Topical Issue Debate

Bus Éireann Services

I would like to share time with Deputy Troy.

I thank the Ceann Comhairle's office for giving us time to raise this matter. I thank the Minister, Deputy Ross, for coming to the House to debate the extraordinary and completely disgraceful situation in Bus Éireann. Proposals regarding the terms and conditions of employees are being leaked to the media before they are released to the employees in question. The serious financial challenges in Bus Éireann have been the subject of a series of reports. Everybody accepts that those challenges exist and everybody wants to see them resolved in the best possible way.

On 30 November last, Grant Thornton consultants finalised a report on the options facing Bus Éireann. I have a copy of the report with me. The report has been extensively leaked in the national media in recent days. On 11 January last, the acting chief executive officer of Bus Éireann said publicly that the company is facing insolvency within 18 months. The Taoiseach told the House on 17 January last - 48 hours ago - that the Minister, Deputy Ross, has not received the report, even though it was completed in November, and therefore could not have read it, even though he apparently briefed the Cabinet on Bus Éireann on Tuesday morning. In an effort to help the Minister, my colleague, Deputy Troy, placed a copy of the report in the Minister's pigeonhole on Tuesday evening. Has the Minister read it? What are his views on the proposals and findings contained in it?

Bus Éireann is an extremely important company for Ireland. The Expressway service is an extremely important part of the company. It provides good employment. A State company should not be joining the race to the bottom in terms of employment contracts and terms so that it can compete with private operators that have fewer conditions on their methods of operation than Bus Éireann does. We need an honest and open discussion about the future of Bus Éireann and the options facing it. The employees of Bus Éireann need to be given the respect they deserve. Proposals to change their terms and conditions should not be bandied around the media for the sake of headlines. We are talking about thousands of people who deserve better than that.

Is the Deputy sharing time with Deputy Troy?

Yes, I will give way to him in a moment. We need the Minister to step up to the mark, take account of what is going on in Bus Éireann and take ownership of the issue as the representative of the Government, which is the main shareholder.

I thank Deputy Calleary for his co-operation.

The Minister knows about the financial challenges facing Bus Éireann. Its losses have been increasing incrementally over recent years. Has the Minister sought an explanation from Bus Éireann management for the situation that has developed? Why has it been allowed to get to this stage? Why is drastic action now having to be taken? Has the Minister read the report? What are his thoughts on it?

Approximately 2.7 million of the total of 7 million passengers who are carried on the Expressway service each year avail of the free travel scheme. Given that the average Expressway fare is €11, does the Minister think it is fair that Bus Éireann receives €4.50 in respect of each free travel passenger? Does he think it is fair that the money paid by the Department of Social Protection has not increased since 2009, even though the number of people availing of free travel has increased by 30%? Has the Minister spoken to the Minister for Social Protection to try to obtain an increase in this regard?

I would also like to ask the Minister about the number of licences that are issued. The National Transport Authority seems to get blamed for the issuing of these licences, but it is simply implementing Government policy.

Has the Minister received a report on the review of how the NTA had issued licences? I understand that he has received a report and that it is on his desk. When will he make its contents available?

I thank the Deputy for raising this very important issue. I agree with a great deal of what Deputy Calleary said. The need for respect on all sides, including among employers, employees and all other stakeholders, is absolutely imperative in this very delicate situation. It would be a pity if it were exploited for political advantage when so many people need protection in this threatening industrial relations dispute. I include in that group those rural communities in particular which are worried about what would happen if routes closed. In particular, I include the employees who feel, due to many alarmist statements, that their jobs are at risk. I also include the taxpayer who it is my duty to protect and members of the travelling public who will be inconvenienced if this particular dispute accelerates.

This Topical Issue is an opportunity for me to clarify a number of the misinformed comments which have been made in recent days. Last week, I met with the chair of Bus Éireann who briefed me on a Grant Thornton report which had been presented to the board by the consultants a few days previously. Following that meeting, I updated my Government colleagues at this week’s Cabinet. First, there may well be different drafts in circulation. However, and as I stated last week, the consultants presented their report to the board. I will clarify once and for all what that report is. Irrespective of what draft people are focusing on, the media and, unfortunately, some Deputies are convinced the Grant Thornton report is a plan. It is no such thing. The report is an analysis prepared as advice for the board which reviews some previously developed options, provides a critique of them and makes suggestions for further areas to consider. The report is not a plan in itself and it was not intended that it would be a plan. On foot of the report and the board's deliberations, the company is now engaged in preparing an actual plan for its future and will be developing and finalising this over the coming weeks.

