Gerry Adams (Louth, Sinn Fein)
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1. To ask the Taoiseach when the Cabinet sub-committee on health last met. [2154/15]

Joe Higgins (Dublin West, Socialist Party)
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2. To ask the Taoiseach when the Cabinet sub-committee on health last met. [3366/15]

Micheál Martin (Cork South Central, Fianna Fail)
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3. To ask the Taoiseach when the Cabinet sub-committee on health last met. [3270/15]

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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4. To ask the Taoiseach when the Cabinet sub-committee on health last met. [7797/15]

Denis Naughten (Roscommon-South Leitrim, Independent)
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5. To ask the Taoiseach when the Cabinet sub-committee on health last met. [19232/15]

Enda Kenny (Mayo, Fine Gael)
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I propose to take Questions Nos. 1 to 5, inclusive, together.

The Cabinet committee on health met last on 25 May.

Gerry Adams (Louth, Sinn Fein)
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Go raibh maith agat.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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If you ask a question, you get an answer.

Gerry Adams (Louth, Sinn Fein)
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I hope the Ceann Comhairle will allow me to raise some matters around the issue of health that are of concern. I understand the Cabinet sub-committee covers a wide range of issues including general expenditure, the Health Service Executive, HSE, implementation plan, the development of primary care and community systems, mental health provision and pay and agency costs, in addition to other matters.

I know the Taoiseach is forbidden to report on conversations had by the Cabinet sub-committee on health but in January, the Minister for Health brought forward his 25 health priorities. Given that the last meeting of the health committee was in May, will the Taoiseach indicate if those priorities were discussed?

I recall the Taoiseach telling me previously that the big challenge for the Minister for Health is to stabilise the health system in order that it can deliver the results we expect. Given what is happening within our health system across a range of disciplines, does the Taoiseach accept that the Government's general health policy is failing and that this committee is failing also because the difficulties within the health service are increasing, not decreasing? We have the difficulties around persuading doctors to buy into the proposal for cover for children under the age of six, which the Government promised to have in place in July. Today, there are 395 citizens on hospital trolleys. In Our Lady of Lourdes Hospital, in my constituency, there are 37 citizens on trolleys, which is the second highest number in the State. Those are the type of figures one would usually associate with the winter months. The Government has failed entirely to end that scandal. I was in Our Lady of Lourdes Hospital last week and it is obvious that the staff and everyone else involved are doing their best but there is not the capacity, given the number of nursing places and the number of beds the Government has scrapped.

At the end of April, 412,422 citizens were on the outpatient waiting list, and 72,000 of them have been waiting for more than a year. Those figures are unacceptable. We have asked here on a number of occasions if there will be a supplementary budget for health. We did not get an answer, but it is expected that the HSE will be over budget by at least €100 million for the first three months of this year.

I will conclude on this crucially important point about the lack of mental health services. This month sees the Green Ribbon campaign to get people talking about mental health. I do not believe there is a family across this island who does not have a story to tell but austerity, the economic crisis and Government policy have had negative impacts on these services, including mental health and well-being.

Big gaps have been created by dint of Government policy. The recent report from the Health Information and Quality Authority, HIQA, on the safety of services in the Midland Regional Hospital found that the hospital was not governed, resourced or equipped to provide the 24 hours, seven days acute surgery, accident and emergency, and maternity services that are required. The Minister, on behalf of all of us, has extended solidarity to the families who were bereaved, and I do so again now.

I commend them for persevering to get to the truth about what happened in Portlaoise. HIQA stated patient safety was not a priority and that there were similar sad and serious cases on all HSE sites. Perhaps the Taoiseach might give us some indication of what the Government is doing and how the health committee is responding to what is a crisis in the health service.

Enda Kenny (Mayo, Fine Gael)
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The Cabinet sub-committee on health is not the Government. The opportunity presents itself during the course of Cabinet sub-committee meetings to receive updates and progress reports from the Ministers involved and request details on an issue from the HSE person involved.

