Iarraim ar gach aon duine na srianta ama a choinneáil.

I raised the issue of the overcrowding crisis at University Hospital Limerick with the Taoiseach yesterday. He sought to downplay the severity of the situation. Indeed, listening to Leo Varadkar, you would be forgiven for thinking that the dire problems at the hospital were a figment of people's imaginations. This morning, however, we wake up to the news that the crisis continues. Nearly 100 patients are on trolleys at University Hospital Limerick. The hospital remains in its highest state of escalation. All beds across the hospital group are being used for surge capacity. Surgeries have been deferred for a second day in a row. People are again asked to avoid coming to the emergency department. GPs and pharmacies, which are already under huge strain, are being asked to help alleviate the pressure on the hospital. Day after day, week after week and month after month, vulnerable people are left without a hospital bed, the emergency department is dangerously overcrowded, and doctors and nurses are forced to treat patients in appalling conditions.

In 2007, the Minister's party promised to end the scandal of patients on trolleys. That was the Fine Gael rhetoric. That was nearly 20 years ago, and things have only got worse. There is now a state of emergency for healthcare in Limerick and the mid-west. The writing has been on the wall for months as regards the escalating crisis at University Hospital Limerick, so why has the Government not stepped in? Why has the Minister for Health not stepped in? That is what the people of Limerick and the mid-west are asking. The root cause of the crisis is clear. The Government has not made the necessary investment in University Hospital Limerick. This has created serious and persistent capacity and staffing problems.

Yesterday, the Taoiseach acknowledged that the population of the region is growing. That is true. What he did not acknowledge is that the Government has not increased even the target for bed capacity to meet this reality. The Taoiseach denied the staffing problem, but there is in fact an urgent need to recruit non-consultant doctors, additional nurses and medical staff for the emergency department, and more staff are needed to extend the operating hours of the acute medical unit. Limerick and the mid-west also need protected capacity for planned procedures. We need to know now when the surgical unit promised last summer will be delivered.

The Government needs to act now to relieve the intense, unsustainable pressure at University Hospital Limerick to ensure people can access their hospital and get the care they need in a timely and safe fashion. Tá stad éigeandála in Ospidéal na hOllscoile, Luimneach. Ní mór don Rialtas aghaidh a thabhairt ar an ngéarchéim agus gníomhú éigeandála a thógáil láithreach. The people of Limerick and the mid-west deserve far better than a never-ending crisis at their hospital. First, does the Minister accept that there is a state of emergency at University Hospital Limerick? Second, what action does the Government propose to take immediately to relieve this pressure and finally tackle this crisis?

I thank the Deputy for again raising this issue. As we know, University Hospital Limerick is currently caring for an exceptionally high number of unwell medical patients in the hospital. The emergency department has seen its highest week of emergency presentations since the beginning of this year. UHL is currently at its highest state of escalation. Surge capacity has been opened there and across other hospitals. Scheduled activity across all sites was deferred and will remain under review, with only urgent, critical and time-critical patients, including cancer patients, going ahead. The emergency department remains open 24-7 and urgent care is being delivered to those who need it most. However, people presenting at the ED who are not suffering with life-threatening or severe illness or injury will face a significant wait.

As the Deputy said, the Government is stepping in. It has invested significantly in University Hospital Limerick and will continue to do so. Staffing at the hospital has grown by more than 1,000 since the end of December 2019, from 2,814 to 3,854 at the end of November last year. That represents a 37% increase in staffing in that period. It includes an extra 146 doctors, 45 more consultants, 348 more nurses and midwives, as well as 84 more health and social care professionals. We will continue to invest as much as is necessary. In 2019, UHL had a budget of €265 million. In 2023, that budget was €383 million, meaning its budget has grown by €118 million over that period. That is a badly needed increase of 45% in just four years. As the Deputy referenced yesterday, we are also investing in bed capacity at UHL, which is badly needed. Some 150 additional beds have been opened in the University Limerick Hospitals Group, ULHG, since 2020 and 98 of those beds are in UHL. We are seeing another 96 beds being progressed, which will open early next year. Towards the end of next year, a further 96 beds will be added to UHL.

The calls for more investment, more capacity and more staff are being met by the Government allocation of resources. We will continue to do that to address what is a significant pressure at UHL. I thank the staff who are working in difficult conditions there. I reassure them that the Government will apply the necessary resources to ensure that capacity at the hospital increases from both a beds perspective and staffing perspective, where necessary. From a management perspective, Ms Sonya Cotter, the assistant national director of the HSE, has been acting CEO of ULHG since 14 February. The CEO, Professor Cowan, is on leave, and the acting CEO will discharge duties in the context of that role. Ms Sandra Broderick has been appointed the regional executive officer of the HSE Mid West region; she started in late December. As the Deputy knows, HSE Mid West includes counties Limerick, Tipperary and Clare.

