Duncan Smith (Dublin Fingal, Labour)
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2. To ask the Minister for Health if he will provide a detailed update on his plans to end hospital overcrowding and accident and emergency wait times; and if he will make a statement on the matter. [26950/23]

Duncan Smith (Dublin Fingal, Labour)
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May saw 11,856 people, including 300 children, waiting on trolleys. What plans does the Minister have to end hospital overcrowding and accident and emergency department wait times, knowing that the numbers in May were higher than the numbers in January when we had the triple respiratory threat?

Stephen Donnelly (Wicklow, Fianna Fail)
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I will start by acknowledging the enormous distress the overcrowded emergency departments are causing, first of all to patients and their families and second to our healthcare workers. I am regularly in emergency departments meeting with patients and their families and our healthcare workers.

Part of the answer to the question lies in the discussion Deputy Cullinane and I just had. One of the things we must do is move to a seven-day service. We are all aware of the pattern in that the hospital gets cleared on Friday and, therefore, beds become available. The best day, if you like, in a hospital is Saturday morning because the emergency department has beds to send patients up the house to. It then fills up on Saturday, Sunday and Monday again and we have this weekly pattern. To be honest, for those working in hospitals in emergency medicine as well as the patients, it is an exhausting pattern. When I met the emergency department leads around the country in the last two weeks, there was strong support from them to say that yes, the emergency teams need to be there, but they need the support of the hospitals and community groups.

The answer lies in doing two things at the same time. An unprecedented level of investment in workforce and infrastructure is required while, at the same time, we move to this new way of working. I will give the Deputy an example. I was in University Hospital Galway last Friday. That hospital's emergency department regularly deals with difficult situations. I was there on a Friday, when it should have been easier but there were patients on trolleys going up both sides of the main corridor. The conversation I had with the team in Galway was to say the Government is going to invest in more beds, a regional cancer centre, a new emergency maternity and paediatrics block, new laboratories and an elective hospital and outpatients department in Merlin Park. We are going to do all of this but it will only work if the hospital and community service also start working in a different way and move to the seven day per week patient care.

Duncan Smith (Dublin Fingal, Labour)
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The Minister mentioned that Saturday is the best day, and I know what he means. However, the average figures are such that even when we get to Friday and Saturday, the numbers are still far too high because of the carryover from the weekend. In respect of the seven-day roster, a number of unions, such as the Irish Nurses and Midwives Organisation, INMO, has said it is willing to talk. The Minister said in an earlier reply that he is setting up a working group. Will he articulate in more detail which groups are reluctant or more resistant to come to talks? Where are the blockages? Where can political pressure be applied to elements of the health service that are not moving as quickly towards a seven-day working roster fhat we all agree is needed to help tackle this ongoing crisis?

Stephen Donnelly (Wicklow, Fianna Fail)
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The conversation has moved in a positive way in recent years. I recall when we had these sorts of discussions at the health committee four years ago and there was quite a lot of resistance. The idea that we would move from five to seven days was not being entertained. However, the engagement I have had right across the board has been very positive. The new consultant contract moves from 40 hours to 80 hours, which is a fundamental change. I meet other representative bodies and their members in community settings and hospitals and there is broad acknowledgement that this is what we need to do. Nurses make the point that they are already rostered in the hospitals 24-7. Junior doctors are already rostered 24-7. We now have a new consultant contract in place. The next areas that will help, and the conversations I am having with those concerned are very positive, include health and social care, community care, discharge teams and, critically, access to regularly scheduled radiology on weekends.

Duncan Smith (Dublin Fingal, Labour)
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The emergency department task force, which is co-chaired by the HSE and the INMO, warned this week that we could have another winter with RSV, Covid-19 and other respiratory challenges. Given everything the Minister has said and offered, and everything in the pipeline, is he considering specific targets? He does not have to mention those targets on the floor of the Dáil but is he considering targets on a month-by-month basis, leading into the winter, and the reduction he wants to see in emergency department waiting lists? Is he considering the matter in those terms or is he hoping the investment that is going in will deliver results? What sort of planning and target setting are being done to combat the trolley waiting lists?

Stephen Donnelly (Wicklow, Fianna Fail)
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The next question, in the name of Deputy Cullinane, relates to exactly that matter. We have two plans, which are, the short-term plan and the multi-annual plan. The direction I have given to the Department and HSE is clear. We must have structural change such that, month by month, the trolley numbers we are seeing come down. What happened last year because of the impact of Covid - and I have spoken to health ministers from around Europe who have experienced the same things in their countries - was that demand went up. There was unmet need; there were probably late diagnoses. There was an enormous level of additional presentation to emergency departments. That was the case here and in other countries. The numbers went up and up every month such that by the time we got to October, November and December, the system was simply overstretched. We are looking to trend downwards towards winter not just through one-off funding but with structural changes so that we go into the winter in a better place.