Hospital Waiting Lists: Motion (Resumed) [Private Members]

The following motion was moved by Deputy Billy Kelleher on Tuesday, 22 September 2015:
That Dáil Éireann:
notes:
— the sharp increase in the numbers on hospital waiting lists since the start of 2014;
— the abandonment of the eight month target for treatment on the adult in-patient and day case waiting lists and the twelve month target for an appointment on the hospital out-patient waiting lists;
— that the new eighteen month targets have not been met; and
— that the most recent figures indicate a further deterioration in the figures and prolonged times patients are on trollies in emergency departments;
further notes:
— the continuing difficulties for patients and staff in hospital emergency departments;
— that the April initiative by the Government has not yet been financed or in any way improved the situation;
— the increase in the number of patients waiting on trolleys during July and August 2015 by comparison to the same months in 2014; and
— the difficulties in the emergency departments are exacerbating the delays in scheduled hospital treatments;
agrees that:
— overcrowding in hospital wards and delays in scheduled treatments pose a risk to patients;
— the most recent announcement of 300 extra beds is not sufficient to meet the demand of the service, in particular for the winter period;
— there is a need for more units to be reopened with an increase of frontline medical and nursing staff to meet demand; and
— health service funding is inadequate to meet the needs of the Irish public; and
calls on the Government to:
— increase further the number of beds and frontline staff so that the overcrowding can be eased;
— restore the National Treatment Purchase Fund to ensure that patients receive needed treatments in a timely manner; and
— fund the health services adequately and honestly so that the demands from the sickest in the country's society are met in a safe manner.
Debate resumed on amendment No. 1:
To delete all words after “Dáil Éireann” and substitute the following:
acknowledges:
— that improving waiting times for scheduled and unscheduled care are key priorities for Government;
— the wide-ranging set of actions which are being put in place by the Health Service Executive (HSE) to achieve improvements in the delivery of both scheduled and unscheduled care;
— the difficulties which overcrowding in Emergency Departments (EDs) cause for patients, their families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances; and
— that optimum patient care and patient safety at all times remain a Government priority;
notes in particular that:
— the Minister for Health convened the ED Task Force last year and the publication, in April 2015 of the ED Task Force action plan, with a range of time defined actions to (i) optimise existing hospital and community capacity; (ii) develop internal capability and process improvement and (iii) improve leadership, governance, planning and oversight;
— the significant progress made to date on the ED Task Force plan is as follows:
— delayed discharges are reducing steadily from 830 in December last year to 586 on 15th September, and the average number of patients waiting greater than 9 hours on a trolley in August was 97, down from 173 in February;
— waiting times for Nursing Home Support Scheme (NHSS) funding have reduced from 11 weeks at the beginning of the year to 4 weeks;
— transitional care funding has continued to support 1,903 approvals, which is significantly above the original target of 500;
— over 1,200 additional home care packages will have been provided by the end of 2015;
— 149 additional public nursing home beds and 24 additional private-contracted beds are now open; and
— in addition, 65 short-stay beds have opened in Mount Carmel Community Hospital, which was officially opened in September;
— in June, the HSE reported a performance against the Minister’s 18 month maximum permissible waiting time of 99.6 per cent for inpatient and daycase treatment and 92 per cent for Outpatients’ Department (OPD);
— in order to maintain progress and make further improvements to achieve a 15 month maximum waiting time by end year, the HSE has directed that hospitals which breached the 18 month maximum waiting time in August are to be fined. The fines will be calculated on the basis of the activity-based funding cost of each procedure and are being imposed from 1st September;
— the HSE has provided 1,004,329 inpatient and day case treatments and 2,176,365 outpatient appointments up to the end of August this year - an increase of 3,461 inpatient and daycase treatments and 39,879 outpatient appointments compared to the same period in 2014;
— the provision of additional funding in 2015 to relieve pressures on acute hospitals is as follows:
— €74 million in April 2015 which has supported significant progress to date on reducing delayed discharges and lowering the waiting time for Fair Deal funding, as well as providing additional transitional care beds and home care packages to provide viable supports for those no longer needing acute hospital care; and
— €69 million in July 2015 - €18 million to support the acute hospital system over the winter period by providing additional bed capacity and other initiatives to support access to care and €51 million to ensure achievement of the maximum permissible waiting times for scheduled care;
— this additional funding came on top of measures already taken in Budget 2015, when the Government provided €25 million to support services that provide alternatives to acute hospitals;
— all of the funding referred to above is additional to the welcome increase in the total financial resources made available to the HSE by the Government in 2015;
— a series of campaigns are ongoing to attract frontline staff in order to meet patient care requirements:
— since January this year, around 500 more nurses are working in the health service;
— since September 2011, almost 300 additional consultants have been appointed to acute hospitals around the country, including 57 more this year;
and
— the number of Non-Consultant Hospital Doctors (NCHDs) employed in the health service has increased by over 250 since last year;
— the National Treatment Purchase Fund (NTPF) as it operated under the previous Government did not succeed in eliminating long waits;
— Fianna Fáil’s alternative budget last year provided only €300 million for health, which is much less than will be provided by the Government; and
supports the Minister for Health in his continued determination to bring about improvements in urgent and emergency care services and in hospital waiting lists.
-(Minister for Health)

I am sharing time with Deputies Boyd Barrett, Pringle, Seamus Healy and Tom Fleming.

At this point in the lifetime of the Government there is no expectation that the health service will improve. It is one of the areas where people had an expectation of an improvement. There was a lot said before the election.

It is something of an indictment that it is like clockwork each year that we see the same problems occurring. One can predict the reasons for them. For example, the problem of the long backlog in the registration of nurses is one of administration. We have known for months there is a real backlog in registering nurses and midwives, and even last week we heard the same criticisms from some of those looking to be registered. What will happen is nurses who are working in the nursing homes will be hired by the hospitals and then there will be a difficulty in the nursing homes because they will not have sufficient numbers to operate properly, and it will have the knock-on effect of increasing pressure in acute hospitals and patients not being able to be released to step-down facilities because they will not be adequately covered for safety purposes in terms of the number of nurses. That was entirely possible to overcome. It is not only about funding. That administrative side is a failure that will cause a problem soon, and we are already starting to see it.

Essentially, the other aspects, of patients waiting longer for procedures and getting sicker with more extensive treatment required, do not make sense from the point of view of the patient who is queuing who requires the procedure or even from the point of view of economics. I support the motion.

Over the four and a half years of its term, the Government has stumbled from crisis to crisis in terms of the fairly disastrous situation in the health service. It is a little like the story of Peter and the dyke, where one crisis appears and the Government moves under pressure to stick its finger in one hole and then, quickly, a crisis develops elsewhere. There have been multiple crises over the four years in accident and emergency departments, chronic rises in the waiting lists, the mess in child mental health services and cuts to all sorts of other services causing problems, whether it is home help or cuts to personal assistants for those with a disability.

Whatever it is, the fundamental problem is that the Government has not reversed the disastrous series of austerity cuts which have taken place since 2008 and have seen €4 billion taken out of the budget, 14,000 staff taken from the health system and 1,600 beds taken out of the system. The slogan of the Government was that it would get more for less. What we see now is one does not get more for less. When one slashes budgets, staffing and beds to that extent, one gets disaster.

Of course, the flip side of that coin is the Minister going on and, essentially, trying to scare people into taking out private health insurance in order to go over to the private system because of the disaster in the public system which, ultimately, is the real agenda of the Government. The Government's real agenda is to run down the public health system and cause a crisis in it through under-funding, under-staffing and under-resourcing in order to terrify people to move into private health. That is what has happened and it is really quite astonishing to have a Minister in charge of the public health system only a few months ago touting, essentially, for the private health insurance sector.

I support the motion.

The one sentence that I ultimately agree with in the motion is that the Dáil calls on the Government to "fund the health services adequately and honestly" because something I believe we have not seen in the State in the past 30 years is adequate and honest funding for the health services.

The reality is that the health services have never recovered from the Mac the Knife cuts in the 1980s when over 3,000 beds were taken out of the health services and by the time we came around to the current crisis in 2010, they still had not recovered from that. Over this crisis, we have seen another 1,600 beds taken out of the health services. This will continue. I do not think, by the time we hit our next crisis, probably in five or six years' time, that the health services will have recovered at any level either.

