Mark Daly (Fianna Fail)
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I welcome the Minister and thank him for attending to deal with what is a very important topic given the waiting times and issues with trolleys in hospitals throughout the country, which have caused so much distress among so many over recent weeks.

Stephen Donnelly (Wicklow, Fianna Fail)
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I apologise about the timing. It was entirely my fault.

I very much welcome the opportunity to address the House on emergency departments. Like many Members, I have visited emergency departments across the country to hear about the first-hand experiences of patients and staff. I have seen the distress that overcrowding causes to patients and their families and to front-line staff working in what can be very challenging conditions.

This experience is being replicated across Europe - in Northern Ireland, Britain, France, Spain, Portugal, Germany, Austria, Finland, Switzerland and many more countries. Some of the best-resourced and best-run healthcare services in the world are under intense pressure due to a perfect storm of flu, Covid and respiratory syncytial virus, RSV. At the peak in Ireland in early January, when we had three days in particular with a very high number of patients on trolleys, there were around 1,500 patients in hospital with either flu, Covid or RSV. However, regardless of winter pressures, there is simply an unacceptable number of patients on trolleys in too many hospitals too often. This is not a new problem but one we must solve.

Our population is growing. Over the past 20 years it has grown by about one third. Our population is also ageing. It is good to see that Ireland now has the highest life expectancy in the EU. However, a population that is growing and ageing means significant additional demands on our healthcare services every year. The demand is growing in the context of a public health service that historically has not had the capacity to ensure patients get the care they need when they need it, in terms of both workforce and infrastructure. Recognising this, the Government has invested in the health service and growing the permanent capacity of our public health service at a level that has never been seen before.

We have added almost 1,000 hospital beds, over 360 community beds and 65 critical care beds. This is the greatest number of beds added since the HSE was established. We have increased the HSE's workforce by more than 17,400. This includes more than 5,000 nurses and midwives, nearly 3,000 health and social care professionals and 1,800 doctors and dentists. In fact, 2020, 2021 and 2022 have been the three best years for the expansion of the HSE's workforce since it was founded. This year will make the four best years.

Of course, all of the solutions to overcrowding in emergency departments are not to be found in the emergency departments or even in hospitals. We are creating integrated services for patients between community and hospital care. To do this, we have built over the past two years an entirely new community service. That means more than 90 new primary care teams have been created around the country, as well as new specialist teams in elderly care and chronic disease management. Around 2,500 staff have been recruited into the community care programme.

We have added millions of extra home care hours and we acknowledge that more are needed. Last year, we funded more than 200,000 diagnostics, directly accessible to GPs for their patients. This year, there will likely be in excess of 300,000. We are investing in the National Ambulance Service and expanding the number of injury units.

We are investing in general practice. We need more GPs, as we all know, and more out-of-hours cover. We need to help GPs move to more nurse-led care, including nurse prescribing and advanced practice nursing. To this end, we are increasing medical college places in the coming years. In fact, the number in 2010 will be tripled. We are investing a lot more in general practice so more nursing staff can be trained and hired. We have built a new network of primary care centres around the country and will continue to open new primary care centres this year. These advances in community care are new. This is a new way of running integrated health services. As the new services bed down this year and become better integrated with hospital care, community care and general practice, we will see more benefits for patients. This means more patients being treated in their communities and supported in their homes. It also means freeing up the hospitals to provide care to the sickest patients. While we have delivered a record number of hospital beds, the current processes do not produce new healthcare infrastructure quickly enough. Put plainly, it takes too long to build healthcare infrastructure. New beds, hospitals and theatres take too long. I am working with my Department, Government colleagues and the HSE to find a way to accelerate the bed programmes. We know we need more beds and that they are part of the solution to easing the pressure on emergency departments. We have to find a way to add them quicker than the current processes allow.

I recognise the deficits in capacity that exist in the HSE. When it comes to pressures in emergency departments, I believe that mistakes in implementation were made in some previous reconfigurations. Capacity should have been provided where emergency departments were being consolidated. It was not always done. My belief is that some of the pressures, particularly along the west coast and in Limerick and Galway, are being experienced in part because, when the changes were made to the emergency departments in question, sufficient capacity was not provided for. The Government is doing something about that now. We are addressing the deficits, putting the beds in place and building up the workforce.

