Iarraim ar gach aon duine na srianta ama a choinneáil.
Ceisteanna ó Cheannairí - Leaders' Questions
I raised the issue of the overcrowding crisis at University Hospital Limerick with the Taoiseach yesterday. He sought to downplay the severity of the situation. Indeed, listening to Leo Varadkar, you would be forgiven for thinking that the dire problems at the hospital were a figment of people's imaginations. This morning, however, we wake up to the news that the crisis continues. Nearly 100 patients are on trolleys at University Hospital Limerick. The hospital remains in its highest state of escalation. All beds across the hospital group are being used for surge capacity. Surgeries have been deferred for a second day in a row. People are again asked to avoid coming to the emergency department. GPs and pharmacies, which are already under huge strain, are being asked to help alleviate the pressure on the hospital. Day after day, week after week and month after month, vulnerable people are left without a hospital bed, the emergency department is dangerously overcrowded, and doctors and nurses are forced to treat patients in appalling conditions.
In 2007, the Minister's party promised to end the scandal of patients on trolleys. That was the Fine Gael rhetoric. That was nearly 20 years ago, and things have only got worse. There is now a state of emergency for healthcare in Limerick and the mid-west. The writing has been on the wall for months as regards the escalating crisis at University Hospital Limerick, so why has the Government not stepped in? Why has the Minister for Health not stepped in? That is what the people of Limerick and the mid-west are asking. The root cause of the crisis is clear. The Government has not made the necessary investment in University Hospital Limerick. This has created serious and persistent capacity and staffing problems.
Yesterday, the Taoiseach acknowledged that the population of the region is growing. That is true. What he did not acknowledge is that the Government has not increased even the target for bed capacity to meet this reality. The Taoiseach denied the staffing problem, but there is in fact an urgent need to recruit non-consultant doctors, additional nurses and medical staff for the emergency department, and more staff are needed to extend the operating hours of the acute medical unit. Limerick and the mid-west also need protected capacity for planned procedures. We need to know now when the surgical unit promised last summer will be delivered.
The Government needs to act now to relieve the intense, unsustainable pressure at University Hospital Limerick to ensure people can access their hospital and get the care they need in a timely and safe fashion. Tá stad éigeandála in Ospidéal na hOllscoile, Luimneach. Ní mór don Rialtas aghaidh a thabhairt ar an ngéarchéim agus gníomhú éigeandála a thógáil láithreach. The people of Limerick and the mid-west deserve far better than a never-ending crisis at their hospital. First, does the Minister accept that there is a state of emergency at University Hospital Limerick? Second, what action does the Government propose to take immediately to relieve this pressure and finally tackle this crisis?
I thank the Deputy for again raising this issue. As we know, University Hospital Limerick is currently caring for an exceptionally high number of unwell medical patients in the hospital. The emergency department has seen its highest week of emergency presentations since the beginning of this year. UHL is currently at its highest state of escalation. Surge capacity has been opened there and across other hospitals. Scheduled activity across all sites was deferred and will remain under review, with only urgent, critical and time-critical patients, including cancer patients, going ahead. The emergency department remains open 24-7 and urgent care is being delivered to those who need it most. However, people presenting at the ED who are not suffering with life-threatening or severe illness or injury will face a significant wait.
As the Deputy said, the Government is stepping in. It has invested significantly in University Hospital Limerick and will continue to do so. Staffing at the hospital has grown by more than 1,000 since the end of December 2019, from 2,814 to 3,854 at the end of November last year. That represents a 37% increase in staffing in that period. It includes an extra 146 doctors, 45 more consultants, 348 more nurses and midwives, as well as 84 more health and social care professionals. We will continue to invest as much as is necessary. In 2019, UHL had a budget of €265 million. In 2023, that budget was €383 million, meaning its budget has grown by €118 million over that period. That is a badly needed increase of 45% in just four years. As the Deputy referenced yesterday, we are also investing in bed capacity at UHL, which is badly needed. Some 150 additional beds have been opened in the University Limerick Hospitals Group, ULHG, since 2020 and 98 of those beds are in UHL. We are seeing another 96 beds being progressed, which will open early next year. Towards the end of next year, a further 96 beds will be added to UHL.
