Mattie McGrath (Tipperary South, Independent)
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I thank the Ceann Comhairle for allowing me to raise this most serious situation in our country which is happening in front of our eyes and which is worsening by the day. I wish to pay tribute to the manager and front-line staff in Clonmel hospital and in the other Tipperary hospitals, St. Patrick's, St. Theresa's, St. Brigid's, Cluain Arainn and Tipperary, for their work. They are dealing under pressure with quite ill patients who are on trolleys in corridors. It is not acceptable in this day and age and the situation is getting worse instead of better. I had a call yesterday from a 98 year old who was on a trolley in Clonmel - or South Tipperary General Hospital, as they like to call it, but I know it as St. Joseph's in Clonmel. There were 19 patients on trolleys yesterday. South Tipperary General Hospital is an old hospital, albeit a very functioning and good hospital. However, it does not have the capacity, nor even the space in the corridors, to allow for any kind of treatment or examination of patients, because the physical width of the corridors is too narrow. The hospital had to employ a security man last week to move the accompanying families out of the corridor. These people were trying to stay with their family members to cover them and be with them while they were waiting to be seen. It is a disgraceful situation by any standards.

I welcome some people who are in the Gallery. I welcome the Dunne family who received an award from Uachtarán na hÉireann, Michael D. Higgins, for their 30 years of care work. I welcome Councillor Richie Molloy, who is manager of the carers. Only for all the work they do there would be many more people in hospital.

I remind the Minister of State that the reality is awful. The fair deal scheme is log-jammed with a 15-week delay. This is where that awful term "bed blockers" is used. It is an awful name. People who do not want to be in hospital and they have decided to go to a nursing home cannot get onto the fair deal scheme. This is costing the health service €4 million a week. Those people could stay in a nursing home for €1,000 a week while it costs €1,000 a day for a bed in a hospital. There is no logic and no joined-up thinking.

I refer to the HIQA report on patient safety which found in 2011 that of the total number of patients who attended the accident and emergency department in Tallaght hospital, 14% of those left without being treated. This is happening in every hospital and it is getting worse. People cannot bear it any longer because it is dangerous and unacceptable. If they have a family to look after them they leave and go to the GP.

I refer to what others have said, including Dr. Aidan Gleeson, head of the emergency department in Beaumont Hospital which is currently under siege from serious overcrowding. He said today that patients left on trolleys suffer increased risk of harm or death. He is an eminent doctor in Beaumont. Patients with heart attacks are being diagnosed late while patients with pneumonia and sepsis may not be getting the resuscitation and antibiotics quickly enough because they cannot get a doctor to examine them. Dr. Gleeson said that this is the reality in hospitals. Those are not my words. One would find better in the Third World. Who is going to take charge of this situation? It is outrageous.

There has been a national crisis in accident and emergency departments for years. I do not blame the Minister of State or the Minister, Deputy Varadkar. However, it must be dealt with and not by this so-called task force. As the Taoiseach told me last week, it is an expert panel. It is a case of all chiefs and no Indians. What we need is a manager like Grace Rothwell and other managers and front-line staff to be on that panel, not individual vested interests representing the consultants or the INMO - I agree they must be represented but at different forums. We need to take this out and look at it properly and to have a functioning and dedicated team of people who know what they are doing and above all, who will have the support of HSE senior management, so that they can deal with the crisis in accident and emergency departments. This task force is not fit for purpose because all the top guns are on it. They are pushing paper around, making decisions, looking for promotion, minding their own jobs and not looking after the health of the public who deserve it.

Kathleen Lynch (Cork North Central, Labour)
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I am taking this topical issue on behalf of the Minister for Health, Deputy Leo Varadkar. I welcome the people in the Gallery who are in receipt of the acknowledgement of the help and care they have delivered to people in need of it down through the years.

I thank the Deputies for raising this issue today. I wish to emphasise that the Government regards trolley waits as unacceptable and it acknowledges the difficulties which overcrowding in accident and emergency causes for patients, their families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances. As of this morning, the 8 a.m. update from hospitals indicated 400 patients on trolleys. While 400 people waiting for a hospital bed is not in any way acceptable, it must be acknowledged that through the hard work of hospitals working together, supported by other HSE services, HSE management and the Department, we have significantly reduced the numbers which were experienced on 6 January of this year.

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. Triage is operated to prioritise patients so those with most acute needs are seen and treated as soon as possible. Senior clinicians are a key part of this system, and working with hospital management to minimise potential risk and ensure the safest possible care is a responsibility they deal with as part of their duties every day in hospitals.

Measures to manage emergency department surges involve the full health system including primary, community and continuing care services to ensure that all available capacity and options are utilised and brought to bear on the situation. Some of the measures taken by hospitals to reduce overcrowding include the opening of additional overflow areas, the curtailing of non-emergency surgery, the provision of additional diagnostics and focus on discharge planning, which I believe is key.

