It comes seven months after the serious risks were first flagged.

The warning comes as HSE figures show that 23 people had been waiting 24 hours on trolleys for a bed by Monday morning at University Hospital Limerick (UHL), reports the Irish Examiner.

"More than seven months after Hiqa exposed serious risks to patient care at Ireland's busiest and most overcrowded hospital, driven by constrained bed capacity, we say the conditions identified in that report persist daily," the doctors said.

Those risks include severe overcrowding and an excessive number of patients waiting on trolleys for hospital beds, all being looked after by exhausted staff.

The consultants on the Medical Board of HSE Mid West told minister Jennifer Carroll MacNeill that "risks to patient care at UHL remain intolerable and unacceptable" at the overcrowded hospital.

They want to see a HSE Midwest development board put in place to deliver the new hospital on the Patrickswell site promised by the minister back in March. She had said the board would be set up quickly and would report back to her by the autumn.

"If the minister has a chairperson in mind for the board, clarity is now urgently needed on when that appointment will be made and when the hospital development board will be formally established to drive the project forward," the doctors said.

They called for plans to guarantee an all-services acute hospital with a minimum of 400 beds in the first phase, and to deliver at least 1,000 beds in the long-term. This would be co-located with the new maternity hospital.

The doctors are also pushing for emergency funding this year, saying it is needed "to address escalating patient safety risks, including urgent recruitment of additional consultants, NCHDs, nurses, health and social care professionals, clerical staff, and technical staff."

They want HSE limits on recruitment suspended across the region covering Clare, Limerick and north Tipperary. The call comes just days after it emerged that the HSE nationally is facing another recruitment pause as it struggles to overcome a three-month budget deficit of €250m.

'Mitigation is not safety'

Medical board chairman and surgeon Colin Peirce said the situation has been building for years.

"This crisis did not emerge overnight, and it has not gone unrecognised," he said. "Frontline staff, clinicians, and patient advocates have been warning for years that the Midwest does not have the acute hospital capacity required to provide consistently safe care for a growing and ageing population.

"Those warnings have been repeatedly escalated over many years. Hiqa has confirmed them. Patients and staff continue to experience them every day. Our teams are doing everything possible to protect patients in extraordinarily difficult conditions, but mitigation is not safety."

Referring to the emergency plans linked to overcrowding, he added: "Escalation plans are not capacity. Corridor care is not acceptable healthcare."

On Monday, the Irish Nurses and Midwives Organisation counted 97 patients on trolleys at UHL and a further six at Ennis hospital. HSE figures show 60 people on trolleys and 43 on temporary surge beds.

Hiqa told the health minister last September that she must either expand University Hospital Limerick, provide a support hospital, or build a new hospital altogether to address the chronic overcrowding. The health watchdog warned Jennifer Carroll MacNeill that "planning for these beds needs to commence now," cautioning that overcrowding continues to pose an ongoing risk to patient safety at UHL.

While campaigners have called specifically for a new hospital offering emergency care in addition to University Hospital Limerick, Hiqa has put forward three options.

Option A would see capacity expanded at University Hospital Limerick on the Dooradoyle site, meaning extra beds added at its current location.

Option B would involve extending the UHL hospital campus to include a new second site nearby under a shared governance and resourcing model. That would mean building a smaller hospital close by to handle non-crisis care or clinics, easing pressure on UHL.

Option C would see the development of a Model 3 hospital in HSE Mid West, providing a second emergency department for the region. That would involve building a hospital similar to Mercy University Hospital in Cork or University Hospital Kerry in Tralee, meaning the Midwest counties would have two emergency departments rather than one.