Hospital Emergency Departments: Motion [Private Members]

I move:

That Dáil Éireann:

— considers the ongoing crisis in hospital emergency departments a denial of the right of timely access to health care with dignity and a betrayal of the Republic envisioned in 1916;

— remembers inspirational figures such as Dr. Kathleen Lynn, a 1916 veteran and founder of St. Ultan’s Hospital for the Children of the Poor, who pioneered public health initiatives in the most difficult and conservative of times, and recommits to the principle enshrined in the Democratic Programme of the First Dáil Éireann that "it shall be the duty of the Republic to take such measures as will safeguard the health of the people";

— condemns the decision of the Government to not invest adequately in the defence of the nation’s health, which saw an entirely predictable worsening of the trolley crisis in the opening weeks of the centenary year; and

— concurs with the view of Dr. James Gray and other health care professionals who have described as a "national scandal" the Irish Nurses and Midwives Organisation figures that show the numbers on trolleys close to 500; and

calls on the Government to:

— increase the number of hospital beds in the system and reverse the flow of nurses and doctors out of our public health system by committing to ambitious multi-annual recruitment targets and allocating the additional €412 million necessary to increase nursing numbers by 2,500 and consultant numbers by 800 over five years;

— commit to incrementally increasing annual funding for the Fair Deal scheme by an additional €125 million in order to increase nursing home bed numbers by 900 additional beds in year one, 800 additional beds in year two and 700 additional beds in years three, four and five;

— commit to increase home help hours and home care packages in year one by 10% at an estimated cost of €31 million and by a further 10% on the baseline year in years two and three with a resulting rise in spending of €93 million; and

— establish an Emergency Department Taskforce on a permanent basis.

The Taoiseach famously promised ahead of the last election that he would "end the scandal of patients on [hospital] trolleys". He has failed spectacularly to keep that promise.

Not only that, he has now refused to give a commitment to end the crisis if re-elected. This is completely unacceptable. Anyone who is not committed to ending the crisis in our emergency departments is not fit to be elected to the Dáil, never mind the position of Taoiseach. Our health system is in a state of constant crisis. This is not a matter of debate; trolley numbers have spiked, waiting lists stretch into years and medical staff trained at home are leaving in droves due to poor working conditions.

This crisis can be boiled down to two key failings on the part of successive Governments: first, an extreme depth of fundamental inequality in how patients are treated, differentiated on ability to pay and location; and second, the sheer incapacity of the system to deal with even demographic pressures, evidenced particularly in our emergency departments and maternity care.

Universal health care, not universal health insurance, is the solution. Sinn Féin is committed to the realisation of a world-class system of universal health care that is accessed on the basis of need, free at the point of delivery and funded by progressive taxation. We believe there is no greater good worth striving for. Whether it is a headline about elderly patients on trolleys in emergency departments or children waiting more than a year for speech and language therapy, the common thread across all these stories is the lack of capacity in the system to meet demand. A lack of capacity means that those in our society who need urgent medical care and attention are left to suffer needlessly as governments dither and introduce tax breaks for the better off in society. An unnecessary tax break is of no use to anybody lying on a trolley in a draughty corridor, racked with pain and worry. When we talk about capacity, we talk about vulnerable people.

Many young Irish people want to become doctors, nurses, surgeons or dentists. They go to college and study for years in a system that grows more expensive by the year. When they graduate, they are faced with a health system ravaged by years of austerity, recruitment embargoes and funding cuts imposed by the Fine Gael and Labour Party Government and by Fianna Fáil before it. For too many, the choice is plain and emigration is the result. If we are to stem the flow of doctors, nurses and others from our health system and attract those who have already left to come home, then we must commence sustained action to address the single biggest factor influencing medical migration – the toxic work environment that currently prevails. Ad hoc, half-hearted recruitment drives will not cut it. To foster and maintain a productive and motivated medical workforce, we must put credible light at the end of the tunnel for staff showing that things will get better and will stay better. We must guarantee to this workforce that the intolerable staff-to-patient ratios will be improved and sufficient resources will be forthcoming which will allow them to practise medicine and provide health care, not firefight and pen-push. This requires a commitment to ambitious multi-annual recruitment targets with revenue allocated to back these up.

In a term of government, Sinn Féin proposes to recruit more than 6,600 consultants, doctors, nurses, midwives, dentists, vital administrators and allied health professionals to reinforce the front lines of our health system. Overcrowding in our emergency departments, and more generally across the health service, has long been at crisis point. The trolley watch figures provided by the Irish Nurses and Midwives Organisation, INMO, regularly highlight the impact of decades of Government failure to provide adequately for the sick and the vulnerable. The INMO trolley watch and ward watch figures for December 2015 show that the level of overcrowding has decreased by 13% compared to December 2014. However, a year-on-year analysis shows that there was an increase of 21% in overcrowding from January to December 2015 compared to the same period for 2014. Yesterday 356 patients languished on trolleys.

