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Dáil Éireann díospóireacht -
Thursday, 23 Jun 2022

Vol. 1024 No. 2

Saincheisteanna Tráthúla - Topical Issue Debate

Healthcare Policy

I thank the Minister of State, Deputy Noonan, for taking this matter. I ask him to outline the plans by the Department of Health for the introduction of the free contraception scheme for 17- to 25-year-olds, which is due to happen in August. I am seeking clarification as to whether it needs to be done by way of legislation or by means of regulation. If the former, when will we see the draft Bill and a timeframe for bringing it forward? My understanding is that it is not clear whether legislation or regulation is required.

My second point relates to engagement with GPs on the scheme. Are there plans to provide training for GPs, especially in respect of long-acting reversible contraceptives, LARCs? Has there been engagement with the Irish Medical Organisation, IMO, on the introduction of the scheme? Has the Department looked at the geographical spread of GPs available to provide support in the implementation of the scheme? Has there been engagement with the HSE on the scheme?

Are there plans afoot for the roll-out of a public information plan on the introduction of the scheme and, if so, when is that campaign likely to begin? An important issue to consider is that third level colleges will be coming back in the second or third week of September. Is the Government satisfied there is adequate support within the colleges in respect of the roll-out of the scheme?

It is important that we get this clarification now and that planning starts in respect of the information that must be disseminated to the public to ensure it will be available in a timely manner.

I thank the Deputy for giving me this opportunity to update the House on this matter, which is one of the Government's top priorities for action this year. The report of the working group on access to contraception, published in October 2019, identified the barriers that exist to accessing contraception. These barriers include accessibility, information, health system capacity and, for a significant number of women who may be just above the eligibility threshold for a full medical or GP visit card, cost. Following the recommendations of the Oireachtas Joint Committee on the Eighth Amendment of the Constitution and the findings of the Department of Health's working group on access to contraception, the 2020 programme for Government commits to providing free contraception for women, starting with those aged from 17 to 25.

The decision to prioritise this cohort was based on research, summarised in the working group's report, showing that women aged from 17 to 25 are most likely to experience a crisis pregnancy, and are also least likely to have independent financial means. A significant number of these women are still in full-time education and dependent on parents and guardians for income, some of whom may not be willing or, indeed, able to fund prescription contraception. The barriers to accessing the most effective forms of contraception are, for this cohort in particular, likely to be exacerbated by current inflation rates and the consequent rise in the cost of living.

The Department of Health's contraception implementation group was convened last year and has been working with partners, including the HSE, towards ensuring the scheme will commence in the third quarter of this year. Funding of approximately €9 million has been allocated for this in budget 2022. The scheme will provide for the cost of prescription contraception; the cost of medical appointments to discuss and prescribe suitable contraception; the cost of fitting and removal of long-acting reversible contraception, for example, implants and coils, plus any necessary checks; and the cost of training and certifying more doctors to fit and remove long-acting reversible contraception, such as the implant or coil. The wide range of prescription contraceptives currently available to medical card holders will also be available through this scheme, including contraceptive injections, implants, coils, the contraceptive patch and ring, and various forms of the pill, including emergency contraception.

The scheme will be open to all aged 17 to 25 who are ordinarily resident in Ireland. Formal contract discussions with medical representative bodies are ongoing with regard to service provision and the legal framework for the scheme is also being progressed. My response has probably answered two of the Deputy's three questions. I am not entirely sure about the third question on legislation and regulation, but I can come back to the Deputy on this.

I raise this matter because concerns have been expressed to me that there may be a need for legislation in the context of this scheme. In that regard, I am concerned about the timeframe we have to pass any such required legislation, with this House only sitting for another three weeks, and likewise with Seanad, which any Bill would also have to go through. The issue here is whether we need legislation. If we do, the problem will be that we may not be able to implement the programme and this scheme in August this year. Therefore, it is important that clarification is provided regarding this matter.

On the other hand, if it is not a matter of legislation, what progress has been made in respect of regulations? Again, regulations cannot be drafted overnight. It takes time to do that, and some support from a legal perspective as well. Where are we with this endeavour and when will we get a definitive answer from the Department on this matter? If we are still uncertain about the issue of legislation and regulations, how can we plan an information programme in the context of the implementation of this scheme? Therefore, some clarification is needed. I ask that the Department respond to me at a very early stage next week to confirm whether this scheme will be undertaken via regulations or legislation. If it is legislation, I would like clarification on the timeframe for bringing that forward and for introducing the Bill into this House.

