Michael Kitt (Galway East, Fianna Fail)
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The next slot is shared by Deputies Catherine Murphy, Coppinger, Ross, O'Sullivan and Finian McGrath.

Catherine Murphy (Kildare North, Independent)
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If there is an inadequate number of beds in our acute hospital system, we will continue to see the type of problem we are witnessing at present. According to the Irish Medical Organisation in its 2015 budget submission, acute hospital budgets have reduced by 29% since 2007. There has also been a loss of 15% in staffing levels and 900 beds have been taken out of the public system over these years. All of this is occurring at a time when we have an ageing population which, understandably, brings new needs in terms of health care services. At this time the fair deal system has been capped and the inevitable consequence is the additional pressure of acute hospital beds being occupied by people who should be in step-down facilities. Not only is there overcrowding in emergency departments, but also because of this there is an increased risk of infection which adds to health care costs.

Yesterday, staff at Naas General Hospital decided to work to rule and the nurses at that hospital have repeatedly told me they feel the environment is unsafe. Overcrowding means they have the added concern that their nursing registration is being compromised. The hospital in Naas is not an exception, but it does accommodate a higher proportion of patients who should fall into the fair deal scheme, largely because there are a large number of nursing homes in the catchment area.

On paper the strategy of postponing elective surgery might seem like a good solution, but it is poor medical practice and will add to the levels of illness in the population and the stress for those waiting for an operation and waiting to go into recovery, which is just as important. It is plain cruel. We need to stop having to resolve a crisis and start planning to ensure we do not have a crisis. More beds will simply have to come into the system and the fair deal scheme will have to be delivered in an entirely different way.

Ruth Coppinger (Dublin West, Socialist Party)
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What did the Government really expect? A total of €2.7 billion was cut from health during the recession. Last year alone, approximately €660 million was cut by the Government and 2,000 beds have been closed. It was inevitable there would be a bed crisis and an accident and emergency department crisis over Christmas and the new year. We have seen up to 600 people on trolleys and a two-week cancellation of all procedures. It is probably the worst crisis we have had, given there was no flu epidemic or vomiting bug, and it was purely due to cuts. There is no solution to this, except for austerity in the health service and everywhere else to be ended and for investment to be made to provide the extra beds, nurses and other health staff needed.

I am very disappointed the Minister is not here. I did some investigating this morning and was genuinely shocked to discover our local hospital, Connolly Hospital in Blanchardstown, is the worst in the country. I have figures for January, since the Minister returned from holidays and has had time to deal with it. On 7 January, 37 people in Connolly Hospital were waiting for a bed and for admission. This was the second worst situation in the country. On 8 January, 38 people were waiting for a bed there and it was the worst situation in the country. On 9 January, 41 people were waiting for admission to the hospital, with 19 people on trolleys and 22 people on the wards. How sickening for nursing staff to hear the Minister, Deputy Varadkar, state they should put their shoulder to the wheel and take an extra two beds into wards when 22 extra beds are already in the wards in Connolly Hospital. Nurses have been driven out of the health service, their wages have been cut and their conditions have been made worse, and now we have the idea they should bear the brunt, when it is not the case it would solve the crisis. Connolly Hospital scored top of the league again on 13 January, with 35 people still in the accident and emergency department.

People in Dublin West would have thought that with the Tánaiste and Minister for - so-called - Social Protection and the Minister for Health, our hospital would have been in safe hands. There were huge public meetings in Dublin West before the previous general election - the biggest meetings I have seen in the area on any topic - when the accident and emergency department was threatened with closure. That was under the Fianna Fáil-led Government and all sorts of promises were given by the Ministers, Deputies Burton and Varadkar, that this would never happen again. We now find out that Connolly Hospital has the worst record in the country despite the Minister representing that constituency. It beggars belief that he is not here to answer on that issue.

Shane Ross (Dublin South, Independent)
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This is an extraordinarily serious matter that has arisen over Christmas. It is strange that it was not properly foreseen and, if it was foreseen, that nothing was really done about it. The terrifying question, which was asked, I think, on "Morning Ireland" the other day, which has been asked ever since and to which we have not got a satisfactory answer, is whether the accident and emergency departments are safe. Eventually, I think, we got an answer, which is that they are in fact not safe in their present situation.

Given that accident and emergency departments, which are the main point of contact between the public and the hospitals, are in absolute and total chaos, there is no meaningful organisation, they are understaffed and there are inadequate resources to deal with people coming in, one wonders what is happening behind it. To me this is like pus coming out of a body. Given the problems that exist at the initial point of contact which cannot be managed, one wonders what is happening inside. It indicates to me that the entire health system in this country is pretty sick.

Nobody has been able to tackle the issue in any adequate way for at least 15 years. One wonders what is going on. Is it political control? Is it some sort of extraordinary disease that has infected the hospitals? Is it inertia? Is it a massive bureaucracy, sitting on top of some particularly fine hard-working nurses and front-line people, but in control? From time to time the revelation comes to us that this system is utterly and totally dysfunctional and we are using sticking plaster to address the system when there is a public outcry. This is what has happened here. The numbers have been reduced pretty quickly from, I think, 600 to 300, but they will increase again shortly. The outlook is not in any way perspicuous until it is fundamentally tackled.

Maureen O'Sullivan (Dublin Central, Independent)
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We know the facts about accident and emergency departments - the overcrowding, the trolleys, the risks and the dangers. We know the knock-on effects, which have meant people being delayed in getting treatment they are awaiting. We know there have been warnings and there has been the certainty that things would get worse. We do not seem to be very good at prevention in this country and there seem to be issues around Christmas time and staffing problems, which if addressed could have prevented this situation escalating.

We know one of the issues is delayed discharge to nursing homes, and this is at a time when there are nursing home beds unoccupied. In addition, some people present at accident and emergency departments needing minor procedures that could be looked after by their doctors or in primary care centres. There is a solution there. We know the solution is more investment in community services.

We have a major alcohol and drug addiction problem in this country. We know that between a quarter and a fifth of beds in accident and emergency departments and hospitals are taken up by people who have addiction issues. People who present at accident and emergency departments, drink-fuelled, drug-fuelled or a mixture of both, provide very challenging behaviour for staff. They also cause great anxiety and stress, particularly for elderly people in accident and emergency departments. Alcohol addiction is an illness and these people need treatment, but there is a need for a separate facility because sometimes they just need a space to sleep it off or be hydrated. I acknowledge what Beaumont Hospital does in trying to link people in with services.

I mention intellectual disability in accident and emergency departments. These are vulnerable people, particularly those with autism, who are very sensitive to noise and light and cannot cope with accident and emergency departments. Equally there is an issue with ageing people with an intellectual disability and the problems that come with ageing. As a result of the moratorium and the cutbacks, they are going in there. There is no registered disability nurse in accident and emergency departments who could support these people. Equally, with the cutbacks there is nobody from the community organisations who could act as support for those people. We need to look at having the right staff to support those two particular groups.

Finian McGrath (Dublin North Central, Independent)
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I am grateful for the opportunity to speak in this very urgent and important debate on the deplorable overcrowding being experienced in our hospital emergency departments. We have also had a record number of people on trolleys in recent days. We have seen further delays in scheduling hospital appointments which will result in more overcrowding. We also have the failure of the Government and the HSE to deal adequately with the problem.

This is a national emergency and something we have to deal with. We cannot hang around on the issue for any longer. Two things will resolve the issue, as the Government knows. We need to provide more beds and increase front-line staff immediately to ease the overcrowding. We also need to restore the number of beds funded under the national home support scheme to at least the 2013 level. While there are other issues, those are the two key things if we are serious about resolving the issue.

On Tuesday, 6 January, the nursing home sector surveyed 442 private and voluntary nursing homes to ascertain the number of unoccupied beds. Within the 277 nursing homes that responded to the survey, 1,261 beds were unoccupied. While we all recognise it is a complex problem, there is another angle. If hundreds of people are stuck in accident and emergency departments and we have these wealthy private hospitals a kilometre or two away, why are we not looking at using them in times of crisis, with their plush accident and emergency departments and empty beds? Why do we not look at that as part of the strategy? When in a crisis or a battle, it is necessary to look at the serious options as well.

It is also important to look at the issue of delayed discharges from hospitals, which is being ignored by many people. The figure for delayed discharges from our hospitals was 782 in October, rising to 800 during December.