The Deputy has asked a number of relevant questions. In dealing with beds, a new modular ward is to come on stream this summer in Our Lady of Lourdes Hospital which will have 20 beds. GP care services for those aged under six years and over 70 will be introduced this summer, as planned, and people are signing up. Fair deal scheme waiting times are down to four weeks and will be maintained at this level for the rest of the year. As the Deputy is aware, they have been reduced from 18 weeks, which was unacceptable. The numbers of patients on trolleys are still high. It is a problem, but it is easing. Although the position is much better than it was, it is not yet acceptable to us.

The private sector is being employed, where possible, to reduce the very long waiting lists. I can give some details of the emergency department action plan which was published in April. It details a range of time-defined actions to make the best use of existing hospital and community service capacity; to develop internal capability and seek process improvement; and to improve oversight, planning, governance and leadership. In view of the experience to date, it was decided to allocate €74 million for the action plan on a strictly ring-fenced basis. I have referred to this previously. Some €44 million is being allocated for the nursing homes support scheme, NHSS, in providing an additional 1,600 places and reducing waiting times from 11 weeks to four. Coupled with the normal weekly release, this funding allocation has seen the number on the national placement list fall to 476 as of 15 May, with waiting times reduced to three or four weeks from that date. Since 2 April, more than 1,800 people have been approved for funding under the NHSS.

Some €13 million was provided to cover the cost of additional transitional care beds and home supports, both of which can provide people with viable alternatives to acute hospital care. The temporary transitional beds in use to address emergency department overcrowding will be replaced with sustainable, more effective beds under the fair deal scheme. A further 173 community care beds will be made available around the country, which can be opened on a short or longer term basis and as part of a mix of short-stay rehab or long-term care beds. Of these, 110 have been opened in district hospitals, with a further 24 opened at Moorhall, County Louth. Some 65 beds are being opened in Mount Carmel Hospital, of which 15 are available, while the remainder will become available on a phased basis from now until the end of June. This will provide more flexibility and improve the flow of patients out of hospital at an earlier point.

The additional funding comes on top of measures already taken in last year's budget, when the Government provided €25 million to support services that provided alternatives to and relieved pressure on acute hospitals. This will enable the HSE to deliver on the Minister's stated objective of reducing the number of patients subject to delayed discharges by one third to less than 500 and the number of patients on trolleys in emergency departments awaiting admission for over nine hours to fewer than 70. The benefits should have an impact within a relatively short space of time across acute hospitals and social care services.

The HSE commenced work immediately on these objectives. On the direction of the Minister, it has the capacity to recruit, where necessary to deliver front-line services. Arrangements are in place to allow the recruitment of such staff where it has been established that there is an urgent service requirement. Figures show that on 19 May there were 668 delayed discharges nationally, a fall of 100 since March.

For the Deputy's information, I will outline a number of additional measures. All hospitals open overflow areas on an ongoing basis, with up to 300 additional beds open, and such areas include day surgery cases, with a curtailment of day surgery activity levels as a consequence. Patients with private insurance are being diverted to private hospitals where consultants have admitting rights. Weekend discharges are being optimised, while level two hospitals are being optimised to decongest emergency departments. This was particularly effective in the Louth-Meath hospital group. Non-urgent elective cases have been curtailed, where necessary. The community intervention team services in Naas and at Our Lady of Lourdes Hospital have been expanded. These escalation measures will remain in place and the daily oversight arrangements in national hospital groups and individual hospitals will continue.

The Minister has given the HSE a very clear understanding of the necessity to control costs and have management exert its responsibility in managing these costs in hospitals. It is not always possible to do so. It is an opportunity for the Cabinet sub-committee on health to receive reports and updates on the progress being made in all of the different areas. There is good news to report in some cases, although not in all. The Department, the HSE and Ministers are working very hard in that regard.

Micheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach said the last meeting was held in May. One of the most famous promises he made before the last general election concerned his declaration that he would end the scandal of patients on trolleys. He did not do it. Before Christmas we had the largest number of patients on trolleys in the history of the system. The promise of universal health insurance is nowhere on the horizon. We are now talking about it happening in 2025, the general election after next, not that I believe it. Approximately a year and a half ago the Taoiseach said he was taking charge of health policy. The then hapless Minister, Deputy James Reilly, was going through a very difficult patch at the time and the Taoiseach declared that he was taking control. He said the Cabinet sub-committee was "not the Government", that it only provided updates. I got the impression that it was a decision maker, that it would recommend key decisions to the Government. The Minister has acknowledged that he was warned in briefing papers from officials about the trolley crisis six months before it happened. We also know this through freedom of information requests. I presume the sub-committee would also have been informed about this and that it took the decision, in the budget that followed, to ignore the warnings and allow the crisis to develop. Some 400,000 people are on long-term outpatient waiting lists, while inpatient waiting lists are going through the roof.

Even in respect of diagnostic tests 27,000 people are waiting for MRI scans, with one quarter waiting for longer than one year, and 17,300 are waiting for CT scans. The Taoiseach spoke about the issue of contracting with private hospitals. That was always available under the National Treatment Purchase Fund, NTPF. The Government mothballed and undermined the NTPF, with the result that the targets which had been reached of six months for adults and three months for children went through the roof.

Leo Varadkar (Dublin West, Fine Gael)
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They did not.

Micheál Martin (Cork South Central, Fianna Fail)
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They did. The Minister should speak to those involved with the NTPF. It was a success but the previous Minister for Health, Deputy Reilly, created a different agency and he employed people who had contracts overseas. They did not even pay tax in this country. The exercise went nowhere. Essentially, the Government undermined the NTPF at a time when it was making inroads. The idea of purchasing treatment was long with us but the parties opposite stopped doing it, with negative results for a range of patients. For example, the situation with paediatric scoliosis is a scandal that has gone on too long. There was warning after warning about this.

The health committee should be meeting much more frequently than is currently the case in order to deal with these issues. Last year it took a full 12 months to decide to provide €500 million to the health service. The Taoiseach knew at the beginning of the year that the health budget was a fraud, just as he knew it was a fraud at the beginning of the previous year. It was deliberately underestimated to enable the Government to budget for other areas. The Government is not being fair to the health service or the people who work in it. This is why morale is at an all time low in all health sectors.

We know from last year's health budget that the Minister for Health has spent an additional €70 million. While I was in Carlow-Kilkenny in the last several weeks, I was amazed by the number of owners of nursing homes who told me they were waiting 12 weeks or longer for fair deal scheme applications to be granted. Last month the Taoiseach indicated that the waiting time was four weeks. I learned from the nursing homes I visited that the waiting time in the south east is 12 weeks. That is an appalling scandal.

Does the Taoiseach agree that the health committee should be meeting more frequently given that waiting lists are out of control, the trolley issue has not been addressed and that we have no information on the Taoiseach's favoured Dutch model of universal health insurance? The Dutch model was Fine Gael's great promise at the time of the general election. The Dutch Prime Minister was forced to miss an EU summit in order to deal with a crisis in the funding of that country's health insurance system. The White Paper appears to have been sidelined and we have not seen any costings for this model. Can the Taoiseach indicate when he intends to publish the costings and can he confirm that the health committee will be meeting more often? Will he be in a position to publish the costings before the end of this session and, in particular, the fees that people will incur in purchasing insurance? Universal health insurance will entail significant taxes for a large proportion of the population. I ask the Taoiseach to outline the numbers who will be paying for health insurance and how much they will be paying.

Enda Kenny (Mayo, Fine Gael)
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The health committee met at least every month. It met on 19 January, 23 February, 30 March, 27 April and 25 May. While they were Cabinet sub-committee meetings, we seem to speak about every matter under the sun that is relevant to the general area of health. Those Cabinet sub-committee meetings receive reports from the HSE and the Department of Health, and recommendations are made where they are necessary for decisions to be taken by the Cabinet.

