David Cullinane (Waterford, Sinn Fein)
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I move:

That Dáil Éireann:

notes with concern that: — 12,624 people were admitted to hospital without a bed and left on a trolley or elsewhere in ward corners and corridors in November, the worst November on record for overcrowding according to the Irish Nurses and Midwives Organisation (INMO); and

— on 29th November, the INMO identified that 660 patients were admitted without a bed, one of the single worst days on record;

further notes with concern:

— the findings of the INMO on the emigration intentions of student nurses and midwives which found that 65 per cent of nursing graduates are strongly considering emigrating, and 33 per cent are considering leaving the major cities in Ireland due to the cost of living; and

— that in 2021, 62 per cent of first-time registrants with the Nursing and Midwifery Board were non-European Union workers, which highlights the lack of supply and poor retention of Irish trained graduates; recognises: — that without adequate recruitment and retention of nurses and other healthcare professionals our health system cannot function, and conditions will continue to deteriorate for both patients and staff;

— that it is extremely difficult to encourage Irish-trained and qualified nurses, or other healthcare professionals such as general practitioners (GPs), back to Ireland, while there is such a chronic shortage of affordable housing to rent or buy; and

— the widely held belief amongst the public that the current Minister for Health, Stephen Donnelly TD, is incapable of addressing the crisis in our health service and has, along with the wider Government, been making the situation worse;

condemns:

— the failure of the Minister for Further and Higher Education, Research, Innovation and Science, Simon Harris TD, to ensure adequate numbers of training and course places for healthcare professionals;

— the failure of the Minister for Health, Stephen Donnelly TD, to address work related retention issues and training capacity challenges; and

— the failure of the Minister for Housing, Local Government and Heritage, Darragh O'Brien TD, for refusing to recognise the housing emergency, its impact on the health service and to take urgent action to increase the availability of affordable accommodation; and calls on the Government to: — commit to urgently review its current housing plan and increase its targets for social and affordable housing to rent or buy, alongside putting one month's rent back into private renters' pockets and ban rent increases for the next three years;

— offer a job guarantee to healthcare graduates;

— urgently identify, examine and consider all potential mechanisms to address the cost-of-living barriers to recruitment and retention of key workers, especially in urban areas; and

— immediately engage with general practice to ensure GPs are supported to take more pressure off hospitals and emergency departments, especially by expanding out-of-hours services, and engage with other primary care professions, such as pharmacies, to ensure late night options are in place across the State.

Eight long years since the incoming Taoiseach was Minister for Health, the health service is facing crises the scale of which we have not witnessed before: 1 million patients on waiting lists; a record 12,500 patients on trolleys in November 2022; and a health service that can only recruit half the staff it needs this year. These crises did not creep up on us or come out of nowhere. They are not a sudden once-in-a-century pandemic nor were they caused by that pandemic. These crises are years in the making and are the direct consequence of two decades of failed Government policy. They were caused by mismanagement of the health service, the housing market and the higher education sector by successive Fianna Fáil and Fine Gael Governments. It did not put the capacity in when it should have, it did not build enough homes when it could have and now it is failing to train anywhere near enough graduates to safely staff our health service. I am afraid patients are now paying the price for that. The consequence of these failures is another generation of talented young graduates who have been trained for export. When is this Government ever going to learn?

The first problem is that we are not training and recruiting enough healthcare professionals and the Minister for Health has accepted this many times. The Government has finally accepted this belatedly but looking at the Minister's amendment to this motion, which brags of a paltry 135 additional nursing places this year, it is clear that he lacks the ambition and vision needed to tackle this problem.

The second issue is retention and this applies right across our health services. There are many reasons so many healthcare workers leave the health service and even our country. There is a severe lack of capacity, they do not have the tools or staff to do the job properly, hospitals are overcrowded and working conditions are appalling. We see it with children's disability network teams and in many other areas where we simply cannot recruit the staff that are needed to provide children and patients with the services they need.

However, there is now a much more fundamental problem driving our graduates abroad and that is the housing crisis. According to a survey by the INMO, two in every three nursing and midwifery graduates are considering emigration. One third directly named the cost of living and the housing crisis as reasons they are considering changing to a workplace closer to their family home. There are major reasons many healthcare workers of all ages across professions are considering emigration. When he became the Minister for Health, the Tánaiste vowed to bring our doctors and nurses home and he failed. When Deputy Harris became Minister for Health, he promised to make sure that every nursing graduate got a job and he failed. When the current Minister for Health assumed office, he made the same hollow commitments, which have not been followed through with the action we need. When the Minister for Housing, Local Government and Heritage assumed office, he promised ambitious targets for affordable homes, yet not a single affordable home to buy was delivered in 2020 or 2021, with only a trickle expected this year.

It is not only new graduates who are being driven to emigrate by the housing crisis.

One nurse living in County Louth wrote to me, stating:

I'm 33. My husband is 34. We both live in the garage of my parents' house. We're considering emigrating next year. Australia has so much more has so much more to offer - better working conditions as a nurse, better opportunities to save and a better lifestyle. It is a shame, as Ireland is our home, but we will never make it on to the property ladder by staying here.

The housing crisis is also stopping students from even completing their courses. In the words of one former student nurse:

I was studying and training to be a nurse in Dublin. The rent was extortionate for a bed in someone's shed. I was waking up at 4.30 in the morning to commute to Dublin to be there for 7.30 for my shift. I finished at 8.30 p.m. and arrived home at midnight to get up again at 4.30 the following morning. I dropped out due to sheer exhaustion. If the rent was cheaper or if there was some form of affordable housing, I may have continued my studies and I may have qualified.

The Government's failure to tackle the housing and the cost-of-living crisis is forcing young nurses and midwives to emigrate, stopping others from coming home and preventing others from even qualifying in the first place. If that is not a disaster or an emergency, I am not sure what is.

Sinn Féin has a plan to fix the housing crisis and to deliver more affordable homes. We have a plan to cut rents and freeze them. We would increase targets for social and affordable housing to rent and buy. We would put one month's rent back into renters' pockets and ban rent increases for the next three years. We also have a plan to fix the health service. We would increase the number of healthcare training places and give a job guarantee to healthcare graduates, including those who go abroad, so we can entice them back. We would invest in hospital equipment. We need more beds and more surgical theatre capacity. We must give those in our healthcare sector the tools to do the job. We would address the cost-of-living barriers to the recruitment and retention of key workers, especially in urban areas, in sectors like housing, transport, energy and childcare. Sinn Féin would invest in healthcare capacity to give workers the tools to do the job and give patients the dignity and the health service they deserve.

Pearse Doherty (Donegal, Sinn Fein)
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Gabhaim buíochas leis an Teachta Cullinane as ucht an rún seo a chur os comhair na Dála anocht. I had to double-check these figures, but last month, 1,108 patients at Letterkenny University Hospital, LUH, languished on hospital trolleys without beds. That is a disgrace. It is the third most overcrowded hospital in the State, and the situation is getting worse by the week. When Fine Gael took office back in 2011, there were 81 patients without access to LUH that November. In November 2022, there were 1,108. That is a disgraceful figure and shows just how out of control the health service has become under both Fine Gael and Fianna Fáil. This level of overcrowding is dangerous not only for staff but also for patients. Yesterday, LUH announced it was cancelling elective surgery due to pressure on bed availability. Patients, nurses and hospital staff deserve better. On a local radio station we heard a mother, Tanya, speak about her son, Oisín, who has cerebral palsy. He waited for 32 hours in the hospital without getting a bed. Eventually, Tanya was so tired and distressed at seeing her son in that situation that she took him home, only to be told later that he had pneumonia. She did not risk going back to that hospital, because it was over capacity and under serious stress. She only had praise for the doctors and nurses in the hospital, who are run off their feet. Tanya and Oisín's story is all too familiar to us in County Donegal and elsewhere.

The overcrowding has created conditions that have caused a recruitment and retention crisis to deepen. This vicious cycle needs to be addressed. The housing failure of the Government has now seeped into every corner of our public services, including our hospitals. A recent survey published by the INMO found that two out of three nursing graduates are considering emigrating. Our nurses deserve better than that. They deserve to be able to look forward to safe working conditions and an affordable place to live. The reality is that there are issues with recruitment and retention not only in Dublin, but also in rural parts of County Donegal. We talked earlier about how the Minister for Housing, Local Government and Heritage is failing. Let me say this again. There were 1,100 people waiting for a bed in LUH last month. That is a failure by any stretch of the imagination. The Minister needs to get his act together on behalf people like Tanya and Oisín who had to go home after waiting 32 hours in a hospital because they could not even get a bed.