Everyone in the House is aware of the circumstances in which Bus Éireann finds itself. It is losing approximately €6 million a year, which is simply unsustainable. These losses are not a result of the taxpayer's subvention. In fact, the company received €40 million last year, which was over 17% more than it received in taxpayer funding in 2015. The Deputy will know and, no doubt, welcome the fact that this year further increases will be made available for PSO services thanks to the fact that I secured an 11% increase in PSO funding generally in the budget. Bus Éireann's losses stem from its Expressway services. Expressway is a fully commercial network of routes which does not receive any Exchequer funding and competes with other operators in a highly competitive market. While some voices in recent days have spoken of a policy problem as a driving force behind all this-----

I cannot allow the Minister to continue because his time is up. However, he will have another two minutes to come back in. As I have been very strict with the other Members, I ask the Minister to stop.

That is fine.

The Minister met the chair of Bus Éireann last week who briefed him on the report. Surely, as the representative of the main shareholder, the Minister should have asked for a copy of the report so that he could study its analysis and ask his officials to brief him on it independently of the briefing from the chair of the company being reported on.

On the assertion of the Taoiseach and the Minister that rural routes will not be affected, I want the Minister to clarify what that means. Does it mean existing Expressway routes which serve rural areas will not be affected? How can the Minister give a guarantee that routes will not be affected when some of the proposals in the report include bans on overtime and the hiring in of buses to cover peak times such as weekend? How are we going to maintain services if the existing fleet cannot cope with demand and there is a ban on hiring additional fleet and on overtime?

The Minister spoke before about his vast volume of writing and the challenge of that vast volume in respect of his current portfolio. I took the Minister up on that challenge and looked today at an article in which he wrote about the then-Minister for Transport, Noel Dempsey. It stated, "Its Minister and only shareholder, Noel Dempsey, has shown a reluctance to become involved in a full examination of the less transparent activities of this mysterious semi-State monster". That monster was CIE. The Minister who will not get involved and who is being reluctant now is Deputy Ross. I ask him to, please, stand up for Bus Éireann, its workers and the services they provide.

It is the Minister who chose to remain silent over the last number of weeks. As he was requested to do, he could have clearly articulated his position and that of the Government. The 11% increase on the PSO leaves funding at a point 20% less than in 2010. The Minister says the PSO has nothing to do with the Expressway service. He is right. Is he going to seek an increase from the free travel funding provided from the Department of Social Protection? Has the Minister received a review from the NTA of the way in which licences are issued? Is that report with him and is he going to share it with the House?

When the Minister talks about there being only eight additional licences, he does not acknowledge how many additional routes each of those licences covers and he does not acknowledge that commercial buses do not serve many provincial towns the length and breadth of this country.

I must ask the Deputy to conclude.

How are they going to be served if the Minister has his way and lets the commercial companies take over?

Excuse me. Is the Deputy going to listen to the Chair? Please abide by the rules of the House. The Minister may go back to his script if he wishes. He has two minutes.

I thank both Deputies for their responses. In answer to Deputy Calleary, I note that the protection of rural communities is a matter on which the NTA has made a statement which is clearly supported by all Members in the House. The NTA says that if rural communities are adversely affected, or indeed any community is affected, it will move in as it has done in the past and ensure and guarantee that connectivity continues. It is an issue for rural communities in particular. The Government supports the NTA fully in that regard and it will be done by way of PSO services. As such, let us not use this debate to scare people into thinking they are going to be abandoned. That is not the case. The NTA has offered to come to the House and brief individuals on this issue so that they can reassure themselves and their communities of this. I am sure I will see Deputy Troy there if he gets up that morning.

Where was the Minister on Tuesday?

Let me get back to the report.

The Minister should get back to answering the question.

I am trying to answer the question Deputy Troy asked. The report he so kindly put in my pigeon hole is an interesting document. It has on the top of it a very significant word - "draft". It also has another thing in it, which is the date of 30 November. This report was seven weeks old.

And the Minister had not read it.

This is why the Deputy should not exaggerate in respect of issues of this sort. It goes on to state, "This version of the report is a draft. Its contents and subject matter remain under review and its contents may change and be expanded as part of the finalisation of the report".