This matter is a priority and focus for the Government right now.

As the Deputy called for yesterday, and as the Taoiseach outlined clearly yesterday, what is needed here is increased capacity, more resources and a focus on better management. All of that is happening.

I asked the Minister to share whether he accepts that there is an emergency at University Hospital Limerick. I can only judge by his response that he shares the Taoiseach's view that, in fact, the Government has done enough. I want to reiterate again today that this is not the case. The Minister is frankly delusional on this matter. I described to him, and he echoed, the facts on the ground about overcrowding and cancellation of surgery. I should also recall that the pressures associated with the lack of resources and capacity have real-life consequences for staff, patients and lives. Lives have been lost at University Hospital Limerick. I am sure the Minister knows all about that. Investigations into those matters are under way. What the people of Limerick and the mid-west region cannot fathom or accept is that in the face of that loss of life, lack of capacity, dire overcrowding and cancellation of surgery, the Government continues to sing the song and parrot the rhetoric that all is well. The resources are insufficient. Staff capacity is insufficient.

We are way over time.

Bed capacity is insufficient.

I thank the Deputy.

When will Government address that fact?

Hear, hear.

We are not singing any song. The Deputy should stop trying to misrepresent the position here. This is a situation where a very significant hospital in the country is under a lot of pressure. We are putting in place significant resources to respond to that pressure. Of course I acknowledge, as does the Government, the difficulties that staff and patients faced yesterday and face today and this week in the context of UHL. The pressures in this hospital are not new, which is why we have dramatically increased resources and will continue to do so until the capacity pressures are resolved. That is why we are in the process of adding two new blocks with 96 extra beds. One will open in the first quarter of next year and I understand the other will open in the fourth quarter of next year. There is, of course, an acknowledgement that all is not well at University Hospital Limerick when we compare it to the performance many other hospitals around the country. That is why we need to address those issues, which are primarily capacity and resourcing issues. I can assure the Deputy that the Government will continue to add more beds and more staff and improve management at the hospital.

Two days is how long the son of pharmacist Niall O’Sullivan waited on a trolley in University Hospital Limerick emergency department before receiving treatment for a fracture. Mr. O’Sullivan spoke powerfully of his son's experience on RTÉ radio this morning. This is not the first time I have raised the human impact and dangers of hospital overcrowding with the Minister. We spoke about this just last month. Clearly, nothing has changed in UHL. Indeed, the crisis has worsened, as the Minister has acknowledged, effectively. It is not just UHL and Limerick, however. Another woman with whom I am in contact spent a hellish night last night in Tallaght Hospital. Upon presenting there with pain at 4 o’clock yesterday, she was left in a waiting room until 9 a.m. today with no pain relief or anything. Another family, this time in St. Vincent's University Hospital in Dublin, had a similar ordeal. I heard from a parent who had to prop his daughter against a wall because she had been left waiting on a chair with an injury that developed into blood poisoning. She was propped up because she was dipping in and out of consciousness from pain and exhaustion. Despite that, there was no capacity to give her timely care.

These cases are not isolated. Whether it is UHL, Tallaght Hospital, St. Vincent's University Hospital, Cork University Hospital, St. James's Hospital or anywhere else, every day now, sick people who go to hospital in Ireland seeking treatment are arriving to find that it is just not there for them, largely due to overcrowding. The word that comes up time and again from people who describe their experiences to me is “chaos”. In a hospital, where patients expect to receive care, what they are receiving is chaos. They are subjected to chaos. That is not to mention the nightmare this is causing for healthcare workers. Among the junior doctors and nurses who have contacted me about their experience is a young medic who said he is looking for work in Australia or Dubai. Pay is a factor for him, but what keeps him up at night is his fear around overcrowding and lack of staffing. Because he is so overworked and must often look after more patients than he should be allowed to, he is scared that something will go wrong and that he will be blamed or, indeed, he will blame himself. Healthcare workers, who are providing an essential and heroic service, deserve better than that.

It is a shocking reality that of the ten HIQA reports carried out in Irish hospitals in the last 11 months, not one hospital has been found fully compliant when it comes to staffing. This is at a time when it needs to be all hands on deck here. Instead, what we are seeing is effectively a sinking ship. We know from replies to parliamentary questions my colleague, Deputy Duncan Smith, has received that the HSE is unable to even guarantee that workers on a career break will not be impacted by the recruitment freeze. Yet, each time we mention the freeze, the Government deflects. The Taoiseach says it is not having an impact and that the HSE is hiring. However, it is plain for everyone to see that there are just not enough staff in our hospitals and, therefore, healthcare workers and patients continue to be placed in harm’s way. Can the Minister offer us a substantial reply and not simply say it is desirable to tackle overcrowding and understaffing? How can he stand over a situation where not hospitals are not fully staffed?