Rose Conway-Walsh (Mayo, Sinn Fein)
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We must ask ourselves how we got to a point where we have the highest level of 25- to 29-year-olds being forced to live with their parents. Some 60.9% of that age cohort do not have a place to live independently. That is almost double what it was previously. That is shameful. Over 5,000 leaving certificate students put nursing or midwifery as their first preference on their CAO application. It is not that young people do not want to become nurses and midwives; it is that the State is failing to provide training. We have both the need and the demand for these course places. That is why Sinn Féin would increase the number of places by 250 this year and continue to increase numbers until there are 2,500 new entrants annually. Almost 4,000 students enrol in pre-nursing courses every year with little hope of being able to study nursing at degree level. We are absolutely failing them. If a student enrols in a pre-nursing course, they are interested in nursing and want to be a nurse. There is every chance that they would make an excellent nurse. Yet, we do not give them the opportunities.

I also want to raise the issue of the lack of home care and home care workers. A woman in my constituency, who is an amputee and a wheelchair user, was discharged from a HSE nursing home at the end of November without any care package. Only later was she informed that the home care package had been agreed on paper, but they have no one to cover her area. Since coming home she has had two falls from the wheelchair, one at night, when her wheelchair landed on top of her. Thankfully, she was able to use her panic button. She is now back in hospital again. I am working with other people who are essentially stuck in hospital because they have no home help hours that would allow them to go home. Some have even been charged for the extra time they have had to spend in hospital. I know the staff in the home care units are going above and beyond, but the system is falling apart. The reason it is falling apart is that we have not planned. We have not planned for the labour required. For every little thing that is done at this point, the Government spends more time patting itself on the back than it does sorting out what needs to be sorted.

Thomas Gould (Cork North Central, Sinn Fein)
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Last week it was announced that the new elective hospital in Cork will be based in Glanmire. That is something I welcomed. However, I was disappointed to learn that it will not be open and operational until 2027. There are tens of thousands of people in Cork on the waiting lists for elective surgery. It is not good enough that the earliest opportunity they will have to access treatment is 2027. We need action to be taken now. The delivery of the hospital must be fast-tracked because those people need to be treated right now.

There is another issue that I wish to raise with the Minister. On 31 December, the GP from the Ashdale Centre in Blarney is retiring and the clinic is closing down. That is only a symptom of the whole crisis in GP services at the moment. I am told that GP services are closing because they cannot get any cover, and GPs are not getting the support they need. GPs are operating as businesses. They should be concentrating on providing healthcare, and not worrying about profit and loss. That is something that the Minister has failed to tackle. When one looks at the number of young doctors who are leaving these shores, one sees that hundreds of them have left this year alone. What are the Government, the Minister and the HSE doing?

I will finish on this point. The funny thing is that the Fine Gael health spokesperson, Deputy Colm Burke, has stated that he regards the treatment of young doctors by the HSE as the reason they are leaving. He has also stated that the HSE fails abysmally in workforce planning, postgraduate training and retention strategies. It is on the Fine Gael website; the Minister can look it up. Fine Gael has been in power for 11 years, and Deputy Burke has said the HSE and the Department of Health need to wake up.

David Cullinane (Waterford, Sinn Fein)
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He is right.

Réada Cronin (Kildare North, Sinn Fein)
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For our health service to work, the professionals who work in it should be able to live in a decent home and make a decent living out of decent wages. Right now, that is not happening, as swathes of our most talented and committed healthcare workers are being forced to emigrate because they know they cannot afford to buy or even rent a decent home. The rents they are paying for shared shoeboxes are crippling them. No matter how hard they work, the wages they are earning are just not enough to have a comfortable life in Ireland.

None of them is looking for luxury here. A decent home and a good job with a decent wage that will help make ends meet is, however, a level of comfort healthcare workers should expect in the 21st century. The Government could take action to address this. We saw how fast it moved recently to work for and indulge big bankers. Despite the inextricable link between the crisis in housing and the crisis in healthcare, however, it is choosing not to do so. Waiting lists are heaving because the housing crisis affects the healthcare crisis. They are packed with people like the young person who contacted me out of the blue. She had a series of seizures in 2021. She was sent home from the accident and emergency department and told to see what happens. What happened was more seizures and she ended up back in the accident and emergency department. This time, she was put on epilepsy medication and added to a waiting list to see a neurologist. Now, 21 months later, she still has not seen that neurologist. She has had no change in drugs and no proper diagnosis, which means she cannot drive and her life is completely on hold. This young person, a student teacher as it happens, has her whole life ahead of her but because of the absolute state of our waiting lists, she is stuck and worried that her condition is deteriorating. Going private - if she could afford to do so - is not an option. The private neurologist cannot see her because her own waiting list is so long. We do not have enough neurologists. We do not have enough medical graduates, junior doctors or nurses. They are all leaving because of the disaster that is our housing policy. That problem is going to get worse.

Johnny Guirke (Meath West, Sinn Fein)
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We all know the health service faces many issues from young healthcare graduates emigrating with very many not intending to come home, and more leaving Ireland because of the costs of housing and rent and the cost of living. As the Minister knows, the biggest issue in my county is the downgrading of the emergency department and ICU in Navan. Last Saturday week, there were 11 ambulances parked outside Our Lady of Lourdes Hospital, Drogheda, because there were no beds or trolleys for people inside. I know that 17 consultants wrote to the HSE, although I am not sure if they wrote to the Minister as well, stating that it was not safe to divert patients from Navan to Drogheda and that if it happened, it could cost lives. The consultants also stated that Our Lady of Lourdes Hospital was 16 doctors short, there was no way they could cope with the extra patients and the move would result in the loss of life.

We heard that from tomorrow, ambulances are to be bypassed from Navan to Drogheda. A review was completed two months ago and we, the elected representatives, do not have a clue what is in it. We complained from day one that the option of protecting, enhancing and investing in the emergency department in Navan hospital was not included in the review. We were very disappointed with that. We are hoping it will not happen but the only thing in the review is how best to close the emergency department and ICU in Navan hospital. That is not good enough.

As the Minister knows, we are surrounded by hospitals that are under extreme pressure. Does it not make more sense to protect and enhance the emergency department in Navan, thereby taking the pressure off Connolly Hospital and the hospitals in Drogheda, Cavan and Mullingar? In 2017, the HSE wanted to close the emergency department in Portlaoise general hospital and there was uproar from the politicians in County Laois. All we ask is that we get the same opportunity as people in Portlaoise did to protect, enhance and retain the services in Navan hospital. Perhaps if we had three Ministers in our county fighting our corner as hard as Ministers fought in County Laois, we would be able to attend our services. I ask the to address that.

Paul Donnelly (Dublin West, Sinn Fein)
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We are here again, as we have been countless times, discussing the health crisis and the healthcare system. Each time, the Minister tells us of a plan he has to sort out the crisis and time and again, these plans never achieve their stated aims. We have told the Minister countless times in this Chamber what needs to happen to fix the waiting list and trolley crises and the lack of doctors and nurses and asked him to look at the housing crisis, which has caused many of these problems in recent times. The Minister has nodded, as every Minister does in every situation, and agreed that this needs to be done but, unfortunately, nothing happens.

We now have a cost-of-living crisis that is driving our badly needed doctors and nurses to emigrate. They cannot stay and work in Ireland due to high rents, high costs of living and the staggering costs of owning a home. Parents have contacted me countless times regarding child and adolescent mental health services, CAMHS, because their children have been on waiting lists for years. Let us think about that. These are child and adolescent mental health services and young people are on waiting lists for years. That is absolutely appalling.

When are we going to be presented with a comprehensive plan to fix the health system and provide one that delivers for all and not just those with the ability to pay? One of the most shocking developments in recent decades has been that while people with money can get access to health services, those without money must wait. That is a shocking indictment of this society and Governments that have created a two-tier society.

While not directly related to this debate, I will refer to an issue that really affected me when I was outside Leinster House earlier. I cannot go without mentioning the horrific abuse in the St. John Ambulance Ireland organisation and the need to immediately publish the report on the matter, as requested by the victims who stood outside in the freezing cold for hours. Nobody should have to stand outside the seat of Government and ask for a report that has already been vetted by a senior barrister. We have already been told it should be published immediately. What is the delay? I appeal to the Minister to ask the people in charge at Cabinet to do so. I believe the matter falls under the remit of the Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman. Will the Minister please find out what is causing the delay? These people have suffered enough and should not have to suffer any longer. They want the report published immediately and that should be done.