In addition to criticising the Government, I have also outlined some ideas to get on and deal with the crisis in our accident and emergency departments. Let us have a bit of respect for patients and particularly for senior citizens and those with intellectual disabilities.

Michael Kitt (Galway East, Fianna Fail)
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I call Deputy O'Mahony, who is sharing with Deputies Lawlor, Neville, Maloney, Twomey, Mulherin, Nolan and Bannon.

John O'Mahony (Mayo, Fine Gael)
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I welcome the opportunity to contribute to the debate. I acknowledge that there has been a major problem since the Christmas period in the accident and emergency departments at all hospitals. I welcome the action taken in recent days which has seen the problem reduce dramatically. The Minister, the HSE and the emergency department task force are meeting to address it in the short term initially and then obviously in the longer term.

I have also seen the extreme trauma and stress that patients, their families and the front-line staff are experiencing in the accident and emergency departments. I recently visited Mayo General Hospital in Castlebar and saw that at first hand. I commend the nurses and doctors on the extreme efforts they are making in difficult circumstances.

While Mayo General Hospital has been no exception to what has gone on in recent weeks, over recent years Mayo General Hospital has done very well in reducing the problems in the accident and emergency department even though it has been taking increased numbers since the accident and emergency department in Roscommon hospital closed. That was on reduced budgets and increasing numbers. I commend the hospital manager, Mr. Charlie Meehan, and all his staff on their efforts in doing that.

Having listened to the debate over the past 15 minutes and last night, it seems to be a question of throwing money at the problem.

Mayo General Hospital managed to reduce the queues at the accident and emergency unit over the past couple of years on reduced budgets.

This is a problem that has been around for 15 years and that was overseen by the Fianna Fáil and Green Party Government, and by Fianna Fáil as the major part of Governments over ten of that 15 years. It was with some disbelief that I saw this motion being tabled, even though it gives us all a chance to discuss a problem that needs to be solved. During that ten-year period the country was awash with money, and the conception and birth of the HSE came to pass. Layer upon layer of management positions were filled, yet during the worst period, from 2004 to 2006, patients in accident and emergency departments were afraid to ask to be brought to the toilet because their trolley would be occupied by another patient when they came back.

The Minister has been criticised for his lack of action on this. What I heard him outline yesterday and in recent days was far better and more effective than 147 reports costing €1 million, about which nothing was done.

I want to be balanced about this. There are many factors contributing to the problem, such as delayed discharges and an aging population. Health is, by its nature, a demand-led service, and as a result it is very difficult to decide on budgets to solve the problem. I have spoken in the Chamber on a number of occasions about the Fair Deal issue. There was an increase in the waiting time from five to 17 weeks last year, and there is a need to remove the cap, which would free up hospital beds. I understand that 40% of beds in step-down facilities in Mayo are occupied by people waiting for clearance for the Fair Deal scheme. It is an issue that needs to be addressed.

Long-term solutions need to be put in place, such as providing primary care centres - I am glad to see three will be provided in Mayo, starting this year, in Claremorris, Ballinrobe and Westport - and community care packages so that patients do not have go to accident and emergency departments but can avail of a safety valve to give them the best treatment outside of these departments. I look forward to the short-term and long-term solutions to come in the near future.

Anthony Lawlor (Kildare North, Fine Gael)
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Like the previous speakers, I welcome this debate. It is a crisis. I walked around Naas General Hospital one Tuesday and saw the trolleys in the accident and emergency department. I spoke to the staff and management. The issue is not simple and straightforward.

This is a Fianna Fáil motion, but the first trolleys in Naas were seen when Fianna Fáil came to power in 1997. The then Minister promised to get rid of them within two years, but actually increased the number of people on trolleys. It disgusted me yesterday to see him in the middle of the INMO demonstration. He stood tall; I think he stood on the 147 reports he commissioned and did nothing about during his time as Minister for Health. He and another former Minister, Brian Cowen, set up 107 forums, but nothing was acted on. It is ironic that Fianna Fáil should bring a motion such as this before the Dáil Chamber today, when it was in power for 14 of the 17 years since the first person was on a trolley, and that it should speak to us in a high-and-mighty manner about the issue. At least we are trying to do something about it.

I commend the staff and administrators in Naas General Hospital for the work they have done to try to deal with this. It is not an easy thing to deal with; it is complicated.

Timmy Dooley (Clare, Fianna Fail)
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I am glad the Deputy had all the answers before the last election.

Anthony Lawlor (Kildare North, Fine Gael)
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The Minister, Deputy Varadkar, asked us to be positive about putting forward sensible ideas that he may take on board. When Deputy Dooley's leader was a Minister in power, he should have listened to some of his backbenchers. Our Minister will examine and act on some of our suggestions. Maybe the Deputy should learn from us, rather than from the lessons he has from the past.

I will deal with a couple of issues which arose from my discussions with the staff and administration in the hospitals I visited. We have to deal with transitional patients-----

Timmy Dooley (Clare, Fianna Fail)
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What is the Deputy doing in the hospitals? What about infection control?

Michael Kitt (Galway East, Fianna Fail)
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Deputy Lawlor has the floor.

Anthony Lawlor (Kildare North, Fine Gael)
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I am sure Deputy Dooley will have his time to speak. There is a new term, "transitional patients," which refers to patients who have not made up their minds whether they should go into a nursing home or are capable of looking after themselves. It is an issue that has not been dealt with.

Naas General Hospital has the ability to recruit extra staff, which I welcome. It is often the case that temporary staff are not available over the peak Christmas period or during bank holidays. Having permanent staff is welcome, but there is an issue with the national recruitment service. We might consider reinstating the group system or having a local system. I note Tallaght Hospital recruits its own staff directly. It is important that other hospitals have the ability to do that.

Consultants in most hospitals do a round once a day. There are opportunities to discharge patients throughout the day. There should be an onus on consultants to increase the number of times they do their rounds; perhaps they could do them twice a day.

One issue no one has mentioned is the fact that the EU working time directive has had an impact on hospital doctors. It may be something we should examine to determine the implications it has had.

Timmy Dooley (Clare, Fianna Fail)
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That was ten years ago.

Anthony Lawlor (Kildare North, Fine Gael)
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It was ten years ago, but Fianna Fáil did nothing about it. It has landed us with the problem to sort out. It is typical Fianna Fáil to say it is in the past.

I welcome the initiatives the Minister has instigated. I am delighted to say that Liam Doran of the INMO is co-chairing the emergency department task force. I would like to see more community improvement schemes being put in place. I welcome the one that will be introduced to Naas this week, which will help to aid discharges and keep people at home. The objective we all have is to keep people living at home for as long as possible. The last place an elderly or sick person wants to be is in hospital. Our objective should be to discharge people as soon as possible after their treatment has been completed. While I welcome this debate, it is ironic that it is coming from the Fianna Fáil side. I hope the Minister will examine some of the positive ideas I have put to him.

Dan Neville (Limerick, Fine Gael)
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I welcome the opportunity to contribute to the debate on the overcrowding at accident and emergency departments. I want to refer in particular to the serious overcrowding in the emergency department at University Hospital Limerick, where serious difficulties have arisen. There is a facility to admit 17 patients through the accident and emergency department, but as many as 40 patients awaited admission last week. Extra resources are urgently needed, and I will discuss how the situation developed. The issue is one of capacity, rather than discharge. The capacity is not available in accident and emergency to deal with the number of patients now presenting there.

There is concern that the wards into which people are being moved from accident and emergency on an urgent basis because of overcrowding do not have the necessary apparatus. They are not designed for the issues that have arisen in terms of the difficulties patients are experiencing.

There is a new accident and emergency department being built with 35 beds, and there are 17 beds at the moment. It has been recognised that there is a need for 35 beds. Unfortunately, they will not come into operation until early 2016 at the earliest, so there is an urgent need with regard to ensuring resources and staff can be applied to the current accident and emergency department.

How did this arise? We have known for some time that there was a lack of planning. When the reconfiguration process occurred, 18 beds were removed from Nenagh, Ennis and St. John's Hospital at Limerick to the University of Limerick hospital but there were no facilities to respond to this. If work is being doubled for an organisation, resources must be applied to respond to it.

Colm Keaveney (Galway East, Fianna Fail)
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Exactly.

Robert Troy (Longford-Westmeath, Fianna Fail)
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The Government has been there for four years and did nothing about it.

