Billy Kelleher (Cork North Central, Fianna Fail)
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I raise this issue because of a letter written by the Irish Emergency Medicine Trainees Association to HIQA and the HSE. By any stretch of the imagination, it is extraordinary that people would go to these lengths to highlight difficulties in emergency departments. We have a situation where up to 400 patients can be waiting on trolleys at certain times in emergency departments throughout the country and the Irish Emergency Medicine Trainees Association has highlighted that this is an unsafe practice. The Minister has made great claims about the success achieved in dealing with the numbers of patients in emergency departments, but there is still a problem with overcrowding in emergency departments throughout the country. It is simply not the case that there has been a significant decrease in the number of patients on trolleys. There are still up to 400 patients at some times waiting to be transferred from the emergency department to a proper ward in the acute hospital setting or referred on to somewhere else.

One of the Minister's stated claims in his "FairCare" document was that the abolition of long waiting times on trolleys, how we dealt with emergency medicine and how we provided safe treatments in emergency departments throughout the country would be a central tenet of his policy. Even though, as I accept, there has been a reduction, after three years of the Minister's administration, it is the case that there are escalating trolley counts in emergency departments throughout the country. In addition, we now have the most senior clinicians in the country stating there are unsafe practices which pose a threat to patient safety in emergency departments throughout the country. Only before Christmas the CEOs of major tertiary hospitals were highlighting the fact that they were in the position where they could no longer guarantee patient safety. The Minister has put great store in the fact that he is a GP, but he should be conscious of the fact that senior clinicians have highlighted issues about patient safety and the transfer of infectious diseases and viral infections because of overcrowding and the fact that staff are under such pressure that it is, to quote the letter, "unequivocally dangerous for patients and staff". At some stage he must accept this fact. He is the last person in denial about this issue. He established the special delivery unit which was going to solve all of the problems in emergency departments throughout the country. There was going to be a sustainable and dramatic decrease in the numbers of patients waiting on trolleys. What we have found out since is that while it made inroads at the start, it is falling back quite rapidly to a point where this month there have been spikes of up to 400 patients a day in emergency departments throughout the country.

If one couples this with the Minister's other claims about outpatient and inpatient appointments, by any stretch of the imagination, these do not meet the aims of his document, to which I referred, which states:

ACCESS is a right - not a privilege

In health, delayed treatment can lead to pain, complications and even death. More than 150,000 people are currently waiting for an outpatient appointment...

Some 340,000 people are now waiting for an outpatient appointment.

James Reilly (Dublin North, Fine Gael)
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When was that statement made?

Billy Kelleher (Cork North Central, Fianna Fail)
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This is in the Minister's FairCare document before the last election.

James Reilly (Dublin North, Fine Gael)
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Correct. The Deputy has had three years available but the Deputy's party would not count it. It is unbelievable.

Billy Kelleher (Cork North Central, Fianna Fail)
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He has had three years to resolve this issue. It is also stated in his FairCare document that accountability will be transferred to the Minister. I am asking the Minister to be accountable at this stage. At least address the issue in our emergency departments and accept that the recommendations in the Tallaght Hospital report should be implemented in our emergency departments throughout this country.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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I call the Minister to reply.

James Reilly (Dublin North, Fine Gael)
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On my way down here from my office, I thought that we might have a discussion on this issue in a level-headed way but we are back to Deputy Kelleher's favourite phrase "by any stretch of the imagination". I can tell him one thing, his stretching of the imagination has been extraordinary. If anyone is in denial, it is the Deputy and the party he seeks to represent.

Billy Kelleher (Cork North Central, Fianna Fail)
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I do not seek to represent it; I do represent it.

James Reilly (Dublin North, Fine Gael)
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After the period of time his party was in power and had boundless amount of money which quadrupled the spending in health, it still managed the extraordinary feat, after 14 years of unfettered access to money-----

Mattie McGrath (Tipperary South, Independent)
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The Deputy is the Minister in charge now.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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Allow the Minister to continue without interruption.