Stephen Donnelly (Wicklow, Fianna Fail)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following: "recognises:

— the invaluable work carried out by our health and social care workers in providing health services to patients;

— that record funding has been provided to permanently increase capacity in our health service, and this year's budget is €22.2 billion (2022), up from €14.8 billion in 2018;

— emergency departments (EDs) are currently experiencing significantly increased demand due to a combination of factors including the circulation of a respiratory syncytial virus (RSV), flu, Covid-19 and Streptococcus A;

— ED attendances were 1,319,367, up 7 per cent compared to 1,232,992 for the same period in 2019, and 14 per cent higher than the five-year average (2017-2021) for this period; and

— admissions from ED were 332,509, up 3.4 per cent compared to 321,523 for the same period in 2019, and 8 per cent higher than the five-year average for this period;

notes:

— that there has been a significant increase in hospital bed capacity, with an additional 934 acute beds provided since 2020;

— that very significant funding of €77 million has been provided across 2021 and 2022 to add an additional 85 critical case/intensive care unit beds, which has delivered a 25 per cent increase in critical care capacity since 2020;

— that the health workforce is continuing to grow at an unprecedented rate and is on track to grow by 4,600 this year, and this will be the third highest annual growth in the workforce after the large record increases seen in 2020 and 2021;

— that there are 16,275 more people working in our health service than there were at the beginning of 2020, and this includes 4,592 nurses and midwives, 2,654 health and social care professionals and 1,758 doctors and dentists;

— that Budget 2023 provides additional funding to expand the workforce by a further 6,000 in 2023, and work is underway to identify priority posts and expedite recruitment so that the initiatives included in the Health Service Executive (HSE) National Service Plan can be delivered;

— the HSE Winter Plan for 2022/23, published in October, which is supporting acute and community services this winter, is estimated to cost up to €169 million to implement, and adopts a bottom-up approach with bespoke individual local plans that seek to address hospital specific issues in conjunction with Community Health Organisations (CHOs);

— the Enhanced Community Care (ECC) programme is a suite of strategic reform initiatives, which seek to reduce dependency on the hospital system by delivering increased levels of healthcare provision in the community setting, with service delivery reoriented towards general practice, primary care, and community-based services;

— the ECC aims to prevent referrals and admissions to acute hospitals where possible, and to facilitate early discharge from acute hospitals where it is safe to do so;

— the key elements of the ECC programme include:

— the rollout of 96 Community Healthcare Networks (CHNs) across the country;

— 90 of the planned 96 CHNs are now established and operational, with over 2,158 staff recruited to the ECC programme to date;

— 33 Community Specialist Teams (CSTs), which provide services to older people and those with chronic disease in the community, have been established; and

— significant investment has facilitated national coverage of Community Intervention Teams (CITs), which help prevent unnecessary hospital attendances and admissions, with 21 teams across all nine CHOs operational and providing services to local communities;

— that in the year 2022 to date, our nursing and midwifery workforce has grown by 1,220, and an Organisation for Economic Co-operation and Development (OECD) report in 2021 saw Ireland ranked 4th among OECD countries for having the highest number of practising nurses per 1,000 people;

— that as of 1st June, 2022, there were 81,431 nurses and midwives on the Nursing and Midwifery Board of Ireland (NMBI) Register, which is the highest ever number;

— recruitment capacity is expanding to ensure that ambitious workforce targets can be met and to maximise the numbers recruited, and this has included the expansion of international recruitment markets, targeted recruitment campaigns and streamlined recruitment processes;

— that since 2019 all Nursing and Midwifery graduates were offered permanent contracts, and this will continue into 2023, also all Health and Social Care Profession graduates who applied for the HSE national campaign were offered permanent positions and this will continue into 2023;

— the Sláintecare public only consultant contract was recently approved by the Government, and the new contract will have a significant impact on the delivery of care, with the working day extended to 10 p.m. and the working week extended to include Saturdays, ensuring that care will be provided when patients need it most;

— that consultant numbers have increased significantly and in the year to the end of October 2022 they increased by 254 to 3,837, the highest number ever, and by nearly 600 since the end 2019, equally, it is recognised that consultant numbers remain low by international standards;

— the non-consultant hospital doctor workforce has increased significantly, and at the end of October it stood at 7,978, over a thousand more than when the Government took office; and

— the Minister for Health has established a National Taskforce on Non-Consultant Hospital Doctor Workforce to address doctor training capacity and retention issues; and

further notes that:

— Ireland, like many other countries, is heavily reliant on international health care workers and the Government is seeking to significantly increase domestic supply production of graduates across all healthcare disciplines;

— in July 2022 the creation of an additional 200 places per annum in medicine was announced, with the first 60 of these places being introduced in September 2022, and the number will grow to 120 in September 2023;

— 135 additional places were also made available across nursing programmes starting from September 2022, with Government seeking to double the number of nursing and midwifery students in the coming years, and Professor Tom Collins is chairing the joint working group on Nursing under the Funding the Future structures, with membership from the Department of Further and Higher Education, Research, Innovation and Science, the Higher Education Institutions, the NMBI, HSE and the Department of Health;

— the Higher Education Authority (HEA) recently conducted an expression of interest from higher education institutions interested in building capacity in dentistry, pharmacy, medicine, nursing, and veterinary from academic year 2024-25 or 2025-26, with recommendations on capacity increases due to be brought to the Minister for Further and Higher Education, Research, Innovation and Science by the end of quarter one of 2023;

— the HEA plans to use a similar process early in 2023 to build capacity in therapy areas;

— both the Department of Health and Department of Further and Higher Education, Research, Innovation and Science are strongly committed to supporting the health of the population through the provision of graduates with the key competencies and skills to be effective;

— in 2021, following the publication of the independent review of clinical placement allowances for student nurses and student midwives, conducted by Sean McHugh (McHugh Review), the Minister announced a number of temporary measures to provide significant additional supports to student nurses and midwives while on clinical placements, and these were worth €12 million;

— the number of general practitioners (GPs), contracted by the HSE under the General Medical Services (GMS) scheme has risen from 2,098 in 2008 to 2,529 in November 2022;

— the number of GP training places has more than doubled in recent years, up from 120 in 2009 to 258 places filled in 2022, and the Irish College of General Practitioners aims to have 350 training places available for new entrants per year by 2026;

— the 2019 Agreement between the Department of Health, the HSE and the IMO regarding GP Contractual Reform and Service Development demonstrates the Government's determination to invest in general practice to ensure that it retains its place at the heart of the health service, and that it remains an attractive option for medical graduates, and as of November 2022, 93 per cent of GMS GPs have signed up to the 2019 agreement;

— the 2019 GP agreement has seen additional investment in GP services of €206 million per year, this will increase to €211 million per year from 2023, representing an increase of 40 per cent on pre-2019 expenditure;

— significant increases in capitation fees have been introduced for participating GPs, a 48.5 per cent increase, as well as additional fees and subsidies for new services;

— the Rural Practice Support Framework rate for eligible GPs has been increased by 10 per cent;

— a €2 million annual fund for GPs in areas of urban deprivation has been introduced;

— under the Government's Housing for All - a New Housing Plan for Ireland, the supply, which is key to improving our housing system, is increasing, and a substantial uplift in housing supply is expected in the coming years;

— this year, the target is for the delivery of 24,600 homes, and the Government expects to exceed this target, with some 28,000 dwellings forecast to be completed, and in the period January to September 2022, 20,807 new homes were completed, more than for the full year in 2021;

— while this is very positive, the Government acknowledges that issues have emerged over the past number of months, including those arising from the war in Ukraine, with unprecedented inflationary pressures and rising interest rates having an impact on the momentum of home delivery;

— the Government is responding to these challenges and on 2nd November published its first annual update of the Housing for All plan, which focuses on priority measures that will improve viability and accelerate supply, across all tenures; and

— coupled with record State investment of €4.5 billion in 2023, this will ensure the ambitious 2023 targets, and the targets for the following years, will be met.

I thank the Deputies for tabling the motion and giving us the opportunity to discuss the real challenges facing patients and our healthcare workers and the real progress that is being made in our health service.

When it comes to healthcare, of course, everything must start and end with the patient. I assure Deputies of my absolute determination to achieve a vision to which we are all signed up, namely, universal healthcare and a public healthcare system in which everybody gets access to good quality care when they need it regardless of how much money they earn, their gender or where they live. To achieve this we need a very strong healthcare workforce. I recognise the very valuable work carried out by our health and social care professionals for so many citizens every day right across the country. We need sufficient numbers of these highly trained professionals, each of whom should be working at the top level of his or her training.

There are more than 16,000 more people in our healthcare service now than there were at the start of Covid-19. That is more than 5,500 extra nurses and midwives, more than 2,600 health and social care professionals and more than 1,700 more doctors and dentists. This will be the third year in a row of record recruitment into the HSE, which is an issue on which I ask colleagues to reflect. While we need to hire many more people, this year will be the third year in a row of record recruitment since the foundation of the HSE. That is an important achievement.

Earlier today, I announced a new €9 million package for student nurses and midwives that includes an annual allowance for meals and subsistence, increased accommodation allowances and increases to be paid to interns, fourth-year nurses and midwives. My understanding is that this measure has been positively received.

Last week, the Government approved a new public-only consultant contract. I acknowledge Deputy Cullinane's public support for that. It is important that a strong message comes from the Oireachtas that it stands behind this contract, and I recognise Sinn Féin's support for it.

I set up a task force on non-consultant hospital doctors, NCHDs. Good progress was made last week, and additional progress will be made in the coming weeks and months to fundamentally overhaul how NCHDs are treated in the public health service. Their treatment is completely unacceptable and must change. That change has started. We have a long way to go. We all want Ireland's public health service to be recognised as one of the best places in the world for doctors to come to train and stay.

Of course we need to do more. We need to set Ireland on a path of self-sufficiency when it comes to having enough healthcare professionals in the years and decades ahead. Deputies across the floor are right that we do not train enough healthcare professionals in this country. In fact, we do not even come close. We need to radically increase the number college places in healthcare in Ireland. I believe we need to double them.