Dan Neville (Limerick, Fine Gael)
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We urgently need an increase in capacity and staff at University Hospital Limerick. Staff have informed us that the accident and emergency department is unsafe and patients being temporarily removed to wards could endanger life. It is unfair on staff. I acknowledge the work of staff under extreme difficulties in that hospital.

Liam Twomey (Wexford, Fine Gael)
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It is inappropriate to say our health services are dysfunctional and it is disrespectful to the people who work in health services. There is an issue regarding appropriate funding for health services and that is what we should discuss. The Opposition should be talking about solutions. We should bear in mind that 2,000 beds have been taken from the health services in the past number of years but because of the professionalism and dedication of the vast majority of people working in health, we have not seen "crisis" or "dysfunctionality". Those buzzwords used by the Opposition are completely inappropriate. Bed stays for acute admissions have been reduced, along with elective admission bed times. A large amount of work has been transferred from inpatient to day care within our acute hospitals and all of that has contributed to major efficiencies that can now be seen in our health services compared with a number of years ago. We still need more consultants, nurses, GPs, physiotherapists, occupational therapists and speech therapists. We must also invest in ambulances, accident and emergency departments, community hospitals, mental health teams and home care packages. We need more medical cards and we should invest in primary care and the infrastructure of health services in general.

In the course of this debate there has been nothing from the Opposition that would even remotely approach a solution or something useful that the Minister of State would actually go to the trouble of noting while listening to the usual rants. I heard interruptions coming from Fianna Fáil today but they were not as bad last night, so maybe the Members were not here. They forgot to include an apology to the Irish people for being contributors to the vast majority of the problems in our health service right now.

Michelle Mulherin (Mayo, Fine Gael)
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Hear, hear.

Robert Troy (Longford-Westmeath, Fianna Fail)
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How many years has the Government been in office?

Liam Twomey (Wexford, Fine Gael)
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The party banjaxed the country. Deputy Troy was not around and maybe he was still a small boy in short pants. That was a time when Ministers were increasing budgets by €1 billion per year but failing utterly to make any improvement to the health services while doing so.

Timmy Dooley (Clare, Fianna Fail)
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Does the Deputy remember why he was elected?

Liam Twomey (Wexford, Fine Gael)
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One Fianna Fáil Minister for Finance stated that putting money into the health Department was like pouring it down a black hole. What happened to him? He was removed from his post because he spoke out. He indicated that putting money into health without proper reform-----

Timmy Dooley (Clare, Fianna Fail)
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Why was the Deputy elected? The Independent Deputy who would solve the problem.

Liam Twomey (Wexford, Fine Gael)
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-----was a complete waste of time.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Other Deputies will have a chance to contribute later.

Liam Twomey (Wexford, Fine Gael)
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Unfortunately, that is all the legacy of Fianna Fáil to the Irish people. It has nothing to contribute only notional ideas like plucking money from the sky to put it into the health area. It has nothing to add about delegation of duties.

Timmy Dooley (Clare, Fianna Fail)
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The Deputy is baiting me. It is upsetting.

Liam Twomey (Wexford, Fine Gael)
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Why are practice nurses in primary care able to do vaccinations, phlebotomy-----

Timmy Dooley (Clare, Fianna Fail)
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It is more like lobotomy.

Liam Twomey (Wexford, Fine Gael)
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-----smear tests and a range of work so GPs do not have to do it? The transfer of work from doctors to nurses in the acute hospital sector has not happened to the degree we would expect it to.

Timmy Dooley (Clare, Fianna Fail)
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That is dead right. It is Deputy Reilly's fault.

Liam Twomey (Wexford, Fine Gael)
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Any time there has been an initiative where people return unused medication, we do not see just a few boxes or cartons but rather we see tonnes of medication returned. That is at huge cost to taxpayers.

The Opposition has made no remarks to upset anybody and always wants to keep things fluffy by blaming others. Why is it that the absence rate of certain groups in the health sector is larger by a factor of ten when compared to other areas? Does that arise from poor management?

Robert Troy (Longford-Westmeath, Fianna Fail)
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They are overworked.

Liam Twomey (Wexford, Fine Gael)
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Should something be done about it?

Colm Keaveney (Galway East, Fianna Fail)
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Too much work.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputies should stay quiet. They will get to speak in the next slot.

Liam Twomey (Wexford, Fine Gael)
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That is a simplistic answer.

Colm Keaveney (Galway East, Fianna Fail)
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The Deputy is making a simplistic attack. He is attacking on one hand-----

Liam Twomey (Wexford, Fine Gael)
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The Opposition has nothing to offer with this. There is no discussion and it has not bothered to examine the issue.

Barry Cowen (Laois-Offaly, Fianna Fail)
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What about the fair deal?

Liam Twomey (Wexford, Fine Gael)
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It is about simple, opportunistic and foolish remarks. Perhaps that is why Fianna Fáil is still not taken seriously by the Irish people.

Barry Cowen (Laois-Offaly, Fianna Fail)
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About as seriously as the Deputy is taken in Wexford.

Liam Twomey (Wexford, Fine Gael)
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It really has nothing to offer only more of the same attitude which got us into this mess. We are working on delivering a health service that is as efficient as possible and we are making the absolute best of the resources we currently have. We will drill right down through the system to ensure we can get the best service for patients. This matter remains about funding and not just for the fair deal scheme. It is about funding for the entire service.

Timmy Dooley (Clare, Fianna Fail)
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It is about priorities.

Barry Cowen (Laois-Offaly, Fianna Fail)
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It is points-scoring.

Liam Twomey (Wexford, Fine Gael)
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We are working in that direction. As we have recovered the public finances to some degree after the disastrous process-----

Colm Keaveney (Galway East, Fianna Fail)
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That is at the cost of vulnerable people. They have been put in corridors on trolleys.

Liam Twomey (Wexford, Fine Gael)
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I do not for a moment take the Deputy to be-----

Colm Keaveney (Galway East, Fianna Fail)
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They are the people who are paying for it.

Timmy Dooley (Clare, Fianna Fail)
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It is the Fine Gael way, at the expense of the weak and poor.

Liam Twomey (Wexford, Fine Gael)
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I do not take them to be a complete pack of fools. I know they like to shout down people.

Colm Keaveney (Galway East, Fianna Fail)
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They have sucked them out of the system and put them on corridors.

Liam Twomey (Wexford, Fine Gael)
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I do not take those opposite as fools-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy should sit down as his time is up.

Colm Keaveney (Galway East, Fianna Fail)
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In more ways than one.

Eamonn Maloney (Dublin South West, Labour)
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I welcome this debate. In common with others, I acknowledge the people who work at the coalface in hospitals throughout the country. They are very dedicated and committed people and we should note their very good work, particularly at this time of the year.

Colm Keaveney (Galway East, Fianna Fail)
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Hear, hear.

Eamonn Maloney (Dublin South West, Labour)
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I have read previous debates on accident and emergency services and if there had not been such a debate this winter, it would have been a break from tradition, as there has been one every year for each of the past 11 years. It is good to have such debate and air issues, as the health system is very important. There are different aspects to the matter.

I will quote a former health Minister from the Opposition side of the House who I agreed with. The debate was approximately seven years ago and the then Fianna Fáil health Minister indicated "there is no single solution to the difficulties" in accident and emergency departments. He was perfectly right. People keep talking about the question of funding and there is also the matter of staffing. Other aspects include a change in the nature of Irish society, as has been mentioned, as there are more older people and they are living longer. That is a good development but it brings its own difficulties. I mention it as a debate such as this is always useful.

Regarding the NHS in Britain, while not everyone would agree, certainly the NHS would be put forward by many as the best system in the world. If we think we have difficulties with the issues we have at the moment, one should have a look at what our neighbour is going through, which puts us pretty far down the queue.

It is important to resource the health system. Very seldom would I praise the Progressive Democrats, alive or dead, but when there was a Progressive Democrats Minister for Health, to her credit, she multiplied funding for the health system by a factor of three, and we all know what that did. It did not solve the problems, so it is not just a simple matter of resources.

Michelle Mulherin (Mayo, Fine Gael)
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The issue of the number of people waiting on trolleys presents a serious challenge for the comfort and care of patients being admitted through emergency departments. If one considers that some of these people are terminally ill, oncology patients and so on, it really puts into context why we need to deal with this issue. I have no doubt this is top of the agenda. The Minister for Health, in his contribution, put his finger on it. The problem of patients on trolleys is a manifestation of symptoms, concerns, issues and problems elsewhere in the health system. In my experience of dealing with constituents, I am glad to say that when people actually get into the public health system, they have many good things to say. We all know that delays and waiting times to get into it are the problem.