Responsibility for the Department of Health and the HSE is divided between the Minister for Health and the Ministers of State at the Department of Health. We examined issues pertaining to the budget last year. There are now 900 more staff in the health service compared to this time last year. An additional allocation of €500 million was provided to the Department of Health for this year. The budget of €993 million for the fair deal scheme is an increase of more than €50 million on the 2014 budget and it provides for more than 22,000 people on the scheme who contribute a further €290 million towards the cost of their care. No plans are in place to make changes in that regard. Between now and 2024 the number of people aged over 65 years is projected to increase by 200,000. This is a serious issue which has to be taken into account and on that basis the Government provided an increased allocation this year. I understand that the waiting period has decreased from 18 weeks to four weeks. I am not sure of the nursing home to which Deputy Martin was referring.

The HSE has carried out a staff morale survey for the first time and it is developing a people and manpower strategy on foot of that survey.

Micheál Martin (Cork South Central, Fianna Fail)
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What was the outcome of the survey?

Enda Kenny (Mayo, Fine Gael)
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The outcome has not yet been analysed but it is an important issue. Recruitment has resumed, as the Deputy is aware, and agency costs have been reduced. The general situation is that a great deal of activity is taking place in the Department of Health and the HSE. It is not true to say that the intention was to introduce the Dutch model of universal health insurance. The intention is to introduce universal health insurance based on a model that is appropriate for Ireland's needs.

Micheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach cited the Dutch model.

Enda Kenny (Mayo, Fine Gael)
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The Dutch model was one of the models we examined in the beginning in terms of universal health insurance.

Micheál Martin (Cork South Central, Fianna Fail)
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It was the only one. The Taoiseach told the people that we would follow the Dutch model.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy should resume his seat.

Micheál Martin (Cork South Central, Fianna Fail)
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Fine Gael paraded it up and down the country.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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There are procedures. Resume your seat.

Micheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach has extraordinary nerve to tell the House he never said it.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy should resume his seat. He cannot hop up and down when he feels like it.

Enda Kenny (Mayo, Fine Gael)
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The model of universal health insurance to be introduced here will be appropriate to Ireland's needs. This is not the Netherlands.

Micheál Martin (Cork South Central, Fianna Fail)
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Am I hearing this?

Enda Kenny (Mayo, Fine Gael)
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Is he listening?

Micheál Martin (Cork South Central, Fianna Fail)
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I am incredulous. I cannot understand what the Taoiseach is saying.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Please resume your seat.

Micheál Martin (Cork South Central, Fianna Fail)
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He is now saying the Dutch model is not suitable for Ireland. He promised the people of Ireland we would follow the Dutch model.

Enda Kenny (Mayo, Fine Gael)
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If the Deputy relaxed -----

Micheál Martin (Cork South Central, Fianna Fail)
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Fine Gael produced a paper on it.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I ask the Deputy to resume his seat and show respect to the Chair. Other Deputies are waiting to put their questions.

Micheál Martin (Cork South Central, Fianna Fail)
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Let us inject a bit of life into this debate. The world will fall asleep listening to us.

Enda Kenny (Mayo, Fine Gael)
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I can confirm to the Deputy, if he is prepared to listen, that universal health insurance will be introduced according to a model that is appropriate for Irish needs. I hope he understands that.

Micheál Martin (Cork South Central, Fianna Fail)
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Is the Dutch model gone?

Enda Kenny (Mayo, Fine Gael)
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I went over there myself to investigate the Dutch model. Certain elements of it will not be introduced here.The system introduced here -----

Micheál Martin (Cork South Central, Fianna Fail)
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He is telling incredible untruths.

Enda Kenny (Mayo, Fine Gael)
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----- will be appropriate for Ireland's needs.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Please stop interrupting the Taoiseach.

Micheál Martin (Cork South Central, Fianna Fail)
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I cannot use the word "lies".