In July, the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, and I announced the creation of an additional 200 medical places per year. That will be phased in. There will be an extra 135 places for nursing from September. We have more than doubled the number of GP training places and will keep increasing that year on year.

I met recently with senior teams in four universities to discuss this vision of doubling healthcare college places. I was impressed and pleased at the reaction. There is a real appetite from the third level sector to grow and expand college places in medicine, nursing, midwifery, health and social care professionals, dentistry, pharmacy and across the board. We need a radical approach to this.

I acknowledge the serious pressures faced in emergency departments by patients, their families and healthcare workers. We are not unique in this. Deputies across the floor will be aware of the pressures faced in other jurisdictions around us, namely, Northern Ireland, England, Scotland and Wales. The number of people attending emergency departments has gone up a lot since before Covid. This is particularly the case among older people, who are coming in with more complex needs, who need more care and who tend to stay in hospital longer.

I was surprised that the Sinn Féin motion does not mention Covid. There are pressures. I am the first to admit it and I am spending every hour of every day working to make things better for patients and healthcare workers, but to table a motion like this after the worst healthcare crisis in the world in 100 years and not mention the pandemic lacks credibility. Right now, we are dealing with Covid, flu, RSV, strep A and all the usual winter pressures.

David Cullinane (Waterford, Sinn Fein)
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It is about recruitment. Covid did not stop recruitment.

Stephen Donnelly (Wicklow, Fianna Fail)
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We have addressed recruitment, but the motion refers to emergency departments as well. It is not credible to talk about emergency departments pressures without referring to Covid. Combining the numbers for Covid, flu and RSV about a week ago, there were about 800 patients involved. We are seeing significant increases.

There are things we can do and are doing. On vaccines, for example, I was happy to see that new reporting from the ECDC shows that, as of 2 December, Ireland has the highest uptake of vaccines for the 60-plus population, for which our healthcare professionals and those who take the vaccines deserve great credit. The winter plan is helping. We would love to see more, but a lot is happening. There has been a significant increase in the sanctioning of emergency medicine consultants and healthcare professional and nurses in emergency departments according to the safe staffing framework. The winter plan funds the recruitment of an extra 600 staff, which is relevant. It increases the work of community intervention teams, GP out-of-hours services and supports, community and acute diagnostics, which has been a success, and the expansion of ambulance services.

While there is nothing normal about the pressures faced by our emergency departments at the moment in the context of Covid, post Covid and all of that, we all know we need a healthcare service with sufficient capacity and working in the right ways to cope with normal winter pressures. We have not had that for a very long time. That is what we are building up capacity to do. What have we done? Since the Government was formed, we have added over 900 hospital beds and increased ICU capacity by about a quarter. We are ahead of the Sláintecare target profile for hospital beds and will keep going. We have caught up and are on target for ICU beds.

Is all this investment making a difference where it really matters, namely, not just in emergency departments but, as Deputies have referenced, with regard to waiting lists? Yes. We focused on people waiting too long, that is, numbers waiting more than 18 months, 12 months, six months or in the context of the targets set out in Sláintecare. Good progress is being made as we come out of Covid. For example, the number waiting more than a year for outpatient appointments over the past two years has gone down by a third despite Covid. For inpatient and day cases, the number waiting more than six months in about the last two years has gone down by about a third. The biggest improvement has been in patients waiting for scopes. The number waiting more than six months in the last two years is down by more than 70%.

Are we where we need to be? No, because we are all signed up to the Sláintecare targets, but significant reductions are being seen as we come out of Covid and capacity becomes available. We have a long way to go. Particular areas are doing very well. I presume Deputy Cullinane took the lead in writing the motion, so I will go to the example of University Hospital Waterford, the Deputy's local hospital.

David Cullinane (Waterford, Sinn Fein)
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It has a number of great Teachtaí Dála who have facilitated its success.

Stephen Donnelly (Wicklow, Fianna Fail)
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I was there recently and was really impressed by the management team and the clinical team. This Saturday, University Hospital Waterford will have gone 1,000 days without having a single patient on a trolley.

David Cullinane (Waterford, Sinn Fein)
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That is down to good management.

Stephen Donnelly (Wicklow, Fianna Fail)
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It is down to good management. It is down to excellent leadership by management and by some of the consultant teams. They have some of the resources they need. In Waterford hospital, the outpatient list has come down by more than 20% in the past year. Over the past two years, it has added more than 200 staff and opened a see and treat gynaecology clinic. Last November, there were women waiting more than two years for gynaecology appointments. In Waterford, that has gone from 24 months to nine. It continues to fall. The new cath lab will be open soon. There is a new modular built emergency department, ophthalmology theatre, MRI replacement laboratory extension, outpatient build. When I was there we spoke about a new 160-bed ward block. That is one hospital and one example.

I fully accept that we have a long way to go. I see the pressures every day for patients, but let us think of the progress being made. Progress like that is being made across the board. We have to back our healthcare workers, invest, grow the workforce and help them run the service as well as possible because other hospitals are capable and others are doing what Waterford is doing. We know much more progress needs to be made but really good progress is now being made. My job, as well as that of Government and of us all here, is to keep doing what is right to get patients care when they need it.

Johnny Guirke (Meath West, Sinn Fein)
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What is happening in Navan?

Stephen Donnelly (Wicklow, Fianna Fail)
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I will give the Deputy a brief to the side, if that is helpful. It is not part of the motion, but I am happy to talk about it.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I was interested to hear the Minister’s comments on Waterford hospital. I wish everybody who uses that hospital all the best. The Minister praised the management team there. I wish I could say the same for my hospital, University Hospital Limerick. I have been talking about it probably on a weekly basis since I was elected in 2016 with different health Ministers through Topical Issues, priority questions, Questions on Promised Legislation, committees or anywhere I could raise the issue.

One figure I want to give the Minister, to repeat and to repeat repeatedly is that this year so far, 16,904 people have waited in trolleys in Limerick. That is a scandal. There is no other trolley count anywhere close to these figures There is no plan to get us out of it. We will build a 96-bed unit which the Minister and the HSE have confirmed to me will deliver 48 additional beds. They will not solve the problems and they will not come for a number of years.

I have had difficulties with the management at the hospital in the past. I do not believe they are up to the task. I have said it on numerous occasions. I have said it to them at meetings and have said it in here. We hear Waterford has good management structure and it seems to have an impact. Limerick has a major issue with capacity and the amount of people. A total of 76,470 people attended in 2021. Today, we reached the shocking figure of 16,904 people on trolleys. I will keep raising this number because it is not just a number. These are people. Sometimes they are close family members or neighbours of mine. They are older people and younger people. The concern I have is one that nurses told me well before the current Minister for Health took office. Nurses have told me to that older people are dying unnecessarily in our hospital all the time because they are lingering on trolleys for way too long.

Older people are dying unnecessarily in our hospitals all the time because they are lingering on trolleys for way too long. Something has to be done. There has to be some sort of a critical emergency intervention. We have had a HIQA report, the Deloitte report and a huge number of other reports. We hear that plans will be made, but that is of no comfort to people. There is not a single day that I do not get phone calls from families in utter distress. These include elderly patients especially and children who are waiting in University Hospital Limerick. These are particularly older people who are abandoned in our hospital, and it is simply not good enough. The Minister will remember the 16,904 people

Chris Andrews (Dublin Bay South, Sinn Fein)
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Housing and health have become intertwined into one big mess and that has happened on Fine Gael and Fianna Fáil’s watch. Government policies in health and housing over the past decade have brought us to a crisis. We are now facing a brain drain from the health service like we have never seen before. A perpetual crisis in the health service under this Government is forcing nurses and midwives to emigrate. A staggering 65% of nursing graduates are considering emigrating. A third of them have already been approached by overseas agencies for recruitment abroad. When I speak with staff who are working in the National Maternity Hospital, Holles Street, and St. Vincent’s Hospital, Fairview, in my constituency in Dublin Bay South, the loss of healthcare staff to emigration is the number one concern they raise with me. Nurses and midwives working in these hospitals should be able to live relatively close by. It is just not right that they are completely priced out of the housing market. It is not right that these essential workers are forced to commute for hours to reach work each day. The rents and prices around St. Vincent's Hospital, Fairview, and the National Maternity Hospital, Holles Street, give staff no hope. The high-tech boom has contributed to the forcing of staff and working families out of their communities. These essential workers do incredible work every day caring for patients but year after year the Government fails to look after them. We need to see a step change in how the Government views nurses and midwives. We all remember the last Minister for Health, Deputy Harris, and his comments around financial penalties against striking nurses and for nurses and midwives who are merely seeking better conditions.

Sinn Féin has a plan to fix the housing emergency. Sinn Féin also has a plan to fix the health emergency and we need a change of Government for that to happen. I agree with my colleague, Deputy Paul Donnelly that we must ensure the Geoffrey Shannon report on the St. John Ambulance is published as a matter of urgency. St. John Ambulance should not be allowed to sit on this particular report. Sex abuse survivors should not be silenced.