The other issue is clear. Listening to people talk about the situation in other hospitals, whether Mayo General Hospital, Beaumont Hospital or St. James's Hospital, it seems there are different dynamics, different problems and different issues to be addressed, so one size does not fit all in regard to resolution of the problem.

I have to compliment the management and staff of Mayo General Hospital. Since this Government came into office, it has made serious inroads into addressing issue of people on trolleys. Through various measures taken between 2011 to 2013, there was a 64% reduction in that period in the number of people waiting on trolleys, including bed management, looking at step-down facilities and so on. At that stage, the national average reduction was 20%. However, we have a problem now and it continues to flare up. I have no doubt that in the short term, with the sort of resources the Minister has said will be put into addressing this, there will be an abeyance of the problem but an abeyance does not mean it will not flare up again because there is an underlying problem.

There is a problem in Mayo General Hospital with delays in discharging patients, but Deputy Neville referred to a problem with capacity. There is a serious problem with capacity, aside from the issue of delays in discharging patients. There has been the massive increase in the number of people presenting to emergency departments. The emergency department in Mayo General Hospital was designed to deal with 20,000 patients per year but is now dealing with 35,000 patients per year. Some of this is down to the closure of the emergency department in Roscommon hospital. This is borne out by evidence of the addresses of people presenting at accident and emergency department in Mayo General Hospital. Many of these people are coming from Roscommon. Many of the additional people presenting are elderly people with chronic illnesses. The business of addressing the problem is beyond delays in discharging patients. There is simply not enough capacity.

I am aware that a business case is being made to the west-north west hospital group through the HSE on behalf of Mayo General Hospital to provide additional capacity in the emergency department and also to provide additional medical beds. If we cannot plan for this, I do not think we will ever get the bottom of the problem. Will the Minister make funding available for this? The idea of the hospital trusts is that the medical needs going forward would be catered for in particular areas. I would like to see this made a reality and funding for an extension to the hospital provided.

The issue that needs to be addressed is why people with chronic illnesses are presenting. It would seem that under the strains and burdens of the budgetary cuts that have taken place, we need to refocus funding. I know it is the buzzword but we really need to see this happening on the ground, with primary care, community care and home care packages being provided. These are the sorts of supports people need in their homes in order that chronic conditions, which we know will not be cured, can be managed. People could stay in their homes and would not be going into acute hospitals. We all know of the issue with the fair deal scheme. We have a number of district hospitals in my county. Previously, €300,000 was granted from the special delivery unit which allowed ten beds to open. That really helped the whole trolley situation in Mayo General Hospital. We also have Swinford and Belmullet district hospitals. Approaching this at either end will lead to a solution. I would like to see specific actions in regard to the problem in Mayo General Hospital.

Derek Nolan (Galway West, Labour)
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People have rightly illustrated the number of different facets of this problem, whether delays in discharging patients, the home help service, the fair deal scheme and so forth. I would like to raise a number of issues specific to University Hospital Galway and the accident and emergency department there. The good news is that additional capacity will come on stream over the next year to 18 months as an extension is built, but we are looking at an immediate problem with the temporary loss of bed capacity which needs to be dealt with.

There are three issues which really affect, and which are somewhat unique to, the emergency department in University Hospital Galway, including the staffing level. The management have acknowledged, and the nurses say, that there is a staffing shortage in the hospital. There was a commitment to hire a large number of nurses to help deal with the shortage, but that has not fully exhausted the panel that is available and we need to do a lot of work to get that done. The staff-to-patient ratio in University Hospital Galway, which has the second busiest emergency department in the country, is behind other emergency departments, and that is a serious problem. Another issue is the building, the actual physical infrastructure of the emergency department in Galway. The Minister for Health, after a discussion with me, accepted that it is not fit for purpose, is not medically safe and is something over which we cannot stand. We need a commitment in the very near future that, in the HSE five-year capital plan, a new emergency department for University Hospital Galway will be provided. That is not a luxury or something we might do. It simply must be done for the medical needs of the patient.

I welcome the offer the Minister for Health made yesterday when he said that the external hospital review and process improvement group, which is currently in hospitals in Dublin, could be made available to University Hospital Galway to look in its processors and how it deals with the systems in the hospital. It was something the nurses' representatives, who are working so hard and so diligently in the emergency department, have asked for, namely, an external review to get the best possible use out of the resources they have, the unfortunate site and footprint in which they operating and how they can deal with it in the short term to make the best possible use of resources.

James Bannon (Longford-Westmeath, Fine Gael)
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I would like to outline a proposal that could be used to alleviate overcrowding in the midlands. According to trolley watch yesterday, the Midland Regional Hospital in Mullingar had three individuals on trolleys in the emergency department and a further nine in wards. I have been informed the three individuals in the emergency department were there from 8 a.m. and were cleared by lunchtime. Since Christmas, I have visited the Midland Regional Hospital on three different occasions and I am delighted to see work has now commenced on the new accident and emergency unit in Mullingar, costing €6 million.

The reality our hospitals face is clear. There are a number of patients in hospital beds who need that extra week of rehabilitation or respite and these patients should be transferred to step-down clinics before returning home to their loved ones. St. Joseph's care centre in Longford is a fine example of a care facility that could be more fully utilised. St. Joseph's is located outside Longford town and it is a prime location, right in the heart of the midlands. The standard of care and the quality of staff is excellent. All of its facilities have been purpose-built for care, but currently a considerable percentage of the wards on the campus are being used for storage and office space. The facility already has a GP out-of-hours service and several other services. If this facility were to become a step-down clinic, it would undoubtedly free up a large number of acute beds in the Midland Regional Hospital, Mullingar.

Using St. Joseph’s as a full-time set-down clinic has been proposed several times over the years and most recently at yesterday’s meeting of Longford County Council. I urge the HSE’s midlands regional manager to urgently take up this proposal, which I have been making for some time-----

Robert Troy (Longford-Westmeath, Fianna Fail)
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Would Deputy Bannon talk to the Minister and ask him?

James Bannon (Longford-Westmeath, Fine Gael)
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If he fails to do this, I ask the Minister to intervene and ensure the establishment of St. Joseph’s as a set-down clinic.

Timmy Dooley (Clare, Fianna Fail)
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Is it set-down or step-down?

James Bannon (Longford-Westmeath, Fine Gael)
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A step-down clinic. We have the facilities, the location and the staff and we need the political will to make it a reality.

Robert Troy (Longford-Westmeath, Fianna Fail)
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The Deputy is the man. He is the politician.

James Bannon (Longford-Westmeath, Fine Gael)
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If St. Joseph’s becomes a full-time step-down clinic it will benefit patients and staff and free up those beds in our regional hospital. I will ask the Minister to strongly consider this proposal. It is a local solution for the midlands that could be used throughout the country. I hope the Minister will take this on board if the HSE does not do so. I thank the current Minister and the previous Minister for Health for investing heavily in the fine facility at the Midland Regional Hospital in Mullingar.

Timmy Dooley (Clare, Fianna Fail)
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That includes the Fianna Fáil Ministers.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I call Deputy Dooley. He is sharing time with Deputies Troy, McConalogue and Keaveney. Is that agreed? Agreed.

Timmy Dooley (Clare, Fianna Fail)
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I welcome the opportunity to contribute to this debate. As Deputy Maloney said, it is almost an annual event; sometimes it takes place more often. I compliment Deputy Kelleher on the way he has sought to identify the issues and for proposing this debate. It gives us an opportunity to identify the problems and try to find solutions, in so far as we can. I want to do so in a constructive way. Deputy Twomey said a lot about hearing little from the Opposition. I listened to the debate over the past two days. I do not think we talked about the dysfunction of the health service because there are some really good practices and people who work exceptionally hard.

There is a shortage of funding, and it is a matter for the Government to prioritise how that funding is spent. The Minister looked for €100 million this year in addition to what he got last year and he was given €25 million, while the Government used the money for tax cuts and other measures. That was a Government decision to use funds that could have been used to alleviate this crisis. The Government has to decide what kind of health service it wants. Does it want to meet the needs of the people or does it want to buy the next election by dangling tax cuts and other offers as it did in the past? That is where I am critical of the political approach. I will not criticise the staff or, as the Government parties did when they were in opposition, suggest that we have a Third World health service. I hope the Government sees that is not the case.