More capacity is only part of the answer, however. The other part, which is also essential, lies in reform, which entails consistently providing patients with the quickest access to care using the capacity available to us.It is simply the case that some parts of our health service fare better at this than others. What is needed is consistency across the health service in applying the approaches we know work best for patients. Changes to working practices are needed, including having senior decision-makers rostered in the evenings and at weekends. In the hospitals, this includes senior decision-makers for patient assessment, treatment, admission and discharge. This is one of the critical changes we are bringing about in the new consultant contract.

It is not of course just about consultants, many of whom already work evenings and weekends. Consultants and their patients need regular access to theatres and diagnostics. Many healthcare professionals are involved in patient discharge, including health and social care professionals, both in the hospitals and in the community healthcare teams. Over the past few weeks, we have seen just how impactful it is when weekend discharge is increased. We have seen just how big a difference it makes to the number of patients waiting on trolleys and we know some of the best performing hospitals, including those that rarely, if ever, have patients on trolleys, already operate much higher weekend and late evening discharge levels.

There needs to be a relentless focus by managerial and clinical leadership on patient flow. We know many hospitals do this very well and we must see this done consistently across the country. Changes to discharge planning and funding are needed in some areas. This includes block-booking of private capacity, block-booking step-down beds in nursing homes and working with nursing homes to avoid unnecessary presentations to accident and emergency departments.

It is this combination of capacity and reform that leads to better access for patients to the services they need. I am determined to continue with the progress being made, adding more beds, diagnostics and theatres, hiring more healthcare professionals, adding more home care packages, finishing the roll-out of enhanced community services, modernising working practices to ensure the services needed are available when patients need them and supporting hospitals and community healthcare teams to ensure there is consistency of the best approaches seen right across our health services. This is what will provide us with the health service people in Ireland need and deserve, and that our healthcare professionals want to provide.

Lorraine Clifford-Lee (Fianna Fail)
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Tá fáilte roimh an Aire. Tá áthas orm go bhfuil deis againn amanna feithimh maidir le ranna timpistí agus éigeandála a phlé inniu. Is ábhar buartha é. Tá imní agus faitíos ar dhaoine ar fud na tíre dul chuig na ranna timpistí agus éigeandála. Tá tionchar ollmhór aige seo. Bhí mé ag caint le bean le déanaí. Shaolaigh sí mac marbh-bheirthe roinnt blianta ó shin. Chuir sí in iúl dom go bhfuil méadú ar mharbh-bhreitheanna i mí Eanáir gach bliain. Níl aon mhíniú ag lucht leighis air sin ach creideann an bhean sin go bhfanann mná torracha amach ó na ranna timpistí agus éigeandála de bharr sin. Tá sé sin ollmhór. Tá siad neirbhíseach faoi phlódú. Bíonn drogall orthu uaireanta, nuair a mhothaíonn siad nach bhfuil gach rud ceart go leor leis an toircheas. Níl a fhios agam an bhfuil aon fhianaise ann chun tacú leis sin ach is cinnte go bhféadfadh sé a bheith ina chúis. Tá a fhios agam go mbíonn an tAire agus an Roinn Sláinte ag bualadh leis an bhFeidhmeannacht Seirbhíse Sláinte, FSS, faoin gceist sin i gcónaí.

Faoi mar a dúirt an tAire, thug sé cuairt ar roinnt ospidéal freisin. Tuigim go rímhaith freisin go bhfuil dúshláin ar leith roimh na seirbhísí sláinte le Covid agus leis an víreas fliú. Tuigim na dúshláin shuntasacha a bhaineann leis na gairmithe chúram sláinte a earcú freisin. Is fadhb dhomhanda í, faoi mar a dúirt an tAire ina óráid. Tá roinnt ospidéal ag éirí i bhfad níos fearr ná ospidéil eile áfach. Caithfidh na hospidéil pleanáil don tréimhse sin i bhfad níos luaithe ná mar atá siad faoi láthair. Bíonn an fhadhb seo againn gach aon bhliain. Is léir go bhfuil fadhbanna bainistíochta i roinnt ospidéal freisin. Glacaim go bhfuil dul chun cinn déanta ag an Aire ina ról mar Aire Sláinte.