Johnny Mythen (Wexford, Sinn Fein)
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Healthcare workers are the backbone of our health system. When we talk about the severe and persistent issue due to Government failure without within our health system we primarily think about the impact on patients. However, we should also consider the intense pressure and stress levels involved in working in such a broken system. This is what our healthcare staff contend with on a daily basis to keep our health system going. This emergency is experienced across all regions of the country. This week alone, there were 22 patients on trolleys in Wexford General Hospital. Less than two months ago, consultants in emergency medicine at Wexford General Hospital stated that the emergency department is under ferocious pressure and is currently seeing between 160 and 180 patients per day. The new 96-bed ward that had been promised by the Government for the hospital must be delivered on time. However, the problem will be with retaining and recruiting the staff to operate these beds. This must be integrated into this planned extension and must be fully guaranteed by the Government. Our health service would not function without the hard work and commitment of our trainee nurses. In a fully staffed, well-functioning national health service, the only pressure that trainee nurses should be under is worrying about securing their degree. Despite the best efforts of teaching hospitals and staff, student nurses are coming under more and more pressure from heavy workloads and the enormous rising rents and accommodation, not to mention the cost of living. This is not right. After exhausting, sometimes double shifts, healthcare staff exit the hospital door and walk straight into a crisis in housing and the cost of living. People wonder why so many choose to emigrate. Average rents in County Wexford are now €1,211. The pandemic bonus payment, which was supposed to reward all our healthcare staff for working under extreme conditions, still has not been paid out to some. The housing disasters are preventing many healthcare workers from returning home to Ireland and it is contributing to young graduates exiting as soon as they qualify. Those who manage to stay here are barely keeping their heads above water.

It is a sad situation when you hear a Minister of State come into this House and quote my local newspaper that denigrates decent hard working councillors, making references to Mickey Mouse, when they are raising the same serious issues about how the housing crisis affects their constituents. The Government must take decisive, drastic action on these matters, as this motion calls for. We need a national health service that covers the whole of Ireland, all of the island, that values and pays good wages to the people who work in our hospitals and give world-class care to all our citizens.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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This motion tonight highlights the terrible situation our health system is currently in and puts forward real solutions that can assist in turning this around. A recent survey carried out by the Irish Nurses and Midwives Organisation, INMO, found that 65% of nursing graduates are currently considering emigrating due to the cost of living. This Government has failed to tackle the cost-of-living and the housing crises. This is forcing healthcare workers to emigrate and preventing many others from coming home.

On the children's disability network teams, CDNTs, a census was carried out by the HSE just over a year ago, which found that 30% of staff places are vacant. That has not been addressed during the year. The CDNTs are simply not capable, given this level of understaffing, of carrying out their role in the delivery of assessment of need and follow-on therapies for disabled children. Also, we know there are insufficient numbers of GPs. Constituents are telling me that they cannot get appointments in the local primary healthcare centre. They are ringing and ringing and no one answers. Eventually, if they get an appointment and get blood tests done, they have to then ring back in to get those results. Then they are referred to a doctor if there is an issue of concern. To me that makes no sense. Some people are giving up because they cannot get through and it is possible that serious issues are being ignored and are not being addressed.

The Minister has failed to put a workforce plan in place to deal with the issue of recruitment and retention in the health service and this has to be addressed. It is also the case that where you live determines what treatment you receive. A child in my constituency - and I have raised this issue with the Minister before - was informed that she could not receive an insulin pump because she was being treated in Cavan General Hospital but that she could receive one if she transferred her treatment to Our Lady Of Lourdes Hospital, Drogheda or to CHI at Temple Street. This motion also highlights the complete failure of the Minister for Housing, Local Government and Heritage, Deputy Darragh O’Brien, to tackle the housing crisis that has forced so many healthcare professionals to emigrate and to prevent them from returning. The Government has to commit to urgently review its current housing plan, to increase its targets for social and affordable housing for renting and buying, to reduce rents and to ban rent increases for a number of years. This also demonstrates a total failure by the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, to ensure that adequate numbers come through, as well as training and course places for healthcare professionals.

In reply to a recent parliamentary question, I was informed that in this academic year only an additional 17 places were created in physiotherapy and none was created in occupational therapy or in speech and language therapy. The Government must ensure that there are adequate numbers of training and course places for healthcare professionals to fill the major gaps in our health service workforce. It must urgently identify, examine and consider all potential mechanisms to address the cost-of-living barriers to recruitment and retention of key workers and offer job guarantees to healthcare graduates. I support this motion.

Catherine Connolly (Galway West, Independent)
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It is Christmas week so I will allow a little latitude if Members want to speak on this very important motion. I will suspend just for five minutes maximum to allow Members to come into the Chamber.

Paul Murphy (Dublin South West, RISE)
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I am sharing time with Deputy Barry. We have a crisis in our health service, as the motion states. According to the INMO, more than 12,600 people were without beds in Irish hospitals in November. It was the worst November on record for hospital overcrowding, and there were only two days in that month when fewer than 500 people were admitted to hospital without an inpatient bed. For the first time, there was a month in which more than 560 children were admitted without a bed in our hospitals. In my constituency, Tallaght hospital had 35 people on trolleys this morning. Recently, Drogheda hospital had 11 ambulances with patients queueing outside, not only because of a lack of beds but because of a lack of trolleys. More than 27,000 people left the State's emergency departments before being treated during a three-month period this year.

At University Hospital Limerick, 72 doctors recently signed a letter warning of persistent overcrowding and unsafe working conditions putting patients at risk. The letter highlighted several near misses at the hospital's acute medical unit, where doctors say patients almost died due to understaffing and a lack of medical cover. The letter states patients have had to wait more than ten hours for a bed in the unit without any medical attention, while other lost patients are sometimes missed and left unseen by a doctor for days. The doctors have made a protected disclosure detailing their grievances because previous warnings have not been acted on by the hospital and because of a climate of fear of retribution. Such is the state of the country's emergency departments and of our hospitals.

Waiting lists are a chronic problem. Recently, the Irish Hospital Consultants Association, IHCA, stated that one in 12 children in the State was on some form of hospital waiting list due to growing hospital staff vacancies and worsening capacity deficits. That is 98,000 children on some form of NTPF waiting list, with more than one in four of them waiting longer than a year for treatment or assessment in public hospitals. It also stated that 21 additional children had been added to waiting lists for scoliosis-related surgery since the start of the year. In September, the Irish Hospital Consultants Association, IHCA, stated that waiting lists might increase by more than 20,000 in 2022, instead of the target reduction of 132,000, while the Irish Medical Organisation, IMO, has warned that the winter plan has, increasingly, become a media exercise rather than a meaningful intervention to alleviate the year-round pressures on our health service. The president of the IMO has stated, “It’s now more about branding than a meaningful intervention to deal with the capacity issues, workforce crisis and patient waiting lists.” The yawning gap between Government rhetoric and the lived reality of all those people who experience the broken health service has never been wider.

Added to that is the housing crisis, which is also now having a major effect on the health service. The Dáil just voted confidence in the Minister for Housing, Local Government and Heritage. The consistently failed policies are going to continue, but the consequences are being seen in education and healthcare. The INMO has stated:

The lack of suitable available accommodation and increasing rents is having a hugely negative impact on our ability to retain nurses and midwives not just in Dublin but in other cities and towns where there is significant pressure on the rental market.

Affordable accommodation in close proximity to healthcare settings should not be a pipe dream for nurses and midwives who work long hours.

Many hospitals have land that is suitable for the development of such accommodation. We also need to give serious consideration to accommodation allowances for nurses and midwives working in urban areas to compensate for the high cost of rent and housing in our cities and large towns.

Approximately 200 nurses and midwives have remained absent on sick leave due to long Covid. It is shameful that the special leave with pay scheme was ended. The Minister for Health must ensure the incomes of the workers affected will be protected. The fundamental cause of all this is that there is a two-tier and fragmented health service and a chronic lack of capacity and staffing in emergency departments, acute and elective hospital services, ICU, public health teams, primary care and GP services, mental health, disability services - I could go on and on. We have one of the lowest number of public hospital beds on a population basis and the fewest specialist doctors per capita, both about 40% less than the EU average. Dr. Brian Turner of Cork University Business School has stated that the health service is having to ration care, through long waiting lists and wait times, as a result of serious capacity and resourcing deficits.

Thousands in the health service have still not received the Covid bonus. There is a dramatic underfunding and underinvestment in our public health service, yet this morning the Blackrock Clinic group reported that its income had increased by 21.5% in 2021 and that its profits had doubled. Just like with the housing crisis, a wealthy minority is doing very well. We need to invest properly in our public health service, take the Blackrock Clinic and other private hospitals into public ownership and build a single-tier, public, national health service, free at the point of use and funded by progressive taxation.