First of all, many hospitals in the country are performing really well and do not have patients on trolleys whereas they would have in the past. They have seen waiting lists come down significantly on what they were in the past. That is happening because of good management, more staff and more resources. We have a larger health budget now than ever before, and rightly so because our population is growing and ageing.

With regard to the specifics of the question the Deputy has asked, there has been an unprecedented level of investment by this Government in the health service workforce in recent years. We have seen consistent growth in the workforce each year since 2020, with the growth in the number of staff recruited in 2023 being the highest since the foundation of the HSE. There are now 26,172 more staff working in our health service than there were at the beginning of this Government. That includes almost 8,500 additional nurses and midwives, more than 4,000 additional health and social care professionals and nearly 3,000 additional doctors and dentists. That is a 22% increase, meaning that for every five people working in the health service in 2020, we now have six.

It is true that in November 2023, the CEO of the HSE announced a pause in all recruitment, with the exception of consultants and graduate nurses and doctors in formal training programmes. This recruitment pause, which was put in place as part of a suite of control measures, included an instruction to reduce expenditure on agency staff and management consultants across the HSE. The reality is that the HSE had already exceeded its 2023 funded workforce targets, which was not sustainable. There are now 146,500 staff working in our health service. The HSE was funded to recruit just over an additional 6,000 staff in 2023. In reality, however, it hired well over 8,000, meaning that it had more than 2,200 staff more than it was funded for. Funding for an additional 2,268 staff has been secured by the Minister for Health. There is much talk about recruitment freezes, but there are a lot more people coming into the health service, and they are badly needed. We will continue to ensure the health service grows, expands and is invested in as our population grows and becomes more demanding given that we have an ageing population.

While we acknowledge that some hospitals are under significant pressure, if we look at the health system as a whole, we will see that waiting lists are down. Trolley numbers are down. Staffing numbers and bed numbers are up. We need to focus on hospitals like UHL that are under significant pressure and others that are feeling pressure, but we also need to recognise the successes of many hospitals that are performing really well for patients.

The Minister's response could be characterised as "Nothing to see here". That is clearly not an adequate answer for all the patients who are languishing on hospital trolleys, for the overworked staff and for those whose procedures at UHL have been cancelled without any indication of when they will actually take place. Every time we raise the reality of overcrowding in hospitals and understaffing, the Minister and his Government colleagues respond with metrics, figures, details-----

With facts.

The patent fact is that the spending is not enough to meet the demand.

That is evidently true from HIQA reports and from the experiences of patients and of overworked staff in understaffed hospitals. Where is the sense of leadership? Where is the sense that somebody is steering this ship, that it will be all hands on deck to ensure the crisis in hospitals is addressed and that we can retain and recruit enough staff to support consultants to supply the teams that are needed to ensure the procedures can take place? When will we see the real action to address the overcrowding that continues to persist in far too many hospitals across the State? It is not just in Limerick but undoubtedly University Hospital Limerick is a particularly egregious example of understaffing, overcrowding and consequent harm to patients and staff alike.

I accept what the Deputy is saying in raising issues to which the Government needs to respond. What I do not accept is the characterisation that the Government's response is that there is nothing to see here. There is a lot to see here. We see it and we are trying to respond to it. That is why staffing numbers in the HSE have grown by 22% in the past four years. That is why we are spending over €23 billion on healthcare now. We are seeing results from that expenditure in waiting times and trolley numbers falling. Are there still problems in our health service? Of course there are and we are seeing those pressures in a very real sense both on staff and patients in Limerick today. We acknowledge that. It needs a response from the Government and it will get one, as well as from a management point of view-----

Why are the cancellations happening? Something is going wrong in the system.

We have the highest life expectancy in the EU.

Thirteen years ago.

Tell that to the people of Limerick whose procedures have been cancelled.

It is our fault because-----

Instead of blaming the patients and the staff-----

Deputy Sherlock knows that when a health system-----

-----you should look at yourselves.

-----is escalated into pressurised management situations, you need to prioritise the patients who need beds most.

Why are they being cancelled?

That is what is happening in Limerick today. Is that welcome? It certainly is not.

Thank you, Minister. We are over time.

We have surge capacity using other beds in the region as best we can. This is a temporary arrangement-----

Táimid thar am.

-----that we will move beyond as quickly as we can.

I remind Members that we are on Leaders' Questions. Bogaimid ar aghaidh anois go dtí an Grúpa Réigiúnach agus an Teachta Denis Naughten.