing capacity risks at UHL; considers that overcrowding robs patients of dignity, endangers lives, exhausts staff and safe discharge requires appropriate support along with patient and family involvement; condemns successive Fianna Fáil and Fine Gael Governments' failure to deliver sufficient capacity and reform, and recognises the Minister for Health's responsibility to sustainably fund the health service, address capacity shortages, and ensure safe care across every hospital; and calls on the Government to: — remove recruitment restrictions blocking the filling of urgent and priority vacant posts, replacement, leave cover, and redelegate recruitment authority to health regions with adequate funding linked to patient needs; — honour permanent contract commitments to nursing and midwifery graduates, and improve staff training, recruitment, and retention through a funded workforce plan; — legislate for safe staffing, fully implement the Framework for Safe Nurse Staffing and Skill Mix, and fund multidisciplinary staffing and surge capacity, ensuring financial controls cannot override patient safety; — take urgent action on the capacity and patient safety concerns raised at CUH and UHL, with clear responsibility for resolving priority vacancies, addressing service restrictions and providing additional staffed capacity; — deliver the promised 3,000 additional acute inpatient beds, funded through a multiannual capital plan with hospital-by-hospital capacity targets to meet population needs; — accelerate elective hospitals in Cork, Galway and Dublin and the opening of surgical hubs to protect scheduled care from cancellations; — deliver a funded Model 3 hospital with a second emergency department for the Mid-West, alongside immediate improvements and expanded urgent care at UHL, Ennis, Nenagh and St John's hospitals; — expand regular and out-of-hours general practitioner, pharmacy, primary care, home care and community services to reduce pressure on overcrowded hospitals, deliver care closer to home, and improve early intervention; — fully fund the National Ambulance Service strategic workforce plan; and — publish funded regional winter plans and multiannual improvement plans with clear responsibility, published deadlines, demand forecasts, staffing and capacity targets, targets to end trolley waits, and escalation arrangements with a target of achieving consistent population-based capacity levels across each region. The situation in our hospitals and the context we are having this debate in have never been so stark. The Minister might have noticed that last month that we reached the milestone of 1 million people on some form of acute hospital waiting list. We have 260,000 more on community waiting lists. The month of September, according to the Irish Nurses and Midwives Organisation, INMO, was the worst on record, quickly followed by October, which was also the worst on record. People are bracing themselves for this month and for December and January. I have spoken to a lot of healthcare staff who work in hospitals, including in emergency departments, and they are bracing themselves for a really difficult number of months ahead. Last year, we saw over 12,000 patients over the age of 75 waiting 24 hours in an emergency department and tens of thousands left without being seen. That is the context. I know that lots of good work is being done in hospitals and staff are doing their best to bring down waiting lists but the people with whom I spoke - staff, patients, healthcare trade unions, advocates and campaigning organisations - are saying that things are not getting better. In many ways, they are getting worse. I spoke to a nurse a number of weeks ago. She works in an emergency department. Almost every day she goes into work, she is confronted with patients on trolleys, patients on chairs and, in some cases, patients on the floor and she has to treat and manage those patients in those circumstances. She said to me: I treat the patients. I manage them in some cases. I toilet those patients. There's no dignity for the patient. There's no dignity for that staff member. There's no dignity for anybody in that circumstance. I am sure I do not have to remind the Minister that when we have chronic overcrowding in our hospitals, it comes with consequences for patient safety. We saw it come into very sharp focus, particularly in the mid-west and Limerick, in the past and I sincerely hope we never see tragedies like that again. The only way we can avoid all of that is to properly equip our hospitals for the winter ahead. In an unprecedented move because I have not seen it in the time I have been health spokesperson, CEOs of hospitals and regional executive officers of hospital groups are raising red flags and telling us that things have never been so bad. They are talking about urgent posts as they see it - priority posts - that are not being filled. The last time this was raised, the Minister compared hospitals and put it back somewhat on hospital managers but if one talks to the staff in those same hospitals, they will tell you that they are working to the maximum. I put down a parliamentary question that the Minister might have seen regarding the amount of money the HSE has spent on overtime, particularly in the area of nursing but also elsewhere. It has gone up each and every year and is at a record amount for this time of the year so that pressure is falling back on existing staff. What is happening at the moment is very dangerous. It is dangerous for patients and it is not good for staff in terms of burnout and morale. When hospital managers say to me that there are very serious patient safety risks because urgent posts are not being filled, I take that very seriously but I do not see the same urgency coming from Government. I and others have raised with the Minister in this House the case of student nurses who have not been given proper contracts. I have never been given an answer as to why that happened. I have not been given a suitable answer as to why it is still the case and why that was allowed to happen in the first place. The Minister cannot pass the buck all of the time and blame everybody but herself. I accept that hospital managers obviously have their job and the HSE and the Department have their job but the buck ultimately stops with the Minister. I am looking at a situation where one million people are on acute hospital waiting lists; 260,000 people on community waiting lists; and a national children's hospital now stands as a monument to Government failure. This hospital should have been opened years ago but we are now hearing that it could be next year or the year after. The whole thing has become very chaotic and I have not even mentioned the chaotic way in which we fund the health service. I hope that despite the amendment tabled by the Minister, she recognises how difficult things are in hospitals at the moment for patients - for every single patient who is not being treated quickly enough and for those coming to emergency departments and being left waiting for too long and in some cases then getting worse. Their condition worsens because they are not being seen. That is not a good outcome for anybody and it is certainly not a good outcome for patients so I very much hope that the Minister will listen to what has been said, lift the restrictions on recruitment and ensure that hospitals have the capacity and the staff that they need to get them through a very difficult winter.