Mick Barry (Cork North Central, Solidarity)
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In this country, screening for bowel cancer starts at age 60. That is not nearly good enough. In France and Germany, it starts at 50, while the US Center for Disease Control and Prevention recommends that screening at 50 be reduced to 45. Ours is at 60, however, and 2,800 people are diagnosed with bowel cancer each year while 1,000 people die from it. I support the campaign being waged by my constituent, John Paul Ricken, who lost his wife Susan to bowel cancer. John Paul says this country is way behind the curve and he is correct.

He says there is a need for a big increase in public investment; he is right. He says that the screening age must be radically reduced in line with best practice internationally. The motion points to the trolley crisis, the emigration of nurses and health staff and the affordable housing crisis. To retain health staff, we need to get them housed near hospitals and health centres.

Clearly a fightback is needed. I urge health service workers and health service campaigners in this State to look at what is happening in Northern Ireland at the moment. On Thursday morning, I will travel to Belfast where I will spend the day standing on picket lines with health service workers, campaigning for real pay increases and to defend the National Health Service, a service that was won by the struggles of working-class people and built around the idea of a health service for people, not for profit, which would provide healthcare to all people from cradle to the grave. That health service has been run down by both Tory and Labour governments alike over the decades but in particular the past ten years of Tory rule where cuts in investment, lowering of pay and privatisation have been a disaster.

Of course, on the issue of pay, just as the Minister did in this State, Tory ministers praised health service workers as heroes and urged them to be clapped on the back while their conditions worsened. Workers on picket lines are suggesting if they worked in Tesco stores, their pay would not reduce much and it would be a much less stressful job for them. After ten years of austerity, they want inflation-busting pay increases. These strikes are not just about pay but also about defending the National Health Service. It is not possible to have a proper public health service when the staff are burned out. The service cannot recruit and retain staff. It is not possible to have safe levels of staffing because of the huge waiting lists and the stress the staff are under to provide the service.

The comments of the Tory Party chairperson that the strikes are divisive and would help Putin were disgraceful. Many Northern Ireland politicians will be on the picket lines for photo opportunities in coming days. All these politicians, including Sinn Féin politicians by the way, are supporters of the Bengoa report, which has been described by health service campaigners and trade union activists in the health service in the North-----

David Cullinane (Waterford, Sinn Fein)
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It is transformative.

Mick Barry (Cork North Central, Solidarity)
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-----as a blueprint for privatisation, which is what it is.

In the past month we have seen general strikes in Belgium and in Greece. What is needed now is a 24-hour general strike in Britain and Northern Ireland. That would involve co-ordination between workers in the struggling health service, the railways, the post office and elsewhere. It would also mean increased co-ordination of health service workers, all striking together on the one day. That is what is needed. That would be a real step forward and would be a step towards a 24-hour general strike throughout Britain and Northern Ireland. That is what is needed as a next step.

Seán Canney (Galway East, Independent)
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I am delighted both Ministers are here to listen to what is being said this evening. We have a crisis throughout the country in the delivery of services. We have waiting lists and all kinds of things going on. All Members hear about it in their constituency offices. What do we do about it? I want to focus on my region and the Saolta group, which serves more than 800,000 people.

In Galway, which is supposed to be the centre of excellence for cancer care, we are not able to deliver what we need to deliver. First of all, we do not have the infrastructure in place. The old emergency facility has been demolished and we have built a new temporary emergency department. We are going to plan for a major emergency department with a paediatric and maternity unit on top of that. We must also replace our labs in Galway and I have spoken to the Minister about this before.

Last week, the Minister announced the commencement of the process to deliver an elective hospital. All of this is going to cost money. If the Minister asks me where we will get the money, I will remind him that 25 years have passed since it was first mooted that Galway would become a centre of excellence. It was described as such by Government Deputies in the area at the time, but somebody forgot to pass the message on. The hospital was built in 1956. We still have the Nightingale wards with 12 beds and one bathroom. We have single bedrooms with no bathrooms in them. These are the kinds of conditions we have in Galway, which is trying to become a centre of excellence. We have a great deal of money to invest - I do not say “spend” - but we have to invest it.

In all, I believe we will be talking about €1.5 billion to get things right in Galway. It is not going to happen in time to save people’s lives if we continue at the pace in which we have been delivering infrastructure. For instance, the radiotherapy facility that is now being completed is 15 years in the making. That is something we cannot stand over in the future. Given the amount of investment that is needed in Galway, I suggest that the Minister needs to appoint a project management hit team that will set out a programme for delivery. Everybody in the team should be accountable for their actions to ensure the programme is delivered in a proper way.

The KPMG report said that we will be short 222 beds by 2030. We will be in 2023 in a couple of weeks’ time, so we have seven years to deliver on this infrastructure. The emergency department which is ready to take off has still not got the approval to go for planning permission, even though we have done the enabling works to set up the department and to get it running. We have been waiting for 18 months for a strategic assessment report to be finalised. If we continue along these lines, we will end up with more talk and less action.

I remind the Minister and the Minister of State that we have been seeking since 2017 to have an X-ray facility delivered into the primary care centre in Tuam. I know the Minister has given a commitment that it will be delivered some time next year. The X-ray facility in the primary care centre in Tuam, which was omitted from the design of the building, needs to be put back into it. The money for this has been sanctioned since 2017. I ask for a firm commitment that we will have no more delays on that.

Danny Healy-Rae (Kerry, Independent)
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I thank Sinn Féin for bringing this very important motion to the Chamber. It gives us a chance to highlight some of the needs and deficiencies in our constituencies. In County Kerry, and in Killarney in particular, we have a critical lack of GPs to service the needs of the people across a massive area. Over 4,000 extra people - refugees and asylum seekers - have landed into Killarney in recent months. Many of these refugees are mothers with young children. They need vaccinations and all of the things that children need. Not one extra GP has been dedicated to the town of Killarney. Dr. Gary Stack, Dr. O’Regan and others are under immense pressure. They were under pressure before this current situation because they were short of staff. As a result, more people are being directed to the accident and emergency services in University Hospital Kerry in Tralee. It is having an impact there as well.

I would like to raise a small matter in the context of the accident and emergency department. When people break or fracture a leg or a hand, they are directed by their GP to go for an X-ray. When they go for the X-ray, they are directed back up to the accident and emergency department to be seen by another doctor. This duplication and replication is not needed and is impacting the other people, including elderly people, who are waiting. There is no need for that. When a doctor gives a patient a letter saying that they need an X-ray, that is what they should get. They should not be clogging up the system; they should be given the X-ray.

I welcome the 132-bed hospital for Killarney Community Hospital. I raised this when I was a member of the health board ten or 12 years ago. I honestly feel I was the first to raise this matter at that time. I am glad to see this happen because we have great doctors and nurses in Killarney, Tralee and elsewhere in County Kerry. We need to give them the best modern facilities they need to make their work that bit easier.

We are clogging up the hospitals, including the district hospitals and University Hospital Kerry in Tralee, because of the lack of home help. People are being allocated home help hours but we do not have the people to come out and do the work. I have asked before for some of the refugees who have cars and have good English to be trained up to give them a purpose here. They are able to work like everybody else. I am asking for that to happen because I appreciate that people are very hard to get.

Mental health is a serious problem in our county. People are being let down. I know that suicides happen outside of the medical spectrum - they can happen unavoidably - but many people need additional mental health services, including one-to-one services. It is not good enough. What we saw with CAMHS in south Kerry, where a junior doctor was blamed, is being replicated elsewhere. It is being replicated in north Kerry even though that doctor was not there at all. This issue needs to be dealt with all over the country.

Ambulance cover is being impacted because people are on trolleys. When an ambulance arrives at a hospital and cannot unload the patient, that leaves somewhere else without an ambulance. We have had several instances where sick people have been waiting for over an hour, and for two hours in some places.

I am glad that Deputy Michael Collins and I initiated a system where we take cataract patients up to the North of Ireland. We have operated 106 or 107 buses since December 2017.

I will raise a final issue with the Minister and Minister of State. When someone applies for a medical card and gets it because they are entitled to get it, it should be made effective from the date they applied for it. I am just asking for that to happen because some people let it go and do not look for the medical card until they get sick.

Richard O'Donoghue (Limerick County, Independent)
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I am pleased to see that the Minister and the Minister of State are here. I thank them for staying on.

I am calling this evening for an investigation into the non-reporting of incidents at University Hospital Limerick, UHL, despite calls continually being made to stop the practice. Staff are unable to put incidents on Q-Pulse because this immediately triggers a response from management as to the origin of the incident, instead it being dealt with in a proper and professional manner as it is supposed to be done. This is not my first time to raise this matter. I know that the Minister, Deputy Stephen Donnelly, has been in Limerick. I met him there when he was announcing a new unit. Management personnel in University Hospital Waterford have been praised tonight for the work they are carrying out there. It is with a heavy heart that I have to come up here to talk about UHL. I know that many of the medical staff there are in desperation because of what they see happening to the hospital in which they work.

People who have worked for years to care for people are now leaving their positions. The roll-over of staff in emergency services shows the Minister what is happening. People have worked in emergency services for five or ten years, but are now leaving because they feel they cannot stay any longer as it is affecting their health and that of their families due to the fact they are coming home worn down and feel they have not done enough to protect the people in hospital.

