Hospital Overcrowding: Motion (Resumed) [Private Members]

That Dáil Éireann:

notes that:

— the Irish Nurses and Midwives Organisation recorded 12,274 patients without a hospital bed in September 2026, the worst September on record, including 1,994 at University Hospital Limerick (UHL) and 1,008 at Cork University Hospital (CUH);

— the number of recorded emergency department experiences lasting more than 24 hours increased from 33,843 to 36,410, up 7.6 per cent, and for patients aged 75 and over, the number exceeding 24 hours increased from 10,019 to 12,106, a sharp increase of 20 per cent;

— recruitment restrictions, unfilled essential posts and delays in offering graduates permanent jobs are undermining patient safety and winter preparedness; and

— there is a significant bed deficit across our hospitals as acknowledged in the Government's Acute Hospital Inpatient Bed Capacity Expansion Plan 2024-2031, especially in the Mid-West which faces continuing capacity risks at UHL;

considers that overcrowding robs patients of dignity, endangers lives, exhausts staff and safe discharge requires appropriate support along with patient and family involvement;

condemns successive Fianna Fáil and Fine Gael Governments' failure to deliver sufficient capacity and reform, and recognises the Minister for Health's responsibility to sustainably fund the health service, address capacity shortages, and ensure safe care across every hospital; and

calls on the Government to:

— remove recruitment restrictions blocking the filling of urgent and priority vacant posts, replacement, leave cover, and redelegate recruitment authority to health regions with adequate funding linked to patient needs;

— honour permanent contract commitments to nursing and midwifery graduates, and improve staff training, recruitment, and retention through a funded workforce plan;

— legislate for safe staffing, fully implement the Framework for Safe Nurse Staffing and Skill Mix, and fund multidisciplinary staffing and surge capacity, ensuring financial controls cannot override patient safety;

— take urgent action on the capacity and patient safety concerns raised at CUH and UHL, with clear responsibility for resolving priority vacancies, addressing service restrictions and providing additional staffed capacity;

— deliver the promised 3,000 additional acute inpatient beds, funded through a multiannual capital plan with hospital-by-hospital capacity targets to meet population needs;

— accelerate elective hospitals in Cork, Galway and Dublin and the opening of surgical hubs to protect scheduled care from cancellations;

— deliver a funded Model 3 hospital with a second emergency department for the Mid-West, alongside immediate improvements and expanded urgent care at UHL, Ennis, Nenagh and St John's hospitals;

— expand regular and out-of-hours general practitioner, pharmacy, primary care, home care and community services to reduce pressure on overcrowded hospitals, deliver care closer to home, and improve early intervention;

— fully fund the National Ambulance Service strategic workforce plan; and

— publish funded regional winter plans and multiannual improvement plans with clear responsibility, published deadlines, demand forecasts, staffing and capacity targets, targets to end trolley waits, and escalation arrangements with a target of achieving consistent population-based capacity levels across each region.

To delete all words after "Dáil Éireann" and substitute the following:

"acknowledges:

— the increased pressure on urgent and emergency care (UEC), given that there has been increased demand in emergency departments (EDs) with patient attendances up 7 per cent (+98,500) nationally, and attendances by people aged 75 plus up 9 per cent (+18,000) compared with 2025;

— the commitment in the Programme for Government to further reducing EDs overcrowding and enhancing urgent care services nationwide;

— the ongoing and important work undertaken by our nurses, doctors and wider healthcare workforce in our hospitals and across the health service, often in challenging and difficult conditions;

— the progress being made providing more care in the community, consistent with the objectives of Sláintecare, and the significant reforms being implemented in primary care, general practitioner (GP) and pharmacy services; and

— that there has been substantial and sustained investment in health service staffing and funding in recent years, with Budget 2027 allocating €29.1 billion for health services as the Government continues its investment in more care, closer to home;

notes that:

in relation to the urgent and emergency care plans that:

