Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Last week the Government managed to set another record: 714 citizens were left on trolleys. I did not think that, even under the stewardship of this Government, it would get that bad. I believed that, as someone who has a fair amount of experience of the health service, I was unshockable but the Government has managed to shock even me.

Last Monday, the general secretary of the Irish Nurses and Midwives Organisation, INMO, said:

We saw record trolley figures last week with a total of 3,112 in just one week and today each daily total from that week has been surpassed by the extraordinary figure of 714 admitted patients on trolleys today... This upsurge was predictable and the INMO warned against inaction or insufficient action in the wake of Storm Emma. It is unfortunate for both healthcare staff and patients that these warnings were not heeded and that emergency measures sought have not been put in place.

It is unfortunate for health care staff and patients that these warnings were not heeded. We see yet again a predictable crisis.

The Government has blamed the flu, the patients, the staff and I am sure now the Minister of State will blame the storm. The truth is there is a lack of capacity within the system. This year there has been a bed capacity review and the passing of a Sinn Féin motion detailing measures that will make an appreciable difference but we have not seen any action on either of these events. There is a state of emergency whereby elective surgery and planned procedures are cancelled but all that does is store up problems for later in the month or the year. We would like to hear from the Minister of State what exactly the Government has planned to deal with a very predictable crisis which has now become a perpetual crisis.

Maurice Quinlivan (Limerick City, Sinn Fein)
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With no disrespect to the Minister of State, Deputy Jim Daly, once again the Minister for Health has not showed up. This is my thirteenth attempt to get him to respond to this topical issue matter and four times I have asked him to respond to a similar question. He has not turned up on any of those occasions. That is not good enough.

I have tabled many questions on the University Hospital in Limerick but I do not seem to get answers. Today 64 people are on trolleys in Limerick. There were 66 yesterday. Last Monday there were 80 and in February almost 1,000. There will probably be more than 1,000 in March and there is no solution in sight. In recent months 13% of those on trolleys have been in Limerick University Hospital. It is a new hospital and before it was opened I tabled a topical issue matter because the nurses in the INMO were concerned that more than 24 people would be on trolleys there every day. At that time another Minister of State, Deputy Finian McGrath, deputised for the Minister whose excuse was that he was at the hustings to elect a new leader for the party. Deputy McGrath said: "there is no basis for any suggestion that 24 patients will be accommodated on trolleys in the new emergency department". Unfortunately, now we almost wish it was only 24 because every day there has been more. What Deputy McGrath said is completely untrue. In 2018 there have been only two days when there have been 24 or fewer on trolleys, 22 and 23. The core problem in the hospital stems from the merger of Nenagh, St. John's and Ennis accident and emergency departments into one so-called centre of excellence in Dooradoyle in Limerick.

We know that a 96 bed project will be delivered in some years' time. What will the Minister do in the meantime? Additional beds should be opened immediately in Ennis, St. John's and Nenagh.

Jim Daly (Cork South West, Fine Gael)
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I thank the Deputies for raising this important matter.

Emergency department, ED, overcrowding has been linked to many adverse outcomes, such as longer wait times, worse patient outcomes, treatment delays and growing staff and patient dissatisfaction. That is why this Government is committed to breaking the cycle of overcrowding in our health service and has again provided significant funding this winter for measures to relieve pressure on our EDs. This winter has been a particularly difficult one for our health services. During February, there was a 7.7% increase in ED attendances and a 5% increase in ED admissions, compared to February 2017. There was also a 9.5% rise in ED attendances and an 8.5% rise in admissions among those over 75 years of age in February, as compared to the same period last year. This increased demand was further exacerbated this month by the impact of Storm Emma and related severe weather across the country.

This growth in demand is well ahead of population growth and reflects international evidence that emergency department demand is driven by more than demographic factors. However, inpatient bed capacity to meet the growing demand is constrained, resulting in an 11.8% increase in patients waiting on trolleys compared to February 2017. As part of budget 2018, €40 million in additional funding has been provided to respond to winter pressures, of which €25 million has been ring-fenced for social care measures to reduce delayed discharges and improve patient flow from our EDs. These measures are being rolled out and include €3.5 million for 20 additional transitional care beds and €18 million for 45 additional home care packages a week in the system during the winter period.

In addition, the Minister for Health, Deputy Harris, recently approved a further €5 million in funding to deliver an extra 324 home support packages, HSPs, across 13 specific sites and an additional 50 approvals per week for transitional care beds, TCBs, for a six-week period across all hospitals to support hospital discharging in the aftermath of Storm Emma and associated adverse weather. Among the sites to benefit are Tallaght, St. James' Hospital, St. Vincent's Hospital, the Mater and Beaumont. As of today, approximately 190 additional beds have been opened this winter at St. Vincent's, Drogheda, Limerick, Waterford, Galway, Beaumont, St. James' Hospital, the Mater Hospital Dublin and Naas Hospital. Further beds are already funded to come on line throughout 2018, including new beds in Kilkenny, critical care beds in Cork and the Mater in Dublin, and as part of the development of a modular build for South Tipperary General Hospital.

