Ms Phil Ní Sheaghdha:

That is fine. On security issues, I will answer Senator Colm Burke and Deputy O'Reilly's questions at the same time. All of the research tells us that when staffing levels are low then assaults go up. We have to have the proper staffing levels to avoid the frustrations and the long wait times etc. We had a dispute in 2016 and part of the settlement was that there would be a security analysis of accident and emergency departments. We found that while the hospital might have security personnel, they may not necessarily be stationary in the accident and emergency department for the 24 hour cycle and that is still the case. Many accident and emergency departments do have security personnel, many do not but the hospital might have for some of the 24 hour cycle.

We have already alluded to the drugs and alcohol issue, the presentations and the fact that is putting our members, and our colleagues working with us, in danger. There is no doubt about that. An education piece needs to follow this. Is it the responsibility of the trade unions? Everybody knows health and safety legislation requires the employer to ensure a safe place of work. We have raised this as an issue and we have gone into dispute on it. It remains an issue that may raise its head as dispute issues arise around the country in the next number of weeks because it is simply not acceptable.

I will address the workforce plan.

The idea that we know all this and yet in the month of July we are still waiting for a plan to tell us how may nurses and midwives will be funded seems to contradict the requirements and obligations of employers under the safety, health and welfare at work legislation. It is irresponsible, frankly, that we do not know.

Deputy Kelly referred to the modular build. We have been involved in discussions in respect of South Tipperary General Hospital. The issue there is space. Over the past two years the authorities have been looking at the car park. There has been an issue in respect of the admission criteria. What type of patient can attend that modular build when we do not have access to the main hospital? Can we put acutely ill people into a modular build like that? We argue that one cannot. There is an issue in respect of the modular builds in Cavan. I was there two weeks ago. One nurse was on her own at night looking after 17 patients away from the emergency department and the main thoroughfare. These modular builds have to be staffed properly, and they have to be proximate and they have to be secure. For the sake of patients, staff have to be able to run with a crash trolley if somebody experiences an adverse event. Staffing is going to cause the delay.

The Deputy is correct in regard to Limerick that the reconfiguration in both the west and the north east put the cart before the horse. The capacity was removed and it was not increased by the measure that was required. That is why there were problems in Our Lady of Lourdes Hospital Drogheda and that is why there were problems transferring into Beaumont Hospital in those years. In the mid-west the problems continue because capacity has not increased. Efficiencies can be introduced, certainly in respect of the voluntary hospital, St. John's Hospital, Nenagh Hospital and Ennis Hospital. There is no doubt about that.

I refer to information technology. It makes no sense that we still spend hours writing patient histories and looking for files. The Sláintecare report calls for transitional funding earmarked for building IT infrastructure. That makes sense and has to be addressed.

In response to Deputy Durkan on the rainy day fund, it is fairly straightforward. We are not looking for current expenditure. What we are saying is that we have choices. The current crisis in health will not be fixed by saying that there could be another catastrophic crisis in eight months. The transitional fund outlined in the Sláintecare report is clearly tied to a time period and it is not ongoing. We need to make sure that we transition to the right model. That will cost money upfront, but it is will not be an ongoing cost. In fact, it will reap significant savings on an ongoing basis.

Primary care services are underfunded and understaffed. We all have a different impression of what primary care means. Clinicians working together out of the same building is a good idea. It means that referrals can happen much more quickly. However, we are on the record as saying that we believe the staff have to be employed by the same employer, which is a problem. We also believe that there is major capacity in the community for the advancement of nursing services and public health nurses. The Sláintecare, capacity review and ESRI reports stated that there is an underinvestment in public health and in community nursing services. That needs to be addressed, because many roles can be nurse-led in the community. They provide good value for money and will develop, and they will prevent people from having to be admitted to hospital.