— during the first ten months of the year, ED attendances rose by 7 per cent, with 98,300 additional presentations nationally when compared to the same period in 2025, with effective governance and oversight essential in ensuring operational grip is maintained at national, regional and hospital levels;

— for 2026, the top six sites accounted for 51 per cent of the daily average 8 a.m. trolleys, University Hospital Limerick (UHL), Cork University Hospital (CUH), St Vincent's University Hospital, University Hospital Galway, Mayo University Hospital, and Sligo University Hospital;

— the next seven sites accounted for 29 per cent of the daily average 8 a.m. trolleys, Mercy Hospital, Tallaght University Hospital (TUH), University Hospital Kerry, Letterkenny University Hospital (LUH), Mater Misercordiae University Hospital, St James's Hospital and Naas General Hospital, this means that 13 out of 29 sites accounted for 80 per cent of 8 a.m. trolleys; and

— to respond to the winter season demand, the Government is progressing with implementation of additional patient safety and patient flow steps, including a GP respiratory support programme, additional specific ED plans for each of the ED sites and identifying key unblockers of patient safety flow for the winter period;

in relation to safe staffing and safe care that:

— the Government supports and has invested significantly in the Framework for Safe Nurse Staffing and Skill Mix (the Framework), noting that the Framework is an evidence-based approach to determine the appropriate nurse staffing levels and skill mix in acute hospital settings and EDs across Ireland;

— the Framework continues to demonstrate positive impacts for patients, staff and organisations where implemented, for example, reduced length of stay, reduction in staff intention to leave, and efficiencies through reduced agency usage;

— Ireland's approach aligns with the World Health Organization guidance, utilising a blended model of Benchmarking and Patient/Acuity-based staffing, the Framework is grounded in a needs-based care principle, measuring nursing workload by systematically assessing individual patient care requirements and levels of dependency, this enables staffing to be dynamically adjusted in response to patient complexity and care intensity, rather than relying on fixed ratios; and

— significant progress has been made, with baseline implementation achieved in all 26 adult EDs, and across 39 acute hospitals nationwide, this means that 96 per cent of identified baseline staffing requirements have now been delivered nationally and is a critical measure of patient safety;

in relation to the Winter Vaccine Plan that:

— vaccination is recognised as one of the most impactful public health interventions available and has led to many lives being saved dramatically reducing the impact of infectious diseases also protecting finite hospital resources, noting that the flu and Covid-19 vaccination programmes are already currently underway for the winter season;

— the flu vaccine is available free of charge to eligible groups from local GPs and pharmacies throughout the flu season, eligible groups include, adults aged 60 years and over, individuals in specified health related at-risk groups, children aged 2 to 17 years, and healthcare workers;

— Covid-19 vaccinations are available to certain eligible groups without charge through local GPs and participating pharmacies;

— the respiratory syncytial virus (RSV) infant immunisation programme is also being delivered this winter, helping to protect babies from serious RSV illness and reducing the risk of hospitalisation during the respiratory virus season, uptake to date has been encouraging, with high levels of immunisation reported through maternity hospitals;

— in the week ending 25th October, shows the following - Influenza activity continues to increase but remains at baseline-low levels overall, noting there were 139 cases notified in week 43, with incidence highest in those aged 80 years and older, in terms of uptake, it can be noted that, of adults aged 60 years and older, there are 34.6 per cent vaccinated compared with 36.9 per cent last season;

— RSV activity has remained stable at baseline levels in recent weeks, with 16 cases notified in week 43, (down from 17 cases in week 42), with incidence highest in infants aged under one year, in terms of uptake, it can be noted that, there is 88.3 per cent cumulative uptake in our maternity hospitals;

— for Covid-19, activity was stable and remained at low-moderate levels, with 203 cases notified in week 43 (up from 191 cases in week 42), incidence was highest in those aged 80 years and older, in terms of uptake, it can be noted that, of adults aged 80 years and younger, there are 37.4 per cent vaccinated, compared with 38.3 per cent at the equivalent campaign stage last season; and