The crisis is partly a reflection of inefficiencies within the system. Not all hospitals discharge seven days a week, for example, but in the main it is directly due to lack of capacity in terms of staffing and bed numbers. There is also the shortage of exit packages, including in the provision of home help hours and home care packages and inadequate numbers of long-stay nursing home beds. Research on overcrowding in emergency departments consistently shows a direct negative correlation between emergency department waiting and length of inpatient stay and, very importantly, with overall outcome. Overcrowding is not just a bad use of resources, it has a direct impact on patient safety and mortality.

Sinn Féin is putting forward this motion in an effort to address seriously the situation in our emergency departments. We need to increase the number of hospital beds available in the system in order to move people from trolleys and into wards. We need to recruit more nurses into our emergency department and acute hospital system. We also need to increase home help hours and home care packages to help support older people in their homes and take pressure off our hospitals. Alongside these measures we need to increase funding for the fair deal scheme further to secure more nursing home beds immediately and we need to develop the capacity of our public nursing home provision. All of this requires serious investment and that is what Sinn Féin is committed to. We are committed to quality public services that benefit everyone.

This motion refers specifically to inspirational figures such as Dr. Kathleen Lynn, a 1916 veteran and founder of St. Ultan's Hospital for the Children of the Poor, who pioneered public health initiatives in the most difficult and conservative of times, and it recommits us all, I hope, to the principle enshrined in the Democratic Programme of the First Dáil Éireann that "it shall be the duty of the Republic to take such measures as will safeguard the health of the people". The ongoing crisis in hospital emergency departments denies our citizens their right to timely access to health care with dignity and is a betrayal of the Republic envisioned in 1916.

This can be changed. Contained in this motion are realistic proposals that can do exactly that. We specifically call on this Government and the next Government to increase the number of hospital beds in the system and reverse the flow of nurses and doctors out of our public health system by committing to ambitious multi-annual recruitment targets and to allocate the additional €412 million necessary to increase nursing numbers by 2,500 and consultants by 800 over the five-year Dáil term.

What is the Deputy's time allocation?

I have ten minutes. We call on this and the next Government to commit to increasing annual funding incrementally for the fair deal scheme by an additional €125 million in order to increase nursing home bed numbers by 900 in year one, 800 additional beds in year two and 700 additional beds in years three, four and five. We call on this and the next Government to commit to increase home help hours and home care packages in year one by 10%, at an estimated cost of €31 million, and by a further 10% on the baseline year in years two and three with a resulting rise in spending of €93 million and we call on this and the next Government to establish an emergency department task force on a permanent basis.

These are all realistic and achievable proposals. The only thing that is required is the will of the Government of the day to pursue such measures. One hundred years on from 1916, let us ensure that we live up to the ideals of those like Dr. Kathleen Lynn, ideals that are still as relevant today as they were back then. Let us implement the appropriate changes that have the potential to make a real difference - changes that will safeguard the health of all our people. I invite everyone in this House to join me in helping make that our shared and collective legacy.

I urge all voices in the House to support the Sinn Féin motion.

Deputy Tóibín is sharing time with Deputies Gerry Adams, Dessie Ellis, Martin Ferris and Seán Crowe. The Deputy has ten minutes.

One of the major legacies of this Government with regard to health care is that access to health care is reducing. Little by little, access is becoming more difficult in every route to health care. This can be seen at GP and ambulance levels, in overcrowded emergency departments and with regard to waiting lists. This State had 601 people on trolleys in a single day. In my region, Navan and Drogheda hospitals had 9,000 people on trolleys last year. That is equivalent to the population of the town of Trim being on trolleys in the period of a single year. It is a shocking scenario. This leads to delayed diagnosis, delayed treatment and sub-optimum health results. The practical facts for people are that their illnesses or injuries become worse and in some cases their lives will be shortened as a result.

The waiting lists contain shocking figures. There are 68,000 people on inpatient waiting lists and 385,507 people are waiting for outpatient appointments. A total of 20% of the State's population has no medical cover whatsoever. Budgets for disability services have been reduced by €159 million. One in three ambulance calls in the State that are classified as emergencies are responded to late. For example, in a one year period in my constituency I was contacted by 40 people who told me that the response to their ambulance calls had been longer than one hour. In seven of those cases, a fatality was involved. I am not saying that the fatality is a direct result of the late ambulance but, undoubtedly, in many cases the health result is far worse when the ambulance is very late. There are children on painkillers waiting for more than six months for dental treatment, while 3,000 children are waiting for mental health services. There is also the backdrop of suicide rates in that regard.