So the new report is signed off, is it?

The Minister is trying to conclude and should be allowed to do so.

We have to see how many reports have been issued.

The Minister has about ten seconds.

I have ten seconds. It is good to see Deputy Troy here today. It is a pity that on 7 December he could not turn up to the joint committee with this draft after it was written.

I am not going to take that from the Minister-----

Nobody was there. Nobody turned up on that day.

On a point of order-----

Not a single Fianna Fáil Member was at the meeting, yet they are very concerned today. The Deputy did not turn up.

On a point of order, I sent my apologies on 7 December.

Not one substitute was at the meeting. Not one member of Deputy Troy's party was there. He did not show up.

It only lasted ten minutes and ended before anyone had an opportunity to ask questions.

The Deputy should resume his seat.

Did the Minister enjoy the birthday party on Tuesday?

The Deputy should resume his seat. In fairness, Deputy Troy did send his apologies.

Nobody turned up. There was no substitute.

I am not allowing the Minister back in. The Deputy sent his apologies.

No Government party is represented here.

The Minister is worse than Donald Trump.

Dental Services Provision

Just for the record, I wish to confirm that I was at the meeting on 7 December.

There were four dental clinics operating in Drogheda to cater for all of the children in primary school throughout Drogheda and south Louth. As of the start of January 2017, no dental clinics are in operation in Drogheda or the south Louth area. It is expected that no dental service for primary school children will be in place before June 2017. This means that 200 primary school children per week will be without a local service over the course of the next six months, which could amount to just under 5,000 children, or 4,800 to be precise, while waiting for services to be reinstated.

I will give some background to the issue. There were two dental surgeries in the Haymarket clinic in Drogheda. These were removed and are no longer in operation. The other two clinics in the health centre at Ballsgrove were forced to close due to extensive fire damage. The new clinic that has been promised for the Boyne centre in Drogheda is not due to open for another six months. Primary school children are currently being referred to the Louth County Hospital in Dundalk, which is causing significant delays, disruption and gross inconvenience for children and their parents. The Minister of State would accept that it is unacceptable that upwards of 5,000 children would be left without a dental service for the next six months.

Will the Minister of State make provision, as a matter of urgency, for a mobile surgery unit to cover Drogheda and south Louth as an interim measure? Will she give consideration to granting emergency approval for same, given the absence of dental services in the south of the county?

We all know that, given an absence of services for six months and the number of children involved, this will cause gross inconvenience and disruption and a backlog will be created. I await the response of the Minister of State. In the absence of a decision, would she at least give a commitment to having the HSE provide transport arrangements, such as an hourly shuttle bus service to take patients to Dundalk or Navan during the six-month interim period?

I thank the Deputy for raising the issue of dental services in Drogheda and south Louth, which I am taking on behalf of my colleague who sends his apologies.

Dental services for children up to 16 years of age and persons of all ages with special needs are provided by the public dental service of the HSE through its dental clinics. HSE dental clinics provide a screening and fissure sealant programme for children at key stages of development, corresponding with sixth class and second class in primary school and fourth class where resources are available. The service includes referral for further treatment, including orthodontic treatment, where necessary. Emergency care for children up to 16 years of age and treatment for special needs patients are also provided.

The issue raised is an operational matter for the HSE and officials in the Department of Health have contacted the executive regarding services in Drogheda and south Louth. I am informed by the HSE that in 2016 the HSE public dental service had four surgeries in Drogheda, as the Deputy correctly pointed out, two in Haymarket and two in Ballsgrove. Unfortunately, in mid-2016 the two surgeries in Haymarket were closed due to flood damage. Services in Drogheda were then limited to the two surgeries in Ballsgrove. Unfortunately, on 26 December 2016 there was a fire at Ballsgrove. Although it did not damage the dental surgeries, it has resulted in the health centre being closed until the fire damage is repaired. As a result, there are currently no dental clinics available in Drogheda.

Alternative arrangements have been made for patients to access services in the nearest available clinics. Currently, all emergencies and routine dental cases for Drogheda and south Louth patients are being catered for in Duleek, Ardee and Dundalk. The potential for minibus transfer for patients with lack of access to transport is being explored by the HSE. I will try to get a further update for the Deputy on that. The public dental service will continue to provide screening, referral and intervention to children in sixth, second and fourth classes. Emergency care will continue to be provided also. The HSE has advised, however, that it is unlikely that decontamination and infection control standards acceptable to the Dental Council would be achievable in a mobile clinic. Such a mobile service could, at most, be used for examinations. However, examinations can be carried out in local schools if necessary. The HSE is closely monitoring the situation on a day-to-day basis. It considers that the arrangements in place are more acceptable and beneficial to patients.

