Róisín Garvey (Green Party)
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Cuirim fáilte roimh an Aire Stáit agus ba mhaith liom comhghairdeas a dhéanamh. I congratulate the Minister of State on his new appointment. It is nice to have him on side. I have always found him to be well able and most respectful. I wish him luck in his new role.

A number of weeks ago the Minister for Health, Deputy Donnelly, and the CEO of the HSE, Mr. Bernard Gloster, visited the infamous University Hospital Limerick, UHL.They made announcements about beds, recruitment and so on. As luck would have it, and it was unlucky for my friend, by accident I ended up visiting a friend who was in hospital that day. When I went to visit her, she was in serious back pain and in serious agony, with an official pain level of nine out of ten. She had been waiting in a hospital bed for an MRI scan for a number of days. She ended up waiting 15 nights in hospital for that MRI scan. I asked her whether I could advocate for her and spoke to the consultant on call who was in charge of the ward that day. I spoke to the head of nursing on that ward that day as well. They both categorically informed me that there was only one working MRI scanner in the entire hospital.

I found this deeply worrying because beds are tied up as a result. People do not want to go home because they are in pain and if they go home, they will not get resolution. People want to know what is wrong with them and what they can do. MRI scans are very useful for that. They also do not go home because if they do, if they are told they can wait as there is a waiting list, there is no waiting list. If they go home, they fall off the list. That is why people sit in the accident and emergency department for hours and hours and days and days, and are in beds and on trolleys for days. They know if they go home, they will go back to the bottom of the barrel again. First, there is no system for people on a list to get priority based on when they entered the hospital. Second, why the hell is there only one working MRI scanner? What is going on?

This hospital is a centre of excellence. It covers a whole region. We know about the problems and the trolley numbers; they are infamous. People are literally dying as a result. I always try to look at solutions. Why is it so bad in UHL? One of the reasons must be the fact that one working MRI scanner means that people are locked into beds. To spend 15 nights in bed waiting for an MRI is absolute insanity. That woman did not want to take up a bed, but she needed to be seen to. All these people on trolleys downstairs are waiting to be seen, but they cannot come up because others are waiting in beds for an MRI scan for more than two weeks. It is absolutely barbaric. You would not get it in India.

I have a very specific question. Will the Minister for Health ask the HSE why there is only one working MRI scanner in UHL? It leads to patients taking up many extra bed nights while waiting for MRI scans. There is no list system. I can write a computer programme. I could come up with a system to have people on a list, even with just a ledger. This is not 1940 when we did not have computers and filing systems. As no list is in place to keep people's MRI scans in order, patients are reluctant to go home because if they do, they go to the bottom of the waiting list. Will the Minister please raise this matter with the acting manager of UHL, who was absent on the day we were there with him and the CEO of the HSE? There was no sign of the acting manager. Will the Minister insist that this is rectified as soon as possible or please give some explanation as to why this is the situation in our centre of excellence?

Alan Dillon (Mayo, Fine Gael)
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I thank the Senator for the opportunity to respond on behalf of the Minister for Health on this important issue for the people of the mid-west region. He recognises that there are significant pressures at UHL. He and the Government have undertaken sustained investment in this hospital and in capacity across the entire mid-west region's health system.

There are currently two MRI scanners in UHL, one owned by University Limerick Hospitals Group and a second operated by Alliance Medical, which serves patients in the hospital and also provides a GP service out of hours. Through this service, a certain number of MRI slots are available at the weekends for patients who have been discharged from UHL during the week to return at the weekend for their scans. Without this service, these patients would remain in hospital. There are challenges in the provision of diagnostic scans in UHL as demand for radiology tests exceeds available capacity. I am advised that priority is being given to inpatients and to oncology outpatients.

Work is currently under way at the hospital as part of the HSE capital plan to reconfigure and extend the current radiology department. This project will deliver an additional MRI at the hospital. The overall investment in extending the radiology department will provide a much-needed and welcome increase in diagnostic capacity for the hospital. A tender for enabling works for this project issued in November 2023. The detailed design planning is in process and will go to tender shortly.The project is expected to be complete in quarter 1 2026. The extension and improvement of the radiology department will also accommodate consultant radiologist offices, on-call facilities,

teaching space and changing room facilities.

