Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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8. To ask the Minister for Health his plans to deal with the growing crisis in hospital accident and emergency departments across the country; and if he will make a statement on the matter. [2382/15]

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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In recent weeks we have witnessed an unprecedented crisis in accident and emergency departments. At its height, 600 patients were on trolleys in hospitals. When the Minister was questioned about this issue last week, he boasted that the position had improved and that the numbers on trolleys had dropped again since that horrendous peak figure had been reached. I note that, according to Trolley Watch today, there are 431 patients on trolleys. How long will we lurch from crisis to crisis? When will the Minister get a handle on the issue?

Leo Varadkar (Dublin West, Fine Gael)
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The Government regards trolley waits of over nine hours as unacceptable. I acknowledge the difficulties 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 what are 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 reopening of closed beds, additional diagnostic scans and consultants doing additional ward rounds to improve and speed up 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 the issue of delayed discharges. Actions being taken include the provision of about 400 additional home care packages, additional transition beds in nursing homes, 300 additional fair deal places and an extension of community intervention teams. In addition, Mount Carmel Hospital will reopen later in the spring and provide important relief for Dublin hospitals.

Last month I convened the emergency department task force to help to develop long-term solutions to the problem of overcrowding by providing for an additional focus and momentum in dealing with challenges presented by trolley waits. Following a second meeting last week, the HSE is working on an action plan to be finalised by the end of the month to specifically address emergency department issues with a view to achieving a significant reduction in trolley waits over the course of 2015.

The number of patients on trolleys this morning is 357. They includes patients on trolleys in wards but do not include patients in day wards. Of these, 169 have been on trolleys for more than nine hours. However, we do expect the number to fall below 200 by the end of the day. As the Deputy knows, patients are not discharged overnight; therefore, the figure is always higher in the morning. As patients are discharged during the day, the numbers fall. We, therefore, expect that there will be fewer than 200 by the end of the day, but then, of course, the number will rise again overnight.

There are significant variations from Mullingar, Kilkenny, Cavan to Kerry where there is no one on a trolley to as many as 24 being on trolleys for more than nine hours in Beaumont Hospital. I will be happy to answer any further question the Deputy may have.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Clearly there is some movement as a result of the crisis that arose last week but there are, as stated by the Minister, 357 people still on trolleys today. As I mentioned, yesterday there were 431 people on trolleys, some of them in wards, resulting in there being more people in wards than there should be. I note from the RTE headlines this morning reference to the fact that 4,000 nurses have resigned in the past three years, 5,000 in total have resigned over the past number of years and warning that 1,000 more are to leave in the next year. Also, some 5,000 beds in total have been taken out of the system and 2,000 beds are currently closed.

It appears that the measures being taken are small in comparison with the scale of the problem, which gives little confidence that we are not going to continue to lurch from one crisis to another. As acknowledged by the Minister in his responses last week, the emergency measures being taken will lead to the cancellation of non-emergency surgery, which will affect waiting lists and result in other people in the health service suffering. Despite the emergency efforts to deal with the trolley crisis the situation is still out of control. Is it not time that the Minister listened to the nurses, who have now been forced to call for industrial action in the form of a work to rule early next month, that what is needed if we are to get a handle on this crisis is thousands more beds and thousands more nurses, significant extra resources and a reversal of the cuts that have been implemented?

Leo Varadkar (Dublin West, Fine Gael)
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I would point out that 4,000 nurses have not resigned. Rather, the number of nursing posts has been reduced, which is not quite the same thing. Between 2008 and 2013, the number of nursing posts reduced by approximately 5,000 but this is offset in large part by the fact that nurses work additional hours under the Haddington Road agreement and also by the graduate nursing programme. However, in 2014 the number nurses employed by the HSE increased by 500. We are now starting to increase the number of nurses working in our public health system. This is in addition to the fact that we now have record numbers of midwives and more consultants than ever before. It is important to put all of the facts in the public domain. The only thing that is better than the truth is the whole truth.

If this was a simple problem it would have been solved a long time ago. The difficulties vary from hospital to hospital. The fact that the work to rule will take place in seven hospitals and not all 28 or 40 facilities indicates that there are particular problems in some hospitals. In some hospitals difficulties arise because of late discharges, either because there is no funding available for the fair deal scheme or, as in the case of the Beaumont-Louth area, there are no nursing homes. What is required is different sets of solutions, a national approach and particular approaches in particular hospitals. That is what the emergency departmental task force is all about.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I was reading from the RTE headlines. The phrase "Lies, damned lies, and statistics" comes to mind.

Kathleen Lynch (Cork North Central, Labour)
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And then there are headlines.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Yes. According to RTE, the figures it obtained from the HSE indicate that almost 11,000 nurses left the profession between 2010 and 2013 and 1,000 more are scheduled to retire this summer. Is the chaos in our health service the result of people being forced to work harder under the Haddington Road agreement, resulting in the huge culling of nurses from our hospitals, particularly our accident and emergency departments? Is it not the case that the reason nurses are flooding out of the system is because they are at their wits end and completely stressed because their incomes have been slashed, thousands of beds have been closed and billions of euro has been taken out of the health service? Nurses can no longer bear that because not enough resources, staff or beds are available in the system patients and staff are suffering. It is a disaster.

Leo Varadkar (Dublin West, Fine Gael)
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I am sure the Deputy is not accusing the media or the people who write the headlines of lies.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I am just quoting the statistics that are being bandied about. Is the Minister disagreeing with them?

Leo Varadkar (Dublin West, Fine Gael)
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No, I am not: I am disputing the Deputy's understanding of them. It may well be the case that 11,000 nurses have left the service in the past five years but it is also the case that 6,000 nurses have come into the system. As such, the net reduction in nurses is approximately 5,000 but this has further reduced to 4,500 because the number of nurses increased in 2014. As I said, this is partly offset by the current record number of doctors and midwives in the system, nurses working additional hours and the graduate nursing programme. The number of nursing hours done is not necessarily the same as the number of nurses employed.

There are approximately 34,000 nurses in the public health service. If 1,000 of them leave this year, that equates to approximately 3% of the overall number. A 3% turnover in staff in any organisation is not enormous. It is manageable. A particular issue, as mentioned by the Minister of State, Deputy Kathleen Lynch, is that mental health nurses can retire at 55 years of age, although they do not have to do so. We are encouraging them to stay on. Also, the HSE's latest recruitment campaign for nurses had almost 4,000 applicants. There are people who are willing to work in our services.