I will discuss one case which I previously brought to the Minister's attention in a parliamentary question. It involves a number of different aspects of the health service, including accident and emergency. One of my constituents in County Meath lives four minutes away from the hospital. Her son called an ambulance for her after she suffered a stroke. The ambulance arrived 40 minutes late. She went into Navan hospital where she received decent treatment. However, she was clinically discharged for 13 weeks, unable to proceed to the National Rehabilitation Hospital due to the fact that it was under fierce pressure. When she went to that hospital, she received treatment and reached a certain level of rehabilitation whereby she was able to return home to live with care from her family. Unfortunately, about a year later she had another stroke. She went back into the hospital and very quickly had a good recovery. However, she was brought to the shower one day with the assistance of two nurses. One of the nurses was called away due to how busy the hospital was and the woman fell and suffered a head injury. As a result of that injury, she was brought to a Dublin hospital. That hospital gave her the wrong blood. She has been in a coma for three or four months and has had internal organ failure as a result. She is coming back very slowly. Thankfully, her mind is showing a strong level of clarity but she is in a bad way physically. She is 68 years of age but she probably will be unable to return home and is likely to remain in a nursing home.

Consider how much it would have cost to have an ambulance arrive on time on the first occasion. How much would it have cost to enable the two nurses to remain with the patient? How much would it have cost to have the necessary resources in the hospital to provide her with the proper bloods? Measure that against the cost of her nursing home care for perhaps 20 years or more. That is the key issue here. The Government is on a fool's errand. It is slashing back on access to hospitals and people's illnesses are becoming more acute, so the treatments that are necessary for them are becoming more expensive. The Government thinks it is saving a few quid at the start, but in the long run it is being forced to put an increasing amount of money into the health services.

Another aspect of access to health care in County Meath is North-East Doctor on Call, NEDOC. Before Christmas, it was brought to my attention that there was no doctor available for North-East Doctor on Call. People had to travel all around the country at night if they required a doctor, or they had to go to the accident and emergency department. Since Christmas, we have been told that a family with young children called to NEDOC in their locality and had to wait four hours for treatment. There were dozens of people waiting in a room which was not built to accommodate those numbers. NEDOC cover had to go from Drogheda to Athboy because there was no cover in Meath. That means all of County Louth is unavailable for doctor on call. What is the Government's response to this and investing in NEDOC? I understand its response is to run a pilot scheme whereby there will be a remote doctor in a location in Dublin speaking through Skype to a patient, possibly with a paramedic present. Will that paramedic be able to deliver prescribed drugs to the patient in that scenario? Is a diagnosis that is made 40 miles away from a patient of the same quality as one where the doctor is sitting in the room with the patient? Cutbacks in NEDOC are causing more trouble for patients and more trouble for the system.

Navan hospital was part of the north-east group. When the hospital in Monaghan closed, the trolley counts in Cavan spiked. When the accident and emergency department in Dundalk closed, the trolley counts in Drogheda spiked. It is now part of the Government's plan to close the accident and emergency department in Navan. The Minister visited the hospital and said it would be a long time before it will be closed, but current Government policy is articulated through the small hospital framework document and that states that Navan hospital will be reduced from a level three to a level two hospital. Navan will lose services with regard to coronary care, the intensive care unit and anaesthesia. That means the hospital will be unable to take the same amount of people.

I have also received information that the national clinical leads in the HSE responsible for policy in hospitals met Ireland-east managers in early December and agreed a series of changes to the delivery of hospital services in Navan which will convert that hospital to a level two hospital. The hospital staff were not told; I was the first to tell them about these decisions. They have not been told when these decisions will be implemented. The GPs in the area also have not been told when the decisions will be implemented. It should be noted that 130 GPs in the Meath area have stated that the health outcomes of citizens in County Meath will be radically reduced if the Government proceeds to reduce the accident and emergency services to shorter hours or to close those services. This is completely inconsistent with what the Minister said when he visited County Meath, as is the HSE small hospital framework document.

What we are seeing develop in the State is a reduction of access to hospitals, especially public hospitals, for people who do not have private health insurance. However, some of the private hospitals, particularly in the Dublin region, have opened emergency department services and they do not have the same level of trolley occupancy, waiting and so forth. The cleavage between those who can afford private hospitals and those who cannot is becoming even clearer. The backdrop for this is the Government gouging funds and staff from the health service over the past number of years. It shocks me that when I put questions to the Minister for Finance about his plans for the next five years, he replies that the major plan for those years is to reduce the universal social charge, USC, by €3.5 billion to €4 billion. At the same time we have this ongoing crisis. The Minister cannot have European public service delivery and European infrastructure based on American taxation. He is either rewriting the economic laws of the planet or he is lying to the people. It is very serious to allow this level of inaccessibility to the health service and this level of a health crisis for the people yet at the same time totally focus tax breaks on those on higher incomes.