Timmy Dooley (Fianna Fail)
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I thank the Minister for coming to the House to discuss this important issue. I know he understands the complexities involved and that he has been engaged with it for some time. Specifically, I wish to talk about the mid-west and the hospital there. In the past two days 87 medics signed an open letter. They gave credit to the Minister and the Taoiseach for their open engagement with them. They have, though, asked for a couple of things. They have highlighted that the new accident and emergency unit, opened in 2017, is capable of dealing with 190 patients a day, but that it is now dealing with something like 240 visits daily. There is a problem there. These medics also referred to the planned growth of beds that should have reached 640 as a result of reconfiguration but that it has not reached anything like that number. There are 90 beds and 200 more on the way, but I appeal to the Minister to do whatever he can at government level, even if it is necessary to set aside planning rules and laws just to get these facilities built, because this is an emergency and this work needs to happen.

Bed building does not just need to happen in Limerick hospital. It can also happen in Ennis hospital, which has 50 good beds and a proper word block. It could manage 50 more beds. The result of what has happened in recent days in Limerick hospital and the focus of all the medical attention being on that facility means day surgery has been cancelled for the past five weeks in Ennis hospital. This means 150 patients are now being delayed due to the work practices that have had to change to reduce the queues in the accident and emergency unit in Limerick hospital. There will be long-term fallout from this situation.

The situation in the mid-west is not working. The greater population, and the significant increase in population in recent months as a result of the crisis in Ukraine, together with the significant changes that have happened across society in recent years, require urgent attention. The open letter I mentioned refers to the inability to retain staff. This is probably not a surprise because some people have used the opportunity to recognise just what a difficult working environment it is, and it is a difficult working environment. While this situation continues to make headlines for this reason, it is going to be difficult to hold onto current staff or to attract new staff.

An entire reboot is needed. The Minister and his Department are rightly apprised of the situation and they are in a position to make this happen. This open letter also referred to the necessity for Limerick hospital to be the first location to get a surgical hub. The Department is talking about building several of them around the country and I ask that support be shown to the hospital and the doctors by putting the first of these surgical hubs into Limerick hospital. Let the investment be front-loaded into the mid-west region to overcome the imbalance that has existed for a considerable time.

Martin Conway (Fine Gael)
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I welcome the Minister to the House. I appreciate how extraordinarily busy he is, so when he comes here it is noted and appreciated.

The situation in emergency departments in recent months nationally has been very difficult. When we speak of it, we must take a moment to think of the people who are on trolleys: those who are very sick, and their anguish and suffering, and the worry and concern of their loved ones, especially as we come towards the end of the pandemic where there is still an element of fear. We must take a moment to tell people we are thinking about them, and we want to make it better.

I echo what Senator Dooley said about the mid-west. The Minister has been there, and he knows the issues and problems; he also knows the solutions. It is about capacity and process. Capacity can be addressed in the short, medium, and long term. In the short term we can requisition more private capacity for the UL Hospitals Group. Some 187 beds were requisitioned from private hospitals. We should have been able to get lot more. We were able to do it during Covid. We could have built more capacity in the short term. I was very annoyed to hear that only five of those beds were used by the UL group, given that this area was the worst affected in the country and had the highest number of patients on trolleys. I would love to know why the number of beds used by the UL group was not higher. Perhaps we might get an answer to that at some stage.

In the context of medium-term solutions, I fully agree with my colleague that we must set aside planning laws. The hospital group must make a proposal to the Minister urgently and he must sign off on it within days, as opposed to weeks. We then need the planning laws to be set aside so that construction can commence. We expect another 96-bed block to be built in addition to the block that is currently being constructed. However, we also need a third 96-bed block. That should be signed off and agreed this year as well to deal with capacity.

To be fair, there have been improvements in the process within hospitals. I refer to protocols for front door, back door, discharge and patient flow. There have been significant improvements in terms of effort but that is not evident due to the serious increase in numbers presenting.

I very much welcome the decision to introduce new blue light protocols in Ennis General Hospital. Ennis is underused. There is significant capacity there that we could utilise. The Minister might tell us how the new protocols are working and what numbers are being redirected to Ennis as opposed to Limerick. I am interested in hearing statistics given that it is two or three weeks since the protocol was introduced.