The Minister for Finance yesterday was being quoted in the newspapers as saying that it was crazy for the HSE to be looking for an extra €1.9 billion to fund the health services into the future, but the reality is that the Government uses the waiting lists in the health services in order to ration the service and to keep costs down. If one wants an efficient health service it has to treat more patients and in order to treat more patients it must cost more, and that is the problem the Government has and that it is not willing to accept. If we want to provide for the patients on the waiting lists, we must invest more money in the health services. No doubt that is what will happen. I believe that more than €2 billion is needed to make the health services work and that will never be seen under this Government or any future right-wing Government in this State that I can envisage.

What we always have then is citizens waiting for years to get an appointment to see a consultant so that they can get onto the waiting list to wait to get a procedure, and citizens then getting letters offering them an appointment with a consultant in 18 months or two years. That is the reality of the situation. Unless the Government gets its act together and invests in the health services, that will never change.

The health service has been devastated over the past number of years. We have seen €4 billion taken out of the budgets and 11,000 staff gone. In this current period, started by Fianna Fáil and the Green Party and continued on by the Fine Gael-Labour Party Government, we lost in the order of 1,600 to 2,000 beds, and we had previously lost approximately 3,000 beds. Those cuts have devastated the service and they are reflected in every aspect of the service at local level, whether it be in hospitals or community care or, indeed, in the mental health services. For instance, South Tipperary General Hospital has lost €15 million or 25% of its budget and well over 100 staff. That hospital is working above and beyond the call of duty and the staff are excellent. It is now working at 120% capacity every day of the year. I commend the staff and the hospital on the work they are doing.

It is essential to reinvest in services, particularly at South Tipperary General Hospital. We need at least ten step-down beds - that has been asked for on a number of occasions. We need community intervention teams to ensure that the overcrowding in accident and emergency is stopped. We need additional medical and support staff. We absolutely need the opening of additional medical beds for the hospital and that needs to be done sooner rather than later.

We are stuck within a health service where lengthy waiting lists appear to be a permanent feature. Approximately 400,000 people, which is one in 12 of the population, are currently on the outpatient waiting lists while well over 50,000 people are waiting for procedures. It is recognised that the care provided by staff once a patient gets into hospital is generally of a very high standard.

Why the mismatch in access to hospitals? The Minister and HSE will have to come to grips with the chronic situation and the continuous gridlock by which sick and urgent medical cases are on an endless journey to secure proper treatment for the majority of the population who are deprived of treatment. In many cases, private consultants refer outpatients back to the public service for procedures so they move from one list to another. They may need to be seen by a consultant in the public service and end up being double handled, which is a ridiculous situation.

It is completely unacceptable and morally wrong to have seriously ill patients accommodated on trolleys in hospital emergency departments. On any given night approximately 300 to 400 patients will be on trolleys in wards and corridors. The recent trend indicates the numbers on trolleys are increasing, if anything, as the demand for hospital services increases and the system struggles to discharge elderly patients. We must reinvest in capacity to meet demand. During recent years, we have lost hundreds if not thousands of beds from the service. We must also keep patients out of hospitals. Preventative measures and programmes must be put in place at GP level. Operating theatres should have better outputs and returns and should be used for longer hours and with appropriate staff in place. It is wrong to have people waiting for something that can be corrected in a reasonable manner with no extra moneys involved.

I welcome the opportunity to speak on this motion. I am looking at the Minister while people are asking for more resources. The Minister would happily take more resources and would absolutely love to be able to deliver on the request being made here for more beds and staff. Who would not? The idea that he does not want that and wants something inhumane to happen to somebody on a trolley is not the truth. It is not the truth of anybody in the House. However, there are realities about budgets. The health budget has been severely cut from €4 billion and many efficiencies have been sought.

My local acute hospital, Mayo General Hospital, has fantastic management and staff and, for the first few years of austerity, was better than the national average in reducing trolley figures. This was brought about by better bed management practices such as weekend discharges and same-day procedures. Step-down facilities were used to try to alleviate the problem of delayed discharges. There have been many think tanks around how the problem of trolleys and people on waiting lists for scheduled care and operations, outpatient and inpatient, can be addressed. However, during recent months, the trolley figures in Mayo General Hospital have increased. There has been a surge during the summer that has never been seen before. It is normally associated with winter. The incidence of flu and colds has increased. The August figure for people on trolleys was ten in 2014 and 130 in 2015. Clearly, there is a problem.

There is increased demand and we have an underlying problem in our health system which we must face and plan for. The issue will not be just hospitals, trolleys and the existing physical structure. We must face and plan for our ageing population. Many of the additional people attending the emergency department are elderly people with chronic illness and, ideally, they should be managed at primary care level to avoid the deterioration of their conditions and their presenting to the emergency department. This can best be done through GPs, specialist community intervention teams and home care packages. Further funding needs to be directed towards this to avoid the bottlenecks happening in emergency departments.

There is also a capacity problem in our hospitals, including in Mayo General Hospital. The emergency department in Mayo General Hospital was initially designed to deal with 20,000 patients per year but is now dealing with 35,000 patients per year. In the longer-term planning we need investment to ensure chronic illness is managed more in the community. These realities are dawning on us, given that people are growing older and living longer. A business case was made to the west-north west hospital group for an extension to the emergency department and additional medical beds. I wish for these plans to progress in order that we can not just always be firefighting the trolley situation but have a longer-term solution. Community and primary care also need to receive funding.

In discussing acute health care, we spend much of our time trying to find ways to solve immediate problems. Very often, front-line staff, management, administrators, Ministers and HSE officials are firefighting to make our system and facilities work in the interests of patients. We all agree that firefighting alone is not enough. We must plan for the future and put in place a framework that will deliver the best health care service for generations to come. Sometimes this involves bold decisions, radical thinking and a commitment to drive a project or change. The Government has been doing this. We have been driving change and changing how we deliver in our health care system.

Acute hospital services in Cork are at capacity in terms of services and the development phase at Cork University Hospital, Mercy University Hospital and South Infirmary-Victoria University Hospital. The last two hospitals operate in buildings dating back to the 1850s and 1760s. I hope Deputy Kelleher agrees that Cork needs a new acute hospital that will be developed in modular fashion over a 20-year period. This will future proof health services and ensure we have the capacity to meet the needs of a growing population in Ireland’s second city outside Dublin and our most populous county.

The report of the non-executive advisory board which the Minister recently received sets out a realistic and achievable vision. It presents an opportunity to develop health services in a more cost-efficient way and ensure it will not happen in just five years but over a 50-year period and for time to come. It is a rare opportunity for our health services in Cork. I have already spoken with the chairman of the group and have met Professor John Higgins. I have spoken to the Minister and I hope we will meet again, and I will raise it at the health committee, of which I am Chairman. It is an important project which needs to be promoted and championed and it can and will deliver improved health services for the people of Cork.

On the motion before us, the Government has provided €18 million extra funding, reduced delayed discharges since December and guaranteed a further €51 million. There is a need to prioritise how we spend our money in health. The motion does not give us a platform within which to bring change or a blueprint on how to bring about change that will deliver a better service. I commend the men and women who work on the front line of our health services. They are doing more with less, they are productive and they have brought quantum change to our health service. They deserve our praise.

If Fianna Fáil proved anything during the boom, it definitely proved that throwing money at problems does not necessarily fix and sort them. The Minister and his predecessor have been working within very constrained budgets, as every Department has, and working in that environment has been difficult. Money alone will not fix the problems. I commend the Minister on his progress on the emergency department task force, reporting implementation, looking at the colonoscopy waiting times, the winter capacity funding of €18 million, the reduction in delayed discharges and a number of measures and plans that are in place and working. Our health care staff in facilities throughout the country are working in challenging circumstances.

Naas General Hospital provides a vital service for all of County Kildare, particularly south Kildare, the area I represent. I commend Alice Kinsella and her team of staff there, and Catherine Hughes, on the fantastic work they do. An endoscopy unit is planned. We cannot get work to begin on it quickly enough. We need extra capacity.

I welcome the 11 extra beds that are coming on line for Naas as well. I invite the Minister to come to see St. Vincent's Hospital in Athy, which is an excellent care facility, at first hand. It is in an antiquated building, but it has an excellent dementia care element and one of the best Alzheimer's units in the country. Even though the hospital building is out of date and has been for a long time, against all the odds this facility achieved its HIQA standard during the summer. That success can be attributed to the staff, from the manager, Helen, all the way down to the porters. It is really a model to be used as an example for the rest of the country in terms of management and staff and everybody working together. Having said that, I admit that a new building is needed. I would like funding to be put in place to allow that to happen as soon as possible. The hospital should not be allowed to slip back down the list.

