Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

We are agreed that emergency department overcrowding is not just a matter of emergency department performance, and I fully concur with that view as expressed by the task force and in the response to questions I posed in advance of today's meeting.

Regarding the measures that the emergency department task force report has commended in terms of the reduction of delayed discharges, could the Minister or Mr. O'Brien advise if additional public nursing home beds are in train? Are they being provided and, if so, where, and what about home care supports? I note that the response I received refers to developing and extending additional and alternative access routes to urgent care, "thereby enabling appropriate admission avoidance". I presume that should have read "inappropriate admission avoidance".

With regard to opening a further 173 community beds, where are those beds being opened? There is reference to 149 of the beds being open now, with the remaining beds being progressed. Clearly, that is not enough. Where are they situated? The recruitment of staff is essential to the additional bed capacity. I cannot emphasise that enough. Can we have an update on the campaign to bring nurses home and the recruitment of nurses who have left the country? There are concerns that the exercise is not as successful as one would have hoped.

Regarding the number of delayed discharges falling from a high of 830 in December last to 728 in March and 573 last August, is this a real development or is it reflective of a seasonal pattern? How do the figures across those months compare with 2014? On the same issue regarding the 30 day moving average of the IMNO trolley watch, that has reduced from 370 in March to 233 at the end of July. Is that also reflective of progress or is it seasonal? How does it compare to 2014? It is also stated that some hospitals might require particular support in respect of the diverse size and functions of the different hospitals in dealing with this overall issue. What hospitals might require particular support and how would those supports translate into actions?

It is indicated in the response I received regarding winter planning that Mr. O'Brien hopes to have the final winter plans agreed at a meeting today, 6 October. Has that meeting taken place and has that been achieved? Is there a sign-off on the winter planning programme and what does it entail? It is planned to have an additional 300 beds open by the end of November. Again, what hospitals are involved and what are the numbers for those hospitals? Are all hospitals included or are some excluded?

With regard to emergency departments, is consideration being given to someone being in charge, that is, an emergency department manager who would have an overview of the operation of the emergency department? It is a view and opinion offered by many people who experience an ED presentation that there does not appear to be somebody with an overview and oversight of the throughput of people from when they first present until they get to meet with an appropriate front-line staff provider.

The response states graduate nurses are being offered permanent contracts with a view to retaining them in our system and that it is essential we introduce measures to retain the existing nursing complement. I am still talking about emergency departments when I say the response Acontinues that detailed plans have been agreed to expedite the build component where it has been identified. Will the delegates indicate in what hospitals that aspect has been identified and what steps will be taken where it has not been identified as part of addressing the emergency department crisis?

I posed a question to the Minster on universal health insurance in terms of the necessity for further research. He stated it was not possible to introduce a full UHI system by 2019, but he then stated something on which he, others and I are all of one mind, that is, there was a commitment to universal health care. Is that the end of UHI? Would the Minister like to elaborate on the matter as that certainly appears to be the case?

My final question relates to the HSE's presentation of a detailed submission to the Department of Health which has been described as confidential. However, it is in the wind that an additional €2 billion will be sought in budget 2016. I ask Mr. O'Brien to confirm if that figure is accurate. The figures for last year were provided or emerged, as the case may be. Will the Minister confirm if there will be a Supplementary Estimate this year because of the shortfall? Is it the case, as has been suggested, that hospitals that have recorded an overspend will face into 2016 with a weight around their necks, thus making an already difficult and bad situation even worse? How does the Minister intend to address the so-called overspend on demand-led services across hospital sites?

The Minister has made a presentation. On consultant posts, he states the vacancy rate has fallen and now stands at about 170, or 6.3%. Is that the full figure? Is the number of locum covered posts included? Is the number given, 170, the net figure? In other words, are there posts that will be permanently filled and are there individuals who will hold locum appointments on a temporary basis? Will the Minister tell us exactly what the figure of 170 represents?

I ask the Chairman to bear with me as I am almost finished. The Minister continued: "Notwithstanding the difficulties in some rural and urban deprived areas, the number of GPs with a GMS contract is stable." In that instance, has he taken into account the age profile of the current complement of GPs located across the country? How can he assess the issue of stability when clearly some areas have not been adequately provided for?

My final comment is to the Minister of State, Deputy Kathleen Lynch, who has acknowledged what I want to say. I refer to the fact that children and adolescents have to wait for more than 12 months for a first appointment. We have noted the reported reduction, but it is simply not good enough, as we know that there is hardship. One only needs to see one case in order to appreciate the immense hardship that waiting involves for a parent or parents. A reduction is never good enough, even if it means a reduced figure of 146 who are waiting for more than 12 months for an appointment. It is an indictment of the system that such delays continue.