The recruitment of staff is one issue, but retention of staff who have been there for years and want to stay but have left because they have no faith in the management of the hospital is another. We saw what happened in England when independent investigations were done outside of the hospital structure, which here is the HSE. Independent investigations which do not have past or current HSE staff on investigation boards are needed. Issues were highlighted in England and prosecutions were brought. The same needs to happen in UHL.

I have spoken of one case, Jessica Sheedy, an 18-year-old girl who died in UHL. The investigation into her death has been going on for more than three years. Parts of the report have been changed four or five times and the family still have not learned the real facts. The family want to make sure, in the name of Jessica, that no other family goes through what they went through. They want lessons to be learned and mistakes, if they were made, to be rectified for the protection of other people who go to the hospital and staff. If a staff member feels that he or she cannot put something on Q-Pulse because management will target them for doing so, how will anyone learn? I ask the Minister and Minister of State to address this. I would be the first to stand up and praise anyone who can help UHL fix the management structure in place there.

Last week I heard from a woman in her 70s who fell and cut her leg. She contacted a GP who was not working. She contacted Shannondoc and was told it was not open. She contacted the hospital which said it would send out her an ambulance, which brought her in. There was no doctor on duty at night to see her. She sat in the waiting room with her daughter and then her son came in. At 4 a.m. the son got mad and asked the staff to do something. A trainee doctor asked if he could take a picture of the woman's leg to send it to a senior doctor as he was only a trainee. Only a trainee doctor was on call, which is not fair to the trainee, staff or patients.

I beg the Minister and Minister of State to investigate the management structure in the hospital. I would be the first person to praise them if they could help to stabilise and help the staff report incidents and ensure they are examined properly in order to save lives.

Thomas Pringle (Donegal, Independent)
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Our health service is at breaking point and if this Government does not do something very drastic very soon, it will only deteriorate further. I have been continually raising concerns regarding Letterkenny University Hospital and the seemingly continuous scaling back of essential services there. The staff at the hospital are expected to work under severe pressure constantly and it is not sustainable or acceptable. This is the main reason so many healthcare workers from Donegal are choosing to leave the county and country.

I have been informed by Letterkenny University Hospital this morning that due to the pressures on the site and the lack of bed capacity, the hospital is postponing a number of elective day cases and inpatient adult procedures. This is completely unacceptable and tells of the extremely stressful environment that workers have to endure. The INMO has reported that 64 patients were waiting on trolley beds in Letterkenny University Hospital yesterday. Some 30 patients were waiting in the emergency department and 34 were in wards elsewhere in the hospital.

Kingsbridge Private Hospital has opened a premises in Letterkenny and is providing medical treatment. Across the Border, a private hospital is expanding due to all of the patients that are being diverted from Letterkenny to private services as Letterkenny is underfunded. The problem is that as more people are diverted to private hospitals for routine operations the ability to retain and train doctors declines because they are the bread and butter operations that keep doctors in position.

Any Deputy who has properly spoken with and listened to their constituents will not be shocked at the INMO findings that 65% of nursing graduates are strongly considering emigrating. Donegal cannot afford to lose any more healthcare staff or young people. If something is not done, there will be no one left to tend to our sick in the county, and that is a very frightening thought.

I would like to take this opportunity, while addressing this issue, to urge the Government to seek a review of job upgrades for domestic and household staff at Letterkenny University Hospital, as they have been unfairly left behind in receiving pay increases, following the recent job evaluations. This Government needs to do all it can to keep the hospital staff we have and value the important work they do.

I would also like to address the lack of mental health services available in Donegal, in particular for members of the Traveller community. The statistics on Traveller men’s mental health are shocking. Last week I attended the launch of the Traveller men's health and well-being research in Letterkenny, where the results of qualitative research on Traveller men’s mental health and their challenges and experiences in Donegal was launched. The launch reminded me of the severe difficulties that the community is forced to face every day. Despite constituting less than 1% of the Irish population, Traveller males account for 10% of young male suicides and the study showed that more than half of the participants reported experiencing suicidal thoughts or attempting suicide in the past. The study detailed the negative experiences Traveller men had with their GPs and mental health services, which created a sense of distrust and discouraged them from seeking help. Many of these experiences were sadly due to bias and discrimination and the experiences were particularly negative for Travellers from the LGBTQI community.

We need to do better. The way we treat minority groups in this country is just not good enough, and I would like to echo Senator Eileen Flynn’s calls for a culturally appropriate policy on Traveller mental health. Successive Fine Gael and Fianna Fáil Governments have failed the Traveller community time and time again and it is about time that important voices, such as Senator Flynn's, were listened to.

This needs to happen at a national level, but also at a community level. I would like to take this opportunity to urge the Government to invest further in community health services. It makes sense to ensure good community healthcare, not only because it would significantly benefit the community but also because it would take the pressure off the regional and national hospitals.

Killybegs Community Hospital for example, has great potential. However, the hospital is under-utilised, with a very long waiting list for long stay beds and with most departments only running a few days a week with skeleton staff. Community health services need to be prioritised and we need to ensure a better healthcare system for all who work in and use it. I support this motion put forward today by Sinn Féin, and I support the motion’s call to offer a job guarantee to healthcare graduates and its call for the Government to engage with GPs to ensure they are supported to take more pressure off hospitals and emergency departments.

However, I do not believe the motion goes far enough in addressing the needs of community health services or mental health services. We tend to prioritise other health services before we consider our mental health. It is important to remember that health, according to the World Health Organization, is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity. This is something for us all to consider in making sure we look after our health services as a whole.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputies across the House for their contributions to the debate. I wish to acknowledge the points raised regarding the challenges that our emergency departments are currently experiencing due to increased service demands. I also wish to acknowledge the invaluable work carried out by our health and social care workers in providing health services to patients. As we are here talking about challenges and the current issues affecting health services, I am conscious that all over the country tonight in our acute and community hospitals, nursing units, nursing homes and Caredoc services, nurses, doctors and healthcare workers are all working, and they will work through the night to make sure that our families and loved ones are looked after. That has to be acknowledged.

There are more than 135,000 people working in healthcare in this country. I am often conscious that when we come into the Dáil and speak about challenges, those people should be acknowledged because they are all doing the very best they can.

As Members have heard from the Minister for Health, it is clear that emergency departments are experiencing significantly increased demand. Attendances and admissions have both increased significantly above five-year averages. That is due to a combination of factors, including the circulation of RSV, flu, Covid and strep A.

To ensure that our acute and community services are supported this winter, the HSE winter plan for 2022-23 represents investment of up to €169 million and includes the recruitment of 51 emergency medicine consultants and associated support staff; full implementation of the safe staffing framework for adult emergency care settings; the recruitment of an additional 608 staff across the health service; increased community intervention teams, GP supports and out-of-hours services to reduce the need for attendances at EDs; increased community services for mental health, disability and palliative care; increased community and acute diagnostics; and expansion of ambulance services, including the introduction of nine pathfinder teams and deployment of rapid handover teams to improve ambulance turnaround times. In recognition of the volume and complexity of service demands EDs are experiencing, this winter plan adopts a bottom-up approach involving bespoke individual local plans that seek to address hospital-specific issues, in conjunction with community healthcare organisations.

The Government has delivered record funding to permanently increase capacity in our health service. There has been a significant increase in hospital bed capacity, with an additional 934 acute beds provided since 2020. An additional 82 beds were added to this plan over the course of the past two years. This includes 72 beds - 24 in Cork and 48 in the Mater - which were set out in the National Service Plan 2022, bringing the total number of beds due to open to 1,228. The winter plan has provided 934 non-ICU acute beds nationally to the hospital system over the number available on 1 January 2020.

Addressing the recruitment and retention of healthcare workers in Ireland continues to be a top priority for me as Minister of State, the Minister for Health and the Government. The total health service workforce in October 2022 was 136,092 people, which was 16,000 higher than at the beginning of 2020, representing the third highest annual growth in the workforce after the large increases achieved in 2020 and 2021. We have been working intensively to expand our recruitment capacity to ensure that ambitious workforce targets can be met and to maximise the numbers recruited. This has included the expansion of international recruitment markets, targeted recruitment campaigns and streamlined recruitment processes.

Quite a few Deputies mentioned the situation in respect of home care. Some 59,000 people received home care today. We have a waiting list of 6,200. Some 3,000 of those people are new entries on the list. Another 3,200 are people who receive home care but who might not receive the full package, especially at weekends. From January we will be recruiting outside the EU. The Minister of State, Deputy English, and I worked hard to secure 1,000 permits to encourage people outside the EU to come here and deliver home care.

The use of private capacity was also mentioned. It is true that when we recruit private companies to deliver home care the carers are paid €27 an hour. The new tender from the HSE will be in on 1 January. Included in that tender will be the provision that any of the organisations that recruit for us privately and that deliver the services will have to pay the living wage, which is currently €12.90, plus mileage. That will be written into the tender. I hope those three measures will make a significant difference. If we got even another 500 or 600 workers, it would make a significant difference to the waiting list and would have a profound effect then on the number of people in acute hospitals waiting to be transferred.