A new dental clinic is due to open in Drogheda in the next six months. It is expected that the opening of this new facility will provide a long-term solution to the difficulties currently being experienced. I have asked the HSE to keep the Deputy updated and to provide a further update to the Deputy of the position as of 31 January 2017.

I note that the answer to my question on a mobile dental unit appears to be "No". I do not know whether the Minister of State or the Minister are aware that mobile dental units are used extensively in parts of England and are very successful. They deal with home care for patients who are confined to their homes, as well as everything else. The response from the Department is not correct. I presume the Department does not want the bother or inconvenience of providing a mobile unit.

I again refer to the 200 primary school children per week in the south of the county per week who will be affected. Over the course of six months that will amount to 5,000 children. The Minister of State said the HSE is considering providing transport, which is to be welcomed if it is followed through on. Will the Minister of State give a commitment to revert to me with a positive response to that proposal?

If not, 200 children per week will be unable to travel to Dundalk or Ardee. The least the Department and HSE could do would be to provide transport. I ask the Minister of State to press this issue with the Department and revert to me as soon as possible. Every week that goes past means 200 children are directly affected.

We are particularly unfortunate that all four clinics were closed due to flood damage or fire. It is an unprecedented situation. The HSE is doing its best to cater for and deal with the more critical incidents and those who need services immediately.

While the Deputy is correct in saying that the service that is currently being provided is not at the same level that was previously available, services are trying to do their best to deal with all emergency cases and routine dental cases. Patients from Drogheda and south Louth are being seen in Duleek, Ardee and Dundalk.

While it is not ideal, an effort is being made to ensure that no one is left without any form of support or service.

I give a commitment to revert to the Deputy about the transport issue but, as I am representing the Minister, I cannot give a commitment on it. I will revert to the Deputy though.

Cancer Screening Programmes

Deputies James Browne and Mick Wallace are sharing time.

I thank the Ceann Comhairle for allowing this issue to be raised as a matter of urgency today. This concerns the publication today of the HSE report which confirmed 13 misdiagnoses of bowel cancer at Wexford General Hospital. In October 2014, two persons who had previously been cleared of having bowel cancer were subsequently diagnosed with it. This led to a review of more than 600 patients, 400 of whom had to undergo further colonoscopies, and it was confirmed in today's report that 11 additional people were identified as having cancer which, to use the HSE's terminology, was "probably missed" by the original screening process. That gives a total of 13 misdiagnoses and we know that one person died before a review could be carried out.

While there is always a risk of human error in medical assessments, it appears that this was much more and it is clear that this should not have happened. My thoughts at this time are with those who were misdiagnosed and their families. It must be an extremely distressing and fearful situation for them to find themselves in. There was also unnecessary stress for the 600 people who were subjected to a review and the more than 400 people who had to undergo a second colonoscopy. All of these people suffered additional and unwarranted stress. It appears that the hospital, on detection, acted quickly to inform the patients and to carry out a recall. However, why were so many failed screenings carried out before an issue was identified? The large number would point to systemic failures as well as human error.

The appointment of an external expert to carry out a review is welcome but it is important that this expert would be free to carry out a wide ranging review and not one just into the individual decisions of the clinician concerned. It is important that it would review the wider aspects of the issue. It is clear that there has been a serious lapse in proper health care. The families have been caused serious and needless stress, one man has lost his life and others will forever wonder whether the cancer could have been identified sooner.

The safety incident management report released today into the discovery of 13 possible missed cancers at Wexford General Hospital is another huge failure on a long and botched list of failures in the Wexford-Waterford HSE area. I would go so far as to say that probably two of the most dysfunctional strands of a malfunctioning national organisation are to be found in the HSE in the south east, in particular, in Wexford-Waterford. We have the Grace case and other similar incidents, the six year delay to a satellite dialysis service for Wexford, the removal of acute mental health services in the county with the highest suicide rate in the country, the long waiting lists, and the complete failure to provide an adequate amount of respite and residential care places for children and adults with disabilities. Now we have this too.

