Billy Kelleher (Cork North Central, Fianna Fail)
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I welcome the Minister to the House to take this issue. It is very topical, given the threatened industrial action in the mid-west region.

Earlier this year, the Minister addressed the annual conference of the Irish Nurses and Midwives Organisation, INMO. He clearly and concisely outlined his vision of the importance of nurses in the delivery of front line services in health. He also said he was conscious of the importance of working together and of listening to nurses and those who provide front line services. In view of what is happening in the mid-west and of the concerns expressed in Beaumont Hospital and University Hospital Galway, it is evident from his inaction that the Minister is not listening to the nurses or to representatives of those providing front line services, who are expressing grave concern about overcrowding in accident and emergency departments and patient safety.

As I looked at Deputy Reilly's website and at old press releases dating from his time as Fine Gael spokesperson on health, I got tired of reading press releases headed "Reilly slams". Reilly was continually slamming the Minister and the HSE. He was doing nothing but slamming at that time. He has now been Minister for six months. I am a fair and reasonable person, but the Minister's only major press release, PR or media hype in that time was about the sacking of the board of the HSE. He subsequently stated that he was assuming personal control of policy and budgetary parameters. Now the HSE is consistently being fingered as being responsible for budgets and for the management of hospitals. There is a disconnect and a failure of the management chain between the Department of Health, through the Minister, and the HSE. It is evident that his proposals, made with wild abandon, to abolish the HSE and set up new management structures is not working.

The Labour Relations Commission, LRC, has offered to intervene tomorrow in the industrial action in the mid-west. The front line service providers, to whom the Minister said he would listen, are clearly stating that patient safety is at risk. They say shortcuts will be taken and there is a major concern about accident and emergency services in the mid-west and in University Hospital Galway. The closure of the accident and emergency department in Roscommon is putting added pressure on other accident and emergency departments.

I do not mind a volte-face or a U-turn, but the Minister is embracing reconfiguration with the zeal and enthusiasm of a latter-day convert. Every day, he is driving this reconfiguration, sometimes without discussion with local communities. This is evidenced by the comments of Deputy McCarthy about the reconfiguration of ambulance services in west Cork.

It is time the Minister took a hands-on approach. He must not wash his hands of this issue. He should roll up his sleeves and get involved, as he said he would do, in ensuring a proper chain of management from the Department of Health, through the Minister who would be accountable to the House, to the HSE.

I am also disturbed by the Government's lack of urgency in dealing with health issues. The Minister established a Cabinet sub-committee on health which has never met. It is six months since the Government came into being but the Cabinet sub-committee on health has never met.

The Minister must be honest about the commitments he has made. His policies are not working on the ground and patients' lives are being put at risk.

James Reilly (Dublin North, Fine Gael)
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The wildness of the Deputy's imagination is matched only by the wildness of his rhetoric. After six months we have made considerable progress, notwithstanding the mess that was left for us to clean up.

Billy Kelleher (Cork North Central, Fianna Fail)
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There is no need for that now.

James Reilly (Dublin North, Fine Gael)
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There was an overrun of €70 million in our hospitals from last year. We are trying to retrench the runaway and out of control budgets in our hospitals which occurred during the first three months of this year under the watch of the previous Government either by intent or through neglect. On top of this, to address the financial morass in which the previous Government left the country we must take almost €1 billion out of the health system, keep the service running and put in train a reform programme.

I put it to Deputy Kelleher that this industrial action serves no useful purpose. I am concerned about the further stoppage planned for tomorrow and urge the INMO to reflect on the impact this action will have on the general public and on patients in particular. I find it hard to reconcile that the nursing unions are taking this industrial action given they are parties to the public service agreement which focuses, in particular, on the need to deliver services in the changed circumstances in which, thanks to the previous Government, we now find ourselves and on co-operation between management and unions.

The shared focus of all those working in the health service should be on safeguarding front line care in the face of our continuing very serious economic situation. The Mid-Western Regional Hospital Limerick was €16.2 million over budget at the end of July 2011 and has had to take measures to reduce its spending, including a prohibition on staff overtime and the hiring of agency staff. As in all areas of the economy and the public service, we must focus on solutions, including efficiency, flexibility and innovative working in order to maintain our public services in the face of economic crisis.

Industrial action by any group will simply exacerbate our problems and, in the case of nurses, may impact negatively on patient care. In recent months, I established a Special Delivery Unit, SDU, under the leadership of Dr. Martin Connor. The SDU is working to unblock access to acute services by improving the flow of patients through the system. It is focusing initially on emergency departments and will be working to support hospitals in addressing excessive waiting times for admission to hospital. The SDU is due to submit a report on the Mid-Western Regional Hospital Limerick to me on Thursday. I look forward to the co-operation of all health service staff with the Special Delivery Unit, which is aimed at ensuring that patients receive safe and appropriate service when they present at our acute hospitals.