Can the Minister answer one simple question? Can she guarantee the people of Limerick that it will be safe to use University Hospital Limerick, UHL, in January and February? That is my simple question to her. As she knows, UHL remains the most overcrowded hospital in the State. To date, 19,215 people this year have been on trolleys there. I have warned that the hospital could face up to 400 emergency department presentations every single day during the winter and it cannot cope with that. My greatest concern relates to January and February when flu, winter illnesses and increased demand will put an already stretched hospital under even greater pressure. If UHL is struggling now, what will happen at the height of winter, which in hospitals is normally January and February? We cannot wait for a serious tragedy before Government acts. These are not just numbers. They are people. They are families and elderly patients who deserve safe, dignified and timely care. The crisis is a result of decades of underinvestment - too few beds and persistent staffing shortages across the entire mid-west. That is documented. We have been underfunded for decades. We need immediate action - more staff, more beds and recruitment of essential staff while the embargo has to go. We need better discharge arrangements and a credible winter plan. We also need a long-term solution. The people of the mid-west cannot continue to depend on a hospital that is consistently overwhelmed. For the Government to say it is doing all it can is simply not true. It is a lie. The warnings are there. The Minister cannot say that she is not aware of the risks facing the hospital. The people of Limerick deserve much better, our healthcare workers deserve our support and our patients deserve safety. What is the Minister going to do to ensure that UHL can cope in January and February?

I thank Deputy Cullinane for bringing forward this motion. This motion followed a briefing from the HSE but I would say that this briefing was more of a warning on the failure to address the overcrowding crisis in our hospitals, particularly in the mid-west. How many more warnings must be received before the Minister takes action and how many more avoidable deaths must occur before patient safety becomes a priority? The situation in the mid-west is simply unacceptable. According to the CSO, people in my own county of Clare must travel further for treatment than people in any other county in Ireland, and that is assuming the service even exists. We do not even have a sexual assault treatment unit in the mid-west. How can the Minister justify such a lack of essential services? What was her response recently when my colleague Deputy Doherty raised the issue of overcrowding, staff safety and the warning of avoidable deaths? She chose to pit hospitals against one another. Pointing fingers and shifting the blame will not put beds or staff in our hospitals and it certainly will not save lives, so let me shift the focus back on the Minister. On her watch, trolley numbers have reached a record four-year high and the number of recorded emergency department experiences lasting more than 24 hours has increased by 7.6%. UHL has been described by patients as chaotic - even like a war zone. I have constituents who are genuinely terrified of being sent there. No patient in this country should have to fear entering a hospital. We have a significant bed deficit across our hospitals and, with overcrowding and the recruitment freeze, patient safety is once again being put at risk. This crisis is not inevitable. It is a result of years of failure to provide the capacity, staff and services that our communities desperately need. Comparing hospitals and making excuses will solve nothing and ignoring the warnings will put more lives at risk. I urge the Minister to listen to healthcare workers and patients and to support this motion and the actions within it, such as a second emergency department for the mid-west as close as possible to Ennis for those in the west and north of Clare. I ask her to immediately remove recruitment restrictions and legislate for safe staffing. These are just some of the much-needed life-saving actions because people deserve better. Patients deserve dignity and staff should feel safe at work but, above all, nobody should have to lose his or her life because this Government failed to act on those warnings. We have already had too many avoidable deaths and we cannot and must not allow there to be another.

Mayo University Hospital is heading into winter in a dangerously vulnerable position. I have read the Minister's response to the motion that has been put forward tonight. When she refers to safe staffing, she says that the framework continues to demonstrate positive impacts for patients. That is just not true and it is not true in Mayo University Hospital. The hospital has 85 vacancies, the emergency department is under relentless pressure, patients are facing unacceptable delays, with 42% of patients seen within the six-hour target, and exhausted staff are expected to do the work of three or four people. Let me say unequivocally that they and all public sector workers have Sinn Féin's full support and solidarity in the industrial action they have been forced to take to get a fair pay deal from this Government. The current crisis is not just a staffing crisis. It is a national patient safety crisis. That is what the Minister is presiding over. I hate to say this because when she became Minister for Health, I thought, "Great, changes were going to be made here. We're really going to see the results of this," and what do I get?