For the most part, the report gives a comprehensive outline of what occurred at Wexford Regional Hospital and Ely Hospital, but surprisingly, or unsurprisingly if one is familiar with how the HSE operates, there is an appalling lack of accountability on the part of those who run our health service. The HSE has its scapegoat - human error and a consultant endoscopist it has labelled "Clinician Y". That is where the HSE is happy to wrap up and tie a bow around its investigation. The problem with the human error scapegoat defence is that further questions must be answered. At some stage, Clinician Y was recruited by the HSE as a full-time permanent consultant. He was also on the specialist register of the Irish Medical Council. Nowhere in the report does the management team discuss the recruitment process of Clinician Y. Who recruited this consultant? Who provided references? Where did Clinician Y operate before operating in Wexford General Hospital? If Clinician Y carried out screenings in other hospitals before being recruited to Wexford General Hospital, what checks have been carried out in those hospitals? Has Clinician Y been replaced on a full-time basis?

The lack of accountability in how the HSE operates is shocking. It is not new and it did not start under this Government's watch, but is anyone doing anything about it?

I thank both Deputies for raising the issue and, again, pass on the apologies of the Minister for Health, Deputy Simon Harris, for not being here.

First, I acknowledge the anxiety and distress for the patients concerned in this programme and extend my sincere sympathy to the family of the patient who, unfortunately, died before the HSE review commenced.

I welcome today's publication of the report by the HSE which identifies 13 cases of probable missed cancers in patients who had undergone a colonoscopy at Wexford General Hospital under the national bowel screening programme known as BowelScreen. When the first two cases were identified, work was undertaken by the HSE’s serious incident management team and the BowelScreen programme to investigate this fully. Following the HSE audit, 615 patients were recalled for either a repeat colonoscopy or an outpatient appointment. This work led to the identification of an additional 11 probable missed cancers.

The Minister for Health has been aware of the incident and has received regular briefs on the progress of the review. The report outlines the look-back process and the actions taken by the HSE and the HSE has related these events to the practice of a single clinician. The matter has been referred to the Medical Council. I am informed that all patients and families involved have been contacted and all had open disclosure and have since been provided with the appropriate support and treatment. The full report was made available this morning on the HSE website.

Since the Wexford General Hospital incident, BowelScreen has reviewed its quality assurance procedures to ensure that all units and individuals delivering colonoscopy services on behalf of BowelScreen are doing so at the highest possible standard. All BowelScreen services are provided in internationally accredited centres. Wexford General Hospital has introduced a number of new patient safety measures across all hospital services, including the appointment of a clinical risk and quality manager.

We should remember that bowel cancer is the second most common cause of cancer death in Ireland and approximately 2,500 people are diagnosed each year. Screening is the most effective way to detect bowel cancer, including pre-cancerous changes. The BowelScreen programme provides a valuable service and 517 cancers have been detected since its initiation in 2012.

In line with good practice, an external review is due to commence immediately to see what further lessons can be learned. It will consider how the incident was identified, escalated and managed and will include recommendations pertaining to governance, accountability and authority at each level involved. The review is expected to take six months to complete and it will ensure that all lessons from the incident in Wexford General Hospital are embedded in the overall health system as quickly as possible.

It is important that confidence is restored in the cancer screening programme. As the Minister of State stated, this is the second most common cancer in the country but we have a very low uptake on screening. This is critical to people's lives because, if the cancer is caught early, outcomes are good when help is obtained. The HSE report makes comprehensive recommendations, which are welcome, but it is a wonder that those recommendations were not already in place given they seem to be fairly sensible and obvious. I am somewhat concerned that the report does not seem to have an implementation plan or timelines. Will the Minister of State state whether a plan and timeline for the implementation of those recommendations will be published and acted on?

It is striking that the issue with Clinician Y's screenings only came to light after two cancer cases were identified externally. Where is the oversight at Wexford General Hospital? Why has it taken more than two years to release the report? Why did it take more than eight months from the time concerns were first raised for 98% of those who needed to be recalled to undergo a second screening? I read today that the HSE is commissioning an external expert to review the quality assurance measures put in place and the overall management of the incident. Is that the case? If so, why is the HSE commissioning an external expert? How independent will an external expert be given that he or she will be commissioned and paid for by the HSE?

I repeat that the HSE is a dysfunctional organisation and has been for a long time. When will we get a Government that is prepared to sort it out?