I thank Deputy Heydon for allowing me to share some of his time. I would like to join him in looking at things in our own locality. In 2007, the Fianna Fáil Party pulled the endoscopic unit at Naas General Hospital from the capital programme. In 2016, this Fine Gael-Labour Party Government will deliver the endoscopic unit to Naas General Hospital. This will enhance the services that are provided at the hospital. The manager of the hospital, Alice, and her staff, including the lead nurse manager, Catherine Hughes, will deliver on a capital programme over the next number of years to develop the hospital. I thank the Minister for the 11 additional beds that the hospital is putting in place to reduce the number of people on trolleys there. I am delighted to welcome the additional staff who are being recruited at Naas General Hospital. I have spoken to him previously about my belief that the national recruitment service is sometimes not fit for purpose. I suggest that local hospitals be allowed to recruit locally. The sooner the legislation for the groups is put in place, the better. The quicker we get that on board, the sooner the groups will be able to work on these matters. I am delighted that three senior decision makers are being recruited for Naas General Hospital. I refer to the consultants who are being taken on there. This will allow patients who previously were being kept in hospital overnight to go home, which will free up more beds. When I looked at the bed management programme the other day, I saw how much pressure the hospital is under at all times and I gained a new appreciation of the manner in which it continues to deliver its services. I compliment the staff of all our hospitals, particularly Naas General Hospital, who give exceptional service to the community.

I am happy to speak on this motion, which is obviously far from perfect. Since we came into government in 2011, we have been working very hard to make effective and long-term changes in the health system. As Deputy Heydon has mentioned, the system was absolutely far from perfect, to be quite honest, when Fianna Fáil left office after 14 years in which it had buckets of money to throw at the health service. I do not know how to describe the Private Members' motion that is before the House. All we see from Fianna Fáil again is a call for more beds and more staff. It is as if the country had buckets of money to throw at the health service, and as if that would fix the problems we currently have. This shows that Fianna Fáil has learned absolutely nothing from the last seven years. It has gone right back into the cycle of what it was doing for the previous 14 years. There is no evidence that Fianna Fáil demonstrated any intent to reform the health service during its time in government. The difference is that the delivery of top-quality health care is central to everything we do and to the decisions we make.

Nobody - not the Minister and not any member of the Government parties - thinks it is acceptable that 338 patients were waiting on trolleys in our emergency departments this morning. We have to look at what the future will be like as a result of the reforms made by this Government. We will continue to make such reforms. Emergency departments will see a reduction of one third in the number of patients on trolleys. There will be a reduction in delayed discharges. We will see easier access to urgent care, improvements in chronic disease management and timely assessments, treatments, admissions and discharges. In particular, there will be a reduction in the length of hospital stays. The list goes on. Among the real broad, standing, durable, long-term reforms that can be credited to this Government is that we have brought 46 primary care centres to towns and cities right across the country. We are committed to opening at least one each month from this point forward. We are expanding the range of services that are available in those centres. We have created hospital groups with a view to reorganising and managing the very limited resources we have. This will ensure we get efficiency for the money we are spending. The approach we have taken in the form of a wellness model, which involves a holistic approach to health care and preventative care, will result in a smaller number of people needing to use our acute and emergency services in the first place.

I would like to conclude by speaking about acute services, which are the subject of a great deal of media and political attention. Although the focus on trolley watch and on waiting lists is warranted, I emphasise that supporting community services will help to alleviate some of the problems in acute services that we are seeing today. We need to provide clerical and administrative staff to public health nurses who provide a vital service in our communities. Our nurses should be able to concentrate on assessing and supporting clients in their homes until that process has been completed. They should be helping to prevent admissions to the acute services, where their clients often end up languishing in beds because there is nowhere for them to move on to. This causes the cycle I have outlined to continue. Public health nurses can sometimes be swamped with clerical work. They maintain that up to 50% of their time is spent doing paperwork. That is something that needs to be addressed and I would like to see it addressed in the future. Tonight's motion, as proposed by Fianna Fáil, demonstrates the short-term populist solutions that we have always seen from the big spenders in that party.

I agree it is a real problem that there are long waiting lists and large numbers of patients on trolleys. While this is not acceptable to any of us, it is nothing new. For most of the time I have spent in this House, unimaginable funds were available and were indeed spent on health by the Government of the day. Despite this, waiting lists continued to grow and overcrowded emergency departments were a recurring feature. Governments across Europe are trying to play catch-up with the increasing demands on their health services as better and more expensive medicines, more sophisticated procedures and more expensive devices become available. Of course we have ageing populations. It was nigh on impossible to deal with this trend during the depths of the recession, but we now have a range of targeted initiatives, some of which are financial. I hope the incentives for consultants and nurses, for example, will begin to have an impact shortly.

We are taking measures to ensure our acute hospitals are used as acute hospitals that deal with major trauma and complex cases. This is the purpose for which they were intended. Despite the considerable publicity around this issue, I believe there continues to be a great deal of inappropriate use of emergency departments. I know that people in my constituency use their general practitioners during surgery hours. At weekends, they will go to private clinics if they have money; otherwise, they will go to St. Vincent's hospital, even though that is not appropriate in many cases. At the other end of the stay in hospital, there has been considerable investment in reducing delayed discharges. This is being done by funding the fair deal scheme, increasing the funding of home care packages and investing in step-down facilities such as the 65-bed hospital that opened in my constituency recently. I was horrified to read recently that some patients who were about to be discharged from Beaumont Hospital - they were ready for discharge - refused to cross the Liffey, as if Churchtown was some sort of offshore island or something. I really think that kind of choice should not be made available to families. They should be allowed to choose between step-down facilities, but they should not have a choice between an acute hospital and a step-down facility.

The overall message for health service improvements and for better patient outcomes, in the context of the ever-increasing and expanding demand for health services, is partly about funding, but it is also about using our resources so we get a better bang for our buck and implementing the kind of change about which Deputy Buttimer and the Minister have spoken.

I welcome the opportunity to take part in this debate. There is no doubt that the health system is far from perfect. Everyone agrees that improvements are needed in certain areas. I acknowledge that waiting lists need to be reduced and the number of patients on trolleys has to be reduced. There needs to be a concerted effort to fill the many vacancies that currently exist for front-line staff in the HSE. The Minister and the Department of Health are actively working on these areas to find better solutions. I firmly believe that their efforts are already showing signs of improving the system. Simply attacking the HSE while offering no alternative is a ploy that is constantly used by the Opposition, particularly Sinn Féin. This approach offers no real solution to any of the problems.

It is just political point scoring. In my constituency, the Lourdes Hospital in Drogheda is regularly highlighted as one of the hospitals with a higher than normal number of patients on trolleys in the accident and emergency department. I am not going to try to defend the figures but I am proactively working with the Minister and his Department to help reduce those figures. In this regard it is important to note that in the last 12 months the number of staff in the Lourdes Hospital has increased by 170; 24 new beds in Moorehall have been sourced to support the hospital; eight new clinical decision units will be opening this month; and 12 new beds, including a surgical assessor unit, are due to be opened shortly.

In Dundalk, the Louth County Hospital offers many valuable services to the general public, from the minor injuries unit to the diabetes clinic, to name but two. I am pleased to note that 12 new transitional care beds are also on the way at Louth County Hospital. I strongly believe that one of the big issues in Dundalk and the surrounding areas is that the general public is simply not aware of the many fantastic services available at Louth County Hospital. I am constantly amazed by the number of people who bypass Louth County Hospital and go to Lourdes Hospital to be treated only to be referred back to Louth County Hospital. This is an area upon which we can improve. I am actively working with the Minister, his Department and the HSE to implement a system whereby the services provided by Louth County Hospital are more visibly promoted, thereby informing the people of Dundalk and the surrounding areas of the many valuable services currently available at the hospital.

The health service has been and always will be made up of urgent issues waiting for the next emergency. Deputy Kelleher and his party, who collapsed the economy, did nothing to help to improve that situation. If there is one thing that the Minister for Health, Deputy Varadkar, should be given credit for it is that he is starting to change the mindset within the health services and is making changes which were only given lip service prior to this. For instance, we have started the concept of universality in health. Nobody expects our children to pay for their primary education. Why should we expect our children to pay for their health care? We have started the process of giving free GP care to every child under six and I hope that as the years go by we will improve that universality for not just our children but for everybody who lives in our country. That is a change in the way we view our health service. We see it now as a right and not as something that will be provided at the behest of whatever Government is in power.