The calls for more investment, more capacity and more staff are being met by the Government allocation of resources. We will continue to do that to address what is a significant pressure at UHL. I thank the staff who are working in difficult conditions there. I reassure them that the Government will apply the necessary resources to ensure that capacity at the hospital increases from both a beds perspective and staffing perspective, where necessary. From a management perspective, Ms Sonya Cotter, the assistant national director of the HSE, has been acting CEO of ULHG since 14 February. The CEO, Professor Cowan, is on leave, and the acting CEO will discharge duties in the context of that role. Ms Sandra Broderick has been appointed the regional executive officer of the HSE Mid West region; she started in late December. As the Deputy knows, HSE Mid West includes counties Limerick, Tipperary and Clare.
This matter is a priority and focus for the Government right now.
As the Deputy called for yesterday, and as the Taoiseach outlined clearly yesterday, what is needed here is increased capacity, more resources and a focus on better management. All of that is happening.
I asked the Minister to share whether he accepts that there is an emergency at University Hospital Limerick. I can only judge by his response that he shares the Taoiseach's view that, in fact, the Government has done enough. I want to reiterate again today that this is not the case. The Minister is frankly delusional on this matter. I described to him, and he echoed, the facts on the ground about overcrowding and cancellation of surgery. I should also recall that the pressures associated with the lack of resources and capacity have real-life consequences for staff, patients and lives. Lives have been lost at University Hospital Limerick. I am sure the Minister knows all about that. Investigations into those matters are under way. What the people of Limerick and the mid-west region cannot fathom or accept is that in the face of that loss of life, lack of capacity, dire overcrowding and cancellation of surgery, the Government continues to sing the song and parrot the rhetoric that all is well. The resources are insufficient. Staff capacity is insufficient.
We are way over time.
Bed capacity is insufficient.
I thank the Deputy.
When will Government address that fact?
Hear, hear.
We are not singing any song. The Deputy should stop trying to misrepresent the position here. This is a situation where a very significant hospital in the country is under a lot of pressure. We are putting in place significant resources to respond to that pressure. Of course I acknowledge, as does the Government, the difficulties that staff and patients faced yesterday and face today and this week in the context of UHL. The pressures in this hospital are not new, which is why we have dramatically increased resources and will continue to do so until the capacity pressures are resolved. That is why we are in the process of adding two new blocks with 96 extra beds. One will open in the first quarter of next year and I understand the other will open in the fourth quarter of next year. There is, of course, an acknowledgement that all is not well at University Hospital Limerick when we compare it to the performance many other hospitals around the country. That is why we need to address those issues, which are primarily capacity and resourcing issues. I can assure the Deputy that the Government will continue to add more beds and more staff and improve management at the hospital.
Two days is how long the son of pharmacist Niall O’Sullivan waited on a trolley in University Hospital Limerick emergency department before receiving treatment for a fracture. Mr. O’Sullivan spoke powerfully of his son's experience on RTÉ radio this morning. This is not the first time I have raised the human impact and dangers of hospital overcrowding with the Minister. We spoke about this just last month. Clearly, nothing has changed in UHL. Indeed, the crisis has worsened, as the Minister has acknowledged, effectively. It is not just UHL and Limerick, however. Another woman with whom I am in contact spent a hellish night last night in Tallaght Hospital. Upon presenting there with pain at 4 o’clock yesterday, she was left in a waiting room until 9 a.m. today with no pain relief or anything. Another family, this time in St. Vincent's University Hospital in Dublin, had a similar ordeal. I heard from a parent who had to prop his daughter against a wall because she had been left waiting on a chair with an injury that developed into blood poisoning. She was propped up because she was dipping in and out of consciousness from pain and exhaustion. Despite that, there was no capacity to give her timely care.
