Mr. Liam Doran:

When the hospitals apply and go to the agencies, it is a short-term gap measure. We could talk for six or seven years about the recruitment embargo and how that absolutely decimated the workforce, but in terms of managing it now, when a hospital seeks short-term relief, the people are not there. Whatever chance there might be in Dublin, and it is a slim one, there is no chance at all outside of Dublin.

The nursing staff who wish to work are working, and that is good. However, we do not have enough of them to meet service demand. The €80 million is the cost. The conversion of that into permanent employment is an absolute must. There have been repeated efforts to do it. However, we are then in the arena of employment ceilings, pay ceilings and so on. A hospital is told that, while it needs the staff, it is over the pay budget that it was given or is over its employment ceiling. The only way a hospital has of getting someone in is if a director of nursing feels there is an absolute clinical need to go to the agency. Does that deliver continuity of care and is it the way to staff a service? Absolutely not. In this year's service plan, there is a mention of 1,000 extra nursing posts. I do not mean to be parochial. That is to be funded primarily by that conversion. That is very welcome, but we have to make it happen, and even if it does happen, it does not increase the overall nursing man hours in the system. There will still be shortages and so on.

If I may, I wish to make a straightforward statement on that. There was an outcome of an expert group report from last August that said that at least 107 nurses are required to look after admitted boarded patients in emergency departments on a dedicated permanent basis. The idea of that is that the emergency department staff are then more free to look after their normal emergency department throughput. The admitted patients would have a dedicated cadre of staff. That expert group reported last August. The Department and the HSE met. There was ping pong between the two of them as to which was going to do anything about it. We met them last Friday and were told that there was nothing in the 2017 budget or service plan to allow for the employment of those 107 nurses, end of discussion. That is the reality of emergency department admitted patients and having a dedicated nursing staff for them. There is nothing in the budget or the service plan for them, even though an expert formula has said that at least 107 are need. We would argue that even more are needed. However, nothing is being done about it.

On the bed capacity review, 150 beds is the tip of the iceberg. The health strategy of 2001 called for 3,000 additional acute beds, with 650 of those to be private. That was parked. There was then the co-location idea in the 2006-2007 period, which was supposed to bring on about six hospitals with about 2,500 private beds on a co-located basis. That was parked. Whether one liked or disliked it, it would have meant an increase in our bed capacity in large acute hospitals. However, it was parked. We have done absolutely nothing about our acute bed capacity and our needs. We have particularly done nothing about our continuing care and long-term care bed capacities.

Dr. O'Connor is absolutely right and we have to be very clear here. While we argue with the HSE and so on, the one success story and good thing that has happened this winter is the reduction in the delayed discharges that took place. Roughly 13 or 14 months ago, we had 800 or more people that were discharged but in an acute bed. I think that is down to around 440 at the moment. That is being driven by additional transitional care beds, additional home help under the winter initiative and a de-layering of the bureaucracy in access to the fair deal scheme, for which the waiting time is now about four weeks rather than ten to 12 weeks. That has to be welcomed. It is late, but it has to be welcomed. The difficulty we have is that the demand for those types of beds will continue to increase. Where are we going to get them from? It does not matter how we de-layer the bureaucracy. Where are we going to get the additional transitional and continuing care beds? There is no plan to develop. The capital thing about bed capacity is not just about the attention-seeking acute hospitals. It also has to be about our long-term care. We must remind everyone that 20,000 to 25,000 people will turn 65 every year for the foreseeable future and will increasingly present with comorbidities that will have to be addressed either with supports at home or in some kind of primary or acute care environment. The bed capacity issue is massive and we have to address it.

How willing is the system to share? Deputy O'Reilly asked that question. It is simply not. My money is mine and the Deputy's is the Deputy's and we do not share.