My closing statement might provide clarification. The free contraception scheme for those aged 17 to 25 represents a wonderful opportunity to increase access to contraception and to better support sexual and reproductive healthcare in Ireland. We hope that the measures will significantly reduce crisis pregnancy rates among this high-risk cohort, who are also the most likely to experience cost barriers to accessing the most effective forms of contraception. The working group on access to contraception and the women’s health task force have, separately, conducted stakeholder engagement exercises in the last five years. The measure is enthusiastically supported by a large majority of stakeholders, particularly clinicians and others working in the area of women’s sexual and reproductive health.

Research conducted in England on the free contraception scheme in that country showed that it was extremely cost-effective and we expect that the outcomes here will be similarly positive. Given that the costs of prescription contraception are typically faced by women, the measures will have a significant positive impact on gender equality. Reducing costs for women will also benefit their partners and families. The scheme will also represent a reduction in the cost of living for those in this vulnerable age cohort who are sexually active and were not previously eligible for a medical or GP visit card. The Department is working hard on finalising the legislative framework and contract discussions with service providers prior to launching the scheme and hopes to be able to provide significantly more detail in the weeks to come.

I will get clarification for the Deputy on how the legislative framework is advancing and on the particularly important point around the information programme and rolling out an information campaign over the coming weeks and months. I will ask the Department to respond directly to the Deputy in this regard.

Regeneration Projects

This is an issue I raise regularly. The situation does not seem to be getting any better. If anything, things seem to be getting worse. People living in flat complexes in the inner city are genuinely frustrated in respect of having been forgotten. They feel, and the evidence suggests they are right, that Dublin City Council has neglected them for too long, as has the Government. They are living in conditions that are just not acceptable. These are not all old flat complexes. Many of the newer flat complexes have serious issues as well. Not too far from here, in York Street, is a flat complex that is only 12 years old. Around Christmas time, the residents of an entire block had to be moved out because of a water leak that occurred due to inadequate maintenance. They had to leave that flat complex during Covid-19 and it was traumatic for them. Therefore, there appear to be serious maintenance issues in all the flat complexes across the city. There certainly are in those premises in Dublin Bay South.

The Glovers Court complex is at the other end of the old York Street. An email was recently sent to all the councillors and Deputies in Dublin Bay South. I will refer to it because it expresses how the people living there feel and how the vast majority of people living in flat complexes feel. The email states that the tenants in Glovers Court are tired of the broken promises and regeneration promises that have been made to them for a number of years and are tired of being told it is in progress and the application has been submitted. The email goes on to state that this is not good enough and that the tenants in Glovers Court want to know what local Deputies and councillors are doing for them, other than emailing the council, which then makes promises to the tenants that are broken. The email continues by stating that the residents are tired of carrying their children over human faeces and urine every day; tired of having to constantly to pay €40 to €60 a week for gas to keep their flats warm; tired of constantly bleaching their walls to get rid of the damp and mould; tired of carrying heavy bottles of water up the stairs because they cannot drink their water because it is contaminated; tired of bringing their children to doctors and hospitals because they are constantly sick because it is colder inside the flats than outside; tired of being woken up at night by the antisocial behaviour in the complex; and tired of being woken by fire sirens because someone has set fire to a flat. The email further continues by stating that a couple of weeks ago there was a fire in the complex and Dublin Fire Brigade could not access it because people were parked there like it was a free-for-all.

The email then went on to state:
...thank God the neighbours got the fire out as if it had of spread, we all would have been killed as we all have gas meters in our kitchens.
Who wants to take responsibility for 33 flats exploding because nobody is listening to our concerns? Nobody wants to fight for Glovers Court and have it demolished as a matter of urgency. We are tired of the racism, abuse and local discrimination because we live in Glovers Court. You cannot leave the flat complex to go to the local shops without being asked, "How do you live in Glovers Court? I would not live in it if the council gave it to me rent free".
The flats are not fit for purpose. When it rains the balconies flood and some of the flats also flood. If you Google Glovers Court, have a look for yourself what people think of Glovers Court. These living conditions are going against European law and we want to know as our local representatives what are you going to do to resolve this?
That sums up not just the feelings of all of the residents in Glovers Court, but the feelings of almost all flat dwellers across Dublin Bay South and the south inner city.

