Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I support the Government amendment and oppose the motion. Senators Thomas Bryne and Marc MacSharry asked about the actions that had been taken. It is possible to explain what is going on, analyse it and act at the same time. Fianna Fáil Members may, however, find it impossible to explain, analyse and act at the same time, but there are those of us on this side of the House who do not think it is difficult to do and that they are not mutually exclusive.

With regard to actions, 900 transitional care beds are being funded in private nursing homes, 500 in January and a further 400 in February, to assist patients waiting on the fair deal scheme to be discharged from hospital and put in transitional care; 173 short stay public beds are being opened across the country for a three month period - they should all be opened by the end of the month; there has been agreement on additional nursing posts, with at least 500 additional nurses directly employed in the public health service this year - in addition, there will also be mental health posts; I am double counting in this regard; up to 300 overflow beds have been opened in acute hospitals; and additional community intervention teams have been introduced in Naas and Drogheda. I also convened the emergency department task force and the HSE is finalising an action plan.

We are going through a difficult period in the health service. There were four years of cutbacks under Fianna Fáil and three years of budget freezes under the Government as a consequence of the recession that those proposing the motion helped to cause. That has left its mark and done enormous damage to the health service.In 2015, for the first time in seven years, there has been a modest budget increase, of approximately €150 million. However, we still spend approximately €1.5 billion less than we did seven years ago and we have approximately 15,000 fewer staff. Even with considerable improvements in efficiencies during the past seven years, rising demand has created enormous problems for us. Those problems are reflected in emergency department overcrowding in some hospitals and excessive waiting times for many patients.

It is important to recall some of the good things that are happening in health. Sometimes, in these debates one can become despondent and begin to believe that nothing ever changes or improves. One of the many things I did today was to visit the National Maternity Hospital, Holles Street where I had the pleasure of opening the new neonatal intensive care unit, NICU, which is a major improvement on the one I remember from when I worked there seven or eight years ago. It was great to see it. Maybe 36 years ago, when I was born, 90% of the children in that NICU would have died, whereas now 80% or 90% survive. Let us allow ourselves, now and again, to recall some of the good things in health.

We have a very good capital programme under way. At long last, planning permission for the children's hospital will be lodged within months, before the summer recess. I hope, with the agreement of An Bord Pleanála, we can start work on it before the country goes to the polls. Work will begin on the new forensic mental health campus in Portrane, allowing us to close the Central Mental Hospital in Dundrum. We have been promising it forever, and now it will happen. We are providing one primary care centre per month and the National Maternity Hospital will move to St. Vincent's University Hospital. The planning application will be submitted this year.

We are succeeding in our efforts to make health insurance more affordable. The numbers of people who have insurance increased in the last two quarters of last year. I expect a big increase in the first quarter of this year and a further increase next month with long-term community rating. The first step in my objective of making health insurance universal is to make it affordable. We must always have regard to this.

Senator Daly mentioned ambulance services. Only last week I announced that we would hire 50 additional paramedics in the west to improve services there. Not long ago, an ambulance was just a vehicle that took a person to hospital. It is no longer like that. Ambulances are staffed by emergency medical technicians, EMTs, paramedics and advanced paramedics. If an ambulance does not reach a person, the rapid response vehicle does and care begins immediately, long before one reaches hospital. We also have the air ambulance, which did not exist before this Government. We have 100 community first responders, and we need many more of them. DELTA and ECHO times are improving, despite how busy it has been during the past few months. We are very close to meeting the DELTA targets, although we are not quite there for ECHO yet. Despite the fact that December was the busiest month ever for ambulances, turnaround times at hospitals improved. This is a tribute to our ambulance service and staff. The budget is not being cut this year but increased by €5 million. It is important that people understand that our ambulances work on the basis of dynamic deployment. We no longer have the idea that an ambulance is just for a particular area, just as taxis no longer operate from taxi ranks, as they used to, but use systems such as Hailo and Uber. Dynamic deployment is the best way to manage a fleet. I already mentioned recruitment, the 500 additional nurses and the 30 consultant posts just advertised.

Emergency department overcrowding is not a new problem and is not unique to Ireland. Many of the protocols we use come from Australia and America where it is also a problem. It is also a problem in Northern Ireland. It is a chronic problem which turns into a crisis whenever there is a surge of patients or significant delays in discharges at the other end. The Government acknowledges that the problem of overcrowding is serious, real and cannot continue. While surges will occur from time to time, the difficulty in Ireland is that it is a year-round phenomenon and extensive time spent waiting for admission on a trolley is a patient safety issue. Some people were shocked by my admission today that delayed treatment can result in increased morbidity and mortality. To me, it was a statement of the obvious. Since everybody knows it is a fact, why deny it? Aside from the discomfort and loss of privacy and dignity, it is a patient safety risk, particularly for the elderly. Senator Moran received the INMO figures, which are done at 8 a.m. The more up-to-date figures show that as of 2 p.m. today there were 279 patients on trolleys in our emergency departments and on wards, of whom 198 had been on trolleys for more than nine hours. The figure will continue to fall throughout the day but will increase overnight.