These cases are not isolated. Whether it is UHL, Tallaght Hospital, St. Vincent's University Hospital, Cork University Hospital, St. James's Hospital or anywhere else, every day now, sick people who go to hospital in Ireland seeking treatment are arriving to find that it is just not there for them, largely due to overcrowding. The word that comes up time and again from people who describe their experiences to me is “chaos”. In a hospital, where patients expect to receive care, what they are receiving is chaos. They are subjected to chaos. That is not to mention the nightmare this is causing for healthcare workers. Among the junior doctors and nurses who have contacted me about their experience is a young medic who said he is looking for work in Australia or Dubai. Pay is a factor for him, but what keeps him up at night is his fear around overcrowding and lack of staffing. Because he is so overworked and must often look after more patients than he should be allowed to, he is scared that something will go wrong and that he will be blamed or, indeed, he will blame himself. Healthcare workers, who are providing an essential and heroic service, deserve better than that.
It is a shocking reality that of the ten HIQA reports carried out in Irish hospitals in the last 11 months, not one hospital has been found fully compliant when it comes to staffing. This is at a time when it needs to be all hands on deck here. Instead, what we are seeing is effectively a sinking ship. We know from replies to parliamentary questions my colleague, Deputy Duncan Smith, has received that the HSE is unable to even guarantee that workers on a career break will not be impacted by the recruitment freeze. Yet, each time we mention the freeze, the Government deflects. The Taoiseach says it is not having an impact and that the HSE is hiring. However, it is plain for everyone to see that there are just not enough staff in our hospitals and, therefore, healthcare workers and patients continue to be placed in harm’s way. Can the Minister offer us a substantial reply and not simply say it is desirable to tackle overcrowding and understaffing? How can he stand over a situation where not hospitals are not fully staffed?
First of all, many hospitals in the country are performing really well and do not have patients on trolleys whereas they would have in the past. They have seen waiting lists come down significantly on what they were in the past. That is happening because of good management, more staff and more resources. We have a larger health budget now than ever before, and rightly so because our population is growing and ageing.
With regard to the specifics of the question the Deputy has asked, there has been an unprecedented level of investment by this Government in the health service workforce in recent years. We have seen consistent growth in the workforce each year since 2020, with the growth in the number of staff recruited in 2023 being the highest since the foundation of the HSE. There are now 26,172 more staff working in our health service than there were at the beginning of this Government. That includes almost 8,500 additional nurses and midwives, more than 4,000 additional health and social care professionals and nearly 3,000 additional doctors and dentists. That is a 22% increase, meaning that for every five people working in the health service in 2020, we now have six.
It is true that in November 2023, the CEO of the HSE announced a pause in all recruitment, with the exception of consultants and graduate nurses and doctors in formal training programmes. This recruitment pause, which was put in place as part of a suite of control measures, included an instruction to reduce expenditure on agency staff and management consultants across the HSE. The reality is that the HSE had already exceeded its 2023 funded workforce targets, which was not sustainable. There are now 146,500 staff working in our health service. The HSE was funded to recruit just over an additional 6,000 staff in 2023. In reality, however, it hired well over 8,000, meaning that it had more than 2,200 staff more than it was funded for. Funding for an additional 2,268 staff has been secured by the Minister for Health. There is much talk about recruitment freezes, but there are a lot more people coming into the health service, and they are badly needed. We will continue to ensure the health service grows, expands and is invested in as our population grows and becomes more demanding given that we have an ageing population.
While we acknowledge that some hospitals are under significant pressure, if we look at the health system as a whole, we will see that waiting lists are down. Trolley numbers are down. Staffing numbers and bed numbers are up. We need to focus on hospitals like UHL that are under significant pressure and others that are feeling pressure, but we also need to recognise the successes of many hospitals that are performing really well for patients.
The Minister's response could be characterised as "Nothing to see here". That is clearly not an adequate answer for all the patients who are languishing on hospital trolleys, for the overworked staff and for those whose procedures at UHL have been cancelled without any indication of when they will actually take place. Every time we raise the reality of overcrowding in hospitals and understaffing, the Minister and his Government colleagues respond with metrics, figures, details-----
With facts.
The patent fact is that the spending is not enough to meet the demand.
That is evidently true from HIQA reports and from the experiences of patients and of overworked staff in understaffed hospitals. Where is the sense of leadership? Where is the sense that somebody is steering this ship, that it will be all hands on deck to ensure the crisis in hospitals is addressed and that we can retain and recruit enough staff to support consultants to supply the teams that are needed to ensure the procedures can take place? When will we see the real action to address the overcrowding that continues to persist in far too many hospitals across the State? It is not just in Limerick but undoubtedly University Hospital Limerick is a particularly egregious example of understaffing, overcrowding and consequent harm to patients and staff alike.