We have heard the standard bluster in debates here. The press or research offices within Fine Gael and the Labour Party issue the doctrine to the backbenchers: deny there is any great problem, and start talking about the people who were in government last and their record. While Fianna Fáil was in government, between 2001 and 2010, it produced a report entitled Quality and Fairness: A Health System for You in 2001. The document contained 121 recommendations, 97% of which were introduced during that period. There was a 55% increase in the number of patients treated; investment in community services; investment in, and development of, a cardiovascular strategy which saw the life expectancy of men and women increase by two years during that period; and a cancer strategy with investment in treatment, infrastructure and the model of care whereby people were treated more quickly by multidisciplinary teams. That was recognised internationally as having a major impact on treating the disease at a time when the incidence of cancer was growing significantly. There was investment in maternity and other infrastructure around the country, including the mid-west, the east coast and the Cork region. Nursing was dealt with and the degree course was introduced. There was some work done on primary care, although much more needs to be done. The Fair Deal scheme was introduced and the National Treatment Purchase Fund was introduced to deal with backlogs at certain times of the year. It is a bit nauseating to hear that Deputy Lawlor has been running around the hospitals. God knows what he has been doing visiting hospitals over the past few weeks.

Kathleen Lynch (Cork North Central, Labour)
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He might have been visiting patients. He might have been doing corporate works of mercy.

Timmy Dooley (Clare, Fianna Fail)
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He may have been, and the best of luck to him. I recognise that has to be done, but I am at a loss to understand how he has been able to telescope all the work done over the past ten years. What was done then dealt with the problems that arose. I am not suggesting that the problems cannot be dealt with now, but it requires effective action and for the Minister to come forward with ideas rather than saying “Look at what ye did”. We can stand on our record. I am not suggesting there were no problems year on year, but they were addressed in so far as was possible. That required investment. I hate the line “Money was thrown at it in the good times and that did not work.” It did work. If that structured investment had not taken place, the health service would not have met the increased demand and the complexity associated with the new levels of treatment. The long-term metric that must be considered is that life expectancy has increased for men and women by two years.

Kathleen Lynch (Cork North Central, Labour)
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Health services are only a small part of that.

Timmy Dooley (Clare, Fianna Fail)
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It is up to the Government, which has had four years and some successes, but there is a gaping hole now because it has continued to reduce the number of beds and its investment. It now has the capacity to invest in a structured way, because there is more money available, yet the Government refuses to do it. An example of that is the Minister’s failure to get the additional €75 million he needed, which would have dealt with the crisis. That comes on top of the promises made. The Government dismantled the HSE, saying that was the big problem, because it was an easy one to sell to the public. It said that if it got rid of the HSE and all the layers of management and brought the system back under the Department’s control, all would be well. That has not worked and will not work. It said it would deal with the funding problem through the introduction of universal health insurance, which initially was to be based on the Dutch model. Then there was to be a bit of the Danish model. Then Angela got a phone call from Enda and there was going to be a bit of the German model, because maybe that would help. We have ended up with the Fine Gael model, which is to deny there is a problem, when that does not work, deny it again, and when that does not work, blame the previous Government, saying it did nothing but write reports and deliver nothing, denying the facts absolutely. The latest is to tell us what it is going to do after two more elections, well out into the 2020s. It says that if the people trust it as they did in 2011, some time by 2030 it will have the problem solved. The Irish people will not buy that canard again. If they look at the promises the Government made prior to 2011, such as "Abolish the HSE and everything will be fine," they will see that they failed. The Taoiseach said “I'll end the scandal of patients on trolleys.” He put it on a poster, in case people might not know about it. That has failed.

The former Minister for Health, Deputy James Reilly, said we would never again see 569 people on trolleys on a single day while this Government is in office. That could be factually correct, because maybe we will never see the day when there are exactly 569 people on trolleys, but we have seen 600 while this Government is in office. The current Minister has said we may see more. I would love to hear how the Government will deal with that, rather than its criticism of the actions taken to resolve the issues between 2001 and 2010.

To help Deputy Twomey, I will be constructive. The Minister could deal with investment for the accident and emergency unit in the mid-west. If he got rid of the procurement rules, that department would be up and running more quickly. On the Fair Deal scheme, he should stop expecting people to pay for the first 15 weeks of care in a private nursing home - €15,000 or €20,000 that they do not have available to them. That is a fairly straightforward way to get 800 people out of acute facilities who have been medically discharged and do not need to be there, creating space for people to move through the system.

Robert Troy (Longford-Westmeath, Fianna Fail)
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I welcome the opportunity to speak on this critical issue today. Last week, 601 people lay on hospital trolleys. That is a new record.

2 o’clock

I know the Minister of State's colleague - the senior Minister - does not do constituency tours. Something tells me that will change in the future. He was invited to visit the regional hospital in Mullingar last week by a local Fine Gael councillor. He did not accept the invitation. I would like to share my experience of what I witnessed after I was invited to visit the hospital by the relatives of patients and by staff in the hospital. I witnessed total pandemonium. It was appalling. Every bed was full. Trolleys occupied by elderly men and women congested the corridors. The relatives of many patients stood beside them and held their hands to comfort them because they had not seen anybody for a number of hours. Many patients had no curtains, no privacy and no dignity. The doctors and nurses who were scurrying around were doing their damnedest to provide a level of care. Quite simply, an insufficient number of staff was available to deal with the quantity of patients who presented themselves to the accident and emergency department. Phones were ringing. The waiting room was full. Children were crying.

We expect people who need treatment to come to accident and emergency departments. They expect to receive comfort and a level of service. I witnessed something that was more akin to a field hospital in a war zone. I do not mean any disrespect to the staff who are doing their damnedest when I say that. The Minister of State and her colleagues are presiding over this health service. They have been presiding over it for the past four years. These problems are not exclusive to Mullingar. One of the nurses who attended yesterday's small protest said that it is completely unacceptable for an elderly patient to lie on a trolley for days with no access to toilet or washing facilities, having been assessed in an area where a curtain was not available to cover him or her. The Irish Medical Organisation has said that elderly patients who are sick and vulnerable are now afraid to turn up at accident and emergency departments. This is appalling. It is a sorry indictment of the record of the Minister of State and her party in government.

The Minister, Deputy Varadkar, spoke yesterday about what happened 14 years ago. His comments offered little comfort to the families of patients who are lying on hospital trolleys, to the patients themselves or to those who have been on waiting lists for many years. The elective surgery waiting list increased by 20% last year. The number of people who have been waiting for more than a year for an outpatient appointment increased by 385%. I know an elderly man - he is 80 years of age - who has had to give up driving because his cataract is so bad. He has been waiting for over two years for that cataract to be removed. This has eradicated his independence. He has been left alone in rural Ireland. I am talking about what is happening now, rather than what happened 14 years ago. The Minister for Health failed to acknowledge in his contribution yesterday that the first accident and emergency consultants to be appointed outside of Dublin were appointed by Deputy Micheál Martin. He did not mention that the number of patients treated by the HSE increased by 50% between 2000 and 2010.

It amazes me to hear officials and Ministers justifying this problem by saying it is seasonal. They say it is happening because it is winter. One would think winter comes once in a lifetime. Winter comes every 12 months. We are back discussing the same issue every winter. The Minister and the Department are failing to prepare. Last year, my colleague, Deputy Kelleher, repeatedly warned that the decisions being taken by this Government would have consequences. He said the decision to reduce fair deal funding would have consequences. While I acknowledge that an additional €25 million is being provided this year, it is a long way short of the €101 million required by the HSE. Nine nursing home beds are lying idle in a nursing home in Mullingar, which is in my constituency, because the fair deal funding has yet to be improved.

I would like to inform Deputy Bannon, who claimed that just three people are lying on hospital trolleys at the regional hospital in Mullingar, that 33 people were lying on hospital trolleys when I visited that hospital last week. The number of patients being treated at the hospital has increased dramatically in recent years, following the downgrading of the hospitals in Navan and Roscommon. We used to hear the mantra that the money would follow the patient. I acknowledge that the management and staff of the hospital are working very hard to provide a level of care there. Deputy Lawlor spoke about doing the rounds more than once a day. That is all very well if there is somewhere to discharge the patient to. Given that the fair deal scheme is not working, people are being left bed-blocking. It is a bad term to use because the people in question have not chosen to be left bed-blocking. They cannot leave the hospital because they have nowhere to go.

