Cuirim fáilte roimh an Aire Stáit, an Teachta Butler.

Tá fáilte roimh an Aire Stáit. I thank the Minister of State for coming to the House to answer this query. I have asked for an urgent update on the establishment of a hospital board, on the expansion of facilities at UHL and on what other measures can be taken, including recruitment of additional consultants to meet demand and population levels in the mid-west.

At the outset I acknowledge and thank the Government and the Minister of State for last December bringing clarity and direction to the healthcare and hospital crisis that has plagued the mid-west for far too long. The HIQA report last autumn laid bare for all to see that the brutal overcrowding in our emergency department is caused by the chronic shortage of acute inpatient beds in UHL. That point remains central to my query for an update today. As we move forward, it is important and welcome that there is a focus on additional beds in Nenagh, Ennis and St. John's hospitals. Nonetheless, it is the provision of further acute inpatient beds that will help to alleviate the accident and emergency overcrowding we are experiencing in the mid-west.

In March the Minister announced the purchase of a 43-acre site in Raheen as part of plans to expand hospital facilities for UHL at Dooradoyle. I am seeking an update from the Minister of State on what steps have been taken since then to move the project forward. We understand that this is not something that will happen overnight. We appreciate that thought and consideration have to be put into establishing a project board, but the project board is the first critical step in developing and finalising the plans and monitoring the progress of the development of the new site at Raheen. While the Minister has accepted and authorised the maximising of the facilities on the existing UHL Dooradoyle site, that is a more complex project. This is the only acute hospital in the region. It is a busy hospital. It is managing all of the health requirements for 440,000 people across the area. It is a phased development. I give full credit to all of the hospital doctors, workers and staff who are going in and out every day. They are doing their absolute best in challenging facilities, and in what is effectively a construction site. The welcome second 96-bed block is under construction at the moment and there are plans for further development on that site. While we have to be more phased in the development and the maximising of facilities on the Dooradoyle site, once plans have been finalised and planning permission has been granted we can plough ahead and go hammer and tongs at the green site in Raheen. I would like the Minister of State to provide an update on those, and I will ask about the consultant numbers afterwards.

I thank the Senator for raising this important issue and for her constant advocacy for health services in Limerick and the mid-west region. She has worked closely with me on various projects for mental health and I acknowledge that, particularly with regard to CAST in Limerick, which is going from strength to strength. I am taking this on behalf of the Minister for Health, Deputy Carroll MacNeill. As the Senator has alluded to, the Government is working to address the challenges facing acute care in the mid-west. We have listened to the strong advocacy of the people of the region and their representatives. It is important that is acknowledged because the lived experience for many people in Limerick has fallen short. It is important that we keep listening.

I recognise the significant pressures at UHL and the impact on patients, families and staff. I commend the vital work of health service staff who continue to provide quality care when people need it most. The independent report by retired Chief Justice Mr. Frank Clarke into the tragic death of Aoife Johnston made 17 recommendations, all of which have been acted on and their implementation concluded in September 2025. Staffing at UHL increased significantly by 42% from December 2020 to April 2026, equating to 4,443 whole-time equivalents. This includes 237 additional doctors, 55 of whom are consultants. Across the mid-west, overall staffing increased by 37% over the same period to 6,179 whole-time equivalents. The subsequent HIQA review identified three potential options. Option A was to expand capacity at UHL Dooradoyle. Option B was to extend UHL to include a second campus nearby and option C was to develop a model 3 hospital in the mid-west, providing a second emergency department for the region.

The Minister has accepted this advice. We are not choosing one option over another. We are delivering all three together in a co-ordinated way. At UHL, work is moving quickly on option A. Two new 16-bed units are now in place. A new 96-bed block opened in October 2025. It is state of the art. I have visited it. A further 16-bed unit is due for completion by the end of this year. Contracts for a second 96-bed ward block are expected to be awarded shortly, and a design team has been appointed for a 66-bed block. Ennis, St. John’s and Nenagh hospitals will see an additional 114 beds by 2031. In total, 420 new beds will be delivered across the mid-west between 2024 and 2031.

We are also using innovative technology to provide care, with a new virtual ward at UHL now providing 40 virtual care beds. This has worked extremely well in the Dublin region and will hopefully be the same in this case. To progress option B, the Minister mandated the HSE in December to secure a suitable site near the UHL Dooradoyle campus. In March the HSE secured a 44-acre site in Raheen. The site provides a significant opportunity to provide meaningful additional care and health services for the people in the region. Work is under way to establish a mid-west region strategic board. The board will develop a comprehensive strategic plan for the organisation of services and investment across the mid-west to support a sustainable, region-wide model of care. This plan will determine which services must remain on the UHL Dooradoyle campus, which can move to the new Raheen site, and which can be transferred to Ennis, St. John’s or Nenagh hospitals. The Minister for Health remains focused on ensuring that HIQA’s recommendations are implemented in a timely and co-ordinated way, and that people in the mid-west have access to safe, high-quality and reliable care.

I thank the Minister of State for mentioning CAST and I sincerely thank her for her leadership on that initiative. It was an initiative, as I understand it, that was proposed from within the ranks in Henry Street in Limerick. The Minister of State really supported it. It was in danger of getting stuck, but she unclogged it and allowed it to move forward with her personal support. That project is getting strong feedback across Limerick. I know the final report has been prepared and submitted.

It is coming shortly.

She will be making her deliberations based on that. I thank her for her support. I also thank her for listing out and reminding us of the progress that has been made. It is important to point out that all the recommendations from Mr. Justice Clarke’s report into the death of Aoife Johnston have been implemented. It is also important for the people of the mid-west to hear that. The reality is that we have huge distance and ground to make up and I acknowledge her commitment to helping us to do that.

I turn to the issue of consultants. The clinical board at UHL has sought accelerated recruitment of consultants and supporting staff at UHL as an interim measure and as something important and meaningful that can be done while we are waiting for the bricks and mortar to be delivered. As the Minister of State knows, we unfortunately have 59 consultants per 100,000 in the mid-west versus the national average of 82 consultants per 100,000.

The Senator mentioned CAST. Superintendent Andrew Lacey drove this from the start. I have a had a lot of discussions with him. That is a sign of a positive initiative that should be replicated around the country. That is what we are hoping to do. It is really important that the staff are in place to deliver the vital services. I also compliment the regional executive officer, Sandra Broderick, who is open to discussions with all politicians and has made significant changes there.

I have some statistics. In December 2020 there were 141 consultants. In April 2026 there were 196, an increase of 55. That is a difference of 39% and is replicated across the region. I take on board what the Senator has said. I will bring back to the Minister the issue of accelerated recruitment because health has to be a top-down approach with the consultants leading. We are also hearing about Croom, Ennis, Nenagh and St. John's hospitals. I am embedded in the fact that healthcare is from the cradle to the grave but much of the healthcare is delivered in the community. When you have strong communities, it takes the pressure off the emergency department. The Senator's point is well made, and I will bring it back to the Minister for her attention.