I accept what the Deputy is saying in raising issues to which the Government needs to respond. What I do not accept is the characterisation that the Government's response is that there is nothing to see here. There is a lot to see here. We see it and we are trying to respond to it. That is why staffing numbers in the HSE have grown by 22% in the past four years. That is why we are spending over €23 billion on healthcare now. We are seeing results from that expenditure in waiting times and trolley numbers falling. Are there still problems in our health service? Of course there are and we are seeing those pressures in a very real sense both on staff and patients in Limerick today. We acknowledge that. It needs a response from the Government and it will get one, as well as from a management point of view-----
Why are the cancellations happening? Something is going wrong in the system.
We have the highest life expectancy in the EU.
Thirteen years ago.
Tell that to the people of Limerick whose procedures have been cancelled.
It is our fault because-----
Instead of blaming the patients and the staff-----
Deputy Sherlock knows that when a health system-----
-----you should look at yourselves.
-----is escalated into pressurised management situations, you need to prioritise the patients who need beds most.
Why are they being cancelled?
That is what is happening in Limerick today. Is that welcome? It certainly is not.
Thank you, Minister. We are over time.
We have surge capacity using other beds in the region as best we can. This is a temporary arrangement-----
Táimid thar am.
-----that we will move beyond as quickly as we can.
I remind Members that we are on Leaders' Questions. Bogaimid ar aghaidh anois go dtí an Grúpa Réigiúnach agus an Teachta Denis Naughten.
Long Covid is tough on individuals who are dealing with ongoing health problems such as tiredness, trouble thinking clearly and breathing issues. It is not just having an impact on individuals; it is also having a profound impact on our workforce and presenting challenges that are complex and far-reaching. A report just published by the EU Commission provides estimates on the prevalence of long Covid and its impact on people's ability to work. This indicates that the prevalence of long Covid in the EU population at 2.9% in 2022 is resulting in a negative impact on labour market supply of between 0.3% and 0.5%. In person equivalence, these figures mean long Covid could be reducing labour market supply in Ireland by over 12,500 people, when the effects of lower productivity, higher sick leave, lower hours worked, increased unemployment and underemployment are combined. Of course, the real number of individuals impacted will be much higher because this is only a statistical model.
The figures may very well be far worse because the sole indicator of the magnitude of the long Covid challenge in Ireland, based on actual Irish data, is a survey I commissioned last year which suggests that an estimated 5% of adults are living with symptoms of long Covid, which would equate to the impact on the labour market of over 22,000 person equivalents. This is not only leading to a significant reduction in labour supply in an economy at full employment, but it also has long-term implications for society as a whole. What these figures highlight is an urgent need to adaptive workplace policies and comprehensive health support services. Sadly, we are still waiting for the regional long Covid clinics to be fully functional, despite being promised in September 2021. Furthermore, the mental health repercussions of the pandemic and long Covid cannot be overstated. There has been an increase in demand for mental health services driven by the pandemic's exacerbation of mental health issues. One example is the increased prevalence of antipsychotic drug prescribing, which points to a deterioration in mental well-being particularly among younger and older people. We need an action plan which not only acknowledges the challenges post Covid and the challenge of long Covid, but also helps people to recover, to return to work, and most importantly, to become full contributors to our society once again.
I thank the Deputy for raising this issue. To be fair, he has been really consistent in raising it for many months now and in keeping the Government focused and under pressure in respect of an adequate response. The European Commission has made a non-binding recommendation on the recognition of Covid-19 as an occupational disease. It did not make a recommendation, however, regarding long Covid, which I know is the issue the Deputy primarily raises. The decision regarding recognition is a member state competency. It is important to note that recognition in Ireland would not encompass long Covid, would only apply to new claims for new cases of Covid-19 and would not benefit those who contracted it during the pandemic which is primarily the cohort mentioned by the Deputy. The report published by the Minister for Social Protection, and laid before the Oireachtas last November, found that Covid-19 does not meet the criteria for recognition as an occupational illness under the Social Welfare Consolidation Act 2005. Specifically, it found that presumptions about workplace transmission would not be sustainable on a general basis in the current environment.