The Deputy and I have discussed this issue on a number of occasions, as has the Minister, Deputy O'Brien. I thank the Deputy for raising this issue, in particular the European committee ruling and the regeneration of social housing flats in inner city Dublin.

The Government and my Department, in particular, have given careful consideration to the report of the European Committee of Social Rights. My Department is committed to ensuring that tenants in social housing are provided with adequate housing that meets the standards most recently laid down in the Housing (Standards for Rented Houses) Regulations 2019. To address the issues raised in the report, my Department is actively engaging with the local authority sector to promote the preventative maintenance of local authority housing stock and provide significant funding for stock improvement works. In addition to funding provided by the local authorities in respect of their housing stock, my Department provides funding across a number of programmes to support the local authority work to maintain and improve their social housing stock. In all cases, it is the local authorities that identify the priorities.

My Department issued stage 1 approval on 14 June 2022 for the regeneration of the existing 38-unit flat complex at Glovers Court. Dublin City Council is looking to add additionality to provide housing for up to 49 households at this location. This approval will allow the council to develop a design to best meet the needs of existing and future residents. It has advised me that it has 219 complexes under its remit. Complexes are prioritised for regeneration based on a number of factors, including their age and condition.

Although Glovers Court is one of the newer complexes, built in 1976, its condition meant that it was prioritised for regeneration during this round. As it now has stage 1 approval, it means Dublin City Council can initiate the process of engaging a design team to work on the design proposal for the regeneration of Glovers Court. This will require the development of detailed designs which will be presented to existing tenants as part of the community consultation process. Once planning is approved, the council can move to the next stages of approval and appointment of contractors.

In the meantime, while this project advances and tenant decanting progresses, Dublin City Council will work with the current tenants to ensure that the Glovers Court complex is maintained to the highest standards possible. With regard to water supply and quality issue the council has informed my Department that it has received no reports of contaminated drinking water in Glovers Court. However, I accept the contents of the letter the residents have sent to elected representatives. I await the response of the Deputy.

They are all very fine words and I appreciate the personal commitment of the Minister of State, but the reality is that people living in inner-city flat complexes have to put up with rats, faeces and racism. It is horrendous for residents living in these communities. I do not feel there is any sense of urgency to progress the work.

I met residents from Andrews Court four years ago in respect of a proposal from Dublin City Council. It will be another four years before a small block housing 11 families will be dealt with. None of the flat complexes on Digges Street, Cuffe Street and Mercer House have playgrounds for toddlers or children to play in and entertain themselves. These are not big asks. It is not unreasonable for families to expect their children to have somewhere to play when living in a flat complex. There is nothing.

Resources are not being put into the flat complexes. If Dublin City Council is not going to invest adequately in the maintenance of flat complexes in order to deal with the issues facing residents, the residents will become demoralised and places will become dilapidated. As I have said, many complexes are in serious need of regeneration. I welcome anybody in the House to come and visit some flats. Some are next to derelict and it is demoralising for residents and public representatives, across parties, to have to meet residents and hear their stories. Flat complexes have been neglected for too long and this has to end. They have to be resourced in order to ensure that residents have a decent quality of life.

I agree wholeheartedly with the Deputy. We recognise the need to modernise and bring living conditions up to acceptable standards. All of these developments have the objective of improving the living conditions of residents and to that end Dublin City Council is developing a long-term strategy for the redevelopment and-or refurbishment of many of these complexes.

In addition to Glovers Court, my Department has provided stage 1 approval for phase one of the regeneration of Pearse House , Constitution Hill, Matt Talbot Court, Liberties Cluster and Oliver Bond House and phase 1A of Bluebell, as well as stage 2 approval for St. Mary’s Dorset Street which is currently going through the Part 8 planning process. A large number of these flat complexes will, in effect, be rebuilt, while others will be refurbished and in some cases amalgamated into one due to the unacceptable sizes of some homes.