Tá mé sásta bheith anseo inniu chun labhairt ar rún Shinn Féin maidir le sláinte agus an bealach níos fearr atá againn chun freastal ar achan duine. Tá mé buíoch den Teachta Ó Caoláin a chur an rún seo le chéile agus tá mé fíor-bhuíoch go bhfuil an tAire, an Teachta Varadkar, anseo.

The emergency consultant in Tallaght hospital, Dr. James Gray, last week described the scale of patients in our emergency departments as a disgrace. He said many of these patients were elderly and the most vulnerable in our society. It is actually worse than that. I have spoken to families whose sick and elderly members will not go to the emergency departments because they know they may be lying on a trolley for days.

Figures recently released by the Irish Nurses and Midwives Organisation show that 92,998 people were treated on trolleys in hospitals across this State during 2015. This is the highest ever number of patients recorded since the Trolley Watch campaign began in 2006 and represents an increase of 21% in hospital overcrowding. It is also an indictment of this Fine Gael-Labour Party Government. In 2007, Deputy Enda Kenny promised to end what he called "the scandal of patients on trolleys" and that promise was broken. Four years later, in Fine Gael's infamous five-point plan, it promised to create a completely new health system. Fine Gael promised to end waiting lists and apartheid in our health service and committed to equal access for all, more and better community care and fewer hospital stays. Sin gealltanas eile atá briste. In fairness to the Minister for Health, at least he made it clear that the five-point plan was not worth the paper it was printed on. In the first five days of this week there were 1,395 patients on hospital trolleys in emergency departments across the State. Of these, 121 were in Our Lady of Lourdes Hospital, Drogheda in my constituency of Louth. On Monday and Tuesday, Our Lady of Lourdes Hospital had the worst figures in the State agus ba sheandaoine iad go leor de na daoine seo. These trolley waits and the spectre and misery of mostly elderly people, but also others, who are sick is an indictment of the Government's health policy. As part of his response to all this, the Minister for Health, Deputy Varadkar, produced new proposals immediately prior to Christmas. These claim that there should be no more than 70 patients a day on trolleys. He also claimed zero tolerance of patients waiting more than nine hours on trolleys. On Tuesday, however, there were more than 200 patients on trolleys for longer than nine hours. In addition, a third of the 300 beds promised last autumn to tackle overcrowding still have not been delivered.

Fine Gael and the Labour Party have no intention of adequately resourcing the health service. Twice in recent months nurses in emergency departments have voted for industrial action. While the strike planned for today has been averted, which I welcome, the crisis in our health service remains. Tá sé an-soiléir gur scrios polasaí an Rialtais na seirbhísí sláinte tosaigh. What is happening in the health service is a direct consequence of Government policy. There is no other way to look at it. It is the responsibility not just of the Minister for Health but of every member of the Cabinet who voted for and implemented these polices. It is time the Taoiseach admitted that his Government seeks ultimately to privatise our health services. The Minister should take the opportunity during the debate to point out clearly that Fine Gael ideology favours a two-tier, private health model. He highlighted as much in various remarks recently.

Sinn Féin has put forward this Private Members' motion in an effort to focus political attention on easing the situation in emergency departments. We are not all about protesting and pointing up the inefficiencies and deficiencies in the Government's position. We have positive solutions to these problems and have published a fully costed health policy. I asked that it be sent to the Minister but I do not know if he has had the opportunity to peruse it. I see he has it before him. He will see in it that there is a capacity to realise a world-class system of universal health care assessed on the basis of need, free at the point of delivery and funded through progressive taxation. I ask the Minister not only to read that health document, but to implement it.

This is a Government elected in a crisis which promised stability but now faces into election on the motto of the British Tories of offering chaos or stability. For many it is clear that the people offering chaos are actually Fine Gael and the Labour Party. Certainly for those in housing need, those who have lost their homes, those who are sick or disabled, young adults, those entering retirement and those with mental health issues, this is a Government of chaos. There is no stability for the people of this country who find themselves in need of the basic services the State should provide. There is no clearer example of this instability than our accident and emergency departments where hard-pressed doctors and nurses struggle to deal with overcrowded waiting rooms backing onto overcrowded halls lined with trolleys, often occupied by elderly people for extended periods that are utterly unacceptable in any context.

