Billy Kelleher (Cork North Central, Fianna Fail)
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I came in here with the hope of learning something about the actions the Minister proposes to take to address some of the concerns highlighted in the HIQA report on the University Hospital in Limerick. The HIQA report, whether the Minister likes it or not, is damning, with its references to "persistent overcrowding" and its use of terms like "unacceptable" and "not fit for purpose". Page 74 of the report lists 11 risk issues requiring action, nine of which are deemed to be high risk. There are risks to patients and that has to be accepted. There is no point in us pretending that this report is doing anything other than highlighting the deficiencies and inadequacies in the emergency department in Limerick. It is also highlighting deficiencies within the overall health system. The report makes reference to the absence of clear interim advice and direction from the Department of Health and the HSE with regard to integrated governance arrangements between voluntary and public services in the context of emerging hospital groups and single boards. That is a criticism of the Department and of the Minister. It is an observation that there is an absence of clear interim advice which is code for saying the Department and the Minister are not quite sure what they are doing. That is what this particular report states.

The Minister has come in here and promised to look at model three hospitals in order to address some of the concerns in the midlands but I do not believe that will happen. The reason for my disbelief is clear to see. One only has to look to Roscommon or the north east and the promises that were made on a new hospital instead of the ones at Navan and Our Lady of Lourdes in Drogheda. These commitments were made and they are far from being carried through. In fact, the reverse has been the case in Roscommon and in the north east.

The bottom line is that there is a massive difficulty in emergency departments throughout the country. As recently as this morning Dr. Chris Luke, in an article in The Daily Mail, said that in the last week he has seen just one or two non-consultant hospital doctors trying to run the emergency department. He described this as stressful, not to mention difficult and dangerous. We have a deficiency of staff in our emergency departments and we are facing a turnover of non-consultant hospital doctors very soon. That will happen in July and I can guarantee it will create huge difficulties in our emergency departments this year. The lack of consultants will be compounded by the non-consultant hospital doctor changeover and the difficulties in recruiting doctors for the areas in which they are needed most. The Minister and I both know that this will happen. It is an ongoing problem.

The Minister has suggested that there are some issues in this report that we can address and that dealing with delays in emergency departments will address all of the concerns raised but that is not the case. There are many inherent problems in our emergency departments throughout the country. The trick has been to use the trolley count as a measure of success versus failure, with the Minister saying that there were 550 people on trolleys in 2011 but now the figure is 300, which indicates success and that we are going in the right direction. The problem is that we are not going in the right direction. We still have inherent problems in our emergency departments throughout the country.

Deputy McNamara just raised the case of a woman with a broken hip waiting for treatment for four days. The Minister is right in saying that there may have been clinical reasons for the wait but I can give the Minister countless examples of people who have waiting in emergency departments for hours on end. I will give the Minister a concrete example of some of the difficulties faced by people in our emergency departments when I respond to his reply.

James Reilly (Dublin North, Fine Gael)
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Deputy Kelleher spoke about emergency departments and then spoke about an unfortunate lady who was waiting for four days for an operation but Deputy McNamara made it quite clear that she was not on a trolley in an emergency department.

Billy Kelleher (Cork North Central, Fianna Fail)
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I never said she was on a trolley.

James Reilly (Dublin North, Fine Gael)
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The way the Deputy spoke about it implied that she was. The Deputy chose to focus on my commitment to explore the lack of a model three hospital in this hospital group and ignored all of the other things that were said with regard to the opening of a paediatric area and an extra 17 beds, as well as our commitment to get the issues around the model two hospitals sorted to ensure that the beds, the urgent care centres and the services of the staff in those hospitals are used in an appropriate way.

