Today I again raise the issue of overcrowding in our emergency departments. Last week, we saw 14 ambulances queued up for up to eight hours outside Wexford hospital. As a local representative for Limerick, this healthcare crisis is something I know the Minister is also familiar with. In our city of Limerick on 3 December, UHL management once again urged the public to avoid the emergency department as 350 people attended in one day. Last month the Minister for Health opened another 96-bed unit at UHL, which has done little to mitigate the overcrowding caused by decades of underinvestment. This week we saw again 103 people on trolleys on Tuesday. We need a vision for healthcare in the mid-west beyond the next five years, and not just more short termism. At this stage the people of Limerick are living with a hospital in a permanent state of crisis. If we are to address the root cause of the problem in the mid-west, which is a lack of capacity and only one emergency department for the entire region, then next week the people of Limerick, Clare and Tipperary need the Minister to commit to a new model 3 hospital in the mid-west that will deliver a second emergency department. Squeezing more people into UHL simply will not work. Politics and politicians have failed the healthcare needs of the mid-west.

As the crisis in our emergency department rages, we have a bad flu season this year. It is a flu season we knew was coming because of the data available since the summer from Australia. The low uptake of the flu vaccine is frightening, and this is something Government has failed to address through an information and awareness campaign to urge people to get the vaccine. The vaccine should be free and it should be universal. We have been saying this for ten years. I cannot understand why we have not been listened to. This is a proven way to take pressure off emergency departments as thousands are going to be hospitalised this year due to flu. It is also incredibly concerning to hear reports that the enhanced flu vaccine was not obtained for cost reasons. As my colleague Deputy Sherlock said, this is appalling penny pinching and it will have serious costs for older people and for scheduled care in our hospitals. We know the enhanced flu vaccine outperforms the standard vaccine, particularly with older people, and this is madness, given the data we have from Australia.

As a TD for Limerick and a Cabinet Minister, will Deputy O'Donovan ensure that the health memo at Cabinet next week commits to a new stand-alone hospital in the mid-west, so option C as well as A and B? Will he account for why the Government did not roll out the enhanced flu vaccine and will he commit to a public awareness campaign to make the flu vaccine universal?

I thank Deputy Sheehan for raising an issue that is very important to both of us, the current situation in University Hospital Limerick. Deputy Sheehan was at the opening of the 96-bed block with me and others. He would agree that there have been substantial improvements made in University Hospital Limerick over the past number of years. It is starting from a really low base, there is no doubt about it. Our colleague from the mid-west, the former Minister, Alan Kelly, has referred to this on many occasions as well. The reconfiguration of the midwestern hospitals group a number of years ago has left a negative legacy with regard to healthcare provision in the mid-west that several Governments, including the current one, have had to try to unwind and deal with. The reality is that over the past number of years we have had a substantial deficiency as regards bed capacity in the mid-west that this Government is dealing with. The new 96-bed unit is open. The second 96-bed unit, which Deputy can see himself as he passes, in Dooradoyle is well under way. Planning permission for that was more difficult than we expected. There is an options appraisal, as the Deputy pointed out, that is with the Minister for Health. It is the Minister for Health who will ultimately bring forward proposals with regard to this. The Minister was in Limerick, where she has arrived unannounced. Oftentimes Ministers are criticised for coming to the hospital on an announced basis. She has arrived in on an unannounced basis and has seen first-hand what Deputy Sheehan and I have seen. I do not in any way dispute what the Deputy said earlier, but the numbers in UHL are going in the right direction. Today there are 26 people on trolleys. That is 26 too many. Ideally there should be zero, but it is not that long ago that the Deputy and I would remember that number being three, four or five times that amount. Bed capacity is the route to this. I pay tribute to the staff of the hospital, many of whom are my neighbours and Deputy Sheehan's neighbours. They have had to work in appalling conditions over many years while we had to grapple with the fact that there were successive elements of underinvestment. There is substantial investment in UHL, and I am glad the Deputy has recognised it, but there is also an options appraisal. The Minister for Health will bring forward proposals with regard to options A, B and C. She has already alluded to the fact that A and B will likely continue.

There will be more room at Dooradoyle and other units in Ennis and Nenagh will continue to be invested in. The surgical unit up at the Mount is currently well under way and the Bon Secours private hospital is open. Significant investment from the public and private sectors is helping to transform the mid-west. We have also seen significant investment in St. Camillus's, St. Ita's and Croom Orthopaedic Hospital. This is all improving the delivery of healthcare for the mid-west. I am not for one minute saying we are finished; there is further work that needs to be delivered on this.

I will come back to the flu question in my next reply.

I thank the Minister for his response. I am glad he acknowledged options A and B were happening anyway because we did not need the HIQA report for them. We need the Government to commit in the longer term, beyond the next five years, to option C because we need a new stand-alone hospital in the mid-west.

The Minister referenced staff burnout, which I am very concerned about, as well as staff leaving. I am concerned that the opening of the new Bon Secours Hospital in Towlerton will cause more staff to leave UHL. In fact, we are already seeing it. The Minister represents the region at Cabinet and this is also about him and his legacy. The fact of the matter is, as he rightly pointed out, we were sold a pup with the Hanly review and reconfiguration. We were screwed in the mid-west and are all paying the price for that short-termism. The Minister needs to give a commitment to the people of the mid-west that there will be a Cabinet decision to deliver a new hospital for Limerick, Tipperary and Clare.

I do not need to be reminded of my duties to the mid-west. I have been here 15 years, thanks be to God and to the people of County Limerick for returning me. It is a great honour and I work very hard, not only on my national duties, but on my regional and county duties, also. UHL is a concern to all of us and the one thing it does not need is politics.

The Deputy is right as regards the flu. We are worried about the amount of people who still have to get the flu vaccine. The vaccine is the best form of protection. There are many people in hospital with the flu - well over three quarters of the people in hospital at present - who are not vaccinated, which is a concern. I use this opportunity to remind people that anyone over 60 or in the age group of two to 17 can get it free, as can healthcare workers. The HSE has done many campaigns. Indeed, on the day of the opening of the hospital in Limerick, it did a campaign in Limerick to try to encourage people to get the vaccine. I encourage people in the House to get it. I have got it, as I am from a cohort of people who are immunosuppressed and need to get it. I encourage anybody who still has not got the flu vaccine to go out and get it.

Hear, hear.