Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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5. To ask the Minister for Health given the decision by members of the Irish Nurses and Midwives Organisation to initiate industrial action on 15 December 2015, the steps he is taking to address the real crisis across our hospital network, specifically through the recruitment of additional staff, including consultants, nurses and midwives, and the provision of additional bed capacity through the re-opening of closed beds and the introduction of new bed numbers, both within existing build, and through planned expansion; and if he will make a statement on the matter. [43045/15]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I am mindful of the decision of the Irish Nurses and Midwives Organisation, INMO, membership to initiate industrial action later this month. I want to establish what steps the Minister is taking to address the real crisis in our hospital network. It presents in particular in the context of accident and emergency departments but is not confined to those units in terms of staff recruitment, bed capacity and other matters.

Leo Varadkar (Dublin West, Fine Gael)
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The HSE will seek to minimise the impact of any industrial action on patients in the seven emergency departments where strike action is proposed. Hospital management will agree contingency arrangements with staff to ensure that adequate resources are provided during the two-hour period of industrial action at each site on 15 December. The strike is avoidable and management and nursing union representatives can reach agreement before then with the assistance of the State's industrial relations machinery. I understand the pressure and frustration that has given rise to the strike ballot.

Recruitment of additional nurses and consultants is a subject of considerable ongoing activity by the HSE and voluntary hospitals. Recruitment campaigns are under way in Ireland and abroad. The HSE staff census returns for the end of October 2015 show that 754 more nurses are employed in the public health services than this time last year. The number of consultants has increased by 393 since March 2011, when this Government came into office, and the number of non-consultant hospital doctors has increased by 1,007, the highest number ever.

We have a plan to address emergency department overcrowding, which was developed by the emergency department task force. The plan benefitted from considerable input by staff representatives, including the nurses' unions. The measures in the plan are currently being implemented and are beginning to show results. Additional funding of €18 million has been provided to support the acute hospital system over the winter period by providing additional bed capacity and other initiatives to improve access to care. This is supporting hospitals to reopen closed beds and to add more beds. Some 197 hospital beds have opened nationally since October, another 38 due to open in the next two weeks and another 200 will open in subsequent weeks.

As I mentioned, HSE figures show an 8% reduction in overcrowding this November compared to last. The INMO figures also show significant improvement in the second half of November. This contrasts with the position during the summer, when overcrowding was 20% to 40% worse compared to last year. Recent progress is definitely going in the right direction and is a big improvement on the start of this year, when there were 500 to 600 people on trolleys on some mornings. For example, at 8 a.m. today, the number of people waiting on trolleys was 244 and 110 patients were waiting for more than nine hours. This is 23% lower than this time last year.

I recognise the continued difficulties being experienced in emergency department and the enormous contribution staff make in meeting the needs of patients. Progress is being made but this needs to be sustained in each hospital and nationally through the full implementation of the emergency department task force recommendations. Additional nurses, doctors and consultants are being appointed. The waiting time for the fair deal scheme, for example, has been reduced from 11 weeks to three to four weeks and the number of patients whose discharges are delayed has been reduced by over 270, which alone frees up 270 beds every day. New acute hospital beds have been introduced for the first time in years. Given the progress that is emerging and the further development under way, I hope that the proposed action can be avoided.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Whatever about the proposed action of the INMO, the crisis continues and is likely to continue until such time as we properly resource our acute hospital network. I refer to the Supplementary Estimate the Minister is bringing forward and which, I understand, will be brought before the Joint Committee on Health and Children in the coming week. Has the Minister built into that Supplementary Estimate a sum of money that will address the current potential for the delivery of additional staff and bed capacity up to the end of 2015? The Supplementary Estimate is particular to this year, in terms of the budgetary provision. Can the Minister tell us whether he has built into it provision for particular steps to address this crisis?

I refer to 15 December, which is imminent. What engagement, if any, has the Minister had since the ballot taken by the INMO? Has he sought such a meeting?

Leo Varadkar (Dublin West, Fine Gael)
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As the Deputy knows, the Supplementary Estimate of €665 million refers to this year. Built into that is the provision for the winter initiative to open additional beds, if we can find and pay the required staff, and to keep fair deal waiting times at between two and four weeks. Its purpose is also to ensure we can keep providing the additional 180,000 additional home care packages and home help hours provided this year. The short answer to the Deputy's question is that all of those measures are built in to the Supplementary Estimate.

I met the general secretary of the INMO on Monday. We have spoken on the phone since then. I met the INMO emergency department nurses committee, at its request, a couple of weeks ago. The current position is that talks have begun at the Workplace Relations Commission, which has now intervened in the matter, and that is the best place for these matters to be resolved, as they almost always are.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In terms of the Supplementary Estimate, could the Minister indicate the breakdown in terms of how the overspend will be addressed, as he would regard it, up to this point in 2015, and the additional moneys he has secured? I presume that is the case in order to address the deficiencies, in terms of resourcing, in the numbers of consultants doctors, nurses, midwives and other professional inputs and bed capacity. Can the Minister tell us what the overspend is, as against the add-on moneys, to bring us up to the end of this month?

On engagement with the INMO, does the Minister have any expectation of revisiting the decision already taken or in terms of any of the measures he is currently working on? Are they being viewed in any way as sufficient to allow for a re-evaluation of the position by the INMO in advance of 15 December?

Leo Varadkar (Dublin West, Fine Gael)
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The questions the Deputy asked on the Supplementary Estimate are entirely reasonable but the question he put down did not ask about it at all. I did not bring the big binder of figures that I will have with me when we discuss it at a committee meeting next week.

It is important to bear in mind that the Supplementary Estimate includes a number of different things. It includes some one-off measures that will not be repeated next year, such as the cost of the symphysiotomy payment scheme, the €50 million waiting lists initiative, the extra payday that occurred this year compared to last year and a number of policy decisions made during the year. These were not overruns. Rather, they were decisions made by the Minister of State, Deputy Lynch, and I, in conjunction with Government colleagues, to put more resources into the fair deal, to spend a little bit more on GP care for those aged under six, to bring in the diabetes cycle of care and open additional beds in hospitals.

There are different aspects to the Supplementary Estimate and it does not involve just overruns. There were overruns in the cost of medicines because more medicines were used and prescribed than we thought. The reduction in the number of medical cards as a result of the improving economy was not as great as we thought it would be.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What about engagement with the INMO?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We are over time and have to move on.

Leo Varadkar (Dublin West, Fine Gael)
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I do not follow the Deputy's question.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I asked the Minister whether he had any expectation the INMO decision regarding 15 December would be revisited.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We are over time.

Leo Varadkar (Dublin West, Fine Gael)
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I cannot speak for it.