Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I do not have the up-to-date figure, but the PCRS had a surplus of about €30 million in 2016. It is a moving figure, but the most recent figures available to me are in that region.

Deputy O'Reilly is correct that the people on trolleys are people who have been admitted by a clinician. It is also correct that people turning up in hospital - this is not blaming people because they often have no where else to go - who may have been able to be treated in a primary care centre in an out of hours GP service in a nursing home or in an appropriate setting, takes staff from the emergency department to deal with them. Reducing hospital attendances through primary care is a component of assisting and alleviating the pressure on our acute hospitals. I equally accept that bed capacity and staffing are the other two big pieces. We have to address the issue using a three-pronged approach, namely, primary care, bed capacity and staffing. When I listen to people on the radio speak of the need to open a certain number of beds in the morning, even if their analysis is correct, they also need to be conscious of the fact that the beds need to be accompanied by staffing. It is not an either-or in regard to bed capacity or staffing. It has to be the bed capacity, the staffing and the primary care.

Deputy O'Reilly made a fair point on whether we are achieving value for money. I have asked myself this question. It is part of the reason the HSE and the Department are sitting down to provide me with an analysis of the winter initiative. That is one of metrics I want them to analyse this month. It is fair to say that it is easy to measure some aspects, for example, if one provides a certain amount of funding for aids and appliances to benefit over 3,000 additional patients. One can establish whether the 3,000 additional patients get the goods and whether they were procured at a reasonable price. It is a quick and easy to answer that. When one gets to the hospital and the numbers on trolleys, then there is a value for money element, because one can measure whether the funding was provided for extra beds and the beds came on stream. The other elements I have outlined are harder to measure on a value for money basis. If there was insufficient capacity in the hospital or if there was not adequate staffing in the hospital. We need to look at the value for money aspect but we also need to look at the blockages are as well. Some of them are not as easily measured from a value for money analysis point of view.

A 'flu outbreak happens every year in every country. The advice available to me from our chief medical officer, our deputy chief medical officer, our expert group on influenza was that the type of 'flu this year was a strain that we had not seen in this country since 2009. I believe the 'flu in 2015-16 largely affected younger people. The strain of 'flu this winter largely affected older people. That does result in increased hospital attendance.

I make the practical, not political point, and in recognition of the staff working in the health service, that during the month of February in spite of the fact that we continue to see too many people on hospital trolleys, we need to recognise the fact that we see more and more people attending our hospitals as the population grows and gets older. We had fewer people on trolley in the month of February this year than last year. It is not an acceptance of the figure, but it is a recognition of the fact that people working in our hospitals, be it in management roles or front-line roles, are doing their very best to reduce the number. In spite of the fact that more people turned up in the emergency departments, fewer people were on trolleys.