I know of a person with a disability who was medically discharged on 30 December last, but the disability services have nowhere for her to go. The bed capacity at the regional hospital in Mullingar has decreased by 20 since 2010. Deputy Bannon was right when he said there is room at St. Joseph's in Longford and St. Mary's in Mullingar. Nobody is making the funding available, however. Sixty fewer front-line staff have been working at the regional hospital in Mullingar since the introduction of the moratorium. Is it any wonder that the level of absenteeism is so high, given that the people who are working at the hospital at the moment are being put to the pin of their collars to try to provide a level of service over which they can stand?

Colm Keaveney (Galway East, Fianna Fail)
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Hear, hear.

Robert Troy (Longford-Westmeath, Fianna Fail)
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The nurses and doctors in question have to go home in the evening and think about the manic situation they have left behind. There are political choices to be made here. I ask this Government to follow its commitment by ensuring adequate resources are put in place to provide for a health service of which we can be proud, and which serves the men and women of our country.

Charlie McConalogue (Donegal North East, Fianna Fail)
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I join my colleagues in supporting the motion proposed by Deputy Kelleher. I want to focus in my remarks on the impact these difficulties are having on Letterkenny General Hospital, which is in my constituency. The staff of the hospital - the nurses and doctors and their managers - have been doing their absolute utmost over the last two weeks to try to deal with the increasing pressures they are encountering day in, day out. The number of people on trolleys at the hospital has decreased to just two today, thankfully. The number in question was 11 yesterday. It was 15 the day before that and it was 19 on Monday. Last Friday, it was 23, with a total of 31 waiting. It has decreased now because all other scheduled operations in the hospital have had to be cancelled.

I will give the Minister of State an example. A man in his early 70s has been waiting two years to have his hip done. He is in exceptional pain. He had an appointment for such an operation cancelled once previously. It has been cancelled again in the last week to allow those who are coming through the doors of the hospital's accident and emergency department to be accommodated. His plight pales by comparison with the plight of many exceptionally sick people who are coming through those doors to look for help. They are hoping for assistance because they are more vulnerable than they have ever been in their lives. The doctors and nurses who want to be able to assist them are not able to take them inside, give them beds and treat them as they require. Instead, these patients have to wait hours to be seen. They have to wait hours not to get a bed but to get a trolley.

All of this comes down to the Government's unfortunate decision not to fund the hospital system properly. It has failed to ensure sufficient nursing staff, doctors and beds are available to deal with this crisis when it arises. The Minister, Deputy Reilly, spent three years blaming the previous Government for the difficulties in the health service. I see he has moved on from that in the last week.

When challenged in the past week about his promise that never again would we have 500 people on trolleys, he moved on from that excuse to blaming the new Minister. He stated that he knew nothing about it and would not be able to answer questions and that the questioners would have to ask the Minister, Deputy Varadkar. The current Minister's policy seems to be that, if he tells us something will be bad before it gets bad, it might be regarded as competence. Indeed, it is a relief to many after having Deputy Reilly telling people for three years that everything would be okay.

The reality has been different. Instead of dealing in the budget with the many people who have been waiting weeks for fair deal scheme approval so that they might leave hospitals and free up beds, the Government chose to spend the extra funding available to it on other issues, for example, reducing the top rate of tax by 1%. Services, beds, doctors and nurses for the elderly and sick in, for example, Letterkenny General Hospital's accident and emergency department were not chosen.

I will highlight two issues that present particular difficulty for Letterkenny General Hospital. When there is a national staff shortage, it is more acute in regional areas. Letterkenny General Hospital is dealing with this crisis. Although it has approval for 16 medical registrars, it only operates with six. This is the result of mismanagement, in that the hospital service did not ensure staff were in place in time to assist in the crisis. Due to the failure of the Ministers, Deputies Reilly and Varadkar, to ensure that the management was in place to deal with the situation, the hospital is stretched.

Kathleen Lynch (Cork North Central, Labour)
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I have heard everything now. That is not like the Deputy.

Charlie McConalogue (Donegal North East, Fianna Fail)
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We hear less and less about the Government's plans for the future and universal health insurance, but instead of being told anything at all, what we need now is a recognition of the reality and for the Minister to ensure that the health service is managed. When we near a pinch point, action should be taken in advance. Unfortunately, we have not seen this approach to date. It is time for a change. I urge the House to support the motion tabled by Deputy Kelleher.

Colm Keaveney (Galway East, Fianna Fail)
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I thank the Ceann Comhairle for the opportunity to speak on this debate. Shortly after Christmas, I was invited by a constituent to speak with her 82 year old father, who had been languishing for 48 hours on a trolley in University Hospital Galway, UHG. Deputy Nolan from Galway aptly and bravely described it as an unacceptable public service for the people of the west. The 82 year old had been sitting there because, having waited since 2013 for an outpatient appointment with an orthopaedic surgeon, he had developed symptoms as a result of the pain relief he had been managing for more than two years since reluctantly presenting at an accident and emergency unit. He was reluctant because he did not want to die in an accident and emergency unit.

He and his family were shook and felt betrayed because he had contributed to the State for 82 years. He left school as a child, paid his taxes and created employment but, in his hour of need, the State reneged on him. His family was quite disturbed by the surroundings, as described by Deputy Nolan. The service in the reference period was shocking. As I drove into Galway city, I was appalled to hear about the significant recovery that was taking place in the country - a tax profile that was €1.2 billion ahead of target - because people were subsidising it. That 82 year old man was subsidising it by having to wait two years just to find out that he had to wait a further two years for a procedure. This is his social contract.

The human cost of our accident and emergency units is just a symptom of a broader problem that has been described by all Deputies and one with which the Minister of State is familiar. I do not dispute that she has a handle on the problem. Significant harm is being done to vulnerable people, particularly senior citizens, who must present at accident and emergency units because of a collapse in aspects of primary care, for example, home help, a lack of beds and the fair deal scheme, an issue that was ignored in the House in November. There was bed capacity in Galway during the reference period, with 157 beds available for discharge. This capacity could have been used to alleviate the dire situation at UHG.

The voices of the elderly man and the accident and emergency unit's staff are not being heard. Clearly, this situation has not emerged from nowhere. We knew about it since September when we held a debate in the House and forecast that this would happen. The Minister of State probably sensed it herself: she has been a Deputy for long enough. I do not mean that disrespectfully. It is an annual debate. We did nothing to prevent this situation from arising. The task force only sat on 23 December and the actions agreed at that meeting were never implemented. Subsequently, the Minister went on holidays. He was entitled to do so. I will not reduce the debate to that issue.

Kathleen Lynch (Cork North Central, Labour)
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Three days.

Colm Keaveney (Galway East, Fianna Fail)
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He was entitled to them. Needless to say, we knew that the crisis was happening. So did SIPTU and the Irish Nurses and Midwives Organisation, INMO. They have been highlighting the situation since September. It was no great shock that this was coming down the line like a train. However, these people's views have been ignored. This is of great concern, as we did not take the opportunity in December to prevent what happened this month. It will continue happening year upon year.

The Minister took his three days off. Unluckily for him, the decisions made on 23 December did not materialise during his absence in terms of the cancellation of electives. This has caused a significant problem. When he returned, his first act was to attack the staff. It was their fault and they should have put their shoulders to the wheel to resolve the situation. I am disturbed by the trend of attacking front-line staff. For example, Deputy Twomey attacked staff for taking sick days or time off. They work in a labour-intensive environment. Staff at UHG report to me that they cannot take their statutory rest periods because of chronic understaffing and the need to be present, as Deputy Troy described, to ensure service delivery for vulnerable people. I am concerned that such staff, who are working in difficult circumstances, have not been respected or acknowledged by the contributions of Government Deputies during this debate. The Minister's contribution the minute he got off the aeroplane was particularly patronising, in that he stated that staff should put their shoulders to the wheel, as if to claim they had not already done so. Since September, the INMO and SIPTU had been highlighting the emerging crisis. Ironically, there was subsequently a range of ballots across accident and emergency units. What the Minister stated was not good management and showed poor leadership. This condescending attitude has added to the impetus for industrial action and is counterproductive to the necessary resolution.

The Minister of State will agree that we are trying to shove through the eye of a needle the consequences of significant cutbacks in primary care. There is no integrated, strategic plan for managing home helps and home care packages with a view to keeping people out of accident and emergency units. As has been described, the consequential bed crisis is multifaceted. It is a capacity issue, in that we do not have enough beds for the number of people presenting at accident and emergency units.