James Reilly (Dublin North, Fine Gael)
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-----of ending up with 569 people on trolleys on a Wednesday three years ago - the first Wednesday of 2011 - before we came into power. What is the number of patients on trolleys on the first Wednesday of this year? It is 269.

Mattie McGrath (Tipperary South, Independent)
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The Taoiseach said it could not be-----

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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The Minister to continue without interruption.

James Reilly (Dublin North, Fine Gael)
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Deputy Mattie McGrath can have his chat when it is his turn. I am dealing with the spokesman opposite who has raised this issue.

Mattie McGrath (Tipperary South, Independent)
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Give us the facts.

James Reilly (Dublin North, Fine Gael)
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I am giving facts unlike the Deputy who is into hyperbole - unintelligible hyperbole.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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I ask Deputy Mattie McGrath to allow the debate to continue.

James Reilly (Dublin North, Fine Gael)
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There has been no spike of up to 400 people on trolleys in emergency departments this year. The Deputy opposite should get his facts right. What has happened here includes ward watch figures, which we accept and acknowledge, where people are on trolleys elsewhere up through the hospital, but there has never been 400. The Deputy should get that right.

Ward watch came in during the course of last year. Therefore, it is very difficult to compare what is happening this year with last year and certainly impossible to compare what is happening this year with what happened in 2011 when we know there were 569 people on trolleys in one day and that was in the emergency departments. That did not include ward watch or how many people were inappropriately placed throughout the system. There has been a massive improvement.

I have always regarded trolley waits to be an unacceptable feature of the Irish health system, which is the reason I set up the special delivery unit in 2011. Since then we have a 33.8% reduction in the number of patients waiting on trolleys, that is, 29,200 fewer people waiting. While such improvements are significant, I accept the challenges continue, particularly in the early part of the year.

It is more than unfortunate but not unanticipated that a number of our hospitals have been experiencing pressures since last week. Many hospitals are coping well with the demands arising from emergency department pressures and the main difficulties are concentrated in a relatively small number of hospitals and I will outline those in the course of my response.

The trolley counts of the last few days are disappointing and both I and the HSE acknowledge the distress and discomfort for patients so affected. This is, in part, as a result of the seasonal flux in hospital activity that traditionally takes place after Christmas and the new year. A similar pattern has been occurring in emergency departments across Northern Ireland and England, with a large surge in activity and waiting times since the start of the year.

Many of our hospitals are reporting increased admission rates with higher acuity of presentations noted, particularly among the frail elderly. In response, there has been an intensive engagement between the special delivery unit and the hospitals affected, concentrating on those with the most pressures particularly in recent days. Hospitals are working with the special delivery unit to ensure they balance the demand for scheduled and unscheduled care, maximise discharge planning and take additional measures to relieve pressures as required.

Additional funding has been provided for enhanced home and community care packages. Funding has also been targeted to address areas of acute services which are likely to experience increased service demand.

In regard to the implementation of the HIQA report on Tallaght Hospital, work is well under way to implement all of the recommendations in hospitals. In line with established HSE policy on the implementation of major reports, the HSE established an implementation oversight group to progress the report's recommendations, which reports to HIQA on its progress regularly. Updates on progress are available publicly on the HSE website.

In all there are 17 recommendations which relate to unscheduled care of the 33 total recommendations in the HIQA Tallaght report. In general terms, there is strong evidence of progress in key areas such as the completion of early morning ward rounds, the application of the Manchester triage system and the robust review of waiting lists. This progress is indicative of the strong national leadership and levels of local engagement around these critical issues. The implementation of the national early warning score and maternity early warning score have also added significantly to the care of patients.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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Thank you, Minister.

James Reilly (Dublin North, Fine Gael)
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I will give other information in the follow-up.

Billy Kelleher (Cork North Central, Fianna Fail)
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If the Minister was being honest all he had to said at the end of his reply was that the prince and princess got married and they all lived happily every after because it is fairytale stuff.

James Reilly (Dublin North, Fine Gael)
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It is real but the Deputy does not want to accept it.

Billy Kelleher (Cork North Central, Fianna Fail)
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The fact of the matter is that the Minister only had to go on to the IMO website and check the trolley watch; what he is doing is playing with figures.