The House is aware the Minister, Deputy Varadkar, convened the emergency department task force to find long-term solutions to overcrowding by providing additional focus and momentum in dealing with the challenges presented by the current trolley waits. It is made up of relevant stakeholders, such as senior doctors, lead hospital consultants, GPs, HSE national directors, union representatives and senior officials from the Department of Health and the HSE. A representative of the nursing home sector should also be on the task force and I have written to the Minister in this respect.

At the task force meeting on 2 February it considered a draft action plan specifically to address emergency department issues, with a view to a significant reduction in trolley waits over the course of 2015. We are determined that the action plan is completed as soon as possible, taking the views of the task force into account, and then operationalised without delay. The task force is due to meet again on 9 March. I reassure the Deputy that we are working hard to find workable solutions to the management of emergency care, with optimum patient care and patient safety at all times remaining a Government priority. The Deputy and I know this is not an issue which arose recently. It has been with us for years. We are determined to find a solution to it. Everyone else in the world has done so and it is not beyond us.

Mattie McGrath (Tipperary South, Independent)
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I am disappointed the Minister, Deputy Varadkar, is not here but I accept the Minister of State. I contend the service is not safe and it is not a quality service; this has been stated by consultants and not by me. The Minister of State said front-line staff endeavour to provide a safe and quality service, which they do, but they cannot do so without the tools or the means. If there is a fire we call the fire brigade, which is why I stated the task force is not fit for purpose and should be disbanded and the job given to people who know how to sort out the problem and who deal with it on a daily basis, not senior HSE officials who were all missing at Christmas when HSE officialdom was closed for almost 11 days. The trolleys backed up again because nobody received a letter.

What about the patients who are waiting in ambulances who cannot be taken from the ambulances and put onto trolleys because the hospital in Clonmel and other hospitals do not have a physical trolley in the building? The Government is looking in the wrong places. St. Michael's unit in South Tipperary General Hospital was forced to close and money was thrown at other services to pick up the slack for a while. It was the case that people who presented voluntarily for psychiatric care at South Tipperary General Hospital were taken by a private company to Kilkenny, but this service was withdrawn by e-mail last Friday week. It is a scandal. Now these patients must sit or stand and wait until 9 o'clock the following morning, on a chair if they can get one. This is exacerbating the situation in the accident and emergency department at the hospital. This is the result of a direct action by the Department, which gave us a service for a year and then took it away. When St. Michael's unit closed a service was provided for patients who present voluntarily, who do not feel well and know they do not feel well and need treatment, but it was taken away by an e-mail to the hospital manager last Friday week. It is scandalous and disgraceful. The actions being taken by one office is damaging and putting more pressure on accident and emergency departments.

The Minister of State does not know what is going on in the HSE and the sooner it is disbanded, as was promised by the previous Government and this Government, the better. Let the people who want to, and who are doing their best to do so, care for sick people, and let us not have officialdom choking everything, and the nonsensical situation of €4 million a week being spent on the fair deal scheme when people should be in nursing homes. The nursing homes sector should be involved. There is capacity in Tipperary and nursing homes will take patients, but official HSE is bonkers and cannot understand what is going on.

Kathleen Lynch (Cork North Central, Labour)
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The Deputy cannot quote a consultant to me as if it were the word of God-----

Mattie McGrath (Tipperary South, Independent)
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He is eminently qualified.

Kathleen Lynch (Cork North Central, Labour)
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I am sure he is very eminent. The Deputy cannot quote in this way and also tell me the same consultant cannot solve the problem with regard to the task force, because that is what he is saying.

Mattie McGrath (Tipperary South, Independent)
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No, I am not saying that.

Kathleen Lynch (Cork North Central, Labour)
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It is a contradiction and he cannot do so.

Mattie McGrath (Tipperary South, Independent)
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Senior officials-----

Kathleen Lynch (Cork North Central, Labour)
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It is not acceptable that people must wait nine hours in some cases for admission when they need to be admitted.

Mattie McGrath (Tipperary South, Independent)
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It is 48 hours in some cases.

Kathleen Lynch (Cork North Central, Labour)
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We have put in place a system for transfers whereby separate services are provided by ambulances for acute transfer to accident and emergency departments and by ambulances which transfer people from hospital to hospital. If one is not acute and needs to be transferred, whether to another hospital, service or home such a service is in place and it is far more efficient-----

Mattie McGrath (Tipperary South, Independent)
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It is invisible. I have not seen it.

Kathleen Lynch (Cork North Central, Labour)
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-----and effective than going by taxi. I know in some instances taxis provide a very good service. The State must take responsibility for people being transferred, and we have done so by way of putting in place a second layer of ambulance transfer.

Mattie McGrath (Tipperary South, Independent)
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There are no ambulances. You pulled the service from Clonmel last week.