This is causing a significant problem, not least for the staff of these units, who genuinely care about the delivery of services and better outcomes for vulnerable people.

It has been suggested here today that the Opposition does not have any solutions to the problems in our health service.

Kathleen Lynch (Cork North Central, Labour)
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No; it has been pointed out that the Opposition does not have a health policy.

Colm Keaveney (Galway East, Fianna Fail)
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One of the solutions we have proposed is that the Government should stop giving tax cuts to the wealthy and instead consider helping the most vulnerable people in our society. That it has not done so is a decision made by this Government and nobody else. In recent months we have seen senior Government Ministers celebrating the wonderful tax returns. Some of them were just short of somersaulting naked down Grafton Street. The reality is that those returns are being subsidised by the 600 people languishing on trolleys in hospitals throughout the State. That is what is happening here. As I said, this is a capacity issue, and the beds could be opened if the resources were made available. I hope the Minister of State is successful in securing those resources.

If we can open the beds, we then have an opportunity to look at other issues such as the terms and conditions of employment of nurses, which have been shattered by this Government. We subsidise nurses' education only to see hundreds of them boarding aeroplanes to Britain, the United States and Australia because the Government has completely destroyed their terms and conditions of work in this country. There is a solution to be found there. I assume the Minister, Deputy Leo Varadkar, in his veiled reference to people needing to put their shoulders to the wheel was referring to hospital consultants rather than nurses. I certainly hope so. Why then is he inviting consultants to have the first go at the trough, thereby ensuring the well-paid are further well-paid while nurses are left with their yellow-pack terms and conditions? There is no consideration for these vital staff who are working on the front line.

I appreciate that the Government must protect jobs in the public service. I am hopeful that the quality of Minister of State's contributions in recent weeks materialises in terms of the actions required to develop a modern and effective primary care service, which would go a long way towards keeping vulnerable citizens of this State out of our accident and emergency units. In an interview on Newstalk in recent days, she referred to the capital programme for senior citizens and additional beds for elder care. That programme should be accelerated. These are the types of solution we are urging from this side of the House.

Kathleen Lynch (Cork North Central, Labour)
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I will begin by addressing some of the points raised by Deputies opposite. Deputy Maureen O'Sullivan made reference to people with disabilities, addiction problems and dementia or Alzheimer's disease and the confusion that reigns when they have to attend at emergency departments. Last Tuesday in the Mater hospital, together with the chief executive officer of the Health Service Executive, I launched national guidelines on accessible health and social care which will see extensive training given to staff to help them to recognise that people with certain difficulties may have a problem understanding questions or instructions and ensure those patients are treated in an appropriate fashion. That type of work is going on behind the scenes all the time.

Deputy Finian McGrath suggested that opening up nursing home beds would solve all our problems. I agree it would solve some of them. However, we do not want a situation in which people in Dublin North, for example, are offered a bed in a facility at the furthest edge of Kildare or Kilkenny. I am not saying they are not nice places, but they are not very appropriate in terms of patient comfort, accessibility for visiting family and so on. We have beds, but they are not always where we need them to be. That is a difficulty we will have to resolve.

Notwithstanding claims to that effect, the problems in our emergency departments are not all down to late discharges. The numbers in that regard change regularly. The current difficulty in emergency departments is a combination of factors. For instance, I was informed recently by a person who advises the HSE that the uptake of the flu vaccine this year is much lower than it was in previous years. We need to start asking people to get that vaccine. As sure as night follows day, there is a flu outbreak on the way.

Turning to the motion itself, I am keenly aware of the issues raised and have listened closely to the concerns and frustrations expressed by Members in regard to the number of patients on trolleys, the overcrowded conditions in which they must wait for treatment and the associated difficulties in moving patients from acute care to long-term community or home care. The Minister, Deputy Leo Varadkar, spoke in detail last night about the wide-ranging actions and integrated approach being taken to managing these issues in order to improve the delivery of emergency care and meet the needs of elderly patients in a responsive, controlled and planned manner. I am particularly struck by the work of the community intervention teams to help older people avoid hospital admission and facilitate early discharge, which is essential in assisting them in returning to their own homes.

On the third Thursday in April 2014, there were 309 patients on trolleys, according to the Irish Nurses and Midwives Organisation, INMO. On the equivalent Thursday in 2011, there were 383 patients on trolleys. This morning, there were 316 such patients. This illustrates clearly that this is not a new problem. Moreover, it shows that the current emergency department situation did not happen overnight. I agree wholeheartedly with the Minister that local leadership, comprising staff, unions and management, with a common view of the issues impacting on their hospitals and an equally common desire to address those issues, is the key to providing an effective and sustainable response. It is appropriate to acknowledge that through the hard work of hospitals, supported by other HSE services, HSE management and the Department, we have made significant inroads on numbers in the past week. The engagement of senior hospital consultants, GPs, unions, senior HSE and Department managers, our incredible workforce of nurses, and the emergency department task force co-chaired by the general secretary of the INMO, all working together, has given a focus to the issue and driven momentum towards finding both short- and longer-term solutions to deal with trolley waits. Consultation and partnership with primary, community and ambulance services mean we are now addressing access to urgent hospital care in a comprehensive manner, which has not been seen before.

The €3 million funding allocation given in December 2014 and the €25 million allocated in 2015 to address delayed discharges have resulted in 300 extra approvals under the nursing home support scheme, a reduction of six weeks in Fair Deal approval times, and the provision of 50 additional short-stay beds, a further 65 transitional care beds and 389 additional home care packages. I am pleased to state that, at this time, no patient who has received approval for home help or home care is waiting for funding for these services in order to be discharged from hospital.

I conclude by reiterating that the problems we have seen in hospital emergency departments are not caused just by the number of elderly people awaiting discharge. It is much more complex than that. I would hate the message to go out from this Chamber that the only people responsible for this particular issue are the older patients who are being cared for in an environment in which they do not want to be and should not be. I would appreciate very much if, instead of repeatedly tabling motions on health, Fianna Fáil would come up with a policy on health.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Government is not even implementing its own policies. We have had nothing but U-turns.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputies Barry Cowen and Billy Kelleher have agreed to share time, with the former having ten minutes and the latter five minutes.

Barry Cowen (Laois-Offaly, Fianna Fail)
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I join colleagues in paying tribute to the hospital staff who have been working in very strained conditions in recent weeks. Several speakers urged that this issue not be used as a political football and that we avoid point scoring, playing on people's unfortunate circumstances and so forth. The Taoiseach stated boldly before the last election that he would end the scandal of patients on trolleys. Immediately after the election, his appointed Minister for Health said that never again would there be 569 people on trolleys on any given day while this Government was in office. The then Minister made that statement in what appeared to be a most sincere fashion. He looked into the camera and made a firm commitment to - almost a contract with - the Irish people that this would be the case.

It is unfortunate that members of the Government now say the Opposition should not use this issue as a political football for point scoring. Those statements came in 2011 just before and after an election. We must remind people, by placing on the public record, again of many of these and other commitments that have not been honoured by this Government. They were probably never going to be honoured by the Government. Against the background of a massive national and international economic collapse, the incoming Government played on people's fears, using and abusing those fears. The Government now hopes and expects that these commitments can be wiped from recent history. The final third of the fiscal rectification necessary had been completed and put in place before they assumed office. Despite having voted against it at every opportunity and ridiculing what it contained, they now want the plan to be the catalyst for retaining power at the next election.

They gave a commitment that bondholders would be burned. The current Minister for Health, Deputy Varadkar, gave a commitment that not another red cent would be paid to banks. He is the straight talker who has proven to be nothing more than a commentator during this sorry debacle. We were told that there would be a democratic revolution and that there would be no guillotines. Deputy Fitzmaurice has spoken lately of turning the system upside down, but that is the sort of rhetoric we heard from this Government prior to the last election and on assuming office. We were also told there would be no increase in third-level fees.

In June 2012, the Government said there would be retrospective recapitalisation of the banks, which would be the game changer to allow this country to prosper and obtain the recovery it deserved. Nothing could be further from the truth, as we heard last weekend when that was slipped into the rhetoric. The Government now wants us to believe there will be full employment by 2018. They say that USC rates will be drastically reduced and that the top rate of tax will also be cut. They say there will be a second pre-school year for children and that they will abolish the public sector pension levy. In addition, they say a five-year plan on taxation will be published in April. These are the new pipe dreams. It is the new virtual reality being given on the back of a lorry in Roscommon by many members of the Government.