James Reilly (Dublin North, Fine Gael)
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No, I am not.

Billy Kelleher (Cork North Central, Fianna Fail)
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The simple fact is that 467 people were on trolleys in Irish hospitals-----

James Reilly (Dublin North, Fine Gael)
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Pardon me?

Billy Kelleher (Cork North Central, Fianna Fail)
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-----on the 8th. The bottom line-----

James Reilly (Dublin North, Fine Gael)
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Not in emergency departments, which is what the Deputy said.

Billy Kelleher (Cork North Central, Fianna Fail)
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We know why they are on trolleys. They are on them because they have been transferred from the emergency departments up the wards but they are still on trolleys. That is the reason the Minister agreed that at least there would be a ward trolley count as well. What has happened is that the trolleys are being moved.

James Reilly (Dublin North, Fine Gael)
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Unlike the Deputy, we have transparency.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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The Minister can reply in a moment.

Billy Kelleher (Cork North Central, Fianna Fail)
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They were being counted in our time too. The Minister used to come in every day of the week and-----

James Reilly (Dublin North, Fine Gael)
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The Deputy's party never counted the trolleys on the wards.

Billy Kelleher (Cork North Central, Fianna Fail)
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-----the first thing he would raise was the trolley count, the point being that the Minister is manipulating the figures.

James Reilly (Dublin North, Fine Gael)
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No.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am saying that in January of this year, by any stretch of the imagination, it has not been a good year in terms of the number of people who are on trolleys, particularly given that it was a central plank in the Minister's policies to drive down the number of people waiting on trolleys in emergency departments. We had a case of 426 people on trolleys on the 6th, 461 on the 7th and 467 on the 8th. Whether they are in the emergency department or in a ward, the fact remains that they are on trolleys and it is not considered good medical practice to have people parked up on corridors throughout a hospital.

Mattie McGrath (Tipperary South, Independent)
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The Taoiseach said it could not be-----

Billy Kelleher (Cork North Central, Fianna Fail)
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That is simply unacceptable. There was a case recently of ambulances waiting outside CUH in Cork because they were unable to discharge patients due to the emergency department being overcrowded. Ambulances that there required elsewhere were waiting because the hospital could not discharge the patients. The Minister is trying to tell me that after three years that he has achieved an awful lot in terms of addressing the trolley counts, but that is simply not credible. The letter from the Irish Emergency Medicine Trainees' Association highlights the fact that after two years the HIQA report into Tallaght Hospital which made recommendations has not been acted upon. The Minister blames the HSE-----

James Reilly (Dublin North, Fine Gael)
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The letter report does not state that.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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I ask Deputy Kelleher to conclude to allow time for the Minister's response.

James Reilly (Dublin North, Fine Gael)
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The Deputy has to correct the record, we cannot have this carry on every day with the Deputy coming in here making statements that are untrue.

Billy Kelleher (Cork North Central, Fianna Fail)
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They have not been implemented.

James Reilly (Dublin North, Fine Gael)
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The letter does not state that.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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Deputy Kelleher's time is concluded.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am saying that they have not been implemented and it is quite clear that there is a long way to go to ensure that we have safe practice in our emergency departments throughout the country, and that is not taking from the excellence of staff who work under extraordinary pressure day in day out.

James Reilly (Dublin North, Fine Gael)
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The contribution from Deputy Kelleher is extraordinary.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister does of course.

James Reilly (Dublin North, Fine Gael)
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First, he tries to attribute it to the Irish Association of Emergency Medicine Specialists that no action has been taken on the HIQA report when it is very clear that many actions have been taken and that there is regular updates.

Billy Kelleher (Cork North Central, Fianna Fail)
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I did not.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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The Minister to continue without interruption.

Billy Kelleher (Cork North Central, Fianna Fail)
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Instead of spinning, if the Minister cared to visit the HSE website, he would note it puts up its progress reports on a regular basis.

Mattie McGrath (Tipperary South, Independent)
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Will the Minister visit South Tipperary hospital?

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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This is not Deputy McGrath's matter.