As I stated, no reports of contaminated or unsafe drinking water have been reported at Glovers Court. The water supply comes from the neighbouring York Street apartments which contain a pump house where water is fed directly from water mains. Dublin City Council committed to my Department today to send its inspectors to the complex this afternoon to ensure all is in order.

In summary, the points the Deputy raised about wider community development supports such as playgrounds and the social cohesion of the community are an important part of such regeneration projects and it is a matter for Dublin City Council to engage proactively with the communities on what they want in their areas and the wider supports they need, as well as the physical regeneration of the houses and apartment complexes.

There is a bigger piece of work around supporting communities to feel proud of and safe where they are living, for young people growing up and the wider community. That is an equally important component part of the physical regeneration of apartment complexes.

School Accommodation

I thank the Minister of State for the opportunity to discuss this matter. I understand that neither the Minister for Education, Deputy Norma Foley, nor the Minister of State, Deputy Josepha Madigan, were able to take this matter.

Tramore Educate Together National School has been in existence since 2014. It was mooted as far back as 2008. My first teaching post was in an educate together school. Many educate together schools are developing schools. It takes a significant amount of energy to get these schools off the ground. As they develop and grow, huge stress continues to be placed on the board of management, which works hard, and principals who have to hold the school community together and make sure that it continues to grow.

I engaged with Eilish, the principal, and Corinne, the chair of the board of management for a number of years on an ongoing basis on provision for their school as it grew. Eilish and I met the Minister, Deputy Foley, in April 2021, at which point I thought the problem had been solved and we were making provision for the school to move forward in a way that would suit the school community.

I visited the school again just last week, however, and met Eilish and Corinne in the company of Councillors Cristíona Kiely, Eamon Quinlan and Joe Conway, who were all elected to represent the area, and the story is not a good one as to where we are. Eilish is trying to run a school that is split over three campuses. It has 160 students enrolled at the moment. Some class groups have their own classes; others are in split-level classes. The school is also being asked to have an autism unit. One class is already established and a further one is to open in September. What we have is three buildings. We have a HSE building which houses senior infants, first class and a nurture room. Then we have the Stella Maris building, which is an old secondary school building currently in private ownership. That is being renovated. It holds the junior autism spectrum, AS, classroom and junior infants. Excuse me. That is the third campus. The Minister of State will forgive me for getting mixed up. The Stella Maris building has a second class and third class split class, a third class and fourth class split class and the senior AS classroom. Then there is the Stella Maris hall, which is being renovated. That holds the junior infant class and the junior AS class. To add a fourth dimension, there is a prefab, which houses the fifth class and sixth class classroom.

This is clearly an unsuitable arrangement. Thankfully, Eilish is now what is referred to as a walking principal. By God, she is walking a lot to cover the distance between these classrooms. To complicate matters, a couple of hundred metres up the road there is a renovation project happening in what is referred to locally as the 50 p piece building, which used to be part of the provision of my school, Glór na Mara. It is now consolidated in one building on one site. That has been renovated. The plan seems to be that it has been renovated for Tramore Educate Together National School. However, I know that building intimately, having taught in it, and it is too small to house Tramore Educate Together National School. We therefore have a situation unfolding in which a huge amount of money is being spent renovating a secondary school that is now in private hands, a huge amount of money is being spent renovating the 50 p piece building for intentions I am not clear on, and we have a school for which we have inadequate provision. I want to work with the Minister of State to find a solution for what has been an intractable problem up to this point.

I thank Deputy Ó Cathasaigh for raising this matter and giving me the opportunity to outline to the House the position on the accommodation in place for Tramore Educate Together National School.

Tramore Educate Together National School was established in 2014 under the patronage divesting process. The patronage divesting process arises from the recommendations of the 2012 report of the advisory group to the Forum on Patronage and Pluralism in the Primary Sector, following which the Department of Education undertook surveys of parental preferences in 43 areas of stable population in 2012 and 2013 to establish the level of parental demand for a wider choice in the patronage of primary schools within those areas. Analysis of the parental preferences expressed in each area surveyed indicated that there was sufficient parental demand to support changes in school patronage in 28 areas, including Tramore.

