Joe Costello (Dublin Central, Labour)
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This day last week we had the largest recorded number of patients sitting on chairs and lying on trolleys, waiting to be admitted to beds and receive treatment in accident and emergency units throughout the country. The previous occasion on which numbers were close to that was in 2006. Last Wednesday, the numbers reached 500 and four years ago it was 495. On that occasion, the Minister for Health declared a national emergency, but she did not declare any emergency last Wednesday. On umpteen occasions the Minister has declared that she would sort out the accident and emergency problems, but clearly she has not done so. These are not just statistics - they are ordinary citizens, generally elderly people. They are all sick, having suffered in one way or another and are awaiting emergency treatment. They should not be sitting in such appalling conditions, waiting for long periods - very often overnight or two nights in a row - without any changing or proper toilet facilities. It is appalling in this day and age. It is not good enough that this situation should be continuing now, without any alleviation over the past ten years. We are raising the issue to impress upon the Minister that accident and emergency is the interface between the patient and hospital services. Unless this is improved we are subjecting our most vulnerable citizens to the most appalling treatment facilities. They receive excellent treatment when they get into the hospital proper, but the interface stage is absolutely atrocious. I do not know what it means for the Minister to declare a national emergency, but she should take this matter seriously. During the last floods, a section of the accident and emergency unit in my own local hospital, the Mater, fell down and is now in an even worse condition than it was before.

Jan O'Sullivan (Limerick East, Labour)
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If it was an emergency in 2006 with fewer people on trolleys, I challenge the Minister to say why it is not an emergency today. Why is the Government not addressing this issue? Some 365 people were on trolleys today, of which the largest number, 41, was in the constituency of my colleague, Deputy Ciarán Lynch, in Cork University Hospital. The second largest number, 33, was in the Mid-West Regional Hospital, which is in my own constituency. Coming in third, was Tallaght Hospital which is in the Acting Chairman, Deputy O'Connor's, constituency. This situation simply cannot be tolerated any longer. I have been talking to people on the telephone who are on trolleys in corridors. In the Mid-West Regional Hospital, which has a very small accident and emergency department, the trolleys are now in wards, corridors and almost out into the hospital's reception area. We are talking about sick people who need attention. They have a right to acute care, as well as respect and privacy. It is simply unacceptable that they are on trolleys awaiting medical attention in public areas. I urge the Minister to intervene. 9 o'clock

In effect, people who are far away from accident and emergency departments are saying that they are focusing on community care and step-down beds. The reality, however, is that those resources are not in the community, including step-down, rehab and long-term beds. They cannot discharge people from our acute hospitals. Almost 900 beds are closed at the moment and 1,000 more are scheduled to be closed this year because of cutbacks in the HSE. The system cannot take it because the resources, which I know the Minister of State would support, have not been put into the community. They are not there. We cannot pretend the problem does not exist and act like the three monkeys and see, hear and speak no evil. Unfortunately, the people who pontificate on these issues are far removed from the problem of the people who are lying on trolleys in our hospitals today. I urge the Government and the Minister of State, Deputy Moloney, to ensure there is a response to this situation and to ensure it is treated as the emergency it is.

John Moloney (Laois-Offaly, Fianna Fail)
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I thank Deputies Costello and O'Sullivan for raising this issue and apologise that the Minister cannot be here.

The HSE accepts that emergency departments have experienced significant increases in the numbers attending to date in January. The work to rule currently in operation by staff at the HSE has led to a disruption in the HSE's normal data collection on activity in emergency departments. As a result data is limited with effect from 25 January.

Jan O'Sullivan (Limerick East, Labour)
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We can get the data for the Minister of State, if he requires it.

John Moloney (Laois-Offaly, Fianna Fail)
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That might be helpful. I am explaining why the Department does not have it to hand. Hospitals which experienced particular challenges last week included Cork University Hospital, Beaumont, the Mater, St. Vincent's, Tallaght, St Columcille's, Galway and Clonmel.

Jan O'Sullivan (Limerick East, Labour)
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The Minister of State has omitted Limerick.

John Moloney (Laois-Offaly, Fianna Fail)
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The facts have not come up from there yet.

Jan O'Sullivan (Limerick East, Labour)
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There were 33 people on trolleys today.

John Moloney (Laois-Offaly, Fianna Fail)
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Figures reported by the HSE this morning at 8 a.m. indicate that Beaumont, the Mater and Cork University hospitals continue to have patients waiting for unacceptably long periods for admission, although it has informed the Minister that the situation has improved from last week and that it is continuing its efforts to improve waiting times in all hospitals, particularly these three hospitals.

Seasonal factors such as the swine flu, winter vomiting and the extremely inclement weather conditions have placed additional demands on emergency departments in recent weeks.

Ciarán Lynch (Cork South Central, Labour)
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Those are annual factors rather than seasonal ones.

John Moloney (Laois-Offaly, Fianna Fail)
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The Minister has been monitoring the situation in emergency departments very closely. This afternoon she met with the CEO and members of the HSE management team to review progress and to ensure that all possible steps are being taken to minimise the waiting time for patients awaiting admission, including to the Mater. The Minister has also asked the HSE to streamline the administrative processes for dealing with applications under the Fair Deal, so that the discharge of patients to a suitable long-stay facility is not delayed unnecessarily.

Following a meeting earlier this week, the HSE has put several actions in train. These include escalating plans to enable patients to be moved to wards; providing for additional ward rounds to take place daily to help earlier discharges from hospitals; the cancellation of some elective surgery and the deployment of day wards to accommodate patients; providing for measures to be put in place to improve transfer arrangements to other hospitals; the better use of discharge lounges, medical assessment units and chest pain clinics to steer patients away from emergency departments; ensuring access to additional diagnostic facilities such as imaging to allow earlier decisions about admission or discharge; providing additional support to day units to avoid unnecessary admission to hospital; improving ambulance and transport stand-by arrangements; and liaison with community units, community nursing and GPs is being reviewed to promote community based interventions.

Escalation plans have been activated again this morning around the country. Day wards are being freed for in-patient accommodation and additional temporary beds have been opened in St. Vincent's and St. Columcille's hospitals. Hospitals have been requested to ensure that all escalation measures are implemented and reviewed as necessary and appropriate liaison arrangements with primary community services are in place to deal with the current pressure. The HSE is also introducing, with effect from 1 January, the hospital award 2010 which is aimed at encouraging good performance in a number of areas, including emergency department waiting times. Non-performing hospitals will be subject to review by the director for quality and clinical care in conjunction with clinical directors. The directorate is liaising with local clinical directors and providing clinical input and support as necessary.

The Minister is confident that the roll-out of the above measures, actively driven and reviewed by HSE senior management on an on-going basis, will deliver a timely and effective service to patients attending our emergency departments.

Joe Costello (Dublin Central, Labour)
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I am glad the Minister is confident.

Jan O'Sullivan (Limerick East, Labour)
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I hope the Minister will convey our views to the Minister.

John Moloney (Laois-Offaly, Fianna Fail)
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I certainly will.