The Government, as the Deputy will know, did an awful lot during the pandemic and subsequently in supporting people whose work was impacted by the fact that they had Covid for an extended period of time. We had an enhanced illness payment system and eligibility criteria that sought to maximise the number of workers who could apply for it. That scheme paid out some €788,000 claims at a cost of over €350 million. A temporary scheme of paid leave was also developed by the Department of Health for certain public health sector employees who were unfit for work after a Covid-19 infection. Special leave with pay for Covid-19 was also introduced for public sector workers. The Department of Social Protection continues to provide a suite of income supports for those who cannot work due to illness and disability, including those who have not recovered following a Covid-related illness. Covid-19, however, does not meet the criteria for recognition as an occupational illness under the Social Welfare Consolidation Act 2005. Specifically, presumptions around workplace transmission would not be sustainable on a general basis in the current environment where infection rates are low. In other words, there would not be not a sufficient level of proof that people got Covid through their participation in the workforce as opposed to getting it through community transmission. What I am saying is that various different Departments, including the Department of Health, the Department of Social Protection and my Department, are looking at ways in which we can respond to people who are unable to work due to extended illness linked to Covid. I accept that the Government needs to progress-----
I thank the Minister. We are over time.
-----quickly the regional long Covid clinics which have been promised.
We are way over time.
From a Department of Enterprise, Trade and Employment perspective, we will keep this issue under close review.
Deputies Grealish and Canney and I, as three Galway TDs, believe that the Government should reconsider its decision to terminate at the end of this month the special leave entitlement for front-line healthcare workers who are unable to return to work due to long Covid. These 143 staff contracted Covid-19 before a vaccine was available, and in many instances before sufficient PPE was available. They have been suffering from long Covid symptoms now for over two years. Front-line workers were publicly commended in Dáil Éireann during the pandemic for risking their lives, as well as those of their families, to deliver essential services. However, the vast majority of people with long Covid symptoms have been ignored by the State through its failure to recognise Covid as an occupational illness.
The very least we should do is support this small number of healthcare workers now in their hour of need. Finally, I ask the Minister to look at the labour market implications of long Covid on foot of the recent EU report on this topic.
The temporary scheme of paid leave was developed by the Department of Health for certain public health sector employees who were unfit for work after a Covid-19 infection. That scheme is due to end on 31 March, which is the end of this month, but I will raise the issue with the Minister and ask him come back to the Deputy directly rather than giving him a stale answer here. I understand what the Deputy is saying but I would like to understand the numbers that are impacted and their circumstances. I presume the Department of Health has these details. I will ask the Minister, Deputy Donnelly, to come back directly to the Deputy if that is helpful.
I thank the Minister.
The regional disparities in this country are stark. I was in Cork for the last two weekends for family reasons. I saw that there have been remarkable advances in infrastructure during the Minister's time in office. They have particularly accelerated in recent years. It is in marked contrast to infrastructural advancements in the mid-west, the south east or any other part of Munster. There were advances in those areas in previous years, such as the partial ring road around Limerick when Willie O'Dea was in Cabinet and the road to Waterford when Martin Cullen was in Cabinet. It seems that if there is no Cabinet Minister, no advances are made.
I wonder if that parochialism is part of the reason our offshore wind strategy is so behind the laudable targets planned by the Government. A target is not a plan. Every couple of years the Government comes out with new targets but we do not have a plan to meet those targets. The Shannon area task force launched a report in Ardnacrusha on 8 July last. The Minister, Deputy Coveney, and the Taoiseach were present. The Minister, Deputy Foley, was there to fly the Fianna Fáil flag. The Minister, Deputy Eamon Ryan, was there too. It became clear that wind energy, in particular floating offshore wind energy, has the capacity to really revolutionise the State, how we provide energy for our households and how we provide energy for the industries that want to invest in Ireland.
As is often the case with reports in Ireland, there has been little advance since then. Essentially, there are three key demands from the Shannon Estuary task force, one of which is around establishing a DMAP on the west coast. Surprise, surprise - the south coast is progressing in that regard and the west coast, which seems to have the greatest potential from what experts say, has had very little advancement even though Clare County Council has been prepared to offer significant expertise in that area as its contribution.