There has also been another significant mindset change introduced under the current Minister, namely, the concept of disease prevention and chronic disease management. Under the contracts that are now being delivered to GPs we have, for the first time ever, a diabetic care management programme for patients in community care and a proper asthma management programme for young children in our communities. This has been discussed by Members on all sides of this House for the past 20 years but for the first time ever it is actually happening.

I would ask that when Fianna Fáil goes to the trouble of tabling motions about accident and emergency departments, it might be brave and offer solutions to the really difficult problems that exist in our health service. I would point Deputy Kelleher to the large number of people who are admitted to hospital beds from our accident and emergency departments across this country because they are abusing alcohol or other drugs. If we managed to halve that number of admissions we would have no patients on trolleys. This is an issue that has been with us for years and we need to have a really serious conversation about it in this House, rather than just the point scoring that we are seeing here again tonight.

Deputy Kelleher must admit that his motion offers nothing other than more money and back to the future with the National Treatment Purchase Fund, NTPF, something that has been around for years.

That is not true.

It does not work quite as well as the Deputy thinks. I know that it was a former Minister for Health, Mary Harney, who introduced the NTPF and while it works up to a point, it does not quite work in the way that is needed.

The Minister has introduced a number of changes into the community health care sector, most notably the community health care organisations. Under this system, each network will be headed by an "identifiable, accountable person" responsible for care delivery by professionals such as nurses, therapists etc. This is something that has been sorely lacking in our health service for too long. We have been unable to determine who is accountable for the decision making process. All too often we cannot find out who is responsible for making decisions, who can stand over those decisions and who will explain to patients and health care providers why services are being denied or are not being delivered in the manner they expect. This is another concept that should have been developed years ago, that is, making people accountable for the decisions they make.

There was a massive increase in the number of people who were paid to be senior managers within the HSE----

The Government took on more of them last week.

No, actually, it happened under Fianna Fáil's watch.

The Government took on more last week.

Fianna Fáil, when it set up the HSE and its structures, institutionalised a form of management within the HSE under which people are afraid to explain why they make the decisions they make. This is now changing.

There is one minute remaining.

Thank you. I could not quite hear with all of the interruptions.

I was just trying to correct the Deputy. Apologies.

Deputy Kelleher and his party must take responsibility for the mistakes they made and acknowledge what the current Minister for Health is doing. He is changing the mindset within the health service. We are doing the right things for the future. We must have disease prevention, chronic care management programmes and so forth. We are treating 25,000 patients in the community who would otherwise have been admitted to hospital. It is a change of approach to how health services are delivered that will deliver better services; it is not just about throwing money at the problem.

The health services, including ambulance services, primary care, hospital beds, new MRI machines, single bed units in new hospitals and so fort, will consume massive amounts of money in the next decade. Hopefully the economy will keep on track, having been rescued by this Government following the work done on it by Fianna Fáil. The standard reaction from Fianna Fáil that we must spend more money without a clear plan about how to spend it will add nothing to what needs to be done in the years to come.

I am pleased to be able to say a few words on this motion. As Deputy Fitzpatrick outlined, everything is not perfect in the health service but the motion before us takes no cognisance of the fact that we have had several years - up until last year - of a reduction in funding for health services because of the economic catastrophe that those opposite us led the country into over a seven or eight year period. It takes no cognisance of the fact that those opposite were the architects in many respects of the Health Service Executive as it currently exists and the overpopulation of administration----

The Government took on more last week.

----versus front-line services that exists within our health services.

I wish to place on the record that in my part of the world there has been a fantastic investment, despite Fianna Fáil's wrecking of the economy, in the health services in the south east in the last five years. There are three general hospitals in the south east - St. Luke's in Kilkenny, University Hospital Waterford and Wexford General Hospital - and all three are getting new accident and emergency departments----

Former Minister Hogan has delivered I see.

All three are getting new emergency departments. In Kilkenny, over €20 million has been spent on the new emergency department and medical assessment unit, construction of which has been completed. The fitting out is now taking place and an opening should take place in the next number of weeks. While St. Luke's Hospital in Kilkenny is a fantastic facility, the emergency department was built in the 1950s as the laundry of the original hospital. It served a population area encompassing pretty much all of County Carlow, most of County Kilkenny and the surrounding hinterland. That €20 million is to be greatly welcomed.

I also place on record my strong support for the recent announcement of funding for State-run residential facilities and an increase in capital funding for these services. The population has increased by 11% in the past seven or eight years, with the number of people aged 80 years and over increasing by between 35% and 40% during that period. As a result, demand for services has increased in a period in which funding for the health service in general decreased substantially owing to the economic circumstances in which the country found itself. I welcome the decision in the previous budget to increase funding for health for the first time in six or seven years and hope the trend will continue this year.

I concur with Deputy Twomey on the significant step forward taken towards universality in primary care and join him in asking that these steps be continued. One of the most outstanding initiatives taken by this Government and this Minister has been to start the ball rolling on universality.

I also welcome the initiatives on chronic care management raised by the previous speaker. I have personal experience in my family of the operation of these initiatives.

It is proving difficult to attract general practitioners to join rural GP practices. If we are to promote primary care, we must ensure these positions are filled which will mean making the role of the rural general practitioner more desirable.

I support the motion tabled last night by my party colleague, Deputy Billy Kelleher. My experience is probably not unlike that of other Deputies in respect of the number of constituents presenting at my clinic desperately seeking help to access the treatments for which they have been waiting for an ever lengthening period of time. Unfortunately, the hallmark of the Government since it first promised to introduce universal health insurance has been to pretend that everything is fine when the opposite is the case.

Government policy has been to continue to deny the blindingly obvious. During its first three years in office, the former Minister for Health, Deputy James Reilly, repeatedly pressed home the message that he had the health service under control and was making progress. Repeated assurances were given in the House and elsewhere that discretionary medical cards were not being withdrawn, despite it being blindingly obvious to everyone that they were being removed from people left, right and centre. The Government was forced into a climbdown when it finally admitted these medical cards were being withdrawn.

Shortly after his appointment, at a time of backlogs and large numbers of patients waiting on trolleys, the Minister for Health, Deputy Varadkar, gave an assurance that there were no issues with approval for the fair deal scheme. After a short period, the Government admitted there was an issue and measures were taken to try to address it. Similar issues have arisen across the health system. To give one example, in Letterkenny General Hospital alone, two years ago 3,000 patients were outsourced for private health appointments to have their treatment completed in the private hospitals to which they were referred. After an initial private visit to a consultant, approximately half of the patients were discharged, while the remainder was transferred to the Letterkenny General Hospital for public treatment. Before this group of patients could be treated, they had to be seen again by a consultant in the hospital for an assessment. Just a few months ago, a number of these patients were again outsourced to the private system for treatment. This unfortunate example of the way in which the health service operates demonstrates the lack of co-ordination at the centre and the absence of any form of management to anticipate developments.

When it became clear that the position of the former Minister for Health, Deputy James Reilly, was no longer tenable, the Government replaced him with the current Minister. One of his first acts was to inform people that the health service could not be fixed in a hurry, change would take time and the previous Minister's policy of introducing universal health insurance might not be realistic. In many ways, members of the public heaved a sigh of relief in the belief that a Minister calling things as they were might be an indication that things could get better. They thought this was a sign of competence where none had been shown in the health service previously.

Unfortunately, waiting lists have worsened in the past year to 18 months. The Minister extended the maximum waiting time for seeing a consultant for an outpatient appointment from 12 months to 18 months and the eight-month target time for inpatient treatments to one year. The new targets have not been met. For example, in Letterkenny General Hospital the number of patients waiting to see a consultant for an outpatient appointment for more than 12 months has increased by 70% and currently stands at more than 4,000. The current position is not sustainable. As a first step, the Minister must admit that is the case. Realistic budgets and an honest appraisal of the current position are required. We need a Government that will finally take some control and start to deliver the health services members of the public are desperately seeking.

I support the motion introduced by Deputy Billy Kelleher.

Many Ministers for Health have come and gone in my time in the House and responsibility for health now rests with the current Minister, Deputy Varadkar. I believed this Minister would take an enlightened approach and solve the problems in the health system with a stroke of the pen. That is clearly not the case.