With regard to clinician Y, as far back as February 2015, the clinician agreed to stand down from all colonoscopy work and voluntarily undertook not to perform colonoscopies outside Wexford General Hospital. He has remained on leave during the investigation process and has undergone retraining in colonoscopy. The Medical Council was advised of the incidents in April 2015.

I agree with Deputy James Browne that, given that this bowel cancer is the second most common cancer and that 517 cases of bowel cancer have been detected since the initiation of the national bowel screening programme, BowelScreen, in 2012, it is important that people have trust both in the service and Wexford General Hospital. Since the incidents, BowelScreen has reviewed its quality assurance indicators to ensure all units and individuals delivering colonoscopy services on its behalf are doing so at the highest possible standard.

To respond to Deputy Mick Wallace, the Health Service Executive is in the process of commissioning a national review of gastroenterology and endoscopy services, which will assess the current operation and quality and safety of the services. I will provide further information on this matter if the Deputy wishes.

Hospital Accommodation Provision

I have proposed this issue for discussion every day this week and I thank the Office of the Ceann Comhairle for selecting it today. We need straight answers on the opening of a new emergency department in University Hospital Limerick. I mean no disrespect to the Minister of State, Deputy McEntee, in saying I had hoped the Minister would come to the House to provide direct answers to our questions. Having visited the hospital, the Minister is aware of the position.

For months, we have been told the emergency department is due to open in May of this year. However, the Government has consistently avoided confirming this date. I am of the view that the reason for this relates more to funding than to a difficulty in recruiting staff. My understanding of the HSE service plan is that it provides sufficient money to open the new emergency department in the autumn and that an additional allocation would be required to open it in May. If that assumption is correct, I call on the Minister to insist that funds are made available to open the emergency department in May 2017, as originally scheduled and restated on many occasions.

Earlier this week, we learned that the Government could find €120 million in unallocated savings to meet the cost of an increase in pay for public sector workers. While I do not begrudge these workers a pay increase, I understand that the shortfall in funding to open the emergency department in University Hospital Limerick is a fraction of €120 million. This is a matter of life and death and I do not say that lightly. Patients and staff in the emergency department at University Hospital Limerick have been squashed into a space that is not fit for purpose. The hospital's trolley figures have been among the highest in the country for months. Only recently, the chief fire officer in Limerick warned that the fire service would "have to take enforcement action if things don't improve." Fire officers do not make idle threats and if the chief fire officer's intervention forces a decision to be taken to open the emergency department in May, I welcome it.

Recently, as many as 16 ambulances were lined up outside University Hospital Limerick because they could not disembark patients due to overcrowding. We have heard many harrowing stories, which I do not propose to rehearse. However, I was struck by one particular case of a man with bowel disease who publicly declared his name and address and provided highly personal information about the difficulties he experienced in the accident and emergency department. This took great courage but the individual in question acted to highlight the intolerable conditions at the hospital. At a protest on this issue last week, which I attended, people explained why the issue was so important that they had come out in protest.

Staff at University Hospital Limerick are struggling to manage and I commend all of them, from the most senior to the most junior member of staff and across medical and non-medical grades. While I am aware that emergency departments are under pressure all over the country, in the case of University Hospital Limerick one element of the solution can be implemented, namely, the opening of the new emergency department. This will not solve all the hospital's problems with capacity and bed numbers, as these problems are shared by all hospitals, but a new department would provide space and dignity for patients and a decent working environment for staff.

The building has been constructed and the fit-out is proceeding according to plan and on schedule and recruitment is under way. I ask the Minister of State to confirm that the emergency department will open in May.

The Deputy will appreciate that I am not able to give the answer she seeks. I apologise again on behalf of the Minister for Health, Deputy Harris, for his absence. I welcome the opportunity to address the House on this issue.

As Deputy Jan O'Sullivan stated, the emergency department in University Hospital Limerick is one of the busiest in the country, with more than 60,000 attendances annually. I commend all of the staff at the hospital and those working in other emergency departments which are currently under severe pressure. The opening of the new emergency department at University Hospital Limerick has been identified as a priority in the HSE national service plan 2017. An additional €1.4 million has been allocated to facilitate the opening of the new emergency department this year. I understand it is expected that the building will be handed over to the hospital group at the end of March. As the Deputy will appreciate, it is difficult, at this stage, to be definitive about the opening date given that a period of deep cleaning, commissioning and training of stall on the new equipment will be required before the new emergency department can open. However, I hope it will be operational as soon as possible.