Under the patronage divesting process, a school can be opened where a school building became, or was due to become, available - for example, as a result of an amalgamation or closure of an existing school. In the case of Tramore Educate Together National School, the planned permanent accommodation is a school property formerly used by Glór na Mara primary school, as Deputy Ó Cathasaigh has outlined. That property is undergoing a building retrofit project. Financial provision has been made in the national development plan for funding support for the refurbishment of schools, including retrofit. To prepare the way for that large-scale retrofit work, a pathfinder partnership programme has been put in place, jointly arranged by the Department and the Sustainable Energy Authority Of Ireland, SEAI. The pathfinder partnership programme focuses on supporting energy efficiency retrofit in primary and post-primary schools. That includes retrofit improvements to buildings, test approaches, building of best practice and development of a scalable retrofit model which can be replicated across the public sector. Where improvements are made, the intent is to optimise improvements relating to fabric and ventilation; to improve efficiency of lighting and heating, ventilation and air conditioning, HVAC, systems; and to deliver space heating by means of renewable heat.

The Tramore school building is one of three schools selected to pilot a procurement approach whereby refurbishment work will be completed at the same time as the deep energy retrofit work. The refurbishment works are being funded 100% by the Department of Education, while the deep energy retrofit works are funded on an equal basis by the Department and SEAI. The project at the Glór na Mara building is progressing well on site and is expected to complete later this year. Having considered the long-term accommodation needs of the school, the Department of Education has acquired additional land beside the Glór na Mara property site to facilitate the provision of additional accommodation on that site. In this way the school will have sufficient accommodation between the retrofitted Glór na Mara building and the newly built accommodation on the site. This will secure the long-term needs of Tramore Educate Together National School.

Pending the completion of all required building works, for the first quarter of the upcoming school year Tramore Educate Together National School will remain in its current interim accommodation arrangements. The school is currently located, as Deputy Ó Cathasaigh said, on a split-site basis, comprising a premises formerly occupied by the HSE, namely the Tramore health centre, and on part of the former Stella Maris Secondary School property, which is now under private ownership. The lease of the former HSE building has been extended until the end of December 2022 to ensure accommodation is in place for the school while the retrofit project is ongoing. On completion of the retrofit project, the school will operate from the upgraded Glór na Mara building and the rented accommodation in the Stella Maris building until the extension project is delivered.

The Department of Education has approved funding for the reconfiguration of a second classroom for special education in the main Stella Maris building, along with a central activities space which will allow for a two-class special education base to function from that location in the medium term. Accommodation is also in place for the school's seventh developing mainstream post.

There is more information in the answer the Minister of State has given me than was made available to the school, so I thank him for that because the school has been kept in the dark on this. Something I find frustrating about this whole process is that one of the first things I asked for when the Government was formed was for the forward planning unit in the Department of Education to do a desktop survey on Tramore and to assess the school needs there and the school lands that were at that time available for sale but that have now been lost to private ownership, which complicates the entire situation.

To speak to the specifics, the classrooms in the 50 p piece building, which I know extremely well as I have taught in it, are 50 sq. m. I have taught a class of 30 fifth class kids in the building and there was not room to swing a cat - not that one should swing cats in primary school classrooms. Modern standards now call for classrooms of 80 sq. m, so these classrooms are too small. They are also a peculiar shape. The building is in the shape of a 50 p piece. The rooms are oblong. That makes for unusable corners. That might seem like a small thing, but when you are trying to fit furniture and children into a room it makes a big difference. There are only seven classrooms. We are talking about a school which will soon have eight class groups and a requirement for special educational needs, SEN, provision and which has an AS unit in it. As for land acquired on the old CBS site, there are now three owners of the site. There is the Department of Education and the diocese, and the site is also partially owned privately. It should have been acquired by the State and we would have had a more consolidated landholding. The only details I can find on plans for the additional accommodation is a red rectangle marking where it could putatively be. Now I have to go back to a principal and tell her that, sometime in the never-never, her school may sit on the one campus. I am not sure that that is a reply I want to give to a principal who has been working so hard to make this school thrive within my town's community.

Given the points the Deputy has raised, it is important that the Department of Education re-engage on this and give it some further consideration. Considering the constraints the Deputy mentioned, particularly after what we have been through with the pandemic, it is critical that this school building is fit for purpose in respect of spacing, layout and future expansion. Census data have just come out today and, from that point of view, I will discuss the matter with the Minister for Education and recommend that the Department go back and re-engage with the school on this.