The main problem I have identified in the health service is the lack of capacity. Those who are able to access services are well looked after, are treated properly and usually have follow-up treatment when they are discharged. The lack of capacity seems to be the major problem. The Minister recently announced that a further 300 beds will come on stream in the health service. Will this be sufficient to address the number of patients who need help? These beds must be a permanent addition to current hospital capacity. We also need to find out where they will be located. Will they be confined to Dublin or spread across the country? Will Wexford General Hospital, for example, be allocated additional beds?

More than 11,000 people have been waiting for 18 months or more for an outpatient appointment and approximately 5,000 children have been waiting for an appointment for more than 12 months. These figures are outrageous and the position is not helped by the fact that the Minister appears to perceive his role as being a lead commentator as opposed to a Cabinet Minister with direct responsibility for the health service.

Despite all the promises made by the Minister, the Irish Nurses and Midwives Organisation recorded a staggering 40% increase in the number of patients waiting on trolleys in emergency departments in August. Since 2006, the number of people aged 65 years and over increased by approximately 118,000 or 25%.

The problem is obviously going to get worse. There will be a significant number of older people who will require hospital services but the capacity is not there to deal with them.

Returning to the issue of my constituency, I listened to Deputy Twomey earlier. The situation regarding knee and hip operations is a total disaster. We depend on Kilcreene, Cappagh and Waterford hospitals but people are waiting years to be admitted to have operations they require. Many of them are in severe pain and unable to walk, yet the services are not there to meet their needs. The other area of major concern in respect of Waterford hospital relates to prostate services. Recently, I made representations on behalf of two people who had GP recommendations for prostate services at Waterford hospital. I received a reply which said that due to significant demand for urology services and patients waiting much longer than the HSE would like for a first review and for urology operations, the two recently appointed consultant urologists are currently only able to see urgent, critical cancerous patients in a timely fashion. If one is not diagnosed with cancer, one will not get any treatment. That is a matter of concern. Many people are expressing such concern. They would like to go to hospital when they are referred by GPs such as Deputy Twomey and they would like to do so in Waterford. They would like to be assessed and they would like to have their minds put at ease. This is a matter of serious concern in the south east.

I could go on. The ambulance and many other services in Wexford are not up to the standard required. As I said at the outset, the responsibility rests with the Minister. It is important that he stops being a commentator and starts being Minister for Health in order to deal with the issues that exist.

I thank Deputy Kelleher for providing us with the opportunity to discuss this matter this evening. Earlier, the House was discussing the Marriage Bill which was an example of where politics works and of how the House has managed to influence and change society. However, I have lost count of the number of Private Members' motions we have tabled on health during the current Dáil. The one thing I am sure of is that the management of the HSE does not give a damn what this House thinks of it. It will just plough on regardless. One can be damn sure that not one senior manager in the HSE is on a waiting list for any basic service. Senior managers do not have to worry about whether an ambulance will get them to hospital. If they have a cancer fear, they do not have to worry about having to wait for a public service appointment. If they did, they would not stand over the system which obtains or allow the situation which exists throughout the country, and which continues to worsen, to continue.

I received a reply to a parliamentary question on orthodontic waiting lists this evening. Orthodontic treatment is not even a hospital service in most cases. The orthodontic waiting list in the HSE west area for young children in particular stands at over 5,000. Nearly 1,300 have been on the list for between 25 and 48 months. The list is from initial assessment to commencement of treatment. There is a qualification in the PQ reply I received to the effect that in some cases treatment is delayed in order to see how the condition progresses. I cannot imagine that all of the 5,133 people on the list fulfil that criterion. In rheumatology, we discussed the issues around the cancellation of appointments in Merlin Park. Before that, there were 2,500 people in Galway and Mayo waiting for a rheumatology appointment at one of the two clinics in Merlin Park. The outpatients waiting list at Mayo General Hospital has increased by 400 this year. We have moved to a situation where in many rural communities we depend on the goodwill of the HSE to provide a rural practice allowance to recruit GPs. It is not an automatic provision anymore. Communities in Bangor and Glenamoy in my county have had to wait to see if the HSE would provide a rural practice allowance before the advertisement could be placed. As such, we have been left for months with temporary arrangements in GP services.

There was a discussion today on the ambulance service. I have no confidence in the management of the National Ambulance Service and I am concerned for people in light of the current position in respect of that service. Staff on the ground, including ambulance drivers and paramedics, are doing a wonderful job in incredibly difficult circumstances, as are the staff in all of our hospitals, but they face layers of anonymous people who do not seem to understand the pressure they are under. If those people do understand it, they are not really convinced about dealing with it. That sums up where we are at regarding our health service. We have had a bad summer weather wise. It was a warm summer, which does not augur well for the ability to get rid of basic colds and flus. If we have a busy cold and flu season ahead of us, what will it do to our emergency rooms, which are already packed beyond belief? What will it do to our waiting lists for respiratory conditions which have already spread beyond belief?

The national cancer strategy, into which so much work and political capital was put, is straining because people are finding it difficult to access basic appointments. They are finding that their treatment is being carried out in circumstances and conditions which are unacceptable. The national and regional cancer centre at University College Hospital, Galway, is absolutely straining. The Taoiseach, who is the leader of the Minister's party, opposed that cancer strategy. For four and a half years he has stood by while conditions have got worse. Again, it is not the fault of the staff because they are doing their absolute best. The problem is the numbers trying to access the service, many of whom are not getting in as quickly as they should. We must ask ourselves why this is the case, particularly when we are spending so much. Obviously, the Minister for Finance, Deputy Noonan, shares my scepticism about the management of the HSE given the manner in which he slapped down its funding request today. When we are spending so much money, why are we not getting better outcomes? Why is the position getting worse? As long as we have a condition and culture in our public service that people cannot be sacked for bad performance, it will continue to get worse. Those we pay handsomely to manage the HSE will fiddle along while Rome is burning. Rome is burning.

There must be a complete change of culture at management level to start with in the HSE before we even begin to address the problems we are discussing this evening. If we continue as we are - and it seems we will - waiting lists will continue to grow. It is not like national debt or other figures we discuss. Waiting lists involve actual people who have particular conditions and who are awaiting treatment. If one is a rheumatology patient with rheumatoid arthritis or any other condition, one is in pain waiting to see a consultant. One may have seen the consultant but one may be obliged to wait for treatment. One has been brought down the garden path, led to Eden, and then the gates are shut for two or three years. If one is a cancer patient, one does not have that time. That is what the cancer strategy was set up to address. It was to bring emergency expert care to cancer centres. That is not happening.

If one is involved in a road traffic accident, one should not be obliged to wait an hour for an ambulance to arrive from the part of the county furthest from the location in which one's accident occurred, particularly if the scene of the accident is closer to the regional hospital in a neighbouring county than it is to the town from which the ambulance has come. One should not be put through an interview when one calls for an ambulance to find out where one is from and the condition of the patient and then be obliged to wait an hour for the ambulance to arrive. Meanwhile, the patient is on the ground awaiting attention. I was in that position during the summer and we flagged down an ambulance that was on a hospital transfer to give the patient, who thankfully was fine, some privacy and treatment. That took an hour. The two nearest ambulance bases were not utilised and the ambulance in question travelled from one of the bases furthest away. This is the service the manager of the ambulance service tells us is world class.

We need something to be done. We need to start again with primary care. The Minister must invest in primary care and give the power and capacity to primary care services to do the things that do not need to be done in accident and emergency departments or hospitals. Primary care must involve not just GPs but also pharmacists and it must take the pressure off the hospitals. We need an emergency system in which one is seen, triaged and dealt with quickly. The Minister must do something around waiting lists. He cannot stand over a system where in University College Hospital Galway there are 7,300 people waiting, which is an increase of nearly 80% year-on-year in terms of the patient list.

The increase at Mayo General Hospital has been 39%, with more than 1,100 people waiting. Sligo Regional Hospital has seen an increase of 65.7%. These people need treatment and attention. They are sick and, in many cases, are old and have given a lifetime of service, paid their insurance and done everything required of them, but when they look for a little bit of care, our system is incapable of providing it. The worst aspect is that no one in the system's management seems to care. The lists get longer and the people in question keep submitting unreasonable funding requests. They claim that they are throwing money at the problem, but they are actually building their own empires and feathering their nests while tens of thousands wait for basic treatment. That is not a republic.