The House is very aware that I regard trolley waits and other delays in the treatment of patients in emergency departments to be unacceptable. However, it should be noted that Deputy Kelleher has just stood up in this Chamber and said that a reduction from 569 people on trolleys on a given day in January 2011, when his party was last in government, to under 300 people on all days since May is the wrong direction of travel. Is the Deputy suggesting that we should be travelling towards 600 or 700 patients on trolleys? We all know that there are lots of problems in our emergency departments but responsibility for delays does not solely rest with those departments. As John Donne wrote, "No man is an island, entire of itself" and so it is with the health service. We cannot fix the emergency departments unless we fix hospital wards and we cannot sort the wards out unless we have access to long-stay beds in the community, home help and home care packages. We also need a properly functioning primary care system that catches illnesses early and treats patients before they require hospital treatment, particularly those with chronic illnesses.

All of the things to which I refer take time to achieve. We would love if they could be achieved more quickly but we are faced with the reality that the health service evolved chaotically over many decades. We are trying to bring order to the service for the benefit of patients.

The special delivery unit, SDU, has had a great impact in supporting those on the front line by means of the establishment of clinical programmes. Provisional patient experience times for May 2014 show that 68% of patients attending emergency departments were discharged home or admitted within six hours and that 82% where discharged home or admitted within nine hours. I accept that this means that 18% were neither discharged home nor admitted. However, when Fianna Fáil was in government it was common for people to be obliged to lie on trolleys for three or four days. A number of my patients have had experience of this, but it no longer happens. I have emphasised that rather than considering just the number of people who are on trolleys each morning, we must take account of patient experience times. I am aware that there are some people who are still obliged to lie on trolleys for more than 24 hours, which is unacceptable.

The 30-day moving average trolley count by the Irish Nurses and Midwives Organisation, INMO, remains below 300 patients per day. The figure as of 6 June last was just 227 patients, or more than 8% fewer than at the same point last year. To date this year, the system has reported 8.4% fewer patients on trolleys compared to the same period in 2013, which represents a reduction of 2,578 patients. Relative to the baseline year of 2011, the percentage reduction in the number of patients on trolleys is 31.9%. This is equivalent to a reduction of 13,224 patients. However, the task of further improvement continues. From the outset the aim has always been to provide the right care at the right time in the right place. One of the most essential actions to assist with this task is for patients to make use of the non-emergency facilities, such as urgent care and medical assessment units, in many of our smaller hospitals, which can cater for the majority of their injuries and episodes of acute illness. I urge people to make use of these facilities. I do not want my comments to be immediately interpreted as my saying that it is the people's fault. That is not the case. We must make people aware of the value of medical assessment units in particular.

As we have seen, there is potential for delays in the transfer of patients from ambulances to emergency departments. In order to address this issue the national ambulance service has developed a hospital turnaround framework, which clarifies the process of clinical handover, establishing clear lines of responsibility and the standards expected.

I could continue, but I will conclude by assuring the House that hospitals are working with the SDU to put in place all possible additional measures in order to support a safe and high-quality patient care service. I am a member of a Government that is committed to everything to which I refer. I do not set myself aside from the Government; I am an integral part of it. We are all striving to fix this problem.

Billy Kelleher (Cork North Central, Fianna Fail)
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My difficulty is that those opposite have been in government for more than three years. Some of the promises they made prior to the most recent general election were quite outlandish. The Minister highlighted the provision of health care, which is essential for emergency departments to work, and he also referred to the home help service. In the context of the latter, the number of home help hours has been slashed by 1 million. Some of what he says just does not match up to reality. For example, he has prioritised the notion of people being cared for outside acute hospital settings and in primary care settings or at home, but this is simply not happening as a result of the fact that the requisite resources are not being provided. The National Association of General Practitioners, NAGP, the Irish Medical Organisation, IMO, advocacy and patient groups and Deputies on all sides have all highlighted the fact that general practice is facing a crisis. However, the Minister is talking about having those with chronic illnesses cared for in general practices throughout the country. As he and I both know, that is not happening because those in general practice have not been given the resources necessary to keep people with chronic illnesses out of our acute hospitals.