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We have to proceed.

Enda Kenny (Mayo, Fine Gael)
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Deputy Martin tends not to listen these days. Perhaps he should.

Micheál Martin (Cork South Central, Fianna Fail)
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I am listening very carefully. You told a whopper of an untruth. I cannot use the word "lie".

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I ask the Deputy to show respect to the Chair by speak through the Chair. He has been around here long enough to know the procedures that are in place. I ask him to adhere to them.

Enda Kenny (Mayo, Fine Gael)
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The Deputy referred to the areas in which change is necessary and asked what is happening in the Department of Health and in health reform generally. I referred to the legislation providing free GP care to all children aged five years and under and those aged over 70 years. That has been enacted, an agreement has been reached and doctors are signing up. From this summer, up to 300,000 children and senior citizens who currently have to pay to see their GPs will no longer have to do so. This represents the first step in the phased introduction of universal GP care without fees and it is a major milestone on the road to universal health care.

In addition to specific projects to upgrade existing facilities, substantial work is progressing on a number of key infrastructure projects. That includes work on the planning application for the national children's hospital, which will be a truly iconic building catering for the children of the entire island. That application is well advanced and is expected to be submitted before the summer. In parallel, the children's hospital group board is overseeing the integration of the three children's hospitals in advance of the move to the new hospital.

Construction on the relocated national maternity hospital from Holles Street is expected to commence in early 2016. These are all major pieces of health infrastructure which will stand all our people in good stead for many years to come.

The Deputy is aware that seven hospital groups have been established as the first step towards independent hospital trusts. Each committee will develop a strategic plan by early 2016 setting out how they would consider reorganising hospital services and integrate with all other health services to provide best care for the populations they serve. Significant work is also underway in delivering community health care organisations and the implementation of activity-based funding across the public hospital system.

The work of the Cabinet sub-committee on health will continue to monitor and assess progress on key reforms to be delivered as part of the future care programme and, where necessary, will revert to the Government for decisions.

I was talking to somebody yesterday whose elderly parent was given a home care package just the other day, which came from the extra allocation made. They were so happy with the extent of the service being provided under that home care package. I know it is only one case, but it means so much in terms of assistance, support and comfort both to the family and the individual involved. These are all part of what we would like to be able to do on an overall basis, but it is not possible to deal with that in every situation.

The work of Ministers in directing where the health system wants to be in the time ahead is making substantial progress. What I have referred to is all part of the pathway to having a single-tier system that is appropriate for our needs in Ireland.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Taoiseach has fundamentally betrayed his promises to the electorate in the area of health insurance. One of the central planks of his party's pre-election manifesto was the great promise of universal health insurance. He says he is still committed to that, but it is absolutely clear that it has been put so far back as to be a really meaningless objective now.

Is it not the case that in recent weeks the Minister for Health, Deputy Varadkar, has essentially been acting as an advertising agent for private health insurance? He has been scaring people over 35 into taking out private health insurance before a deadline, or to endure penal premiums that will increase over the years. That indicated a fundamental abandonment of the idea of a single-tier system, with the Minister actively championing the two-tier system.

Why would anybody take out private health insurance? The only reason people would do so is because they believe they will get premium care over and above what people get in the public system. People are being encouraged to do that due to fear of the situation in the public health system. They look at the public health system with its longer waiting lists, trolley crisis and massive cutbacks, and say: "Oh my God, maybe I need to take out private health insurance in order that I will not have to suffer that."

The Minister is reinforcing the notion of a two-tier system by saying: "Get your private health insurance now or we'll penalise you." Is it not the case that the Taoiseach has fundamentally backtracked on the principle of universality? The Minister, Deputy Varadkar's, deadline essentially means that this Government is reverting to championing actively a two-tier health system.