I welcome the opportunity to contribute on this debate. Like Deputy Calleary, I have lost count of the number of times that we have raised the issue of the challenges facing the HSE. I am disappointed that the Fine Gael commentator for the HSE is leaving the Chamber.

Yesterday, there was a vote of confidence in the Government and Ministers and Government Deputies fell over themselves coming forward to discuss a recovery. It is good that we acknowledge the economic recovery of recent years, but it was primarily built on four years of regressive policies that, in true Fine Gael style, favoured the minority while the majority suffered. It is not just me saying this. The ESRI confirmed that we have had four years of regressive budgets. Even last year's budget, in which the Government gave some money back to people, saw someone on €70,000 per year benefiting four times more than someone on the minimum wage. The Taoiseach stated that he had received telephone calls at the time from constituents who were happy with his stewardship and the budget. His claims about those calls are as believable as his claim that it was not his intention to sack the former Garda Commissioner.

Tonight, we are focusing on the HSE. It is a sad state of affairs that, despite the recovery, our health services remain in crisis. Consider the latest figures. The Minister's objective is to play down people's expectations and, consequently, for the situation to appear progressive if that level is somehow exceeded. He abandoned his predecessor's targets and moved the goal posts. Despite that, the Government has been unable to meet its targets.

Deputies have stated that people must take responsibility for their actions. The Government has been in office for four and a half years. It is about time that it started taking responsibility for its actions and policy decisions. Between August 2014 and August 2015, there was a 59.5% increase in the number of outpatients waiting 12 months, a 162.3% increase in the number of inpatient day cases waiting nine months and a 430% increase in the number of inpatient day cases waiting 12 months. On top of these figures, the level of overcrowding in accident and emergency departments increased by 40%. As my colleague stated a few moments ago, behind all of these statistics are real human beings. They are our families, our friends and our constituents. They are suffering as a direct consequence of the policy and budgetary decisions taken by the Government. Given the fact that the accident and emergency service patient figures increased in a summer month, it is frightening to think what it might be like during the winter months. Summer is not the season for flus, colds and additional requirements placed on accident and emergency services.

Many challenges face my constituents. They do not benefit from the health service when they need it. No orthodontist has been recruited to the Longford-Westmeath area since a vacancy arose in 2013. Instead, the area has been amalgamated with Laois-Offaly. A parent approached me to tell of how an 18 year old daughter had been awaiting an appointment since she was 11 years of age. What does this say about the level of care in the HSE? Westmeath has only five respite care beds. Two of them are in the southern part of the county. Such beds are predominantly used to give the families of people with high levels of medical need a break. What break was given to Westmeath in the past two weeks? The two respite care beds in the southern part of the county in St. Vincent's hospital were closed. There was a waiting list when there were five beds. What will it be like with just three? Do Government Deputies believe that is progress or fair? I do not. The reform agenda is closing beds.

The Deputy has no credibility on this issue.

I do not know where Deputy Twomey or the Minister's credibility is.

The Deputy's party broke-----

What I am saying through the Chair is hard fact. If the Deputy opposite, who happens to be a Government Member and has voted through every budgetary decision of the past four and a half years and to hell with the consequences for people across various constituencies-----

And who has been in the Dáil since 2002 and has seen what Fianna Fáil did to the country.

I am sorry if the truth hurts. The ambulance service was mentioned. No one realises the situation until he or she must make the call. There is insufficient emergency cover in Longford. A number of weeks ago, two ambulance crews assigned to serve County Longford were called to Roscommon where there was a lack of resources. We all know where Fine Gael's credibility lies in County Roscommon. As a result of the reduction in Roscommon's services, there was a reduction in services for County Longford. That is not right or fair.

Given the figures that have been mentioned, do we tell an 82 year old woman who can barely walk and has been waiting in excess of 22 months for a knee operation that we are sorry, this is how the waiting list is and nothing can be done? We should remember that one of the Government's first decisions was to abolish the patient treatment fund, which was intended to provide such operations for people who had been waiting in excess of six months. That was a policy decision, whether the Deputies opposite care to admit it. There are many more people involved than just that lady. I am not unique in terms of the numbers approaching me with grievances about this matter.

I know for a fact that a part of the reason for there being such a problem with accident and emergency services is bed closures in the relevant hospitals. In the Midland Regional Hospital Mullingar in my constituency, there are 16 fewer beds than there were in 2010.

Consequently, it is no wonder that now, or earlier this year, we experienced the highest trolley count on record. If the Government does not consider putting in adequate resources and ensuring there are sufficient beds in hospitals, the problems in accident and emergency units will continue.

I could go on at length and give examples of how the HSE is failing the people. I do not expect the Minister to micromanage the HSE and I do not expect him to know the difficulties faced in every hospital or in every service. However, I do expect the Minister to give up sitting on the sidelines and to give up telling the people what they already know about what is wrong with the health service. I expect him to start implementing the reform agenda he promised - that is, to start ensuring the money follows the patient, that the hospitals that are most efficient are rewarded, that there is more community care and primary care within communities and that the appropriate number of consultants are recruited. I expect him to live up to the commitments that were made in advance of the last general election in order that, at a minimum, Members can stand over a health service of which they can be proud and that Ireland can have a health service that will deliver for all citizens regardless of their means - that is, a health service that will deliver for the people based on their medical need, not based on their income.

Last night my colleague, the Minister, Deputy Varadkar, updated the House on the range of measures being undertaken to address long waiting times and access issues in acute hospitals. He spoke of the almost 40,000 additional outpatient clinic appointments that have been provided to patients in 2015, of the 290 additional consultants who have been appointed since the Government took office, of how there now is the highest ever number of non-consultant hospital doctors, with 5,500 employed at present, as well as of the 122% increase in applications for nursing and midwifery registration this year. It was heartening last night to hear from both sides of the House the acknowledgement of the incredible hard work and dedication of those nurses, doctors, managers and allied health professionals. They are at the front line, interacting with patients and working to deliver a high-quality and safe service, often under major pressure. They combine the clinical expertise and the human interaction that are at the core of any health service. The Government must ensure that people are seen and treated in a timely fashion, whether in an emergency department or for scheduled care, that is, in a clinic or for elective surgery.

The priority being placed on this goal by the Government is shown clearly in the more than €140 million in additional funding that has been provided this year, of which €51 million has been provided to the HSE to focus on reducing long waiting times by optimising internal capacity and using targeted initiatives where necessary. This ensured that by June, waiting times had fallen below the maximum permissible waiting time of 18 months set by the Minister for 99.6% of inpatient and day case treatments, as well as 92% of outpatient appointments. It will also ensure that progress is maintained and that the HSE can continue to reduce waiting times to a maximum of 15 months by the end of the year. The additional funding of €74 million to alleviate the problem of delayed discharges has led to a steady reduction in the number of patients who are in hospital because there is a delay in putting in place arrangements for their personal care needs. From a high of 830 last December, the latest report indicates a current number of 584. The waiting time for the nursing home support scheme funding has been reduced from 11 weeks at the beginning of the year to between two and four weeks at present. These are major improvements, as I am sure Deputy Kelleher will acknowledge. The winter period will increase pressure on hospitals and they will need to gear up for it. That is why the Government is providing €17 million this year to open 300 additional beds and undertake other specific plans to improve patient flow. It also was evident from last night's debate that there is general agreement on the need to build up primary care and community services. Developments such as community intervention teams and the provision of care in patients' homes in order that they can avoid hospital admission or be discharged at the earliest opportunity are key, as is the provision of minor surgery by general practitioners, for which €500,000 has been provided by the Government in 2015.

Beyond the immediate issues, for long-term sustainability, full year-round demand and capacity planning must be established. It is crucial that this be supported by integrated working between hospitals and social and primary care services. In tandem, the national clinical programmes directorate of the HSE, which has successfully developed models of care for a wide range of medical conditions in collaboration with health professionals and patient representatives, is now turning its focus to integrated care programmes. These will provide the health service, for the first time, with the capability of designing clinically led, multidisciplinary, cross-sectoral, integrated models of care for older people, children, maternal health and chronic disease, as well as improving the flow of patients through the hospitals.