Fianna Fáil is a republican party that fights for constitutional republicanism. It is committed and dedicated to the bedrock which established the State, including the Proclamation. We believe in fairness, equality and equal opportunities in education, as well as the provision of care for the sick and elderly, and security for all the country's inhabitants. That is what republicanism is about.

This Government would have us believe that the recovery is ongoing and the emergency is over. Unfortunately, however, that recovery is not evident in my constituency or in many others. It is not evident in hospital accident and emergency departments throughout the country, nor when 1,400 places in the fair deal scheme are slashed. Neither is it evident when community care facilities are diminished, nor when home help hours are being slashed. It is not evident when we see the slow place in rolling out primary care centres, or in the manner in which ambulance personnel are asked to work. It is not evident in the lack of funding made available for house adaptation grants for the disabled and elderly. They are told they will have to wait from three to five years before their applications are adjudicated upon.

If the emergency was truly over, we could afford the necessary staffing levels for hospitals, and many of the issues I have mentioned could be addressed also. If the emergency was truly over, the Government would abolish the USC, which was an emergency tax for an emergency situation. If the emergency is over, why does the Government not abolish the USC and stop talking about it? They cannot do so, however, and they know it.

Kathleen Lynch (Cork North Central, Labour)
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We will see soon enough.

Barry Cowen (Laois-Offaly, Fianna Fail)
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They think the people can be taken for fools again. They think they can stand on the back of a lorry every second week. The Government's credibility has been shot on these and many other issues. Whether the election is in one week, a year or in 15 months, the Government will be found out in that regard.

I note that Dr. Crotty, a consultant haematologist in Tullamore and a spokesperson for the consultants and physicians, and the INMO, have said that when they see patients on trolleys they lack privacy, confidentiality and dignity. It also threatens patient care. Dr. Crotty claims that studies show mortality rates increase by up to 30% in such circumstances. When in Government, my party did not build state-of-the-art hospitals, such as the one in Tullamore, for the Minister of State and her colleagues to allow a situation whereby patients are faced with the risk of a 30% increase in mortality because the 11% rise in patient numbers has not been matched with adequate staff.

To return to the issues of equality and fairness, they offer equal opportunities in order to help people to achieve their dreams. The Minister of State referred to problems in employing hospital staff. Over the Christmas period, I received a letter from a constituent, as follows:

Dear Barry,

There have been changes to the benefits applicable to single parents whose child is seven or more. These changes mean that I may have to drop out of my midwifery course and become long-term dependent on the State. Until the changes, a single parent could return to full-time education, retain a single parent allowance and receive the maintenance grant, subject to the means test. Such parents took on their courses on the basis of the supports existing at that time. They had worked out that the grant would make it possible to cover the cost relating to return to education, such as travel, books, accommodation and child care. They had a legitimate expectation that these supports would not be pulled once the course had begun. Under the changes, single parents already in full-time education whose child is seven or older in July 2015 must change their single parent allowance to the back to education allowance, which is the same amount. But they can no longer receive the student grant. Or they can keep the grant but lose their other payment.

I am studying to be a midwife and there is an acute shortage of these professionals at this present time. I did a year on the back-to-nursing course and am now in year two of a four-year degree course in Trinity. I love my course and cannot wait to be a qualified midwife working in Ireland and off benefits. However, the rule changes mean that I cannot continue. I live with my mother in Portlaoise and commute to Dublin by train daily while I have lectures. I cannot afford to live in Dublin and, in any case, my daughter is settled in school in Portlaoise and my mother cares for her when I am away. Any financial support I get from the father of my child is intermittent. I will get a grant of €5,915 until the end of this academic year. It just about covers the cost incurred by returning to full-time education. Apart from my travel costs, I have to pay €50 a week for accommodation while I am on placement in the maternity hospital I am assigned to in Dublin. I also have to eat out when living here, as there are no cooking facilities. My mother, who is separated, cannot help financially. I am repaying a loan I was forced to take out when my grant was paid late. The loan is at very high interest rates, as normal lenders would not accept me.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy should conclude.

Barry Cowen (Laois-Offaly, Fianna Fail)
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I am just about finished, although I will not get to complete reading the letter.

The Minister of State asked me and Deputy Kelleher what was our policy. Our policy is allowing people such as this correspondent the opportunity to realise their dreams and take part in a society they can be proud of. That person should be allowed to become a nurse, but she cannot continue her studies or realise her dream without the benefits and programmes that were put in place by a Fianna Fáil Government. That is what Fianna Fáil is about, if the Minister of State wants to know. It is about fairness, equality and equal opportunity in education, as well as protecting our citizens, and the provision of care in our hospitals.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank all the Deputies who contributed to this debate. We were accused of playing politics by putting down this motion, but nothing could be further from the truth.

Highlighting the concerns of society and the front-line staff who work in our emergency departments over patient safety and dignity is not playing politics. The Government was playing politics when it pretended it was going to solve all the problems. It made promises to this effect, and that is playing politics. It is pretending it is going to do something it has had no notion of doing. That is what is disingenuous in this whole debate.

The Taoiseach said he would end the scandal of people of trolleys, but, of course, he did so in advance of the election. The previous Minister for Health fell into the camera with the usual ould tear saying he would resolve this issue, and he said there would never again be 569 people on trolleys. The bottom line is that there were; there were 601 people on trolleys. What is even more disturbing is that the Government knew this would happen and did nothing about it. Therefore, I am not playing politics with the matter at all; I am just highlighting the Government's inability to deal with a crisis it knew full well would happen at some stage. It was warned that there was an impending crisis over delayed discharges by the Minister for Health, Deputy Varadkar, who took up his new portfolio last July. He was warned in November that there was an impending crisis because of delayed discharges and the lack of funding for the fair deal, home care packages, step-down facilities and home help.

The bottom line is that the politics being played is being played on the Government side. There is but one thing, and one thing only - spin. There is absolute spin on a continual basis. Week in, week out, 300 to 400 people are on trolleys, yet the Government has tried to convince everyone here that it is on top of the problem. It was not until the number on trolleys in emergency departments reached 601 that it was realised there is a crisis in emergency departments throughout the country. Front-line staff have been saying this for years, as have Opposition Deputies, consultants and people dealing with the coalface. The Government has been telling us the contrary consistently.

Farcically, in March 2013 Government Deputies tabled 43 questions on waiting lists and 17 on the trolley count to applaud the Minister and give him a clap on the back. He was trying to convince us he was getting on top of the problem. That is how farcical circumstances were. That is playing politics. I certainly do not believe that my highlighting the issue everybody else is talking about, particularly when it involves the compromise of patient safety, is playing politics. The Taoiseach stated in the Chamber only yesterday that patient safety was not what it should be. We tried to interpret that in a number of ways but the bottom line is that he was trying to absolve himself from anything that may happen or could have happened owing to overcrowding in emergency departments. The buck has to stop with somebody. The bottom line is that there are not adequate resources being put in place.

It has been said nobody should blame the old person in the hospital for taking up the bed. Of course nobody is blaming the person in the hospital for taking up the bed. What we are doing is pointing the finger quite clearly at the Government and HSE for not ensuring there is a proper bed to which a person can go, such as his own bed at home if there are home help hours and a home care package. However, if the patient is incapable of going home and requires full-time nursing care, he should be in a residential unit or step--down facility rather than a hospital in which he does not want to, and should not, be.

Our duty is quite simple. It is to highlight the fact that the Government has played politics with health services for years. The Members opposite did so in opposition and, by hell, they are doing so in government. There is continual spin over the substance of the matter. The Government has provided inadequate funding in 2015 under the health budget. The only way it will get through this year is on a wing and a prayer in the hope that medical cards will be taken from people because of the financial qualification guidelines. It is hoped those earning a little more than what is specified in the financial guidelines will lose their cards. I cannot see any other way in which the Government will match the budget. In the meantime, it is responsible. I commend the motion to the House for the right reasons and hope the Government will take on board its sentiment.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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Given the importance of the particular issue on which we have been voting, and in particular given the absence of the Minister for Health at this important time, as a teller, under Standing Order 69 I propose that the vote be taken by other than electronic means.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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As Deputy Seán Ó Fearghaíl is a Whip, under Standing Order 69 he is entitled to call a vote through the lobby.