My second point, which is connected, concerns the mess in the public health system. Whatever the Taoiseach may say, evidence is piling up that the situation in the public health system is getting worse. Last week, statistics revealed that 71,000 people have been waiting longer than a year for an out-patient referral. That is a huge figure. The Minister admitted that in the case of St. Vincent's Hospital and Loughlinstown Hospital, the reconfiguration process had actually worsened the situation. Last week, the Minister said it cannot be dealt with without extra resources going in. Are those resources going to go in or will the crisis continue to get worse?

Last week, doctors in Beaumont Hospital described the situation for those waiting in the accident and emergency unit as "institutional abuse". It is a pretty serious allegation for doctors to write to Tony O'Brien in the HSE and say that the hospital was guilty of institutional abuse against patients. Patients were afraid to leave the plastic chairs they were sitting on in case somebody would take them when they were awaiting admission to a bed. That is an outrageous situation.

There were record numbers on trolleys in February. Meanwhile today, psychiatric nurses in Galway are taking industrial action again after they were forced to walk out a couple of weeks ago due to assaults on staff. They believe that is the result of a lack of resources, including inadequate staffing.

Notwithstanding promises made by the Minister when the walk-out occurred, that negotiations would take place and the issue would be addressed, it has clearly not been addressed. Otherwise they would not be taking industrial action again today.

While it is implicit in the Galway case, in Cork a psychiatric nurse was suspended for blowing the whistle on patient safety issues. In the Portlaoise case we know that frontline staff were making reports to senior management about a lack of resources and dangers to patient safety, yet they were ignored. From how many other places are we getting reports of this kind by frontline staff that are either being ignored or silenced by senior management? Is there a policy to hush up the dangers to patient health and safety issues, instead of addressing them through the necessary resources and staffing?

All these issues point to a serious and worsening situation across our public health service.

Enda Kenny (Mayo, Fine Gael)
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The Deputy's comment in respect of an abandonment of the universal health insurance concept is simply not correct. The Minister and the Government have pointed out that the original target for the introduction of universal health insurance cannot and will not be met.

It is important for Deputy Boyd Barrett to understand that health insurance must be affordable before it can become universal. The Government has put in place quite a number of the steps that lead to universal health insurance and a single-tier system. The Deputy is aware that long-term community rating was brought in to encourage younger people in particular to take out health insurance so as to reduce and contain the cost for everyone, as well as putting an end to double-digit increases every year, which we have had for so many years. It was an important step forward in everybody's interests that the significant increases in costs every year would be reduced for everybody. There are a number of other measures that the Minister will bring forward in due course to make health insurance affordable for more people in future.

The steps in respect of those under six and over 70 are two important elements of the process leading to free access to GP services as part of the universal health insurance concept. The Deputy is aware that the primary care centres are being built and opened on a continuous basis and the reforms I referred to. These include the national children's hospital and the national maternity hospital, and all of these are very major pieces of health infrastructure. Changes have been introduced and money has been allocated for very specific purposes. As everybody has pointed out, it is not always about the extent of resources that apply. Many years ago, there were massive amounts of money being ploughed into the health system and it was inferior to what we have now. The management has a responsibility here, as well as the application of resources. One is not separate entirely from the other but the concept of having a well-managed and well-resourced health system should lead to a competent, professional managerial capacity in hospitals.

The Deputy mentioned Portlaoise and the tragic cases that occurred there. The Minister for Health went there and met the families and parents who lost their babies for many hours, empathising and understanding the difficulties that they had, and he has taken appropriate action since. The report produced by HIQA and its recommendations have been accepted in full. I outlined the details of some of the changes that have already taken place here in answer to questions recently. The fact that the Minister for Health took the time to go to Portlaoise and meet the parents was important in him being informed as Minister of the necessity to have a comprehensive response to the HIQA report. The Minister wrote to the director general of the HSE on 15 May, directing that a swift and targeted response be put in place by the HSE to the immediate needs of those parents and families, including, in particular, counselling and support, a case review and other facilities as would be appropriate. He has obviously requested a response from the director general confirming that those services would be operational by this week, 22 May, at the latest. He has asked for weekly updates from the HSE on progress on the provision of those particular services. The HIQA report, which is very extensive and independent, set out the eight recommendations and the Minister has responded by committing the Department and the HSE to their full implementation. The Deputy knows those recommendations.

