Tá fáilte romhat, a Edwin. I am not used to seeing you in this setting, but you are very welcome. I am sure we all agree on that.

Over the last few days people have listened in horror to the testimony presented at the inquest into the death of 16-year-old Aoife Johnston. Aoife died in University Hospital Limerick on 17 December 2022. The inquest is ongoing and we await its verdict. We have heard that on that fateful night in 2022 when Aoife presented to the emergency department it was under enormous sustained pressure. The senior house officer on duty that night has said that nursing staff were "overwhelmed" with patients seeking treatment. She said that staff were left in an "impossible situation" due to the severity of the overcrowding. Staff shortages were a huge issue and the doctor said that the emergency department was "not a safe environment" for patients. Aoife had presented with suspected sepsis, so time was of the essence, but she was left waiting for 13 hours, lying across two chairs as a makeshift bed, before eventually being seen by a doctor. There was not even a trolley available for her. Aoife’s heartbroken parents Carol and James called out for help as their daughter deteriorated, but have said that there was no help. Carol said “we watched our daughter die – I wouldn’t wish it on anyone”.

I raise Aoife’s case because it speaks, in the most heartbreaking way, to the depths of the crisis at University Hospital Limerick. The chaos in the emergency department that Aoife and her family faced that night is what faces patients and staff all the time. The hospital’s full overcrowding alert was enacted every other day last year. We should let that sink in for a moment. This is a hospital operating at permanent surge capacity and the surge is every single day. UHL is in a constant state of emergency because it simply does not have the level of staff or beds it needs to deal with demand. The result is chronic overcrowding, persistently high trolley counts and people denied healthcare with thousands of appointments cancelled every month. The hospital is short 200 vital staff. The panels are in place but staff cannot be recruited because of the Government’s embargo. The blocking of recruitment when a hospital is on its knees just beggars belief. To get ahead of this crisis, the hospital also needs 288 additional beds and it needs them to be delivered rapidly. While the Taoiseach’s Government has announced some limited measures, they fall far short of what is required and the reality now is that staff, patients and the public in general feel very unsafe. Is mór an chailliúint í Aoife Johnston. Thug a bás léargas ar na fíorchontúirtí a bhaineann le róphlódú in Ospidéal na hOllscoile, Luimneach. Tá fíorathrú ag teastáil ó mhuintir an mheániarthair maidir le cúram sláinte.

This cannot go on. The people of Limerick and the mid-west are at the end of their tether with the constant crisis in their hospital. They are screaming out for action and they believe the Government is not listening. They want the Government to effectively address the crisis with speed and purpose. Here is what the Taoiseach's Government must do: firstly, it must end its dangerous recruitment embargo so that University Hospital Limerick has the staff it needs to meet demand; secondly, it must deliver the additional beds the hospital needs with urgency to tackle overcrowding; and thirdly and importantly, it must invest ambitiously in local out-of-hours community health services to relieve pressure on the emergency department. These three steps would transform the situation. Will the Taoiseach take them?

Gabhaim buíochas leis an Teachta. I thank her for raising this very important issue. I join the Ceann Comhairle and the Deputy in welcoming Speaker Poots to Dáil Éireann. It is great to have you here and everyone in this House looks forward to working with you and colleagues and counterparts in the Northern Ireland Assembly and the Northern Ireland Executive.

I thank Deputy McDonald for raising this extremely important issue. She alluded to the inquest into the death of Aoife Johnston being in progress and I am very conscious of that. Like the Deputy, I do not wish to say anything to cut across that process. We will certainly all have a lot to say when that process concludes. I express my deepest sympathies, and I know the sympathies of everyone in this House, to the family of Aoife Johnston. I cannot imagine their pain, their grief at the loss of a daughter and sister and the pain they are living with every day. The inquest is ongoing so I will refrain from commenting on that, but as the Deputy knows, the chief executive of the HSE, having considered a report he received into the death of Aoife Johnston, which had very significant findings about the care of Aoife and the operation of the hospital, appointed the former Chief Justice, Mr. Justice Frank Clarke, to conduct a formal investigation. The outcome of that investigation is going to be very important – I am sure we can all agree on that – in informing any further decisions that need to be made. In instigating this investigation the HSE CEO quite rightly apologised unreservedly to Aoife’s family and moved to assure them that any issues raised will be investigated thoroughly, fully and without fear or favour. I add my voice to those sentiments. I understand the HSE expects that report from Mr. Justice Clarke by the end of May, but of course it is important that he has sufficient time to fully complete that work and deliver a good and robust report.