While acknowledging the need for productivity improvements and reforms across the health service, the recently published health system capacity review outlines that in order to reach international standards of bed occupancy level, the acute hospital system needs additional beds front loaded. In response to this recommendation, the Minister has asked the Health Service Executive, HSE, to develop a plan to identify the location and mix of beds across the hospital system which can be opened and staffed by this November to improve preparedness for winter 2018-19 and relieve overcrowding in our hospital EDs. The Department of Health is working with the HSE to develop this plan as a priority.

We all wish for a better health service and improved hospital services. It is only though continued investment in capacity, in hospital staff and in reform of our health services in line with Sláintecare that we can deliver this. I assure my colleagues that this remains a priority for this Government and we will continue to work hard and stay focused on this issue.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I left my crystal ball at home but I did not need it because I could have predicted that the Minister of State would blame the storm, make a nod towards the staff, the patients and the disease profile. There is a real lack of accountability and sense of responsibility for this problem. The Minister of State does not have to take my word for it. The INMO publishes the figures. After seven years of Fine Gael in government the problem is getting increasingly worse.

When Fianna Fáil was in government 469 people on trolleys was declared a national emergency. Fine Gael has picked up that ball and run with it fairly enthusiastically surpassing the Fianna Fáil figures to reach 714 which is nothing short of disgraceful. The Minister of State did not acknowledge that. The transitional care beds and the investment are all to be welcomed. The Government does not need another bed capacity review or another report from the HSE. It can see that if there are 485 people on trolleys we are short 485 beds. That is very simple mathematics.

The Minister of State cannot dress this up or hide behind statistics. The simple fact is he has managed to preside over a health service that is not an attractive place for people to work in. Nurses, doctors and allied health professionals will tell one that. They tell me that. The Minister of State must be aware of that. There is a crisis in recruitment and retention, which is leading to a crisis in capacity, and there are no answers coming from the Government. I have been to the print room and have seen people from the Minister of State's party. They are voting no confidence in his ability to sort this crisis out. They are printing leaflets to give to their constituents to advise them on how they can get treated abroad. That is a vote of no confidence. They have no confidence that this will be improved. Judging by the words just uttered by the Minister of State, I would have no confidence that he has any plan to improve this. The plan is blame the weather and in the meantime, ask the HSE to devise another plan. It beggars belief.

Maurice Quinlivan (Limerick City, Sinn Fein)
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There is nothing in the Minister of State's response that I have not seen before. There is nothing in his response that helps anybody in Dooradoyle who is on a trolley. As I said earlier, we have the worst trolley crisis in history. It has been ongoing for years in Limerick. I think I will be standing here next year talking about the same thing. Nothing in the Minister of State's response will help people. We hear about how it is sometimes so overcrowded that the relatives of elderly patients on trolleys are not allowed to stay in the accident and emergency department so they have to leave before their relative is even admitted. We heard today that they are not getting any hot meals while they waiting and some are waiting for 20, 30 or 40 hours. A huge number of these people are older people. I need far more than the Minister of State's response and I ask that he forward my comments to the Minister with the request that the Minister stop ignoring my emails to him and arrange a meeting with me to discuss this matter.

Jim Daly (Cork South West, Fine Gael)
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I wish to clarify that I certainly did not blame patients, staff, the system or the weather but the facts are there. I know Opposition Deputies are not always interested in engaging with the facts. Soundbites and headlines make up easier discourse in which to engage but the facts are there. There are underlying challenges and I was merely outlining those challenges and the steps that are being taken to deal with them. A total of €100 million was put into the winter initiative this year. This is a fairly significant investment by any standards. It was designed and designated merely for access measures made up of €40 million for winter measures, €10 million for waiting list measures and a further €50 million for the NTPF for waiting list initiatives. This is not small change by any standards. A total of 189 additional beds have been opened this winter. Clearly, it is not enough but we are not going to open 721 beds. One does not open beds based on the number of people waiting on trolleys on any one day. We need a review and to look at capacity and where the pinch points are. It is not just a case of clicking one's fingers and opening beds so, of course, the HSE has a job of work to do to identify the issues. That is how systems are run and that is how an organisation like the HSE has to perform. It has to produce a report and carry out analysis. A total of 189 additional beds have been opened this winter. The Deputies opposite may not wish to hear this but some very significant steps are being taken towards alleviating the winter pressures. I had no difficulty in acknowledging that there was an 11.8% increase in the number of people waiting on trolleys this February compared to last year so we have no issue with accepting and acknowledging the challenges and there is no desire to hide from them. Of the 189 beds, 22 new beds have been opened in St. Vincent's University Hospital, 25 have been opened in Drogheda and 17 in University Hospital Limerick. These are new beds that have been opened this winter. This winter, 28 new beds have opened in University Hospital Galway, 19 in University Hospital Waterford, 20 in Beaumont Hospital, 23 in St. James's Hospital in Dublin, 24 in the Mater hospital and 11 in Naas General Hospital.