Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

The Vice Chairman made a very good point and she is correct that almost all health issues are connected in some way. The emergency department is often just the place where the flaws and shortcomings show up. I accept her point. I did not mean any disrespect in what I said earlier and I apologise if that is how it came across.

Hospitals do not need delegated sanction from the director general of the health service or me to procure items such as pillows and blankets. The hospital may have been so overwhelmed that it was unprepared at the time. I hope it does not happen again and that they do not need to procure extra pillows. We can both agree that is not the solution. Deputy Catherine Byrne is correct about home help, home care and social care. If my fairy godmother arrived tomorrow and gave me an extra €50 million, I would give very little to the hospitals. It would go to social care, fair deal and home care packages, which would free up hospitals. In the 2015 budget, the fair deal scheme and home care packages were increased by €10 million each. Whether it is enough to meet rising demand will become apparent as the year goes on. The fair deal is under review and the Minister of State, Deputy Kathleen Lynch, is due to receive the review in a matter of weeks. We will deal with it when it arrives.

The HSE TrolleyGAR counts people on chairs. It counts anybody who is in an emergency department, who a doctor says needs to be admitted and who is waiting for a bed, whether on a chair or a trolley.

Deputy Regina Doherty asked about the things that do not cost money. These include physicians doing two ward rounds per day and senior decision makers being present. Given that senior decision makers are more experienced, they are more likely to discharge patients, can see them more quickly and are less likely to admit them. This is very important. Although postponing elective procedures does not cost money, they come back again to bite us. Discharge planning does not cost money and we should plan for the discharge of patients from the day they are admitted. The full capacity protocol, which is not agreed, does not cost money. It is used in many other jurisdictions to move patients up the house so it becomes a problem for the whole system, not just the emergency department. Encouraging people to use the minor injury units, such as in Dundalk, Smithfield and Cork rather than going to the big hospital does not cost money. Hospital avoidance by referring people direct to diagnostics or outpatient departments, OPDs, does not cost money. The Deputy is correct that many other measures cost money and that all these should be happening all the time. However, when one is in a surge scenario it is worth making the point and asking everybody to redouble their efforts and do what they can.