In my area of Dublin, Beaumont Hospital, James Connolly Hospital and the Mater struggle to meet the needs of patients every day. I read last week of a Mr. James Coyle of Cabra, a 72 year old man, who had to sleep overnight and be treated in a chair. He praised the staff who were doing their best in a desperate situation. The accident and emergency department had to close its doors for a period after Mr. Coyle arrived because it simply could not do any more. Not only is the system placing great hardship and suffering on those in need of care, it is breaking the backs of those caregivers whom we often hear lauded by the Government, as long, that is, as they are not threatening strikes or stoppages or asking the Government to do more. We often hear people being told to stay away from accident and emergency departments unless absolutely necessary. One has to wonder in this crisis who would go to accident and emergency unless there was no other option, which begs the question of how many people in need of care are staying away due to the widespread knowledge of the severity of this very real crisis. This is a major threat to public health, health workers and our families and loved ones. Speaking of Tallaght hospital, Dr. James Gray said of one patient:

This man, like the others in non-designated patient conduits, had no privacy, no dignity, was subject to constant noise torture, constant light torture, resulting in major sleep deprivation and pressure effects causing pain as a result of lying for an advanced period on a trolley not designated for same, as well as boarding conditions that constitute an infection control hazard.

In its eagerness to commemorate the Battle of the Somme, it seems the Government has sought to recreate its conditions in our hospitals. The Government will claim it inherited this mess. While that may have a kernel of truth, it would be fairer to say that the Government has compounded and exacerbated the mess. This is the result of a failure to reform the health service, to tackle its two-tier nature, to refocus funding to where it is needed and to treat nurses and front-line doctors with the dignity and respect they deserve. It is the result of five years of grinding austerity which has chiselled away at the foundations of the health service while the Government hoped and prayed for a saviour in the form of private health insurance.

In our most recent budget document, Sinn Féin showed how the Government could invest an additional €383 million in health. This would have tackled the trolley crisis, improved ambulance cover and disability services and reduced waiting times and prescription charges. Predictably, it was ignored by this austerity Government. We followed that document with the launch of our costed, staged and realistic plan for health to undo the damage of this and previous Governments. People with mental health issues are being turned away from accident and emergency departments. Often, there is no psychiatrist on hand, particularly at weekends. Many who need urgent and immediate help are left for hours on end. The winding down of mental health services delivered locally in Drumcondra, Clontarf and Ballymun and centralised on the North Circular Road is another example of the doublespeak of the Government. In A Vision for Change, the Government outlined how mental health services would be delivered locally. Tús Nua in Ballymun, which worked with more than 30 people at one stage, is now being wound down and, in effect, removed from the area.

It has reached the stage, not just in my constituency, but in all constituencies, at which people are afraid to attend accident and emergency departments. Who could blame them? The long waiting lists represent many people suffering in their homes and hanging on for long-awaited treatment, but the public face of the crisis is in the accident and emergency departments of the large hospitals. This is testament to the failed health policies of successive Governments, but it is the legacy of some outstanding failures in health over the past 20 years or so that has landed us where we are now. Ministers for Health like Brian Cowen, Micheál Martin, Mary Harney, Mary Coughlan, James Reilly and the current Minister are responsible for the cutbacks and disorganisation. They pandered to the private sector and ran down the public service that thousands of loyal, talented and hard-working front-line workers had built up over generations and that the people trusted to look after them when they were at their most vulnerable.

The worsening situation in Kerry contradicts the Minister's claim that the conditions causing the crisis in our hospitals are improving. Last week, 56 patients were lying on trolleys in Kerry General Hospital. Yesterday, 16 people found themselves in this distressing situation. Today, there are nine. These numbers are up to four times higher than they were during the same period last year. The hospital's Loher ward, which was supposed to cater for 30 patients, is being used in the short term as an oncology unit and will ultimately be used as a lab.

The reality for patients is that the crisis is only getting worse. The Minister's remarks show just how detached he is from the scale of the chaos and overcrowding that is gripping hospitals throughout the State. He is dismally failing to address the underlying causes of the crisis. Instead of doing his job, he is disgracefully attempting to lay the blame for the crisis at the feet of the heroic nurses who have worked through his slash-and-burn approach to the health service. The Minister is more focused on trying to spin himself out of responsibility rather than on actually tackling the crisis, which will only continue to worsen so long as we have health Ministers who are more focused on optics, PR lines and re-election than on running the Department of Health and prioritising patient care.

It is long past time that the Fine Gael and Labour Party Government accepted the scale of the crisis. The first step must be to engage constructively with the nurses and ensure their concerns are addressed and that we see tangible changes in our hospitals as a result. We need a Government that is prepared to invest in health and the delivery of front-line services. We need a Government that ends the two-tier system, which is something that can no longer be tolerated. People must have access to quality health care on the basis of need and not on the basis of income.

I have been dealing with a pair of cases over the past 12 months. Both patients are now dead. One was a young man with a history of attempted suicide. He was admitted to the Valentia ward of Kerry General Hospital on a Thursday evening and was released that Friday morning despite having been brought to the hospital by the Garda and signed in by his mother. He took his life that night. This is how much the Minister's health service failed that young man. The second patient was a woman in her late 50s who had a history of clots. She was brought to the hospital's accident and emergency department and lay there for 28 hours before it was discovered that her condition had been exacerbated. She lost her life two days later. That is testament to the health service for which this and previous Governments have been responsible. We need a health service that will do our people justice, in particular patients who are in need of care.