In the case of Mid-Western Regional Hospital Limerick, it is vital that we focus on solutions, including the introduction of new rosters and redeployment of nurses to areas of greatest need in the hospital. New rosters become even more important in light of the need to maintain and improve services in a financially constrained context. As regards pressures in the emergency department, it is clear that risk issues arising from overcrowding should be regarded as a problem with which the entire hospital must deal. Hospital management cannot accede to a demand that no extra beds should be put up in wards. This is provided for in the escalation policy and represents a lesser risk than allowing an unsafe build up of trolleys in the emergency department.

Billy Kelleher (Cork North Central, Fianna Fail)
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While I welcome the Minister's reply it lacks answers. Are we questioning the validity of the INMO to raise serious issues of concern with regard to patient safety? It has tried everything else and now believes industrial action is the only way it can get the Minister to listen to its concerns in respect of the serious shortcomings that are now evident in the health services. The Minister can engage in all the historical debates he wants about how we got where we are. When in opposition, he knew where we were and gave many commitments in that regard. Political choices are being made every day by this Government. The Government made the political choice not to burn the bondholders and to provide funding for job creation but has made no political choices in regard to the critical area of patient safety and health provision. The only political choices it has made in this area relate to increased capacity and ensuring reconfiguration of hospitals throughout the country is expedited while not ensuring proper procedures and extra facilities are put in place in the context in particular of University Hospital Galway, which the Minister, amid fanfare, also visited.

I wish the Special Delivery Unit and Dr. Connor well. However, it is evident from what is happening in the North that this will run out of steam very fast. While in the short term it might assist in addressing hospital waiting lists, the situation in Northern Ireland illustrates it will not work in the longer term. The Special Delivery Unit informed the Mid-Western Regional Hospital Limerick of its proposed visit well in advance. It is clear that management of the accident and emergency department was changed in advance of that visit. Staff have told me there were few hospital trolleys on the corridors at the time of that visit because of the forewarning by the Special Delivery Unit of its visit. The Minister should refer the Mid-Western Regional Hospital Limerick to the Health Information and Quality Authority, HIQA, which should undertake a full audit of it in the context of patient safety. Nurses are not taking industrial action for the good of their health rather they are doing so for the good of patients.

James Reilly (Dublin North, Fine Gael)
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The Deputy has made several points, all of which I would like an opportunity to address.

Catherine Byrne (Dublin South Central, Fine Gael)
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The Minister has two minutes to respond to Deputy Kelleher's supplementary questions.

James Reilly (Dublin North, Fine Gael)
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The Deputy's suggestion that we should send HIQA into the hospital until such time as the SDU report is available and the actions recommended therein are taken is nonsense. If there is a need to send HIQA in following that report, consideration will be given to the matter. It is to misunderstand what the SDU does to say that it must make a morning raid in great drama. Its purpose is to examine, analyse and issue recommendations to support management and staff of the hospital. I have no doubt it will make those recommendations. As I said earlier, I cannot see how taking industrial action will improve or make safer the situation for patients.

The Secretary General of the Department of Health, Mr. Michael Scanlan, received a letter today from Mr. Fergal Hickey, President of the Irish Association of Emergency Medicine, the salient part of which states:

Many Irish hospitals are overcrowded. The fact that they or the HSE choose to manifest all of the overcrowding in the emergency departments is inappropriate, clinically unsafe and inequitable. There is now irrefutable international and national evidence that preferentially condensing all of a hospital's overcrowding into one single clinical area, the emergency department, increases the risk of avoidable death and harm not only for those hospital in-patients who remain in the emergency department because no bed is available for them but also for emergency department patients who can be discharged and those who do not wait in the ED to be seen because of excessive delays. A better, fairer, safer way to treat all patients during times of emergency department overcrowding is by implementing a simple patient care practice used successfully in other developed health care systems, namely, the full capacity protocol. Full capacity protocol is an internationally validated protocol. The IAM believes strongly that the full capacity protocol, FCP, is a reasonable measure and fair approach to the significant dangers created by overcrowding of emergency departments. One or two additional patients admitted to multiple hospital wards at times of significant emergency department overcrowding is much safer and more clinically just for all patients than is allowing tens of additional patients to be detained for more than six hours in a single dangerously overcrowded compromised emergency department.