We must consider introducing a similar protocol in Nenagh. People, including medical experts in Tipperary are looking for that. Perhaps it could be introduced in St. John's Hospital as well. We must be imaginative and creative. We must also remember that since reconfiguration, we now have advanced paramedics in most if not all ambulances and they are well capable of making a diagnosis and deciding where it is best to redirect patients. In the past, there was an ambulance driver and a nurse, who did great work, but now it is an ambulance driver and an advanced paramedic, which is the reason we can redirect patients in need of non-critical care to places like Ennis and Nenagh. The people who need to go to the emergency department in Limerick should go there.

I have a couple of practical proposals. One relates to the location of Shannondoc in the campus in ULH. That could happen very quickly. The 50% of people who show up at the emergency department with a referral letter could be redirected to Shannondoc to get a letter of referral. That is also causing a lot of problems. People are going to the emergency department because they cannot get a GP or they get frightened for one reason or another, but it could help if a GP was on site in the hospital in Limerick. That is something that should be piloted. I know the consultants in Limerick are looking for that as well.

I am conscious that the debate started late. The Minister has heard my suggestions and proposals umpteen times so I will leave it now to other speakers.

Niall Ó Donnghaile (Sinn Fein)
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Ba mhaith liom fáilte a chur roimh an Aire. I apologise at the outset for missing the Minister's contribution, but I was following it in the office. I hope he does not mind me beginning on a slightly different subject, and then I will return to the substantive point we are discussing here today. Yesterday in the Seanad I raised the case of young Dáithi MacGabhann from Belfast. He is waiting on a heart transplant. The Minister will be familiar with the progress on the human tissue Bill in this jurisdiction. Dáithi and his family campaigned for similar legislation around soft opt-out organ donation and achieved great success when Stormont was unified in support of the call. A law was passed that because known as Dáithi's Law. Due to the absence of the Assembly and the Executive, the family has to campaign again and is working to ensure that the Secretary of State brings forward legislation. The Minister knows that organ is an all-Ireland issue in terms of waiting times and generally. Dáithi's family have asked me if the Minister would be prepared to meet with them to hear about their campaign and to join the calls of this House and many others in supporting it.I will correspond with the Minister on that. I know they are keen to discuss the case with him.

I will return to today's statements. In the past week, we have had two very dramatic examples of the impact a system in free-fall has on this society, with a flailing Government presiding over a health service teetering on the brink of collapse. On one hand, we had thousands of people marching and protesting to show their support for patients and health service staff while, on the other, we had a damning report into child and adolescent mental health services, CAMHS, by the Mental Health Commission. The commission's comprehensive report identified serious risk to the safety and well-being of children accessing CAMHS. In an article in The Irish Timesthe journalist, Ms Kitty Holland, stated:

The report finds poor monitoring of medication; children waiting days in emergency departments for psychiatric care ... exhausted, overwhelmed and inadequately supervised staff; psychiatrists not trained to work with children; poor risk management; poor clinical governance; and chaotic, paper-based record-keeping.

This is an appalling dereliction of duty by the Government and those in CAMHS responsible for the welfare and well-being of children. The thousands of people on protests gave a very clear response to the Government's prolonged and systemic incompetence in handling the health service. The message from the protestors was very clear. They want a health service that is localised and capable of responding to people's various needs, including the peaks and emergencies that are part and parcel of a modern healthcare service. They want a health service that does not exist on a long-term drip of continual crisis, one that has the planned capacity to look after its patients, whether children or adults, wherever they are located on the spectrum of the health service, from the doors of accident and emergency departments to the operating theatre. The protestors know what the Government is pretending it does not know, namely, that this Government, whether it is led by a Fine Gael or Fianna Fáil Taoiseach, has woefully failed all those who work in the health service and all those being treated in the healthcare system. The protestors know the Government is pretending it does not know there is a direct link between the crises in the health service and housing sector in which a chronic shortage of housing to rent or buy is coupled with a cost-of-living crisis.

The housing disaster is preventing many healthcare workers from coming home and driving out our young graduates. The Irish Nurses and Midwives Organisation, INMO, in a recent report found that 65% of nursing graduates are strongly considering emigrating and 33% are considering leaving the major cities in this State due to the cost of living. In 2021, 62% of first-time registrants with the Nursing and Midwifery Board of Ireland were non-European workers, which highlighted the lack of supply and poor retention of Irish-trained graduates.