— it is widely recognised that flu and Covid-19 vaccinations can significantly reduce hospitalisations by preventing illness and serious complications, in mid-January this year, it was reported in Ireland that around 76 per cent or three quarters of intensive care unit admissions due to the flu were in people who had not received the influenza vaccine;

in relation to investment and recruitment that:

— there has been substantial and sustained investment in health service staffing and funding in recent years, between 2019 and the end of 2025, overall health funding increased by approximately €10.6 billion, or 68 per cent, while the health service workforce increased by more than 30,000 staff, or approximately 30 per cent;

— within acute hospitals specifically, real expenditure increased by approximately 52 per cent and staffing by 33 per cent over the same period, compared with an increase of approximately 14 per cent in hospital activity;

— investment continued in 2026, with Budget 2026 providing for an additional 3,300 Whole-Time Equivalent (WTE) staff, by the end of September 2026, the actual workforce had increased by over 4,000 WTE since the beginning of the year, and by over 6,000 WTE in the past 12 months;

— there has been continuous significant increases in funding of the Neonatal Abstinence Syndrome since 2022 to this year's budget of €292.9 million, which is providing for an additional 263 service posts;

— significant Government investment is being provided to expand healthcare education to address future supply of healthcare workers to ensure Ireland can meet growing healthcare needs, including an investment of €28.5 million to support the delivery of more than 1,100 additional healthcare training places by 2028, representing a significant increase in training capacity across medicine, nursing, pharmacy, social care, and Health and Social Care Professions;

— there is no blanket recruitment freeze in place, the purpose of the workforce and financial controls in place are to ensure that available staffing is directed towards patient needs and priority services, while preventing recruitment and other expenditure from creating unfunded and unsustainable commitments, this arises from recruitment activity that is greater than sanctioned by the Government and the Houses of the Oireachtas;

— each Health Region must manage recruitment within their available pay allocation, taking account of the cost and mix of staff, agency expenditure, overtime and allowances; and

— the most recent Health Service Executive (HSE) data shows that nationally, 1,145 of 1,375 graduate nurses and midwives have been offered positions to date, an offer rate of 83 per cent, and more than 1,000 have accepted, it is likely that this offer rate has improved as we know through the Nursing and Midwifery Board of Ireland registration data, that 1,184 graduates have now successfully completed the registration process and the Department of Health is looking for further ways to enhance graduate recruitment;

in relation to multiannual capital funding that:

— the enhanced National Development Plan provision for the health sector for 2026 -2030 is €9.25 billion, this multiannual capital allocation is the largest ever capital investment plan in the history of the State and largest investment ever in health infrastructure in the State, this multi-annual investment is translated through the HSE annual Capital and Digital plans; and

— the establishment of the Mid-West Health Planning Board is central to the medium to longer term strategy for the Mid-West Region, the Board is made up of senior regional HSE leaders and multidisciplinary expertise across service delivery, clinical care, infrastructure, finance, and enterprise, it also includes patient and service-user representation to ensure that community needs and lived experience inform the Board's work, it is tasked with developing a robust service configuration and capital development plan for the Region and to put in place a credible roadmap for safe, accessible and sustainable healthcare in the Mid-West, it will focus on how services can be organised across hospital, community, primary care, and pre-hospital services and at how care can be provided closer to home, where appropriate, how pressure on UHL can be reduced, and how existing and future locations can best work together for the whole region;

in relation to moving care closer to the community, that:

— our health service continues to make steady progress towards providing more care in the community, consistent with the objectives of Sláintecare, for example, reforms in primary care through the Enhanced Community Care Programme, the structured chronic disease management programme in general practice and the continued evolution of community pharmacy services have strengthened the healthcare system's ability to meet population needs closer to home;

— notwithstanding demand pressures that remain significant, these investments are creating stronger alternatives to hospital-based care and providing a foundation for more integrated, person-centred services as close to home as possible, – creating a 'home first' approach as opposed to a 'hospital first' approach to the provision of health services, when it is clinically appropriate to do so;