I fully accept that there is a very serious situation at University Hospital Limerick. It would be simply not credible to suggest anything to the contrary, but I need to say that against a backdrop of legitimate questions that need to be asked in terms of the level of investment that has been made in that hospital. Let us look at a number of facts. Staffing at the hospital has grown by over 1,100 since the end of December 2019, or from over 2,800 staff at that time to over 3,900 staff as of the end of February. This is a 42% increase in staffing levels in the hospital. It includes very specifically 161 more doctors, 49 more hospital consultants, 433 more nurses and midwives and 116 more health and social care professionals. University Hospital Limerick now has more emergency department consultants than any other emergency department in Ireland.

I want to pick up a valid point the Deputy has raised, which I have heard her make a few times. I have raised it with the HSE as recently as today. The Deputy talks about the safe staffing levels and the nurse numbers required in the hospital. I have been told, very categorically in black and white here, that the extension of safe staffing to EDs and to general and specialised medical and surgical settings is fully funded. Therefore, I absolutely expect the delivery of the safe staffing levels to EDs and to general and specialised medical and surgical settings in UHL and indeed all hospitals. I am going to pursue that on the basis of the issue the Deputy has raised and I will come back to her. I have also seen that the budget for the hospital is now €382 million. That is a 44% increase in five years. There is no other hospital in the country that has seen that level of increase. The recently published hospital activity report, which gives an overview of the change in expenditure at hospital level, places UHL at the top. Total expenditure in Limerick has more than doubled. It is the largest increase in expenditure over the period.

I turn to the three specific issues the Deputy has raised, all of which are sensible. On the embargo, we live in a country with a health budget that sees capacity for 2,200 net additional posts within the health service this year. We can debate around recruitment, but there is funding for 2,200 additional posts. There will be more nurses, more doctors, more therapists and more people working on the front line of healthcare at the end of this year than at the start of it. I have been very clear on safe staffing levels and the fact they are fully funded in the settings I have outlined. I will come back specifically on the Deputy’s view on the impact of recruitment on the staffing levels in that hospital. The second point was on beds and the Deputy acknowledged we have worked to increase bed capacity while saying we need to go much faster and much further. We have already had 150 new beds open in the University of Limerick Hospital Group since January 2020, with 98 of them at the hospital. Work has commenced on a 96-bed ward block at the hospital in Limerick and there have been a number of other interim measures taken in recent weeks that I can perhaps come back to in a moment.

The Taoiseach says he is listening, but clearly he is not. If everything were as rosy as he portrays, how is it that University Hospital Limerick consistently has the highest trolley count? How is it that front-line staff and their unions consistently have said they do not have the staff to deal with the level of demand? This is a hospital that is enduring surge every single day. The Taoiseach is not disputing that fact.

No.

The facts as they present on the ground are that the emergency department is not safe.

People do not believe the hospital is safe, and that is a major problem. The panels have been established. Additional staff are needed, as are additional hospital beds.

We have to start from a position of acceptance. The Taoiseach can quote whatever figures he wishes. We could go into the history of the closures at Nenagh and Ennis, which created a regional pressure point at University Hospital Limerick. That is all in the past, however. We need to deal with the present. In the current circumstances, the situation is unsafe. Rather than trading numbers with me across the floor of the House, I would like a commitment from the Taoiseach that the recruitment embargo will end, that the additional staff will be recruited, that there will be far greater ambition as regards beds and that he will make this hospital safe again. That is the demand from Limerick and the mid-west.

I say this respectfully, but it is hard for me to answer the question if, when I use a number or statistic in answering, the Deputy just tells me I am not listening or asks me not to quote statistics at her. When she quotes statistics at me, I reply. When she asks a question, I endeavour to answer. I made the point that context is important. It is important for people in Limerick who are watching this discussion today. The impression is sometimes given that resources are not going into a hospital. This is a hospital that has more emergency department consultants than any other hospital in Ireland. That has to be acknowledged. We must have an honest debate. It is a hospital that has seen a greater increase in staffing levels than many other hospitals and which has had a massive increase in its budget. As the Deputy has acknowledged, we are also taking more measures in respect of beds and bed capacity.

The hospital is unsafe. The Taoiseach should acknowledge that.

Hang on a second. Every day, there are many people in that hospital getting very good treatment and there are many incredible people working in it. The Deputy and I have acknowledged that.

That is not in question.

We cannot have a conversation on the matter.

I am sorry; I am trying to be helpful. There have been a number of very difficult issues. One of these is before an inquest which neither I nor the Deputy wish to cut across at this point, although we will both have plenty to say when it ends, as is appropriate. However, I accept that there is a need to do a great deal more in Limerick. I am telling the Deputy that I am specifically following up on the safe staffing levels for Limerick, which have been funded. The Minister for Health recently outlined a number of additional measures he intends to take in the here and now to increase capacity. It is not a question of a lack of budget or a lack of willingness to do more. There is also a need to ask why we are not seeing improvements for patients when we are putting so much additional investment into a hospital. That is what the Minister intends to get under the bonnet of.