Currently for patients in the mid-west, GPs can refer directly to a community radiology diagnostics service. These services facilitate access to X-ray, CT, DEXA and MRI scans for patients. In 2023, more than 19,000 radiology scans, including MRIs, were carried out in the HSE mid-west under the GP access to community diagnostics scheme, reducing referrals to emergency departments, acute medical units and outpatient departments. This record activity for the scheme surpassed the 15,755 radiology scans completed in 2022.

All MRI referrals are vetted by a consultant radiologist and patients are prioritised based on their clinical need. The Minister is aware of, and has been engaging extensively to relieve, the significant pressures on the broader health system within Limerick and across the region. University Hospital Limerick has received substantial investment in recent years. In 2019, the hospital had a budget of €265 million. This year, the budget is €382 million, meaning it has grown by €117 million, or 44%, in just five years. We are also investing in additional bed capacity. Since January 2020, 150 new beds have been opened across the University of Limerick Hospitals Group, of which 98 are in University Hospital Limerick. On top of this existing investment, in April 2024, the Minister announced a package of additional measures to address the ongoing issues within the hospital. I know the Minister will continue to work with the HSE to ensure that the new regional executive officer for the mid-west is fully supported in delivering improvements for the region.

Róisín Garvey (Green Party)
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I thank the Minister of State. My question was why only one MRI scanner was working. I presume, therefore, that the second scanner, which the Minister of State indicated was available, was broken on the day. The response did not answer that question but that is not the Minister of State's fault as he did not write it. He stated that one MRI scanner is owned by the UL Hospitals group and the second one is operated by Alliance Medical. Is that part of the insurance company? Does that mean it is a privately-owned scanner and that private patients get priority? As a public patient, I would find that appalling, as would many others who cannot afford private healthcare.

The response also stated that a tender was issued in November 2023 for a third scanner for the radiology department. I wonder why the hell it took so long. Last November the trolley crisis was still appalling and had been for years. Why did a tender only go out last November, meaning we will have to wait almost another year, if it is provided on time? There seem to be mountains made out of molehills at every turn in the HSE, especially when it comes to UHL.

The Minister of State said that GPs can refer patients directly to a community radiology diagnostics service. Is he referring to the primary healthcare centres or where is that service available? If it is available in the community, why are GPs sending people to accident and emergency departments? Are there not enough community radiology diagnostics services in the community? There is obviously something else going on there as well.

While I appreciate it is not the job of the Minister or Minister of State to manage UHL, there are serious questions still to be answered about what the hell is going on in that hospital.

Alan Dillon (Mayo, Fine Gael)
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I thank Senator Garvey and recognise the concerns she has raised on behalf of people in the mid-west region who are trying to access these essential services. I will bring the questions she raised back to the Minister for Health, Deputy Donnelly, and his officials.

As already advised, significant capital investment has been made by the Government to expand the radiology department at University Hospital Limerick. Work is under way to deliver the much-needed capacity, including an additional MRI scanner. Enabling works have started and the procurement phase has commenced. The Minister continues to work closely with the HSE and University Hospital Limerick to deliver much-needed improvements for the people of the mid-west.

A new regional executive officer has been appointed to support the Minister and the CEO of the HSE to ensure the expert team de-escalates pressures on the emergency department and manages patient flow at University Hospital Limerick. Many of the changes the Minister has sanctioned are having an immediate effect on patient flow. These include the implementation of the GPs on the door at the emergency department and the rostering of senior management on the floor. Other changes will be brought into effect in the medium term and in time for the winter surge later this year.Those also will include 16 additional fast-build beds, which are to be commissioned on the hospital site, the procurement of 20 permanent step-down and rehabilitation beds in Clare and the temporary procurement of 50 step-down beds in Nenagh, pending delivery of the new 96-bed block. Other measures will address long-term challenges to provide enduring stability to the area. These include developing the capacity of the model 2 hospital in Ennis, of Nenagh and St. John's hospitals, and the provision of a second 96-bed block by 2028. The Minister is committed to working closely with the Oireachtas, elected members in the mid-west and the HSE to ensure the delivery of improved services for the people who much need them.

Eileen Flynn (Independent)
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Before we move on to the next Commencement matter, I welcome to the Chamber members of the Seapark Residents Association of Malahide. It is lovely to see young people in the Gallery and they are very welcome.