At the start of the year, a major incident was declared at University Hospital Limerick, UHL, because of the number of people presenting in the accident and emergency department. In response a protocol was agreed whereby a limited number of patients could be brought by ambulance to Ennis instead. A meeting was held on 17 January with the Minister for Health, HSE senior management and the management of UHL as well as Oireachtas Members from the area. The Taoiseach's attendance at the meeting was noted and very welcome.

The acknowledgement by HSE management that UHL's model 2 hospitals such as Ennis, Nenagh and St. John's Hospital were underutilised was very welcome. At the meeting, I asked what additional resources would be provided to Ennis hospital in light of the new protocol and was told that a review would take place. It was implicit in the reply that those resources would be provided. Instead, all surgery stopped in Ennis for the month of January. Two newly equipped theatres lay idle and specialist staff were redeployed across the hospital.

I raised the under-resourcing of UHL with the Taoiseach's predecessor, Deputy Micheál Martin. I agree with him that it is not the Taoiseach's job to run a hospital but it is the Taoiseach's job to ensure that hospitals are adequately resourced within the constraints of national finances and that hospitals across the State are equally resourced. By any figures, UHL seems to be understaffed relative to the population of the region and relative to other regions and it is the Taoiseach's job to ensure that the existing resources are adequately managed.

Is the Taoiseach happy that the mid-west and UL Hospitals Group is adequately resourced relative to other parts of the State? If so, is he happy that those resources are being adequately managed?

What we want to achieve in healthcare, guided by the Sláintecare plan is essentially three things. We want healthcare to be affordable, that is, free at the point of use for a lot of people and affordable for everyone; access where people are getting healthcare in a timely manner; and we also want good patient outcomes. I am not satisfied with where we are with that as a country and I acknowledge that we have a lot more work to do and not just in the mid west region but across the country as well. People will bandy about a lot of different figures as to which region has the most beds, the least beds or which budget and I am not sure we always compare like with like when we do that. However, since December 2019, or roughly since this Government took office, we have seen a very big increase in investment in healthcare.

University Hospital Limerick, for example, has grown its workforce by more than 1,000 full-time staff since then, just two and a half years, and its budget has increased by 20%. A 96-bed inpatient ward block is under construction in Limerick. The Minister for Health turned the sod on that back in October. As I have indicated before, we need to start planning for further bed expansion in UHL because it will be needed.

In relation to Ennis, Nenagh and St. John’s hospitals, there has been a shift in policy. Our ambulance service is different from what it was ten or 12 years ago and we believe we can now safely bring patients directly to hospitals like Ennis, Nenagh and St. John’s if the patient is stable. That makes sense for many reasons I do not need to explain to Deputies. Unstable and severely ill patients go to the emergency department in Limerick while those who are sick but stable will go to Nenagh or Ennis. We acknowledge additional resources will be required in those centres if they are to see additional patients.

The medical assessment unit pathway for Nenagh came into force on Tuesday, 7 February and the pathway for Ennis Hospital came into operation on 9 January. The new pathway allows stable medical patients meeting agreed clinical criteria to be treated in the model 2 hospital rather than having to go to the emergency department in Limerick. We think that will make a positive change and a difference. It is envisaged that similar measures will be introduced in St. John’s Hospital in Limerick in the near future.

Like the Taoiseach, I hope it will make a positive change but the change it did make was the cancellation of surgeries in Ennis, two theatres lying idle and specialist staff being redeployed. There is something badly wrong with the utilisation of the model 2 hospitals.

The Taoiseach talked about figures and the Minister for Health talked about 1,000 people in the UL Hospitals Group. I received other figures yesterday saying just 60 of the 3,000-odd whole-time equivalent positions created in 2022 were in the UL group, notwithstanding the fact that UHL is the most consistently overcrowded hospital in the country. This time last year we learned there were no additional beds to be provided there, despite the fact they were being provided in less crowded hospitals.

This has an impact on real people. I have a letter from a 78-year-old woman who presented at Ennis Hospital and was told that, because there was no orthopaedic consultant available, she had to go to Limerick. She was on a trolley in Limerick for days. That is just another statistic but it is a real life affected by the fact we are not utilising our model 2 hospitals in the region to the extent we can and should.

I do not know exactly why surgery was cancelled in Ennis during that period. The Minister for Health is beside me and has said he will check that out. It could be that the hospital was simply full of medical patients. That happens, particularly during winter when the surgical wards have to be given over to medical patients because so many people come in with pneumonia, respiratory infections and other things. That is why surgery is sometimes cancelled and it is one of the reasons we want to develop surgical hubs and elective hospitals.

The Deputy will know what is happening in Croom, for example, where there is elective and managed care only. One of the risks of using the medical assessment units more in Ennis and Nenagh hospitals is that if more medical patients are taken to those hospitals, surgical beds may be taken up by medical patients, thus requiring surgeries to be cancelled. That is something we always have to factor in and is one of the reasons we are moving towards surgical hubs and dedicated beds.