I will declare an interest, in that I have been on a trolley within the past 12 months. Attending the hospital probably saved my life. My brother-in-law has also been on a trolley in the past week.

Some 4,000 patients were on accident and emergency department hospital trolleys or chairs during December. In the Dublin area alone, 1,318 patients were on trolleys. Last year in Tallaght hospital, in my constituency, the news that a 91 year old patient was left on a trolley for 29 hours made headlines. That awful scenario was unacceptable to everyone, but the Taoiseach had the brass neck to blame hospital staff for the accident and emergency crisis. He conveniently ignored his and the preceding Fianna Fáil-Green Party Government's cuts of billions of euro in health funding, the removal of thousands of beds from the hospital system, the shortage of key staff, the lack of step-down facilities and the failure to roll out primary care facilities. By way of example of that last point, some of the primary care services allocated to my area ended up in the constituency of the Minister for Children and Youth Affairs, Deputy Reilly. Waiting lists for life-changing operations have also lengthened nationally. It seems to be much easier for Government politicians to blame hard-working hospital staff or seriously ill patients for getting sick instead of blaming the broken health system that the Government has created.

What is happening in the health service is a direct manifestation of a continuity of cuts. According to the Irish Nurses and Midwives Organisation's trolley and ward watch analysis, the number of patients on trolleys has increased 40% between 2012 and 2015. I accept the Minister for Health's contention that the crisis cannot be solved overnight, but his party has been in power for five years and a strike this week by nurses who were at the end of their tether because of understaffing and overcrowding was narrowly averted at the 11th hour. This Fine Gael-Labour Party Government has had five years in power while patients and their families have had to do their time suffering hardship on trolleys and queuing on long waiting lists only to be told that elective surgeries are cancelled because of a lack of beds or key staff.

According to The Sunday Times, the HSE appointed 55 additional general managers last year following the lifting of a ban on recruitment and promotion in the public sector. The HSE now has 268 general managers earning up to €80,000 per year each, a 26% increase on the 213 at the start of 2015. Is this the long-awaited reform we have been promised? The Government is approaching the health care crisis by continuing to bloat middle management levels and pushing front-line staff to breaking point.

The accident and emergency crisis is made worse by the lack of home care support, physio support and lengthy elective surgery waiting lists, yet the minutes of the HSE directorate meeting of 26 November, which I read last night, state that the HSE is aiming to make €20 million in cuts to social care home support and transitional care costs in 2016 to make up for the loss in revenue.

It is time to end the chaos brought about by this Government. Universal health care, not universal health insurance, is part of the solution. Sinn Féin's Better For Health policy paper shows how we would begin to address this problem in government. The costed policy document outlines how we would increase the number of hospital beds per 1,000 population, ensure adequate registered nurse or doctor-to-patient ratios and sufficient beds, roll out sustained investment in community services that allows for either appropriate care without hospital admission or discharge to appropriate care settings or both, increase nursing home bed numbers, increase home help hours and home care packages and establish an emergency department task force on a permanent basis. However, the Government has firmly closed its eyes and ears to the problem and is hell bent on privatising our health services. Many of us in the community will fight that tooth and nail. This is personal for many people.

I understand the Minister is sharing time with Deputies O'Reilly and Mulherin. Is that agreed? Agreed.

I move amendment No. 1:

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


— that timely access by patients to emergency care and improving waiting times in Emergency Departments (EDs) continues to be a primary focus of Government policy;

— that the demand for emergency services is growing in line with overall population growth (1% per year), a projected increase of over 19,000 in the number of people over 65 years; a growing number of people in the old and frail elderly category (nearly 3,000 aged 85 years and over) and the increasing burden of chronic illness in the population;

— that this Government made additional ongoing funding available in 2015 to address ED overcrowding and that a wide-ranging set of actions are being implemented by the Health Service Executive (HSE) and hospitals to achieve improvements in the delivery of care in EDs;

— the difficulties which ED overcrowding cause for patients, their families and hospital staff who are doing their utmost to provide safe, quality care in very challenging circumstances;

— that it is Government policy to support older people in their own homes and communities for as long as possible, that provision for such home and community based services was significantly strengthened during 2015, and that these levels will be maintained in 2016;

— that nursing home placements are required by those patients who can no longer live independently or return home even with appropriate supports, and that waiting times for the Nursing Home Support Scheme funding have reduced from 11 weeks at the beginning of the year to 3-4 weeks; and

— that optimum patient care, improving patient safety and overall population health at all times remain a Government priority;

notes in particular that:

— the Government has prioritised a number of initiatives during 2015 which have had a positive impact on trolley numbers:

— the Additional Winter Capacity and Closed Beds Initiatives were established in July 2015 to fund and support additional bed capacity during the winter peak period; as of Friday 8th January, 2016, 321 beds have opened or reopened with a further 127 beds to open or reopen during quarter one, 2016;

— delayed discharges have reduced steadily from 830 in December 2014 to 533 on 11th January, 2016 which has freed up almost 300 beds to be used by acutely ill patients every day;

— an additional €35 million (over projected 2015 expenditure) of ongoing funding has been provided for the Nursing Home Support Scheme during 2016, which will deliver 1,222,750 total weeks of care, supporting an average of 23,450 clients per week for 2016; this is an increase of 649 clients per week on the 2015 position and an increase of 33,825 care weeks above the 2015 position;

— transitional care funding has supported over 3,800 approvals, which is significantly above the original target of 500;

— over 1,200 additional home care packages were provided by end 2015;

— 173 additional short-stay nursing home beds were open by the end of 2015, 149 of these in public facilities; and

— in addition, 65 short-stay beds opened in Mount Carmel Community Hospital in September;

— for 2016, the Department of Health will have total funding of approximately €13.6 billion (a seven per cent increase on the 2015 Budget) demonstrating the Government’s commitment to addressing the reductions experienced by the health sector consequent on the economic downturn which commenced in 2008;

— a series of focussed campaigns are ongoing to attract frontline staff in order to meet patient care requirements:

— in the past 12 months there are nearly 900 more nurses working in the health service;

— since March 2011, over 300 additional consultants have been appointed to acute hospitals around the country, including 92 consultant appointments between January and November 2015;

— the number of non-consultant hospital doctors employed in the health service has increased by over 390 in the last 12 months and by over 1,000 since March 2011; and

— ED consultants have increased from 56 to 84 under this Government;

— on 11th January, 2016, revised proposals of the Workplace Relations Commission were accepted by the Irish Nurses and Midwives Organisation National Executive in relation to the HSE National Escalation Policy, which will enhance patient safety and care in EDs; and

— the Emergency Department Task Force Implementation Group, convened by the Minister for Health, continues to ensure that a system-wide focus is maintained on addressing ED overcrowding challenges by Hospital Groups, working with the relevant community healthcare organisations; the Emergency Department Task Force Implementation Group has also been overseeing Hospital Groups’ winter preparedness and during this peak winter period, the Department of Health is engaging in weekly meetings with the HSE; and

supports the Minister for Health in his continued determination to bring about improvements in urgent and emergency care services."

I welcome the opportunity to speak to the House again on what is being done to improve access to our acute hospitals, particularly initiatives to alleviate pressures in our emergency departments. I acknowledge once again the distress for patients and their families caused by cramped and overcrowded conditions in some of our hospital emergency departments. I am very cognisant that these crowded conditions make emergency departments a very challenging work environment for nurses, doctors and other hospital staff.

In recent weeks, I have taken the opportunity to visit emergency departments, many for the second or third time. These visits have enabled me to meet patients and families attending the departments. These interactions have often been difficult. My visits have also allowed me to see at first hand the challenges for health care staff who are endeavouring to provide high-quality care in these circumstances.

I welcome the fact that, for the first time since I was made Minister for Health, Sinn Féin has chosen to use its Private Members’ time to debate the issue of health. It has taken it almost two years, but I welcome that it has chosen at long last to rate health as an issue for Private Members’ time. However, the fact that it is only doing so in the dying days of this Dáil is clear evidence that health is not a priority for it. The party offers little more than soundbites during Leaders’ Questions. Unlike the water charges and property tax, improving health is not a red-line issue for Sinn Féin in entering coalition with Fianna Fáil, should it have the opportunity to do so. That also speaks volumes.

By contrast, this Government is committed to improving the health services, and we have adopted a four-pronged approach to address the causes and challenges of emergency department overcrowding: measures to reduce numbers coming into hospitals; measures to expand capacity within hospitals; changes to work practices and processes in hospitals; and measures to get people out of hospital sooner.

In addition to supporting major recruitment campaigns for doctors and nurses, the Government has allocated more than €117 million in additional funding during 2015. This funding was provided to enable the HSE and voluntary hospitals to implement a range of actions to reduce emergency department overcrowding, such as increasing bed capacity, reducing waiting times for funding for the fair deal scheme, and increasing access to alternatives to emergency department services.

From the Opposition benches, I have heard, and will again no doubt hear again today, much talk about the need for additional resources to solve the problems in our emergency departments, but, unfortunately, talk is all it is.