Hospital Admissions

I thank the Ceann Comhairle for allowing this matter to be debated. I represent the constituency of Limerick City.

We have severe overcrowding at University Hospital Limerick, UHL, emergency department, ED. HIQA carried out an inspection of the ED at UHL on 15 March and issued a report. The report found that there were 88 people on trolleys. That figure has been consistent every since. There was a welcome change this morning when it dropped to 63. When the report came out, my view was very simple, namely, that the people of Limerick and the mid-west are entitled to the same delivery of healthcare as those in any other part of the country. At the moment, that level of healthcare is not being provided due to of the crisis of overcrowding at UHL. Staff are working very hard and are under great pressure. There is great fatigue among them.

I called on the Taoiseach on Tuesday to have the HSE provide assistance at a national level. I welcome that the Minister for Health, Deputy Donnelly, last night requested that the chief operations officer of the HSE write to the CEO of UHL and the chief officer of Mid West Community Healthcare informing them that she had mandated that the performance management improvement unit of the HSE is to engage urgently with the hospital and Mid West Community Healthcare in the context of addressing the issues raised in the HIQA report. My understanding is that officials from the performance management improvement unit are now in UHL and will be there for the next four to six weeks to assist management to ensure that we can address the issues that HIQA found, such as an inadequate number of nurses in the ED on 15 March. Notwithstanding the fact that we have had 98 additional acute beds and ten ICU and high dependency unit beds provided in recent years, the report states that these did not seem to make a significant difference in the context of the number of people on trolleys in the ED.

I know many of the families involved. I know that this matter had reached the point where the performance management improvement unit needed to come in to UHL. The Minister has committed to providing whatever resources are needed. What I want is an update to the effect that officials from the performance management improvement unit are in the hospital and that an action plan will be put in place. I am also seeking information on how quickly that action plan will be implemented. We have regularly seen more than 100 people on trolleys in the hospital. That is unacceptable.

The medical, nursing and other staff at the hospital are doing their level best, but they are battling against a situation in our region where we have the second highest number of ED presentations and the lowest number of ED inpatient beds. In fact, we have the second lowest ratio of any of the model 4 hospitals in terms of the number of inpatient beds, which stands at 530. We need additional beds. A 96-bed acute is due to come on stream, but we also need an elective hospital. The more immediate issue is to ask when will the action plan to be drawn up by the performance management improvement unit be issued? When will we see improvements for the people and the patients of Limerick and the mid-west?

Great urgency is required in respect of this matter. I very much welcome that officials from the performance management improvement unit are in UHL, but I want an update from the Minister of State as to when the action plan will be put in place.

I welcome the opportunity to address the House on this important issue raised by Deputy O’Donnell.

I wish to acknowledge the distress that overcrowded EDs cause to patients, their families and front-line staff who are working in very challenging conditions in hospitals throughout the country. The Minister has visited UHL and has been concerned for some time about the emergency care performance there. It must be recognised that UHL continues to deal with record volumes of patients attending its ED. To the end of May, attendances at the ED were up 11% compared with the first five months in 2019.

After his visit to UHL, the Minister requested that a HSE expert team review the day-to-day functioning of the ED in a leadership, management, operational and clinical context. Following this intervention and the recent HIQA report, the HSE’s performance management improvement unit has been directed by the chief operations officer to lead a process, in partnership with UHL team members, supporting the hospital and community services in driving a programme of work to respond more effectively to the current pressures. The performance management improvement unit will ensure that all necessary immediate steps are taken to address the safety issues identified. A detailed plan will be developed as a matter of urgency in order to ensure that they do not reoccur. The plan will cover issues including admission avoidance, pre-admissions, community interventions and alternative pathways, as well as issues relating to patient flow through the hospital and its ED. There will be a strong focus on pathways for the over-75s.

The Minister also welcomes the recent publication of HIQA's report and is concerned about the significant risk to service users identified in it. The inspection focused particularly on the important issues of patient flow and inpatient bed capacity in the hospital, staffing levels, respect, and dignity and privacy for people receiving care in the ED. The HSE has been requested to prepare comprehensive short- and longer-term improvement plans for all 29 EDs, including that at UHL, in order to ensure sustainable improvements in emergency care performance. The Minister met with senior HSE management yesterday and received an update on progress in the development of those plans.