Increased efforts have been made to retain all staff, with attractive opportunities being offered for career development and progression as well as educational and development opportunities. We have already increased consultant numbers significantly but we recognise that consultant ratios remain low by international standards. The new contract will support further recruitment and retention. The HSE will also be focused on offering prospective consultants a variety of different work patterns, as mentioned in the Minister for Health's opening comments. The NCHD task force is focused on both immediate improvements in the NCHD experience and looking towards the future medical workforce. A priority area of the task force is to inform medical workforce planning and set the policy direction for the future configuration of the medical workforce. While it is important we continue to strive to improve the day-to-day experience of those delivering health services, we also need to address the challenges in our medical workforce configuration to protect future patient care and to build a sustainable clinical workforce.

Over recent years, the Department of Health has focused on supporting, strengthening and expanding the number of undergraduates and the education and training opportunities for the health workforce. The Minister for Health and I are committed to continuing to increase the number of training places into the future to ensure a sustainable workforce planning model for Ireland. We recognise that Ireland, like many other countries, is heavily reliant on international healthcare workers. We are seeking to significantly increase domestic supply of graduates across all healthcare disciplines.

By integrating general practice, primary care, community-based services and hospitals, through the enhanced community care programme, we will deliver end-to-end care, keeping people out of hospital and embracing a home first approach. People who receive home care more than likely also attend day care centres and receive meals on wheels. Those three elements together support people to age well at home. The momentum behind the enhanced community care programme recruitment and implementation is significant, with more than 2,400 staff already recruited, an achievement of 70% of the total 3,500 additional staff required.

Along with the Minister, I again thank Deputies across the House for their contributions. I reiterate the Government's commitment to improving our health service.

Darren O'Rourke (Meath East, Sinn Fein)
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I welcome the opportunity to speak on the Sinn Féin motion. I commend Deputy Cullinane on bringing it forward. We have recruitment and retention challenges across our health service, and this Government, like previous ones, has not done enough to address them. The motion states that there is a widely held belief among the public that the current Minister is incapable of addressing the crisis in our health service and, along with the wider Government, has been making the situation worse. That statement is true.

It is truer of the delivery of services at Our Lady's Hospital, Navan, County Meath, than anywhere else. Government policy, as stated in the small hospitals framework document of 2013, is to close the Navan accident and emergency department and to downgrade the hospital to a model 2 hospital. The Minister has been made aware repeatedly of concerns about the safety of critically ill, unstable patients presenting at the Navan accident and emergency department. To state them clearly, however, those safety concerns are directly related to a chronic under-resourcing of acute and emergency services at Navan. For years staff were not recruited and not retained. Acute and emergency services were allowed by design to drift into a situation of precarity. Given the population of Meath, given the demand for emergency services in Meath from the people of Meath, given the physical distance to the next nearest emergency department, and given the state of overcrowding in those same emergency departments, there are no spare beds, no spare trolleys and no spare chairs. Adults are left waiting in the back of an ambulance, in a car park. Sick children have it even worse. They are sent out with their parents to wait in the car. It is not a situation that should be allowed to proceed.

Incredibly, despite the protestations of clinicians working on the front line - the repeated protestations of 17 consultants, to be exact - tomorrow morning a bypass protocol will be introduced at Navan and will mark the next step in the diminution of services at Navan and a step closer to the closure of the accident and emergency department there. What of those protestations? Will they say, as the motion states, that this Minister's approach and that of the Government will make matters worse? They state clearly and repeatedly that the Government's proposals and the HSE's plan will lead to worse clinical outcomes and will put lives at risk. They point to the HSE's track record in the region: repeated promises but failure to deliver. They point specifically to a bypass protocol and the fact that there are still no full-time consultants in neurology, stroke or rheumatology. As a result, the experience of the health professionals in our region, at both Navan and Drogheda hospitals, is a negative one of repeated promises but changes implemented without the necessary staffing, capacity or additional resources for our health services.

The plan for Navan hospital must be one of investment and bringing it to a standard to ensure it is safe for the people of County Meath. The county has a population of in excess of 220,000 people. We know a review has been on the Minister's desk for two months at this stage. We have been very critical of its terms of reference, as the Minister knows well, but it is completely unacceptable to transfer risk from one hospital to another. Investment must be made to ensure that services are safe at Drogheda and Navan hospitals. That is the plan that must be presented and introduced. Anything other than that is a failure in my opinion.

David Cullinane (Waterford, Sinn Fein)
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I thank all of the speakers, including the Minister and Minister of state, for their contributions. The Minister's contribution was much different from the script we were handed. It was less harsh, which may speak to the Minister's style. That is commendable but I want to address some of the issues raised in the written text, which were much more strident. I am afraid the Minister's officials or somebody over there had a bad day and decided that Sinn Féin was to be attacked for tabling a motion raising very important issues related to recruitment and retention in the health service and acknowledging the real problems we have in our emergency departments.

For the purpose of the record, I fully accept that Covid has had an impact on our health services. It has had an impact on the their ability to deliver healthcare in the way we would have wanted. Obviously, Covid and a number of other factors have caused the crisis in our emergency departments, which has led to the cancellation of scheduled care. This, in turn, drives up waiting lists. I think we can all accept that is the reality but we also have to accept that many of the issues related to recruitment and retention, the trolley count, which we had when the Minister was in my seat and long before, and the unacceptable waiting lists predated Covid. While I acknowledge that Covid has obviously had an impact in more recent times, it cannot be used as an excuse for the long-standing deficits in our health services.

The Minister's written speech specifically mentioned Waterford. I was the author of the motion and the written reply suggests I do not accept the good work being done at University Hospital Waterford.

Stephen Donnelly (Wicklow, Fianna Fail)
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I did not say that. I do not know what version of the speech the Deputy has.

David Cullinane (Waterford, Sinn Fein)
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I know the Minister did not say it. I am talking about his written speech. In fact, it is quite the reverse. I think the work that University Hospital Waterford management has done is phenomenal and I have said for some time that it is a beacon of hope for other hospitals. We need the same level of management elsewhere. It has not only been the manager, who is really important as the person who drives on the team, but the team effort in University Hospital Waterford that has resulted in hitting the milestone of 1,000 days without having a patient on a trolley. That is phenomenal and we need the same level of management in other hospitals.

As a Deputy from Waterford, I must also point out - know the Minister of State, Deputy Butler, will partially agree with me on this - that we had to fight for resources. The mortuary was stuck in the capital process for about seven years before it was delivered. The HSE had to be shamed into delivering it because of what was happening in the mortuary. It was not because of anything the system did. Management fought for it, as did staff. The new mortuary was hard-fought and won. The battles we had to go through took the gloss from it when it came. It was a similar scenario with the cath lab. At how many meetings did the Minister of State, before she was ever appointed, and I beg Ministers for Health to give us the service we need? We still have no plan to deliver 24-7 cardiac care. Then there was the palliative care unit, half of which had to be funded by the people of Waterford. The new Dunmore wing, which has good single isolation rooms for a hospital and made a big difference during Covid and for palliative care, also came out of a battle to get matching funding lasting many years. The people of Waterford had to put their hands in their pockets to fund it. I do not need to be reminded of how good University Hospital Waterford is because I am in there all the time. We meet hospital management and we have seen the good and the bad. We have also seen a lot of hard work done by people to get us to the point we are at today. It did not happen by accident but because of the level of campaigning by local people in the constituency.

To address the substance of the motion, we need to do more. Often, when I raise issues, the Minister's response is to say he agrees with me. Maybe in some respects he does agree with me but agreeing with somebody and doing what needs to be done are two separate things. I acknowledge lots of the additional investment that has been made in the health services recently. As the Minister said, I acknowledged the new hospital contract, which is very important and will make a big difference. I will acknowledge it if we get progress on the new contract for junior doctors, which will also be important. However, the recruitment and retention crisis in our health service will not be addressed unless we substantially increase training places. To say the heads of the universities were pleasant when the Minister met them is not a plan. The Government has to act. It has to make a policy decision that it is going to do this. While I accept our universities have a level of autonomy, the Oireachtas, as a political body, can make a decision to get serious about workforce planning. This means substantially increasing training places, ratcheting up training across all elements of healthcare and proving better opportunities for graduates to work in the public system. Some work has been done but we have an awful lot to do still to get many more of them to work in the system rather than emigrate.

An Teachta O'Reilly, who is sitting behind me, has tabled numerous motions on recruitment and retention over many years, yet we still have not reached the point where we have the training places we need. We have not dealt with the recruitment and retention issues that existed long before I took up this role. We have a long road to go on this and it must be the number one priority for me, the Minister and everyone in healthcare in the coming years.

Catherine Connolly (Galway West, Independent)
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In accordance with Standing Order 80(2), the division is postponed until the weekly division time on Wednesday, 14 December 2022.