The health service is fundamentally broken. It is only held together by the goodwill and hard labour of healthcare workers who are battling this crisis daily. The current system is delivering the wrong care in the wrong place at the wrong time. It can be fixed, however. The Government needs to immediately make use of all public and private healthcare infrastructure to alleviate pressure on the overall health service. It needs to sort out the chronic shortage of affordable housing to rent or buy and tackle the cost of living, which would be an incentive for graduates to stay and for those abroad to return home.

Other measures the Government can introduce include more hospital inpatient and community beds; more acute, subacute and community step-down beds; more front-line doctors, nurses and allied health and social care professionals; long-term planning for workforce development; and a health service that works smarter and embraces technological innovation, acting speedily to resolve the constant shortage of medicines. All these measures will significantly reduce overcrowding in the healthcare system. It is inhumane, unsafe and undignified. The staff, patients and relatives of those in the health service, many of whom were protesting last week, deserve much better. Taxpayers deserve much better. The Government needs to act swiftly and effectively.

Annie Hoey (Labour)
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I thank the Minister for attending. I sit on the Joint Committee on Health whose members are contacted daily, via the committee and by personal email, about issues that have all contributed to the latest hospital overcrowding and the crisis in workforce planning. I have seen vacancies at consultant level, eye-watering waiting lists and so forth.

My colleague, Deputy Duncan Smith, our party spokesperson on health, outlined his concerns around community care options and what we have available. I agree that people need real community care alternatives to hospital emergency departments, which is part of the overcrowding crisis. There is a lack of options. There needs to be stronger co-ordination between community care facilities in hospitals to ensure step-down beds are available to communities for speedy discharges. We hear all the time about people waiting in beds because they have nowhere else to go while others are waiting to get into those beds, and that home health needs to be readily available for people.

We also hear every day about the impact of this crisis, not only on patients but also on staff. Nurses and midwives are being pushed to the brink. Paramedics dealing with a huge upsurge in demand are at breaking point. They are literally sitting outside hospitals in their ambulances, as in the case of Our Lady of Lourdes Hospital in Drogheda, because they cannot get the patients into the hospitals. Tens of thousands of health workers are experiencing unprecedented levels of burnout. It is safe to say the public is losing confidence in our health service. It is alarming that we are expecting more shameful records to be broken next week. The HSE has a duty to provide a safe environment for all health workers and patients but that is not happening in the vast majority of hospitals. This is causing real serious damage to workers' physical and mental health.

To jump across to the other side of the country, my party colleague, Councillor Conor Sheehan, who is a representative for Limerick City North, has also spoken about the severe lack of resourcing in University Hospital Limerick, UHL. That has been highlighted for a number of years by many Members of this House and the Lower House. We have seen figures suggesting that UHL is possibly 50% more overcrowded than other hospitals in the country. My party colleague believes that when St. John's Hospital, Nenagh General Hospital and Ennis General Hospital were downgraded, UHL never got its fair share of resources to create the centre of excellence that was promised. UHL is understaffed and has fewer beds per capitain comparison with the five other acute hospitals.

Three years ago, it was clearly shown by the then clinical director, Dr. Gerry Burke, that the University of Limerick Hospitals Group was poorly resourced in comparison with the six other groups. At that time, the disparity amounted to a 10% deficit in annual funding, with very large disparities in staffing, particularly medical staffing and health and social care professionals, and a large disparity in acute beds. Dr. Burke indicated that more than 200 additional beds were needed and that view was backed up by Professor Lenehan, the current clinical director. Dr. Burke's research showed that, on average, the five other hospital groups in Ireland had up to 25% more hospital doctors, 27% more consultants, 50% more healthcare professionals, HCP, and 7% more nurses and midwives compared with UL Hospitals Group. The group needed 130 more doctors, 120 nurses and 200 HCPs to bring it up to the same level as the other five hospital groups. It is a dire situation at UHL at the moment and very little has been done to correct these anomalies. It is important to recognise that there is a staffing deficit in UHL. Many people working in the hospital feel they are being gaslit to some extent by the suggestion that the situation is not too bad.