Emergency department overcrowding is not a new problem; nor are long waiting times. They certainly are not unique to Ireland. Moreover, they did not start when the present Government came to office. I recall speaking several times about waiting lists while on the opposite side of the House, so they always have been there. Now that the economy is recovering, we can afford to deal with some of these problems, and this year the Government has prioritised funding for them. I wish to conclude by assuring Members that the Government is making every effort to ensure sustainable improvements.

I am grateful for the opportunity to make a short contribution to this important debate in support of my party's motion. This also is an opportunity to compliment Fianna Fáil's health spokesperson, Deputy Kelleher, who has done an excellent job in that role. The role of health spokesperson is challenging and demanding, and since his appointment he really has been excellent at identifying the issues that affect hospitals, individuals, patients and the hospital staff.

Our Lady of Lourdes Hospital, Drogheda, has been in the news headlines continuously, and unfortunately, this has been for all the wrong reasons. Headlines such as "Drogheda trolley crisis escalates," "Trolley crisis continues at our Lady of Lourdes Hospital, Drogheda," and "Drogheda hospital: 'It is wall-to-wall trolleys,' " have been catching the attention of newspaper readers and others who have an interest in this issue. In 2011, one key element in the Fine Gael Party's manifesto presented to the people was the reduction of waiting lists. In 2012, a press release sent out by the same party stated that hospitals across Ireland had achieved considerable success in reaching the so-called nine-month priority treatment list, PTL, target, which includes inpatient and day cases. Three years later, however, we have gone backwards, as the waiting list timeframe has increased by 60% from last year. The Minister of State should note that this is neither progress nor positive action but is a step backwards. Instead, the Minister moved the goalposts and set an 18-month waiting target, to be achieved by the middle of this year. Hospital waiting lists were subject to the same strategy of diminishing expectations that unfortunately has been employed in other areas of the health service. Incredibly, even this vastly reduced target has not been met within the Minister's timeframe.

I will give Members a snapshot of the current statistics in respect of Our Lady of Lourdes Hospital, Drogheda. First, I applaud the staff in the hospital, who do tremendous work under a heavy stress load. They save lives daily in that hospital. However, the situation is getting worse and, unfortunately, there is no end in sight and no formula to tackle the serious problems that exist there. Our Lady of Lourdes Hospital endured the greatest level of overcrowding in the month of August, when there were 680 people on trolleys.

In over a year the number of people waiting on an outpatient appointment has increased by 579%. There are now an additional 1,349 people waiting longer than 12 months for an appointment, which is scandalous. The trolley crisis in Our Lady of Lourdes Hospital in Drogheda has been escalating throughout the year. In June, a total of 728 people were on trolleys for an extended period of time, which represented a surge of 243% since 2013. My office has been inundated with calls from people who are alarmed by this escalating crisis. They are worried that members of their family and close neighbours will not be able to access adequate care if needed in an emergency. The conditions in the hospital, brought about owing to a lack of resourcing by Government, is appalling.

When in power, Fianna Fáil introduced the National Treatment Purchase Fund, the main aim of which was to purchase spare capacity from the private sector to reduce the number of public patients waiting for treatment in public hospitals. We propose to reactivate this fund. Fianna Fáil in government will convene a special task force to produce a plan to ensure all scheduled day case and inpatient care is delivered within the internationally recognised target of six months. What we need is an immediate enforcement of a six-hour target for the one million patients attending emergency departments every year, with a ban on any patient staying over six hours in an emergency department. In the UK, there is a target of 90% to be accommodated within four hours.

I am very worried about this crisis. It is impacting every family in the north east, including Louth, Cavan, Meath and Monaghan. I urge the Minister to tackle this problem and to do so urgently.

I thank all Deputies who contributed to this debate. Having listened with interest to the contributions from all sides of the House, it is clear there are challenges in our health services, which in itself is an understatement.

I am amazed and perplexed by some of the contributions of Deputies on the Government side, in which I was accused of playing politics with the health services. I have been Fianna Fáil spokesperson on health since the previous general election. I can safely say that my criticisms are justifiable and are based on observations. We try to come up with solutions to the challenges in our health services.

The Government sought a mandate to abolish waiting lists and lengthy waiting periods on hospital trolleys, to introduce universal health insurance, increase capacity in our hospitals and introduce reforms that would enhance the ability of the health service to deliver care. The great universal health insurance plan, abolition of the HSE and recruitment of additional consultants were key commitments made to the people in 2011. The Government sought a mandate on those proposals but has since then consistently denied that to be the reality.

I am not the one who stood up on the lorries in Roscommon, Cavan, Drogheda, Galway, Cork and Monaghan or who sent letters to constituents promising that all hospital services in their areas would be retained. I have not played politics with the health issue because it is much too important. The difficulty for the Government is that it sought a mandate to improve the health services and made solemn promises which have not been delivered on. We have a crisis in our health system. This must be acknowledged and addressed. Choices will have to be made. At the commencement of this debate last night I said that the Government will have to make choices in the next number of weeks on what is to be prioritised. Will it prioritise the 80 year old woman who is waiting 18 months for an outpatient appointment? Will it prioritise the child who cannot access speech and language therapy? Will it prioritise the elderly man who receives only half an hour a week of home help or will it prioritise those who do not need those services and can live within the resources they have? They are the choices the Government will have to make in a couple of weeks time when it presents its budget to this House.

Let us move away from the pretence that it is for historic reasons that the Government cannot address some of these issues. All these promises were made in the full knowledge that the country was facing difficult financial circumstances. None of these promises was made in the golden era, rather they were made in the darkest hours of the country. Members of the Government stood outside hospitals and said on television programmes that even with the financial challenges it faced on taking government, it would resolve all these issues. The point is that it has not done so. We still have huge numbers of people waiting day in, day out on trolleys in emergency departments. We have an escalating crisis in the outpatients appointment system. The inpatient system is crumbling. The answer from Government to this is to change the targets from one year to 18 months. The Minister of State, Deputy Deenihan, alluded to this in his speech when he applauded Government on the €51 million in funding provided to the HSE directed towards reducing lengthy waiting times by optimising internal capacity and using targeted initiatives where necessary, which ensured that by June waiting times had fallen below maximum permissible waiting times of 18 months set by the Minister. The previous waiting time target for outpatients was one year and for inpatients was nine months. The Government has shifted the targets because the figures were so alarmingly bad. These are not gross national product or other figures often spoken about in this House, rather these are real people, many of whom are in agony and pain and unable to access a consultant in a timely fashion to find out what is wrong with them in order that they can be treated in a timely manner.

There has been a massaging of the figures. Deputy McConalogue referred to patients being put into the private system, assessed and returned to the public system, following which, when the figures increase again, these people are referred to the private system again. That is not good enough. I am not the one who had no confidence in the ability of, in particular, the previous Minister for Health, Deputy Reilly, to deliver health care. I am not the one who moved him to the Department of Children and Youth Affairs. The Taoiseach had no confidence in the previous Minister to deliver on the commitments. It was because there was no delivery on the commitments made that the previous Minister for Health and Deputy Leader of Fine Gael, Deputy Reilly, was sidelined and moved to the Department of Children and Youth Affairs. The Taoiseach said he would take a hands-on approach in terms of assessing what the Department of Health and Health Service Executive required in budgets.

As late as today the Minister for Finance, Deputy Noonan, said that health system budget control is not up to scratch, following which he berated Mr. O'Brien, director general of the HSE, for seeking €1.9 billion. In June of this year the Minister for Health, Deputy Varadkar, stated that it is estimated that satisfying the unmet needs will cost between €700 million and €1 billion, on top of the natural increase needed yearly to cope with the rising ageing population. When the Minister, Deputy Varadkar, highlights how much is required to fund a proper health system, it is okay, but when poor Mr. O'Brien does so, he is berated for inefficiencies and incompetence. The Government cannot have it both ways. One day the Minister, Deputy Varadkar, arrived into the Dáil and told me that all the problems in the health service are not all resource-based. In an article in the newspaper the following week he stated that he needs at least €1 billion. The reality is there are resource problems in the health service. There is not enough capacity. Our emergency departments are overcrowded and we are unable to shift people from the acute hospital setting to step-down facilities or their homes or other community facilities. There are blockages across the system.

There will be 600 people in the acute hospital system tonight who should not be there and do not want to be there but there is no place for them to go. They are healthy, in effect, but cannot leave hospital because there are no facilities to which they can go in terms of home care packages, home help supports, community step-down facilities or long-term care.

That is happening tonight. Moreover, it will happen tomorrow night and the night after. Surely, it is not beyond the ability of this Government to address the issue.

