The Minister is very welcome back to the House. I thank her for coming in to take my questions on this matter. She knows, as we all do, the importance of this issue for the mid-west. At the outset, I thank her for the wonderful news she gave us yesterday. We have had many sad days in healthcare in the mid-west, but yesterday was really positive. It is very important that we remember all the people who lost their lives prematurely while in University Hospital Limerick, UHL. I am conscious that this week is the third anniversary of Aoife Johnston’s death. I want to acknowledge those who lost their lives.

I thank the Minister for putting her shoulder to the wheel and taking on what is the most important challenge for those of us in the mid-west. When we last spoke in the House on 27 November, we discussed the HIQA report and acknowledged that it laid bare for all to see that the problems that have been accumulating in accident and emergency care in the mid-west are caused by a chronic shortage of acute inpatient beds in UHL. The Minister may not be aware that this put to bed an ongoing local debate about the root causes of the problems we were experiencing with the emergency department. It was important that the report highlighted that inpatient acute bed care is what we require.

While I welcome the Minister’s other commitment yesterday to provide additional beds in Nenagh, Ennis and St. John’s hospitals, I want to flag that those are not actually acute inpatient beds.

I do understand.

That distinction matters if we are to be clear and direct with the public about what is required to make UHL safe.

I welcome the Minister’s commitment to maximise the use of space on the current site at Dooradoyle, option A, in tandem with identifying a nearby adjacent site for the extension of services at UHL, option B.

I just have three questions. Does the Minister envisage the relocation of the maternity hospital on the Ennis Road in Limerick to option B, the second site adjacent to Dooradoyle under the governance of UHL? That would be in line with the long-standing objective of full colocation of maternity services and acute hospital care. The very welcome announcement in the media yesterday did not specify the provision of a second emergency department for the region. I acknowledge that the Minister has said she will proceed with option C. Given the scale of population growth and the level of existing demand in the mid-west, will the Minister clarify whether she envisages a second emergency department as part of option C?

This morning, Oireachtas colleagues from across the mid-west have been responding to yesterday's welcome announcement. Queries are arising in the context of funding. The national development plan, NDP, envelope which the Minister announced last week may not support fully funding the scale of investment needed across the mid-west. Will the Minister provide clarity on where funding for these projects will come from?

We did discuss the report in November. I knew then the approach I would be taking. I am very pleased to have spoken to the Cabinet about that first, as was appropriate, and to have secured its support for the approach I want to take, which is to implement all three options in the HIQA report and to meet the need for additional acute bed capacity and healthcare capacity more broadly across the mid-west.

As Senator Ryan said, we are progressing with options A, B and C. Option A is the delivery of acute beds at the site. I thank the Senator for explaining it, but, as Minister for Health, I do understand the difference between acute and non-acute beds. I also understand the need for non-acute beds in Ennis and Nenagh in the context of step-down services and as a key component of flow, which, the Senator will understand, is something that Limerick has improved enormously over the period during which I have been Minister for Health. I thank those responsible for their excellent management and I thank the staff for the extraordinary work they are doing.

UHL is one of the busiest hospitals in the country, but it is also the one that is discharging best at weekends. It has the best level of consultant rostering at weekends, which is a consequence of the implementation of the reforms we have introduced in the past 12 years. There is no point in putting additional acute beds into Limerick if we do not put non-acute beds in other locations, particularly as this will allow us to move people out of those acute beds and move them to services somewhere closer to home. That is the essence of Sláintecare, and that is how patient flow works. I am sure the Senator will welcome all those things happening at the same time, particularly as they are codependent in the context of allowing patient flow to work.

The second question was on the location of the maternity unit and the second emergency department. Our priority is to secure an appropriate site in relation to option B, as mandated by the Government, and to consider all of our options in respect of option C. The best, most appropriate structure to do that is to consider it alongside the best clinical advice possible. I will be engaging with clinicians on the best way to structure that going forward once we have secured an appropriate site and have seen what flexibility that will give us as regards options A and B and the appropriate clinical distribution of the services across the two sites. I will take the clinical advice in relation to that, as I am sure, will the Senator, and put it at the centre of future development.

We have a huge opportunity in the mid-west to do something we really have not had the chance to do with many other hospitals, which is to have a genuine fresh start. I have spoken to health ministers from around the world, including when I was at the G20 summit, from Singapore, Indonesia and Norway about the different perspectives and what they are learning about how to design hospitals best, the right size, the best clinical distribution. I hope we and the people of the mid-west will be beneficiaries of the fact that we have a genuine opportunity to think quite differently. The clinical community will be at the heart of that as will the patient forum and public representatives. We will take the best clinical advice we can as to how to distribute services across the Limerick region and the mid-west more broadly. It is as important for the people of Limerick as it is for the people of Clare that more services are delivered away from UHL and in Ennis. That is why full understanding of integrated care for the region is as important for the people of central Limerick as it is for the people of Clare. Everything that is delivered appropriately in Clare releases capacity for the over-congested site that is Dooradoyle and all the traffic implications for the people of Limerick and the need to move care in appropriate ways elsewhere. However, the first and most important thing is that we now have Cabinet approval and a plan. I have mandated the HSE to get the appropriate site.

On funding, I ask the Senator to speak to her excellent colleague, the Minister, Deputy Chambers, in the Department of public expenditure and reform. He will be a key part of that. I have the funding for the relevant site but in all things, like all Ministers, I have a limited capital envelope. Where I get projects to shovel-ready I have a commitment from the Minister they will be funded irrespective of the capital envelope as it is now. Our bigger challenge is not the allocation of funding at the other end but getting projects shovel ready. The Minister for public expenditure is responsible for two pieces here – implementing the terms of the accelerated infrastructure task force and making sure his officials ensure it is implemented, and then providing the capacity to fund in a range of different ways. I would welcome the Senator’s support with both of those crucial things for the people of the mid-west to make sure her party colleague delivers for them.

That is great news. I am delighted to hear that Minister, Deputy Chambers, will be supporting us in this. I know he will not be found wanting. I am looking forward to hearing the Minister for Health’s decision on the maternity hospital relocation. We would, of course, advocate for the relocation and colocation of it closer to UHL.

While yesterday’s Cabinet decision is very welcome and nothing less than what the people of the mid-west need and deserve, it is, of course, a long-term plan and pathway to safer care. The reality is that patient care for people in the mid-west is no different now than it was yesterday or than it will be tomorrow or next winter. That remains unacceptable. It will be 2029 before the next major block of acute beds will be delivered. I am firmly of the view that urgent interim measures are required in the years between now and then. I will continue to engage with the Minister on what immediate actions can be taken in the interim for the people in the mid-west while we await delivery of this very welcome medium- and long-term solutions.

It is clear to see how much University Hospital Limerick has improved over the past year. I am so disappointed to hear this constant doing down of UHL, as its performance, particularly since the 96-bed block opened, has been quite extraordinary. We look at the HSE figures every day. This morning, there were 248 people on trolleys. Our threshold for what is tolerable is 280, so it is like a good summer's day today and we are right in the middle of flu. According to the HSE figures, which are what we track throughout all of the hospitals, there were 18 patients on trolleys in UHL yesterday. In Galway, there were 39. Last week, in the same way, Limerick was outperforming Galway and other hospitals like Galway across the west and north west every single day. The work UHL is doing to make sure that is being delivered is based on weekend discharging and consistent patient flow. Last weekend, there 34 patients on trolleys on Friday, nine on Saturday morning, 15 on Sunday morning, it went up to about 30 on Monday and back down to 18 yesterday. The performance is consistently better and I thank every person in UHL who is making that possible.

I thank the Minister.