With regard to a broader patient safety response, high-quality health care means care that is evidence-based, appropriate, timely, effective, efficient, equitable and patient-centred. All of these factors did not apply in many cases, as the Deputy is aware. Patient safety is fundamental to quality health care and the health system must be enabled to deliver safe care while at the same time balancing competing pressures in what is an ever-changing, dynamic and complex environment, as Deputy Boyd Barrett is well aware.

It needs to be acknowledged, however, that the delivery of health care can always carry inherent risks, as we are all aware, and the scale and complexity is without parallel in other sectors of business, as it is always difficult to determine what might or might not happen. It is clear from recent incidents and events that the capability of the Irish health system to prevent issues and manage patient safety is being challenged and has been found wanting. That is why the Department and the Minister accepted the recommendations from HIQA in full and will get on to implement them. Clearly, the movement of setting up the hospital groups, with committees to make recommendations, is another part of that. The overall level of services and what might be provided best in any hospital in any group or locality is a matter of a considerable importance. It has taken up a great deal of time over the years.

These are all part of what the Minister and the HSE are now driving to bring about structural changes that will allow for the very best level of care and attention to be given, with a patient-centred system. I do not accept the Deputy's premise at all of the abandonment of the issue of insurance. I have pointed out the reason young people have been encouraged to take out insurance, so that it should be affordable and it can reduce costs for everybody else. That leads, in part, to the introduction of the universal and one-tier health system, where a patient is central and treated on his or her needs, as distinct from resources.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputy Denis Naughten sends his apologies. He is having a procedure on his foot so he cannot take Question No. 5. I am anxious to move on as there are questions here that are as old as the hills.

Gerry Adams (Louth, Sinn Fein)
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I want to concentrate on the issue of people on trolleys. The Irish Nurses and Midwives Organisation, INMO, has revealed that between January and April, there were 35,135 occurrences of people on trolleys, an increase of 26% on the same period last year. It is the worst figure since the INMO started to keep these records. We could deal with the huge scandals, patient safety issues and the lack of resources but I want to deal with an issue that affects the "small" people. On 18 May, around the time the Taoiseach's sub-committee was meeting, there were 65 patients in Our Lady of Lourdes Hospital who were deemed to be ready for discharge but they could not be discharged. There are 310 beds in the hospital, so 65 of those beds could not be used by the people requiring procedures and who ended up on trolleys or having surgery put off.

The trauma for people on trolleys is that they are sick and many are elderly etc. How could we expect anything different if the Government cuts home help services, care in the community, close public nursing beds and strip away protections for people in their family home? They will end up in hospital. Today, there are 37 people on trolleys in Our Lady of Lourdes Hospital, which is the second-highest number in the State. That is a direct result of Government policy. It has closed 2,000 beds. This Government and its predecessor stripped services from the Louth county hospital at Dundalk.

Yes, the modular unit at Our Lady of Lourdes in Dundalk is welcome. I lobbied the last Minister as well as the Taoiseach for it as, I am sure, did other representatives. My point is that it is a huge injustice that, on the one hand, people are on trolleys and, on the other, that as many as 65 people were told they could be discharged but they had nowhere to go. That is a mark of the Government's poor stewardship of health.

Micheál Martin (Cork South Central, Fianna Fail)
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I raise one specific issue. The Taoiseach replied in relation to Portlaoise. The health committee of the Cabinet met in May. The Taoiseach said it meets monthly and gave out the dates of the previous five meetings. Repeated warnings were given in relation to safety in the maternity unit at Portlaoise in particular as well as to other obstetric units. The Joint Committee on Health and Children was informed by the then Minister during a particular crisis that Portlaoise was a band 3 hospital and there was no change to its status. The director of the HSE, the inquiry and HIQA are saying that the funding was never provided to match the grade the Government gave the hospital. In other words, the Government made a statement saying Portlaoise was at a certain level. HIQA says that despite that statement to the joint committee, the money was never provided. Does the Government feel any sense of responsibility? Can the Taoiseach confirm or clarify if there was any intervention by the health committee or Ministers in terms of the statement that was made to the joint committee? Was this a political announcement and statement but the money was never provided subsequently to match the grading?

