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

I welcome the Minister and his officials. I disagree with Deputy Kelleher in lumping the HSE in with the Minister, the Department of Health and the Government on the issue of the assessment of need and the capacity to operate within budgets. As I well recall it, the HSE sought substantially more than was afforded to it for funding for the service plan for 2015. Its assessment was more in line with the reality of this year and the additional provision being provided under the Supplementary Estimate before us. It was the Minister and the Government who failed to provide the required funding. On the reference to HSE's incapacity to operate within budget, again I believe Deputy Kelleher is wrong about that. I believe it has the capacity but with under-resourcing, underprovision and a fault line in regard to accurate forecasting of the potential presentation of footfall, it would have found itself in a very difficult, if not an impossible, situation over the course of this year and that manifested itself on a number of occasions. The bottom line in regard to all of that is underprovision and insufficient resourcing with the result that it had neither the human resources nor the physical wherewithal to cope within reasonable timeframes.

I would make a number of points in response to the Minister's opening remarks. The €600 million he is seeking now is €65 million less than has been adjudged required to bring us up to the end of this month. Can he clarify for the record if the €65 million additional payment in respect of the so-called UK-Ireland bilateral health care reimbursement agreement has been received? It is important to note that he referenced in his remarks the difficulty there has been historically in having private health insurers provide payment for specific service provision and that he is now seeing a €100 million initial payment. Is that an upfront payment? There was not necessarily a correlation but a joint difficulty of taking the money from the health insurer entities and in regard to the British arrangement. Is this money promised or has it been received?

When the Minister talks about addressing the areas of unmet need, he is again confirming the situation, to which that I have alluded, with respect to the HSE. This is unmet need and it is unmet most certainly because of under-resourcing and undercapacity.

I wish to make a number of other brief points. On the emphasis on reduced delayed discharges, reduced waiting lists and reducing emergency department overcrowding, these are the areas of critical concentration in dealing with the issues in the hear and now which I believe will continue to be the areas of critical concentration. It is important that everything is done to address these matters as quickly as possible. The Minister stated that he cannot introduce all the capacity required over night but that he has responses in train that could be introduced relatively quickly. Will he elaborate on the specific set of measures he hopes will be in put place now and towards the end of this month to get us through this last period of 2015? Has there been an uptake in terms of nurse recruitment? Apart from the winter months initiative in regard to the additional 300 beds, are other bed capacities being created that would add to that much needed resource to deal with the numbers presenting, which is expected to continue to rise.

There are a number of points to be welcomed and it would be wrong of me not to do so. We have seen a significant reduction in the delayed discharges from 850 to 558 as of the beginning of this month. The delivery of that improvement will compliment the additional bed capacity but there is no reason to be complacent. Delayed discharges are indicative of underprovision with respect to future care needs, either in terms of home care packages or residential long-term care provision. It is important we recognise that this needs to be part of any package of measures to address this particular vexed difficulty.

The Minister stated that at the start of the year, he put in place maximum permissible times for inpatient and day-case treatment and outpatient appointments but, in fact, what he actually did is not what he said he did. He actually extended the maximum permissible waiting times in each of these areas up to 18 months. That is something that needs to be revisited. Eighteen months in that respect is unacceptable. We heard voices on his side previously, either in this committee or in the Dáil Chamber, which were hugely critical of much shorter waiting times across inpatient and outpatient need, including day-case treatment, and yet we have permissible waiting times now of up to 18 months and 15 months by the year end. What is current position on that?

The number of people waiting for outpatient appointments has fallen below 386,000. We should reflect on that number for a moment - there is no reason for celebration in this matter.

We have a huge job of work to do and I emphasise "we" because it is critically important that these matters are addressed comprehensively across the board.

I will conclude with a brief comment on the nine hour wait on trolleys and the Minister's recent indication of a penalty on hospitals that exceed nine hours. That is the wrong way to go about the matter. It is not about penalising those who fail to realise a timeframe regarding trolley use for patients. Those hospitals may well be the hospitals that need even more support.