There continues to be substantial investment in UHL to address capacity issues, including a 28% increase in UHL’s workforce since the end of 2019 and the opening of an additional 98 non-ICU acute beds. This includes the 60-bed modular ward block that was established to provide a rapid-build interim solution to begin to address the bed capacity issue at UHL and improve patient flow.

In order to deal with the increased level of presentations this year, reform of service delivery as outlined in Sláintecare is vital. This includes the expansion of community care and other measures to provide people with the care they need outside of the ED and improve patient flow and egress from hospital by providing more home care packages and nursing home supports. Investment of €1.1 billion was allocated in budget 2021 to expand capacity, increase services and support reform, and this level of investment has been maintained in budget 2022.

I do not have a date for the publication of the action plan. We will come back to the Deputy with that.

I thank the Minister of State very much. I welcome that the HSE, at a national level, and the Minister requested that the performance management improvement unit move to assist and to work in partnership with the management, the nurses and medical staff at the hospital. We must see results for the people and patients of Limerick. We cannot have a situation where we have people on trolleys for an inordinate length of time. It is very distressing for them and their families. UHL provides a very good service, but we are at the point now where we have to see the numbers on trolleys coming down. I welcome the fact that they are down to 63. That is still way too high but it is moving in the right direction.

We must also, as part of the work being done by the performance management improvement unit, ensure that the capacity of the other hospitals in the group is being used to the optimum. I refer here to St. John's Hospital, Ennis Hospital, Nenagh Hospital and Croom Orthopaedic Hospital. The hospitals in the group must work very much in the context of a partnership model. We must also see that diagnostics are used properly and ensure that if people are coming to the hospital, they will be seen within a reasonable timeframe. We must also ensure that if people need to be admitted to inpatient beds, they will be admitted within a reasonable timeframe.

These are short-term measures, and that is why officials from the performance management improvement unit needed to be deployed to the hospital. The assistance that is needed at corporate level in the hospital is also there and is working with local management, medical, nursing and other staff.

In the medium term, planning permission has been obtained for the 96-bed acute block and a preferred bidder has been selected. That project should proceed to construction immediately. This 96-bed acute block will be located on the existing site. We then need to look at an elective hospital for our city and the region in general. Cork and Galway have already got such facilities. This matter was covered in the original Sláintecare proposal. It now needs to be looked at by the Government in the context of consistency and equality.

The people I represent in Limerick, the mid-west and north Tipperary deserve the same level of service as is available elsewhere in the country. This is not the case and it needs to be corrected.

I agree wholeheartedly with the Deputy's closing remark. I mentioned in my opening statement that the Minister met senior officials from the HSE yesterday to discuss the issues in University Hospital Limerick and the immediate responses required to address the pressures being faced by all 29 emergency departments. The Minister was updated on the progress of the University Hospital Limerick expert team review and the response to the HIQA report. He was also informed that the HSE's performance management improvement unit is to engage urgently with the hospital group and the CHO to provide intensive support to the hospital and community teams to ensure the issues identified in the expert team's assessment and the HIQA report are addressed as a matter of urgency. The HIQA report provides an important opportunity for a renewed focus on the capacity, capability, quality and safety of emergency care services delivered to the people of the mid-west region by University Hospital Limerick.

As I mentioned, significant resources have been invested in University Hospital Limerick in recent years. This has seen an increase in University Hospital Limerick’s workforce of 28% since the end of 2019. It is accepted that a key part of the solution for Limerick is additional beds, as the Deputy mentioned. A total of 150 additional beds have been opened in the University Limerick Hospitals Group since 1 Jan 2020. Of these, 98 have been in University Hospital Limerick. Further plans for Limerick include the provision of a 96-bed ward block at University Hospital Limerick, of which approximately half will replace older stock.

As with the Deputy, I welcome the reduction in trolley numbers but it is still too high. The matter of performance in hospital emergency departments is under constant review by the Department, including seeking assurance regarding the appropriate escalation measures for emergency department overcrowding through ongoing engagement with the HSE. I assure Members that the Minister, Deputy Stephen Donnelly, and the Government are committed to driving an improvement in emergency department performance in Limerick.

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