I need only refer to my home area, between Meath and Drogheda, to highlight the impact of overcrowding even further. My Labour Party colleague, Councillor Elaine McGinty, who is based in Laytown-Bettystown in County Meath and who has been a very loud advocate for the Save Navan Hospital campaign, was this weekend out protesting the closure of the Navan Hospital accident and emergency department, which plans to send patients over to Our Lady of Lourdes Hospital in Drogheda. I have already spoken about the ambulance queues outside Our Lady of Lourdes Hospital. My Labour Party colleague, Deputy Ged Nash - I have mentioned a lot of party colleagues - spoke about the scenes of chaos outside Our Lady of Lourdes Hospital when 11 ambulances were parked up at one point on a particular Saturday night. Ill patients were being treated in ambulances because of a lack of beds and trolleys in the hospital. It is very hard for people to understand that. The Minister must understand that people in counties Cavan and Meath cannot contemplate the accident and emergency department being closed when there are queues of ambulances outside the accident and emergency department to which they are going to be sent. I understand that there are concerns around overcrowding in the accident and emergency department in Navan Hospital. This comes down to whether it is better to be in the overcrowded emergency department in Navan Hospital or to be on the road outside Our Lady of Lourdes Hospital in Drogheda. That is a dire situation for our health service to be in.

I wanted to outline to the Minister some of the areas my Labour Party colleagues have been working on and highlighting in recent weeks and draw to his attention, as I am sure he already knows, the overcrowding in hospitals across the country.

Lynn Ruane (Independent)
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I welcome the Minister to the Chamber. I will start with a quotation: “It turns out, however, that the cost [of austerity] could be large – much larger than the benefit." That statement is not from a left-wing politician but from a report by International Monetary Fund, IMF, economists in the last few months. We have seen our health service spiral into what feels like an unprecedented disaster. It is devastating to see and feel the impacts on patients and medical staff as they struggle to navigate this crisis.

I want to focus today on what austerity took from our health service and why we need to let go of an austerity mindset if we ever want to repair it.In 2014, a study in The Lancet examined the effect of austerity on the Irish healthcare system. It found that €3.3 billion had been cut from the health system since austerity began. Budgets were slashed by 22%. It found that there were 12,200 fewer HSE staff and 941 fewer public beds in the system since austerity began. Those figures are from 2014, but the system still has not recovered. The consequences of austerity are all around us today. They have gradually eroded our health system over the last decade, leading us to the breaking point we are experiencing now.

Since I have limited time today, I can only focus on staffing as one example of the impact of austerity on the health service. A direct line can be traced from those staffing cuts that were made a decade ago to the chaos and suffering that we are experiencing. A 2017 study on the impact of austerity on Ireland’s health workforce found that permanent staffing was reduced as a supposed money-saving measure to ultimately make our budgets look more streamlined for the EU, yet the study found that the reduction in directly employed staff was to a great extent matched by a marked increase in agency spending. It did not matter how many doctors’ contracts we cut on paper because we still needed the doctors and, therefore, the shortfall had to be made up through agency staff instead. The agencies charged high fees to supply staff, so the HSE ultimately ended up spending more than they would have done on permanent contracts. The amount spent on agency staff doubled in the austerity decade from €136 million in 2010 to €355 million in 2019. We are now spending well over €1 million per day on agency staff. We are evidently still living with this austerity hangover. These changes in spending were never reversed from austerity. The special, once-off austerity budget measures have just become standard, everyday budget measures. We have watched as our health service has buckled and we are paying for the pleasure. These staffing cuts have had significant knock-on effects. The remaining staff were put under more and more pressure and had to work more unreasonable hours.

I am highlighting this example because it clearly shows how spending cuts that were made decades ago have created these cycles. They have set off these chain reactions where the health service has deteriorated and worsened. These cuts created a runaway process which has now escalated beyond control. We are at the end of a long decade of a downward spiral where the effect of every euro that was cut was amplified. It is no longer enough to simply carry out business as usual. If we want to reverse these catastrophic chain reactions that have seen so many staff leaving the service and put in piecemeal bits of spending here and there, we will not make a difference. We need transformative spending to dig our way out of this. What concerns me is that the Government still seems to be clinging to an austerity mindset, whether actively or not, when it is clear our only solution to reverse more than a decade of cuts is through radical, unprecedented levels of investment into our public service.