— the Government continues to expand community-based and digitally enabled models of care, offering increased choice and improved outcomes to patients, these approaches focus on preventing avoidable hospital attendance and admission, supporting earlier discharge and are key avenues for relieving pressure on our health services;

— technological advancements such as remote monitoring and telehealth are transforming how healthcare can be delivered, creating new opportunities for remote monitoring and virtual consultations; and

— virtual wards are now operating in every HSE Health Region and have provided care to over 5,300 patients, freeing up over 48,900 virtual bed days, these services are helping to relieve pressure on EDs and acute hospitals while ensuring that hospital capacity is available for those who need it most;

in relation to Surgical Hubs and Elective Hospitals, that:

— significant progress has been made in increasing elective care capacity through the development of new Surgical Hubs and Elective Treatment Centres (ETCs), known also as Elective Hospitals, under the National Elective Care programme;

— four Surgical Hubs are currently operational at TUH, Mount Carmel Community Hospital, Swords and Cork, with hubs in Limerick, Galway and Waterford due to open in the coming months, additional new surgical hubs for Sligo and LUH are in design phase;

— once all surgical hubs are fully operational, the Surgical Hubs will deliver additional capacity across 12 specialties: Gastroenterology, General Surgery, Gynaecology, Ophthalmology, Orthopaedics, Ear Nose and Thorat (ENT), Pain Relief, Plastic Surgery, Urology, Vascular Surgery, Dermatology, and Maxillofacial Surgery, examples of elective procedures include Biopsies, Steroid injections, Carpal tunnel treatments, Hernia repairs, Tonsillectomies and Cataract Surgery, some of the benefits already delivered or underway include:

— the Reeves Day Surgery Centre opened in late 2020, and has become the blueprint for Ireland's Surgical Hub Programme, up to end August 2026, the Centre has treated more than 20,000 patients since opening and was delivering almost 5,800 procedures annually by 2025, the facility has supported a 17 per cent reduction in TUH's total day-case waiting list, with three in four patients waiting less than the 12-week Sláintecare target; and

— the South Dublin Surgical Hub at Mount Carmel Community Hospital is demonstrating that dedicated elective capacity can deliver measurable reductions in waiting times and waiting lists, while simultaneously releasing capacity within acute hospitals;

— since opening in February 2025 to end of August 2026, the Hub has delivered 8,006 procedures, including 4,275 procedures in 2026 alone, reduced average waiting times in participating specialties from 8.5 months to 4 months, a reduction of more than 50 per cent, reduced the number of long waiters by 63 per cent, from 330 patients to 121 patients and supported patients from across the wider Dublin Midlands network, including hospitals with significant concentrations of long waiters;

— the Dublin and North East Surgical Hub commenced operations during the week of 29th June, 2026, and is currently in the early stages of implementation, it commenced activity in specialties with some of the largest waiting lists in the region, including Plastic Surgery, General Surgery, Urology and Pain Management, most importantly the Hub is being targeted at a region with one of the largest concentrations of long-waiting patients nationally, particularly in Beaumont and the Mater hospitals, where more than 3,100 day-case patients are waiting over 12 months for treatment;

— the Cork Surgical Hub opened on a phased basis from 29th September, with Gynaecology amongst the first procedures delivered, expanding to include General Surgery, Dermatology, Ophthalmology and Neurology, Hernia repair, Carpal tunnel Surgery and pain relief injections;

— plans are progressing for Elective Hospitals in Cork, Galway and Dublin, a Planning Application for the ETC at St Stephen's in Cork was lodged on 12th October, while an application for planning permission for Galway at Merlin Park is expected to be lodged in early 2027, work on the Preliminary Business Cases for Dublin is advancing; and

— separating elective from emergency and acute care means fewer cancellations and delays for elective care and frees up hospital theatres and day beds in Model 3 and Model 4 hospitals for more complex cases and better addresses unscheduled care needs.".