I welcome the Minister of State, Deputy Niall Collins. Tá fáilte roimhe.

St. Luke's Hospital is the seventh biggest hospital in the country. There are very few hospitals in the centre of the country, which leads to St. Luke's having a huge catchment area, well beyond counties Carlow and Kilkenny, and the surrounding hospitals are not performing well. Yet in St. Luke's, posts remain unfilled across cardiology, dermatology, respiratory medicine, rheumatology and neurology. These are not peripheral specialties. They are at the core of a service for any modern model 3 hospital.

St. Luke's is facing severe understaffing. The absence of permanent consultants in these areas has very real consequences: longer waiting times, increased reliance on highly expensive locums and agency staff, reduced continuity of care, pressure on existing staff, and, ultimately, an impact on patient outcomes. Consultant-led care is directly linked to improved patient flow, faster diagnosis, safer discharge decisions and reduced admissions. When three emergency medical posts are vacant, for example, that pressure cascades through the entire hospital system.

What really concerns me is the broader structural inequality at St. Luke's. As a model 3 hospital, it serves not only Carlow and Kilkenny but a huge catchment area. When we compare this to other model 3 hospitals nationally, there is a clear perception and operational reality that St. Luke's is not receiving matching funding, workforce allocation or capital investment. Letterkenny University Hospital and St. Luke's are both model 3 hospitals, but Letterkenny has 1,000 more staff. Other model 3 hospitals in Sligo and Tralee have bigger budgets than St. Luke's. In comparison to other model 3 hospitals, simply put, St. Luke's receives less funding and has fewer key consultant positions. There is a sense that St. Luke's is being penalised for performing well over the years.

The staff on the ground are working hard and the management are doing all they can. Indicators show the hospital is under huge strain. There appears to be an implicit assumption that the hospital can continue to manage without the investment it desperately needs. However, the hospital is struggling, particularly with the absence of a second CT scanner, which is urgently needed. A business case has been submitted and it is now at the appraisal stage. The existing scanner at St. Luke's is operating 24-7 under significant critical strain as the hospital is experiencing such high demand. The absence of a second scanner has a knock-on effect across the entire hospital. It delays diagnosis, slows clinical decision-making and prolongs stays in hospital for patients and contributes to discharge delays for patients who are medically fit to leave but still waiting on imaging. This in turn obviously leads to pressure on beds. A second scanner is essential to improve patient flow and reduce wait times. Staff in St. Luke's are crying out for additional support. The pressure on the ground is incredibly real. Without additional resources, they simply cannot meet the growing need.

To add to what my colleague has said, the population catchment around St. Luke's is significant and has grown significantly over the last decade. It includes parts of south Kilkenny sometimes known as Waterford. From our meetings with the hospital team, it is clear there is an especially critical need for these posts to be filled. As my colleague said, four medical assessment unit, MAU, consultant general physicians, one consultant respiratory physician, one consultant cardiologist, a consultant dermatologist, a consultant rheumatologist and two consultant neurologists are required. These staff are absolutely vital to the services that St. Luke's provides.

The other issue in need of critical attention here is the development of the new-build Dolmen Wing ward block to replace the old medical one and medical two and surgical two units. These are the old long wards of the original 1941 hospital building, which served St. Luke's very well, but which became very challenging during Covid and had to be shut. The 86-bed Dolmen Wing ward block facility is a vital project that needs to be proceeded with. I look forward to the Minister of State's response.

I thank the Senators for this opportunity to address the House on this important matter. St. Luke’s General Hospital in Kilkenny provides a range of important services including general surgery, maternity, emergency, paediatrics, hepatology and acute psychiatry. The hospital serves a significant population, including the people of counties Carlow and Kilkenny, as well as areas of counties Tipperary, Waterford, Wexford, Kildare and Laois.

I acknowledge that the demand for healthcare services is increasing, due both to the development of new treatments and our ageing population. Considerable extra resources have been provided to increase the level of services at St. Luke’s General Hospital, Kilkenny. Notwithstanding the very difficult recruitment environment impacting the healthcare sector, staffing at the hospital has grown by 262 since the end of December 2020 - from 1,185 to 1,447 at the end of November 2025. This represents an increase in staffing of 22%.

The HSE has also advised that St. Luke’s Hospital plans to progress consultant appointments to develop services, including rheumatology and neurology. These posts can be integrated with community services to provide the most appropriate care in the most convenient setting for the patients. The budget for St. Luke’s General Hospital has also increased significantly. In 2020, St. Luke’s General Hospital had a budget of €102.7 million. In 2025, the budget increased to €155.6 million, meaning its budget has grown by almost €53 million in five years, an increase of 51%.

St. Luke's General Hospital has 260 inpatient beds and 25 day-case beds.

Between 2020 and March 2025 30 beds have been delivered. The Acute Hospital Inpatient Bed Capacity Expansion Plan 2024-2031 aims to deliver 82 beds between March 2024 and 2031 for St. Luke’s General Hospital. There has been and continues to be significant capital investment in St. Luke’s hospital. Projects delivered to date include provision of a new MRI completed in 2022, a 72-bed replacement medical ward block completed in 2022, and the electrical infrastructure upgrade works completed in 2025. The HSE's capital plan 2026, including building and equipment, and the HSE digital for care capital plan published on 24 February 2026 outlines the investment in public health infrastructure over the coming five years. The plan demonstrates the Government’s commitment to improved services, increased productivity and strategic reform of our health service. It provides for capital funding of €1,327 million for building and equipment and €263 million for digital for care. Additional projects are being progressed in the HSE's capital plan 2026, published on 24 February 2026. These include refurbishment and extension of the existing mortuary, proposed new ward block development to include a critical care unit and a new 50-bed acute mental health unit. These developments show the Government’s commitment to the progressive development of St. Luke’s General Hospital, Kilkenny.

I thank the Minister of State for the answer. We certainly recognise that there has been significant investment. However, the posts and capital projects we are talking about are absolutely vital given the population increase in the catchment. What has happened in St. Luke's over the past five years in particular has been something truly phenomenal and the staff are under severe pressure while trying to deal with the increased numbers. I welcome the additional investment but it is still not enough. These posts we are talking about are the absolutely vital component of that. Separately, it is hugely important that the Minister meet the management team and clinical staff of St. Luke's hospital as a matter of urgency to try to address these chronic shortages in the hospital. The hospital is performing extremely well under extreme pressure and that is down to the dedication of the staff and management team in the hospital.

In the final seconds I also reiterate that it would be good for the HSE to meet the hospital staff. While we recognise that there is additional staffing in place, it is over-reliant on agency staff to meet the basic needs. That is so costly for the HSE, as we know. I reiterate the point on the perceived lack of balance in terms of how St. Luke's as a model 3 hospital has been treated in relation to other model 3 hospitals around the country.

I again thank the Senators for raising the important issue and giving me an opportunity to highlight how committed the Government is to the progressive development of St. Luke's General Hospital in Kilkenny. Significant additional resources have been allocated to the hospital in recent years to meet the needs of patients. Staffing at the hospital is now approximately 1,447 whole-time equivalent posts, an increase of 22% since December 2020. The hospital's budget has increased considerably in the same period. Funding allocated to the hospital has increased by 51%. There is a strong commitment to the health capital investment at St. Luke's hospital and a number of projects are being progressed in the capital plan, which was published on 24 February. The positive progress made in recent years to increase the level of services at St. Luke's hospital in Kilkenny is a testament to the Government's commitment to the hospital and to the people of Kilkenny, Carlow and the south east in general.