Cuirim fáilte roimh an Aire Stáit, an Teachta Murnane O'Connor. There was a bit of a delay, but I am delighted to see her here because it is great to have a Minister of State from the Department. I am very happy that we waited to have the correct Minister of State in place. I thank the Minister of State so much.

I raised the issue of low staffing levels at St. Luke's Hospital in February in the Chamber alongside Senator Noonan. I do not think it was a Minister or Minister of State from the Department who answered our question. We heard at that stage that there was a commitment to the progressive development of St. Luke's. It is an area that the Minister knows plenty about. We had news over the summer that St. Luke's in Kilkenny has the highest staffing deficit in the Dublin and South East HSE region with 148 vacancies recorded in August. This comprises approximately 67.5 whole-time equivalent nurses. These are vacancies in nursing. We heard about these vacancies at the start of the year as well, so they are still in place. This has a direct impact on patient and staff safety. Staff are under significant pressure, including huge trolley pressures daily with no relief because of massive overspending by some hospitals, but not in this case by St. Luke's.

As the Minister of State knows, St. Luke's serves a very large catchment area as there are few hospitals located in the centre of the country. It has done incredibly well in the past in managing budgets, but in many ways, it seems that the hospital is being penalised for working within its limits. Ongoing staffing shortages include two emergency department consultants which had been promised. I have written several times to the Dublin and South East HSE team and I have never really received a satisfactory response. It took a long time to get any response and even when I got one it was not up to scratch. St. Luke's has the third lowest ratio of emergency department consultants per patient attending in the country.

Despite it being an incredibly busy model 3 hospital, it is simply not safe enough for patients.

Another question I have, which the Minister of State will, I am sure, be able to answer, is around the Carlow injury unit and when it will be fully staffed. I am a little concerned that when the Carlow injury unit opens, it will poach staff from the emergency department in St. Luke's where the staffing levels are already so low. Clarification on how those human resourcing systems will be put in place would be helpful. People in Carlow-Kilkenny are being let down by this. We are being punished for St. Luke's being a very effective hospital and for doing such a good job. The inequity is frustrating and it is having a direct impact on staff morale as well.

We heard recently that several health regions are having their spending powers removed. I am wondering how this will affect the staffing constraints already facing St. Luke's. I recognise that the HSE has been over budget but prior to 2020 there was significant underspending in the health service and it was hugely affected by austerity years combined with changing demographics and an ageing population. Our hospitals and healthcare centres must be staffed to safe levels for both patients and the staff themselves and we need budgets that reflect the reality on the ground.

There is a critical need for these clinical posts. Instead, we have seen the hospital over relying on highly costly agency staff which is not good value for money and there is a serious perception that St. Luke's is being treated differently to other model 3 status hospitals in the country. It would be helpful for us to understand where the staffing plans are and what was being made to ensure that we have safe staffing at St. Luke's and also, of course the Carlow injury unit when it will open.

I thank the Senator for raising this important question. The Senator and the Acting Chairperson, Senator Noonan, have constantly be raising these issues, and rightly so. I thank the Senator for this opportunity to address the House on this matter. I am taking this Commencement matter, as the Senator will be aware, on behalf of the Minister, Deputy Jennifer Carroll MacNeill.

The Government is committed to the development of services in St. Luke's General Hospital. As the Senator will be aware, we visited there recently - it is a few months ago the way the months are flying - with the Minister. St. Luke's General Hospital provides a range of important services to the people of Carlow-Kilkenny as well as counties Tipperary, Waterford, Wexford, Kildare and Laois. To meet the increase in demand for services, considerable additional resources have been provided in St. Luke's. Staffing at the hospital grew from 1,185 to 1,505 between the end of December 2020 to July 2026. It has grown quite considerably. This represents a significant increase of 27%. The HSE has advised it continues to actively progress and approve vacancies and implement workforce planning measures to support service delivery - they are constantly onto that - while staffing levels, patient activity and service requirements are also monitored on an ongoing basis. The budget for St. Luke's hospital increased by 62% between 2020 and 2026 and important capital projects are being progressed. These projects include the refurbishment of existing wards to accommodate acute beds, including space for a paediatric day unit which was completed this year.

I would also like to respond to the Senator's question on the update of the staffing of the new Carlow injury unit, which is important for us all. Enabling works have started on this unit. The work has commenced. While the work is progressing well and we hope to have it open as soon as possible, all efforts are being made to operationalise the injury unit prior to the planned opening in 2027. To put it simply, the contractors are in, it is being worked on, but my priority, like that of the Senators, is to have it up and running as soon as possible. This represents a key step forward in delivering this important service for the people of Carlow and surrounding areas. Recruitment for the Carlow injury unit will follow the national model for injury units. It includes: advanced nursing practitioners, emergency medicine medical staff, radiography, administrative support, and operation and governance roles. The HSE will ensure that staffing is phased in line with the construction process, commissioning requirements and service readiness. Even though Kilkenny will lead this now and it will be working in conjunction with Kilkenny hospital, they will have their own separately. Their staff will be different while they all work together, to clarify that.

I am also happy to inform that Senator the HSE has confirmed that the staffing, as I have said, in the injury unit will not impact the posts committed in St. Luke's hospital. The posts remain part of the hospital work plan and they are separate from the staffing model of the injury unit, because there were - the Senator is correct - huge concerns about that. Most of them are nearly hired now. Work has started. The main thing is we get it open as soon as possible.

I thank the Minister of State. I am glad to hear that the staffing will remain separate to St. Luke's and it will not draw from it, because, as the Minister of State mentioned, there were concerns around that. It is good to have that confirmation that it will not be drawn from the same pool.

I am delighted that work is progressing. I hope that we open the unit as soon as possible because the key thing is it will also alleviate a lot of pressure on St. Luke's accident and emergency department as well as a consequence of Carlow having its own injury unit.

On the question of the two outstanding emergency department consultants, I recognise the Minister of State is saying staffing and spending have increased but our whole metric around staffing has to be around safe staff levels. The HSE faced underspending powers in 2020 during austerity. I recognise a huge amount of money has gone into it but the challenge is that we still have two outstanding positions in accident and emergency - the third lowest ratio in the country despite the catchment area being so huge. That is a risk for patients who are coming in and it is a risk for staff. Those posts have been promised and they have still not been delivered. I cannot understand. When will they be delivered? I suppose we need clarity on that because it is dangerous for people.

We do not have a written response for the Senator but we will get that provided for her.

Apologies, I will get that for the Senator.

I will get clarification about those particular posts because it is important. I will be in contact with the Department today.

What I can say, as the Senator said earlier, is that Kilkenny hospital is outstanding. It is a model 3 hospital. The staff do great work there.

It is important, as she said. Working through the HSE and with the Department, there has been an increase in staffing but on those two particular posts, I certainly will come back to her.

On the injury clinic, we are moving as quickly as we can. When you give a time, there are always delays. We hope to have some of it ready or operational by the end of this year and then, in early 2027, it will be fully operational. It is great to see this. It adheres to Sláintecare. For the people of Carlow and the surround areas, it will be good to have this operating.

I thank Senators Stephenson and Noonan for their commitment. They are constantly highlighting the importance of this too.