Reference has been made to opening up 300 beds. Those 300 beds will come on-stream at the end of this year, but we have already taken thousands of beds out of the public hospital system throughout the country. It is true that some of that happened on my watch, but I was not one of those promising to increase the number of hospital beds at the last general election. I was telling the people the reality. I did not stand outside hospitals and promise to build a new hospital in the north east, maintain services in Roscommon or maintain services in Mallow. I was not one of the people who made those pledges. However, I am certainly going to ensure that I hold those in the Government to account for the pledges they were elected on. I would be failing in my duty if I did not. That is why I will consistently and continually put down motions in the House.

Such motions are not calling for a major or inordinate increase in the level of funding required. Today, I was accused of spending billions under this motion, but I have simply pointed to some key areas with regard to the National Treatment Purchase Fund and the recruitment of additional consultants. This is simply about enhancing the capacity of the emergency departments and the throughput in hospitals. These problems are primarily self-inflicted by the Government by undermining the fair deal scheme and community nursing home facilities for a long period as well as undermining the home care system through the reduction in home help hours and the inability to move people from an acute hospital setting to a more formalised setting more suitable for their needs. Such measures could enhance the ability of the emergency departments to address some of the problems with overcrowding.

I commend the motion and I make no apology for it. I would be denying my responsibility as an Opposition spokesperson by not holding this Government to account. Primarily, I will hold those in the Government to account on the commitments on which they sought a mandate, although they are denying that they said these things every day of the week. It is shameful that they are doing so on a consistent basis. At the least they should stand up and declare what they committed to, as against what they are actually doing, and be honest about it. The idea that they are denying their mandate is beyond belief at this stage. The people deserve better. More important, the thousands of people waiting on hospital lists throughout the country deserve better. The hundreds waiting on trolleys tonight, tomorrow night and the night after certainly deserve better. I commend the motion and I thank Deputies for supporting it.

Amendment put:
The Dáil divided: Tá, 73; Níl, 47.

  • Breen, Pat.
  • Bruton, Richard.
  • Burton, Joan.
  • Butler, Ray.
  • Buttimer, Jerry.
  • Byrne, Catherine.
  • Byrne, Eric.
  • Cannon, Ciarán.
  • Carey, Joe.
  • Coffey, Paudie.
  • Collins, Áine.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Conway, Ciara.
  • Coonan, Noel.
  • Corcoran Kennedy, Marcella.
  • Costello, Joe.
  • Creed, Michael.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Deering, Pat.
  • Doherty, Regina.
  • Dowds, Robert.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Feighan, Frank.
  • Ferris, Anne.
  • Fitzpatrick, Peter.
  • Griffin, Brendan.
  • Hannigan, Dominic.
  • Harrington, Noel.
  • Harris, Simon.
  • Heydon, Martin.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Keating, Derek.
  • Kehoe, Paul.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lynch, Ciarán.
  • Lyons, John.
  • McEntee, Helen.
  • McFadden, Gabrielle.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • McNamara, Michael.
  • Mitchell, Olivia.
  • Mitchell O'Connor, Mary.
  • Mulherin, Michelle.
  • Murphy, Eoghan.
  • Nash, Gerald.
  • Neville, Dan.
  • Nolan, Derek.
  • Noonan, Michael.
  • O'Donnell, Kieran.
  • O'Donovan, Patrick.
  • O'Dowd, Fergus.
  • O'Reilly, Joe.
  • O'Sullivan, Jan.
  • Perry, John.
  • Phelan, John Paul.
  • Reilly, James.
  • Ring, Michael.
  • Ryan, Brendan.
  • Spring, Arthur.
  • Stagg, Emmet.
  • Stanton, David.
  • Tuffy, Joanna.
  • Twomey, Liam.
  • Varadkar, Leo.

Níl

  • Adams, Gerry.
  • Aylward, Bobby.
  • Boyd Barrett, Richard.
  • Broughan, Thomas P.
  • Browne, John.
  • Calleary, Dara.
  • Collins, Niall.
  • Colreavy, Michael.
  • Coppinger, Ruth.
  • Cowen, Barry.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Donnelly, Stephen S.
  • Dooley, Timmy.
  • Ellis, Dessie.
  • Fitzmaurice, Michael.
  • Fleming, Tom.
  • Halligan, John.
  • Healy, Seamus.
  • Healy-Rae, Michael.
  • Kelleher, Billy.
  • Kirk, Seamus.
  • Lowry, Michael.
  • Mac Lochlainn, Pádraig.
  • McConalogue, Charlie.
  • McDonald, Mary Lou.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McLellan, Sandra.
  • Moynihan, Michael.
  • Murphy, Catherine.
  • Murphy, Paul.
  • Ó Caoláin, Caoimhghín.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • O'Dea, Willie.
  • O'Sullivan, Maureen.
  • Pringle, Thomas.
  • Shortall, Róisín.
  • Smith, Brendan.
  • Stanley, Brian.
  • Troy, Robert.
  • Wallace, Mick.
Tellers: Tá, Deputies Paul Kehoe and Emmet Stagg; Níl, Deputies Billy Kelleher and Niall Collins.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 73; Níl, 46.

  • Breen, Pat.
  • Bruton, Richard.
  • Burton, Joan.
  • Butler, Ray.
  • Buttimer, Jerry.
  • Byrne, Catherine.
  • Byrne, Eric.
  • Cannon, Ciarán.
  • Carey, Joe.
  • Coffey, Paudie.
  • Collins, Áine.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Conway, Ciara.
  • Coonan, Noel.
  • Corcoran Kennedy, Marcella.
  • Costello, Joe.
  • Creed, Michael.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Deering, Pat.
  • Doherty, Regina.
  • Dowds, Robert.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Feighan, Frank.
  • Ferris, Anne.
  • Fitzpatrick, Peter.
  • Griffin, Brendan.
  • Hannigan, Dominic.
  • Harrington, Noel.
  • Harris, Simon.
  • Heydon, Martin.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Keating, Derek.
  • Kehoe, Paul.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lynch, Ciarán.
  • Lyons, John.
  • McEntee, Helen.
  • McFadden, Gabrielle.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • McNamara, Michael.
  • Mitchell, Olivia.
  • Mitchell O'Connor, Mary.
  • Mulherin, Michelle.
  • Murphy, Eoghan.
  • Nash, Gerald.
  • Neville, Dan.
  • Nolan, Derek.
  • Noonan, Michael.
  • O'Donnell, Kieran.
  • O'Donovan, Patrick.
  • O'Dowd, Fergus.
  • O'Reilly, Joe.
  • O'Sullivan, Jan.
  • Perry, John.
  • Phelan, John Paul.
  • Reilly, James.
  • Ring, Michael.
  • Ryan, Brendan.
  • Spring, Arthur.
  • Stagg, Emmet.
  • Stanton, David.
  • Tuffy, Joanna.
  • Twomey, Liam.
  • Varadkar, Leo.

Níl

  • Adams, Gerry.
  • Aylward, Bobby.
  • Boyd Barrett, Richard.
  • Broughan, Thomas P.
  • Browne, John.
  • Calleary, Dara.
  • Collins, Niall.
  • Colreavy, Michael.
  • Coppinger, Ruth.
  • Cowen, Barry.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Donnelly, Stephen S.
  • Dooley, Timmy.
  • Ellis, Dessie.
  • Fitzmaurice, Michael.
  • Fleming, Tom.
  • Halligan, John.
  • Healy, Seamus.
  • Healy-Rae, Michael.
  • Kelleher, Billy.
  • Kirk, Seamus.
  • Lowry, Michael.
  • Mac Lochlainn, Pádraig.
  • McConalogue, Charlie.
  • McDonald, Mary Lou.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McLellan, Sandra.
  • Murphy, Catherine.
  • Murphy, Paul.
  • Ó Caoláin, Caoimhghín.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • O'Dea, Willie.
  • O'Sullivan, Maureen.
  • Pringle, Thomas.
  • Shortall, Róisín.
  • Smith, Brendan.
  • Stanley, Brian.
  • Troy, Robert.
  • Wallace, Mick.
Tellers: Tá, Deputies Paul Kehoe and Emmet Stagg; Níl, Deputies Billy Kelleher and Niall Collins.
Question declared carried.
The Dáil adjourned at 9.25 p.m. until 9.30 a.m. on Thursday, 24 September 2015.