This year, the Government left billions of euro on the table in the budget, citing the fact that our surplus may have been a windfall from corporate tax receipts. The Government called this “the rainy day fund”, and a couple of months later nearly 1,000 people were waiting on trolleys in our emergency departments. It is beyond time that we realise that the rainy day has arrived.

Senator Conway mentioned the issue with GPs. I will not shame the surgery in Tallaght on the record, but there is a surgery in Tallaght that is making women, children and older people show up before the surgery opens and queue down the street just to make an appointment. This is not even to see a doctor. No wonder people are showing up in accident and emergency departments when they are waiting for days and weeks to see a doctor. By the time they need help, they show up in the accident and emergency departments, which are bursting at the seams. Receptionists are triaging people. These are receptionists who are answering the phones and who are prioritising people's illnesses as to whether they will see a doctor, even though they have no medical training. We need to address the situation with GP capacity in communities and also ensure that we give adequate investment to the health service to reform.

Shane Cassells (Fianna Fail)
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I thank the Minister for being present. Last Saturday, when people took to the streets across the country there was a palpable sense of exhaustion and frustration. That is even worse than anger because people genuinely feel that nobody is listening. When the Minister faces that mammoth task of reforming and making fit for purpose the massive entity that is our health system, he relies on the advice of many different strands of medical professionals so that he can make the best calls in cancer care, maternity care, community care and in so many different areas where improvements are happening and differences are being made. He has specialists in those fields who are telling him what they think is best. While none of us here are medical experts, we have expertise in the fields of how societies are structured and what components are needed to make that function properly. For those of us who have come through the local authority system, in particular and who have spent years working on county development plans and who have spent endless hours and meetings working on minutiae of where education, childcare, sport, industry and health facilities need to go, we know what it takes to put all those aspects together so that people can access what they need and what makes a town work. This is all about access.

As the Minister said in his opening speech, there is an unacceptable number of patients on trolleys. We have a population that is increasing, in particular on the commuter belt on the east coast. Ordinary people who are living in these centres of populations that planners who are employed by this State have created cannot for the life of them understand why the emergency healthcare that their population centres demand is not available for them. Neither could I, until last May when I sat in the boardroom in the Department of Health with all of the top people from the HSE and the Royal College of Surgeons in Ireland. I asked them to their faces if any of them in their decision-making process had familiarised themselves with the development plans of the counties where they were making decisions that impacted the people that live there. The blank faces of these eminent medical professionals told me all I needed to know. They had not.

The Minister speaks of better access for patients, and it is not happening for a reason. When you build a house, you have a plan. When you build a town, you have a plan. The people who are charged with important arms of our State, such as those in the Department of Education, law enforcement and industry, read these plans accordingly and they plan for that but our health managers do not seem to think that these development plans are important because they operate in their medical silo. That might be okay for them, but it is not okay for our citizens, because the failure to plan is what is resulting in these deficiencies in our society. It is exactly why Limerick is a mess and why this impacts towns such as Ennis. This is why I stand in defence of my hospital in Navan. It is madness to take two of the fastest-growing towns in the entire country with a population of 40,000 men, women and children each and then combine them into one, overcrowded hospital and think that is a plan. It is dangerous, as I demonstrated and as I had warned prior to Christmas when 11 ambulances were backed up in the car park in Drogheda. Nobody thinks that is acceptable - not the planners I have spoken to across the region, not the politicians, not the patients and not the ordinary men and women on the streets with whom I stood outside my hospital in Navan last Saturday. They do not understand why they are expected to be triaged in a car park in Drogheda. It is not acceptable. We cannot stand over it. It would not be tolerated anywhere else.

The debate on access needs to be turned on its head. Instead of the HSE trying to close accident and emergency departments, we need plans for investment, such as the already authorised north-east regional hospital that was supposed to be based in Navan. I implore the Minister to engage and turn this debate on its head. He has led reform across so many areas. Let him now engage with us on reforming this area as well.

Mark Daly (Fianna Fail)
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I understand the Acting Leader wishes to propose an amendment to the Order of Business.