James Reilly (Dublin North, Fine Gael)
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Correct. This is not Deputy McGrath's time.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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It is Deputy Kelleher's matter.

Mattie McGrath (Tipperary South, Independent)
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The Minister will not visit any hospital. He ran out of Clonmel the last time he was there.

James Reilly (Dublin North, Fine Gael)
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I can tell the Deputy that South Tipperary hospital had 24 people on trolleys yesterday morning.

Mattie McGrath (Tipperary South, Independent)
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Yes, it is shameful.

James Reilly (Dublin North, Fine Gael)
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What is the number of patients on trolleys in that hospital this morning? The Deputy who is from south Tipperary and should be interested should be able to tell me what the number was this morning.

Mattie McGrath (Tipperary South, Independent)
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What was the number last Sunday and Monday?

James Reilly (Dublin North, Fine Gael)
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The Deputy does not know.

Mattie McGrath (Tipperary South, Independent)
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I do know.

James Reilly (Dublin North, Fine Gael)
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That is his level of interest but he can come in here and make noise. What is the figure?

Mattie McGrath (Tipperary South, Independent)
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The Minister is the one making the noise.

James Reilly (Dublin North, Fine Gael)
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What is the figure?

Mattie McGrath (Tipperary South, Independent)
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It is 15.

James Reilly (Dublin North, Fine Gael)
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The Deputy does not know. Deputy Kelleher is better informed than Deputy McGrath.

Mattie McGrath (Tipperary South, Independent)
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It was 17-----

James Reilly (Dublin North, Fine Gael)
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There were 47 people on trolleys in Galway University hospital yesterday morning. This is utterly unacceptable but we get surges of activity and we take action. Today that number has fallen to 30 and it will fall further as we open more beds in the Merlin Park hospital and take other actions as well.

It is the same in Cork. The system experiences surges in different parts of the country at different times and I have already pointed out that this happens in the North of Ireland and England. We take action to address it. Deputy Kelleher mentioned my raising the figure of 56,000 people waiting for outpatient services. The Government of which he was part never bothered to count the number of people waiting for outpatient services. We were the first Government to do so and tomorrow we will release figures showing a massive improvement in the number of people who have had to wait over one year. It is well over 100,000 people; that is the legacy left by Deputy Kelleher's Government. I am reminded of the words of Bill Clinton when he said that what was really annoying people was that it was taking him so long to clean up their mess.

The bottom line is that there have been 29,200 fewer people on trolleys in the past 12 months since we took over. That is progress and is attributable to the men and women who work in our health service. I want to commend them at every opportunity. Despite the January we have had, the figures are still lower this year than this time last year. No amount of finger-wagging and head-shaking from Deputy Kelleher-----

Billy Kelleher (Cork North Central, Fianna Fail)
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But-----

James Reilly (Dublin North, Fine Gael)
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I am not here to listen to the rubbish that comes out of Deputy Kelleher, because he is hell-bent on painting a picture that bears no resemblance to the truth. We cannot compare a figure that takes Trolley Watch, a figure agreed by the Department, the INMO, the HSE and the special delivery unit from this year, and compare it to last year by adding in Ward Watch when Ward Watch did not exist last year. That is simply not logical-----

Billy Kelleher (Cork North Central, Fianna Fail)
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The reason Ward Watch is in place is that trolleys were being hidden in hospitals.

James Reilly (Dublin North, Fine Gael)
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It is not credible.

Billy Kelleher (Cork North Central, Fianna Fail)
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What about the Tallaght report?

James Reilly (Dublin North, Fine Gael)
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Further action will be taken. The people on emergency unit trolleys are those who are most acutely ill and those most seriously in need of help.

Mattie McGrath (Tipperary South, Independent)
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Health and safety.

James Reilly (Dublin North, Fine Gael)
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They are going to get help and it is improving. We are not where we need to be by a long shot. Given the financial disaster we were left with, the moneys we have, the 20% reduction in the budget, the 10% reduction in staff and the 8% reduction in the growth of the population, Deputy Kelleher's shaking his head will not cure it.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister has forgotten what he said.