The new facility will triple the size of the current emergency department and immeasurably improve the experience of patients in terms of their comfort, privacy and dignity. The Deputy will be aware that the new unit is being fitted out and recruitment of the additional staff required for the enlarged facility is ongoing. Pending the opening of the new facility, the hospital group is working to alleviate pressures in the emergency department by maximising the use of the model 2 hospitals in its region, namely, Ennis, Nenagh and St. John's hospitals, to free up beds in University Hospital Limerick.

In addition, the HSE winter initiative plan 2016-2017 has provided €40 million additional funding for winter preparedness. As part of this initiative, University Hospital Limerick was identified as one of the nine focus sites experiencing the greatest challenges in terms of emergency department pressures. As the figures on delayed discharges released today show, much of this funding has been put to good use. In line with this initiative, University Hospital Limerick is receiving an additional six home care packages per week until the end of February 2017. In the first three months of the winter initiative, that is, from October to December 2016, community health care services in the mid-west facilitated 1,672 discharges, most of which were from the University of Limerick hospital group. These discharges ensure patients do not experience delays once they have been medically discharged from hospital and free up capacity in the hospital, which is extremely important.

I also note that in early November, the operational hours of the medical assessment unit in University Hospital Limerick were extended by three hours per day. This unit facilitates the immediate assessment, diagnosis and treatment of patients presenting with chronic medical conditions and represents a significant improvement for such patients.

I was also delighted to learn that a transit lounge to accommodate patients deemed medically fit for discharge or suitable for transfer to Ennis, Nenagh and St. John's hospitals opened at University Hospital Limerick earlier this week. The lounge will accommodate 15 patients and will open from 10 a.m. to 6 p.m. It will be staffed by two staff nurses and one health care assistant. In opening the lounge it is hoped to turn around beds earlier in the day, thus making capacity available for admitted patients waiting in the emergency department or overflow areas.

I am assured that pending the opening of the new emergency department, the University of Limerick hospital group is working to identify ways and means to improve processes and systems in the emergency department and throughout the hospital group, with a view to improving service delivery. I apologise again that I cannot provide a definitive date for the opening of the new unit. I will convey the Deputy's request to the Minister and I am sure he will revert to her in due course.

While I appreciate the various efforts that are being made in the meantime, my main concern is that no date has been provided for the opening of the emergency department. I cannot understand why a date cannot be provided given that the building is complete, the fit-out is ongoing and recruitment is under way. The reason given by the Minister of State is that deep cleaning, commissioning and training of staff in new equipment are required. I do not see how this cannot be completed by May. The timetable for opening the new facility has been public for a long time and thus far the project has proceeded in accordance with that timetable. I again call on the Minister to indicate that the emergency department will open in May, as intended.

The issue appears to be the additional €1.4 million allocated to facilitate the opening of the new emergency department this year. I appreciate the Minister of State may not be in a position to answer my question.

Is €1.4 million sufficient to run the unit from May to the end of the year, including in terms of staff and so on? If not, we need an additional allocation. As I said, because of overcrowding in this unit, there is terrible suffering by patients and staff.

According to the fire chief, he will have to take enforcement action if things do not improve, which is a serious undertaking in terms of his duty as fire chief. I hope that this will concentrate minds on the need to ensure that there is adequate funding to enable this unit to open in May. I do not accept that deep cleaning, commissioning and training of staff will take more time than is available between now and May. I would welcome any assurance the Minister of State, Deputy McEntee, could give me in this regard. I hope that the Minister, Deputy Harris, will give us an answer soon. If additional funding is the issue, the amount required being not that large in the scheme of things it needs to be found.

Again, I apologise but I am unable to answer the Deputy's question directly. As I understand it, the unit will not open in May but is to be handed over to the hospital group at the end of March, with the timeline in terms of deep cleaning, commissioning and training of the staff yet to be identified. I will make the Deputy's views known to the Minister, Deputy Harris. A huge amount of funding has been already put in place to try to alleviate the problems in this area. It would be better for everybody if that funding was invested in the opening of the unit rather than on fighting fires or other measures which are always going to be a temporary fix. I will bring the Deputy's concerns to the Minister and ask that he respond to her as quickly as possible.