We were obliged to almost force the Government to fund home care packages. Such packages constitute a very proactive mechanism to ensure people can move, on a step-down basis, from acute hospital settings to their own homes, where they can then receive treatment and care. These packages are an integral part of the solution to the problem of taking people out of emergency departments and hospitals in general. The report in respect of University Hospital Limerick highlights the fact that there are huge deficiencies in the area of safety alone. What I find most amazing is that on the many occasions when Deputies on this side of the House and front-line medical professionals at the hospital have highlighted the fact that there is overcrowding at the emergency department in Limerick, that patients' safety is being put at risk and that the staff there are operating under huge pressure, the Minister has continually denied that this is the case. The HIQA report confirms everything that has been said, including by those on the front line, in respect of this matter. That report must be acted upon immediately. The difficulty is that I do not believe the Minister is capable of acting upon it.

James Reilly (Dublin North, Fine Gael)
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My goodness. The Deputy's claims would be laughable if the issue was not so serious. His party was in government for 14 years and it did not deal with this matter.

Billy Kelleher (Cork North Central, Fianna Fail)
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It is a serious matter.

James Reilly (Dublin North, Fine Gael)
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That Administration did not do anything and now I am expected to clear up the mess it left behind in jig time. That is the issue here, is it not?

Billy Kelleher (Cork North Central, Fianna Fail)
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It is a long jig.

James Reilly (Dublin North, Fine Gael)
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Let us be realistic about this matter. I have not denied that there is overcrowding in our emergency departments and neither have I denied that a problem exists. I have set out to address that problem.

The budget relating to home help hours was restored in 2013. In this year's budget, we have taken additional money out of the long-term care nursing home support scheme in order that we might provide more innovative ways to allow people to stay at home rather than going into long-term care before they need to do so. People do not want to enter such care any sooner than is necessary. Regardless of how nice nursing homes may be, I know of no one who wants to be in one unless it is really necessary. We do not often - the previous Fianna Fáil-led Government certainly never did - provide a range of alternatives in that regard. There is a need for a more tiered approach and we must explore the position which obtains at facilities such the excellent one in Waterford operated by the Holy Ghost Fathers, which I visited. People use the latter as their home but they are not in a nursing home per se. At another facility in Carlow, people go out during the day before returning to stay at night while others stay during the day and go home at night. These individuals need a range of services which will help them maintain their independence and address the issues which arise for them as they get older.

My commitment to addressing the health services issues in question remains unstinting. I am utterly determined that we will fix this problem. However, we have always stated that the introduction of universal health insurance would take two terms of Government.

Billy Kelleher (Cork North Central, Fianna Fail)
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That is never going to happen.

James Reilly (Dublin North, Fine Gael)
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Universal health insurance will mean that we will have an equitable system which, as befits any proper republic, will cherish all citizens equally.

Billy Kelleher (Cork North Central, Fianna Fail)
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That is nonsense.

James Reilly (Dublin North, Fine Gael)
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That is precisely the direction in which we are moving. All the actions we have taken to date are leading us along the path to that goal. As a doctor, I accept that we must care for those who are acutely ill today. It must not be a case of "Live horse, get grass" and people being obliged to wait for treatment.

Last year, for the first time, we counted the number of people on the outpatient waiting list, which was something Fianna Fáil refused to do for the 14 years it was in government.

Billy Kelleher (Cork North Central, Fianna Fail)
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The list is getting longer.

James Reilly (Dublin North, Fine Gael)
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We addressed that issue. I accept that our efforts in this regard have not been completely satisfactory but at least we can now quantify the problem and begin to deal with it.

Billy Kelleher (Cork North Central, Fianna Fail)
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And the list is growing longer.

James Reilly (Dublin North, Fine Gael)
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Some 99% of people waiting for inpatient procedures were treated in under eight months. When Fianna Fáil was in power, it had neither targets nor figures. It threw billions at the problem and quadrupled the health spend over a 12-year period. However, we still ended up with a dreadful crisis in the health service. In that context and as the Deputy alluded to, on a single day in January 2011 there were 569 people on trolleys in our hospitals.