Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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2. To ask the Minister for Health his plans for structural changes affecting hospitals and primary care and to address the shortage of residential nursing home places following the record high numbers of patients waiting for admission on trolleys; the numbers of non-urgent elective surgical procedures that have been cancelled and the way will they now be accommodated; his plans to ensure that nursing staff no longer feel forced to engage in work-to-rule and that this action does not affect patient care and the throughput of hospitals; and if he will make a statement on the matter. [2599/15]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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My question seeks to establish the Minister's plans to address the ongoing crisis across our acute hospital network and the related issues of the under-provision in primary care and in residential nursing home places and other matters.

Leo Varadkar (Dublin West, Fine Gael)
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The Government regards trolley waiting times of more than nine hours as being unacceptable and it acknowledges the difficulties which the current surge in emergency department activity is causing for patients, their families and the staff who are doing their utmost to provide safe quality care in very challenging circumstances.

All hospitals have escalation plans to manage not only patient flow but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care. These plans include the opening of additional overflow areas, the re-opening of closed beds, the provision of additional diagnostic scans and additional ward rounds being undertaken by consultants in order to improve the appropriate flow of patients through hospitals.

The Government has provided additional funding of €3 million in 2014 and €25 million in 2015, to address delayed discharges. Actions being taken include the provision of additional home care packages, additional transition beds in nursing homes, 300 additional fair deal places and an extension of the community intervention teams. Where it is necessary to prioritise emergency and trauma surgery, cancer and complex non-urgent cases, the HSE assures me that this is being done. Inevitably, this will affect waiting lists and waiting times. The challenge is to minimise the need for cancellation at short notice and to manage the impact of such cancellations effectively within the hospital and in collaboration with other hospitals. As I have mentioned it may be necessary to increase elective activity over the summer period.

Last month I convened the emergency department task force in order to develop long-term solutions to overcrowding by providing additional focus and momentum in dealing with the challenges presented by the current trolley waiting times. My Department and the HSE are currently working together on a plan which will ensure that trolley waiting times are contained throughout the year, that operational arrangements in acute hospitals and across acute and community care are designed and implemented consistently so as to contribute to sustainable improvement in the future and to the provision of a strong basis on which to evaluate and manage performance.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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While some of the steps outlined by the Minister in his response are indeed required, nevertheless he has not indicated in his reply the importance of providing adequate staffing. I did not note it in the reply he has read into the record of the House. It is very important to recognise that the crisis that has presented in recent weeks across our acute hospital network, is continuing. I have noted that the INMO trolley watch yesterday indicated 431 people on trolleys. There is a continuing suspension of elective day case surgery at a number of sites, including at the Louth County Hospital in Dundalk, where the staffing resources at that hospital are being redeployed to Our Lady of Lourdes Hospital in Drogheda, in order to prioritise urgent patient care and surgery there. This decision is to be reviewed on a weekly basis. That problem is continuing and I have provided one example.

I refer to the situation of the impending work to rule which no one wants to see happen. The nurses do not want to take these decisions. It is critical that appropriate steps are taken to recognise the complexity of the situation and the need for all elements to be progressed.

In conclusion, we discussed the matter in the Joint Committee on Health and Children last Thursday when the Minister and the director general of the HSE came before us. We did not on that occasion have the information that was revealed yesterday by the Minister's colleague regarding an expected further difficulty because of the exodus of some 1,000 nurses between now and June. I ask the Minister to outline to the House exactly what action he is taking to address the chronic shortage of nurses, both in terms of acute hospitals and the needs of the psychiatric hospitals.

Leo Varadkar (Dublin West, Fine Gael)
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Adequate staffing levels are a given; I do not think it should have to be stated. The Deputy may be interested in some of the facts. We have more consultants than ever before and if we can achieve agreement with the IMO on the new consultant scales we will be able to regularise and advertise for quite a number of posts in the next couple of weeks, although, inevitably, such posts will take a few months to fill. We have significantly more midwives than previously, with an increase in numbers, from 900 or so, a few years ago, to close to 1,500 now. This increase is along with a falling birth rate in recent years. In the past year the number of nurses employed by the HSE increased by 500. It is true that the number has reduced by 4,500 from a number of years ago but I refer the Deputy to the extra hour worked by nurses, the graduate nursing programme and the extra 500 nurses employed last year. We are starting to go in the right direction again. Approximately 32,000 to 34,000 nurses are in the system while 1,000 retirements is equivalent to 3% of the workforce. It is not unusual to have a 3% turnover in a workforce in any given year. In the most recent recruitment campaign by the HSE more than 4,000 nurses applied for positions. However, we are not complacent - I note the particular issue in mental health care as the Deputy mentioned - and active workforce planning will be necessary.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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While the Minister made reference to increased bed numbers, it is very important to understand that this cannot be achieved with a static complement of nursing staff. It is very important that the crisis we have recently witnessed and which continues, is addressed holistically in the round. It cannot be done simply by the introduction of additional beds on wards. If the same complement of nurses remains, then not only patient care will be impacted; despite the best efforts of the heroic nursing staff, the truth and the bottom line is that patient safety can also be compromised. It is hugely important that we have adequate nursing staff recruited. We have to recognise and realise that there are competing locations for our highly qualified new, young nursing graduates. It is very important that every effort is employed to make the opportunity and the contract here as attractive as possible. As I said earlier, it is not just a case of monetary return, but also there is the importance of career path development. The Minister of State, Deputy Kathleen Lynch, very rightly highlighted this situation that in the coming months will compound the problem we have been discussing. What steps is the Minister taking to ensure that existing staff are retained? What further steps is he taking in order to ensure that not only applications are received but that actual recruitment is the result? On the back of the situation regarding the flu vaccine revelations last Thursday, what steps are now being taken to ensure if it is at all possible that all hospital staff - despite the fact that the flu vaccine is not of the exact match for the flu virus presenting - and all staff across our hospital sites are vaccinated in order to help avoid any loss of service due to contracting the flu virus? Is there a situation now in hand or planned?

Leo Varadkar (Dublin West, Fine Gael)
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I am not sure what the Deputy means by revelations with regard to the influenza vaccine. The vaccine used in Ireland is the same as is used all around the world and as recommended by the World Health Organisation. The reason we have to be vaccinated against the flu every year is because the virus changes and mutates every year. It is the case that this year the vaccine only has about 25% to 30% coverage.

It is the responsibility of infection control and occupational health units in every hospital to ensure that staff are vaccinated. Individuals also have a personal responsibility in this regard and the vaccine is available to staff free of charge. The other advice we are giving to people revolves around infection control, whereby we are encouraging them to "catch it, bin it, kill it". In addition, GPs are being advised to prescribe Tamiflu antivirals to the members of high-risk groups in order to reduce the duration of the illness.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister did not respond to my other question.

Leo Varadkar (Dublin West, Fine Gael)
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My time is up. The Deputy can only ask so many questions and I can only respond to so many.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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How convenient.

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy can ask his question again. It is a case of fewer questions more answers.