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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In my question, I asked whether the Taoiseach is concerned given that there were lots of reports in the case of Portlaoise from frontline staff about the situation. We have a similar case with the psychiatric nurse suspended on foot of going to the media about the situation in Cork. My question is more general as to whether the Taoiseach is responsive and whether it is the policy of the Government to be responsive when health professionals blow the whistle about patient safety issues or are they to be censored and silenced? Is the Taoiseach cognisant of that?

I asked about the longer waiting lists and more people waiting for over a year for out-patient services. A number of areas were specifically highlighted as being particularly bad. There was an acknowledgement by the Minister that the hospital group, including St. Columcille's in Loughlinstown and St. Vincent's, had an issue. The Minister has said this resulted from reconfiguration which was supposed to improve the situation. Some of us warned it would worsen it. The Minister further said the problems which had arisen could not be dealt with without additional resources. If that is what the Minister is saying, will the additional resources be provided? Will there be upgrades of Loughlinstown or St. Michael's as necessary to deal with problems that have emerged from a botched reconfiguration?

Enda Kenny (Mayo, Fine Gael)
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There is a shortage of nursing homes in Deputy Adams's locality in the north east. That is partly due to the collapse of the construction industry a number of years ago because of the economic situation. The new unit I have referred to at Moorehall is now open and there is a number of planning applications in for further developments. I might add that the home help and home care package budget has not been cut. That is an issue of importance.

Deputy Adams mentioned trolleys. Yesterday, Monday, 25 May at 8 a.m., there were 292 patients waiting on trolleys. At 8 p.m. that was down to 175. Today at 8 a.m., there were 259 patients waiting on trolleys and at 2 p.m. there were 243.

Gerry Adams (Louth, Sinn Fein)
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Does the Taoiseach consider that is okay?

Enda Kenny (Mayo, Fine Gael)
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I am sure the number has gone down at this stage. As of 19 May, there were 668 delayed discharges nationally of whom 381 were in the Dublin academic teaching hospitals. That compares to a high of 830 in December last year. I note that €25 million was provided for support services to provide alternatives to relieve pressure on acute hospitals. Of that €25 million, €10 million was used to provide an additional 300 places under the nursing home support scheme, reducing the waiting time from a period of 17 weeks. Some €8 million was allocated to provide access to an additional 115 short stay beds in the Dublin area and €5 million was used to provide 400 additional home care packages which will benefit 600 people. A further €2 million was used to expand the community intervention team services in primary care across Dublin and the surrounding regions.

Deputy Martin referred to moneys for Portlaoise. The budget there is approximately €50 million for this year which is similar to other hospitals which were formerly called model 3 hospitals.

Micheál Martin (Cork South Central, Fianna Fail)
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It is a different grade.

Enda Kenny (Mayo, Fine Gael)
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The Health Service Executive signs off as the Minister does on the budget for a given year. I make the point again that this is not just about funding or a lack thereof: it is also about management, professionalism and competence in doing a job effectively in the interests of the patient. If one looks at Wexford, Portiuncula or Clonmel, there are similar sized hospitals to Portlaoise. It is not just a matter for financial resources, it is a case of management responsibility working with the resources they have to provide an effective, patient-centred solution.

I went through the beds being identified as open in other places and gave Deputy Adams the trolley count. I do not have the details of the reconfiguration to which Deputy Boyd Barrett referred but if he puts down a Topical Issue or raises the matter by way of a question to the Minister directly, he will get the detail of that.