We need an ORESS offshore wind auction for floating wind. We do not know when that will happen. We need supports for ports. Again, Shannon Foynes Port will have to be developed if we are to harness wind energy capacity off the west coast. There has been very little advance on that. I would like to hear what the Government has to say to that.
There is a lot in the Deputy's question. I will try to answer the various elements of it. First, I am glad the Deputy is noticing progress in Cork. That is always important in terms of the scale of development there.
For developing political careers.
The mid-west has had a great year too. If we look at the performance of Limerick and the mid-west more generally, three of the biggest IDA Ireland announcements in the country this year happened just outside Limerick, involving Analog Devices, Eli Lilly and Verizon. Thousands of jobs and hundreds of millions of euro of investment will be coming to the mid-west over the next few years. We are also seeing a lot of infrastructure delivery on the back of that such as the rail connection to Foynes Port and the Adare bypass progressing, albeit slower than some of us would like. In the past couple of weeks, €4 million has been allocated to Cork-Limerick motorway project. There is a lot happening in the mid-west but a lot more will happen in the next number of years.
The Shannon Estuary task force did a fantastic job. I have met the task force a number of times and have spoken to its chair on many occasions now. The big ask from the task force from an offshore wind energy perspective is to ensure Shannon Foynes Port is at the centre of country's plans to assemble and bring ashore offshore wind-generated power. That will happen; it is just a question of how quickly. We need to get a DMAP process under way for the west coast of Ireland. That is happening for the Irish Sea and for the south coast. It is a resourcing issue to make sure it happens on the west coast as well. I am determined to ensure the west coast is not left behind from a timeline perspective. The Minister, Deputy Eamon Ryan, and I are working on getting the resources in place to make that happen. Clare County Council has been very helpful in that regard.
We are also looking at a demonstrator floating wind project off the west coast and a centre of excellence. Yesterday, I got Cabinet approval for a hugely ambitious offshore wind industrial strategy which will run not just between now and 2030, but beyond. I assure the Deputy that Shannon Foynes Port and the Shannon Estuary is a big part of that vision, which is very real, by the way. ISIF is currently speaking to the Shannon Foynes Port Company about funding models to make what could be an investment of up to €500 million in the port over the next number of years. That obviously has to go through a planning process first. There is a lot happening here. In my view, the Shannon Estuary will be a cluster of green technology development, powered by clean power coming onshore from both fixed and floating platforms off the west coast that are generating power from wind.
The Minister's determination is laudable but I wonder what will triumph when it meets the inertia of the Department of the Minister, Deputy Eamon Ryan. There is little coming from the Government. It acknowledges what needs to be done but we all know what needs to be done. That is why we put a task force together. The reality is that it is not happening. Even the industrial wind strategy from the Minister's Department lacks specifics with regard to what will happen on the west coast, not to mention the other plans the Government is coming up with, which fail to prioritise wind energy. I heard the Taoiseach express similar determination when he described it as Ireland's "moonshot". That rhetoric is completely unmatched by the reality of what is not happening on the ground and what needs to happen on the ground. With respect, the ground in which we need to see development is the mid-west if we are to harness wind energy, and floating wind energy in particular, off the west coast. We need to do it now.
I hear the Deputy's frustration. I assure him there is no lack of ambition in this regard in my Department or that of the Minister, Deputy Eamon Ryan. The Minister has done an extraordinary piece of work over the last number of years to make this prospect a reality. We have had our first round of auctions and 3 GW of draft supply contracts are in place. One of those projects is off the west coast - off the coast of Connemara - by the way. This is happening, but we cannot deliver a plan that aims to deliver 37 GW of offshore wind power generation in 25 years overnight. We need to change the planning and permitting systems and we need to have a marine plan. All of this is happening and is led by the State. This will take a number of years to take shape, in particular off the west coast. Shannon Foynes Port will be at the centre of a lot of that. We will see hundreds of millions of euro being invested on the back of it. It costs approximately €3 billion to put 1 GW of power generation capacity offshore and we are planning to do nearly 40 GW. That gives us an idea of the scale of investment we are likely to see over the next 25 years.