The dream team of Sinn Féin and Fianna Fáil provided in their alternative budgets for 2015 nothing at all to address emergency department pressures. In contrast, we have provided €117 million and a further €51 million to reduce waiting lists. It is fair to acknowledge that the parties recognised the issue in their more recent alternative budgets for 2016, having ignored the matter entirely for 2015. Sinn Féin promised to provide €86 million and Fianna Fáil promised more, €90 million, but that is still less than the €117 million the parties in government actually provided in 2015 and the further significant funding we are providing this year. The parties opposite call for more resources but their own policy papers promise less. I look forward to hearing the speakers opposite explain this contradiction in their contributions, referring specifically not to their recently published pre-election policies but to their existing alternative budgets for 2015 and 2016.

Both parties talk a lot about the need to hire more staff, but Sinn Féin's plans are to cap consultant and management pay and increase their taxes, in a move that would be guaranteed to make recruitment even more difficult than it is already. They propose to pay general practitioners €120 per year per patient for unlimited visits, which would surely render many practices unviable. I doubt that it would be possible to agree it by negotiation with general practitioners.

Fianna Fáil, in its alternative budget, made no provision for the Lansdowne Road pay restoration for nurses, young doctors, ambulance drivers, paramedics and therapists. I do not see how we could possibly recruit more staff if we did not fund, or reneged on, the commitments made in the Lansdowne Road agreement.

It is little surprise that, in the case of Fianna Fáil, joined-up thinking is so absent. After all, it ran away from the health Ministry in 2004 after Deputy Martin's period as Minister for Health and Children. During this time, the Fianna Fáil-led Government, supported by Independents, promised to end waiting lists permanently within two years and ensure sufficient bed capacity in hospitals. Perhaps this is a matter for its next billboard. Instead, Fianna Fáil set up the HSE. Thereafter, it was so scarified by the experience that it was happy to leave the Ministry to Ms Mary Harney, even after the demise of the Progressive Democrats in 2007. It was prepared to leave it to an Independent rather than take on responsibility itself.

As part of the health strategy developed during Deputy Martin's period as Minister, 3,000 additional hospital beds were to be provided. In fact, in the period that followed, 2005 to 2011, the number of acute beds was reduced by 1,245, or 10.3%. Trolleys remained a persistent problem. Yesterday, the number of patients on trolleys, according to the Irish Nurses and Midwives Organisation's Trolley Watch figures, was 356. This is down 27% on the same day in 2011. I am using Trolley Watch figures because Ward Watch figures were not collected at that time. The problem was 27% worse under Fianna Fáil after 14 years of rule. On the relevant day in 2011, the figure was 492.

As for Sinn Féin, we have seen its health policy in action in Northern Ireland. Just like Fianna Fáil, it has done everything possible to avoid taking direct responsibility for health ever since its awful tenure in the portfolio from 1999 to 2002. The then Sinn Féin Minister, Bairbre de Brún, became famous for setting up inquiries and review groups during her four years in office. Perhaps she was taking lessons from Deputy Micheál Martin, who was Minister for Health and Children at the time in this jurisdiction. In medical circles, her unwillingness to make any decisions was called "paralysis by analysis". It was even wondered whether she would reach the point at which she would have to order a review of the reviews because so many had been commissioned. Under Sinn Féin's watch in Northern Ireland, waiting lists hit a record high, with the longest treatment queues in the whole of the European Union. That is Sinn Féin’s record on health.

The recently published Sinn Féin health policy, Better for Health, gives us an insight into its current plans. It is a strange combination of old ideas that were tried and failed elsewhere and good ideas that would require a level of investment that is just not realistic. Sinn Féin's approach to policy is almost childlike. Its approach to finite resources is to want to have it all anyway, so it promises to put an extra €5 billion into health and billions of euro into education and housing. At the same time, it promises to abolish the property tax and water charges. I am not even sure it could fund everything if it raised taxes to the highest they have ever been in this country. Even if it robbed a bank, it would never pay for it all.

We know from experience that the winter period, and particularly the new year period, is a time of peak activity for emergency departments throughout the country. None the less, from mid-November up to this week, there have been improvements in the numbers of patients on trolleys. This week, trolley numbers are somewhat higher, given the increase in influenza, but an analysis of recent performance through a 30-day moving average shows a 10% improvement in the overall numbers on trolleys against the same period last year. There is some significant variation, with hospitals such as Letterkenny, Portiuncula, Mullingar, St. James’s, the Mater, Tallaght and Connolly showing significant improvements, while others have fared less well, and some have disimproved.

In the first couple of weeks of 2016, emergency departments are seeing a 7% increase in the number of patients attending, with some sites showing a 17% increase in attendances by comparison with the number for this time last year. Putting that in context, there are, on average, up to 3,000 patients presenting to emergency departments daily, with nearly 200 patients presenting at larger emergency departments each day.

In order to manage this particular peak period, the emergency department task force implementation group has been overseeing hospitals' winter resilience plans. My Department and key members of the implementation group hold a weekly meeting to monitor emergency department performance and patient waiting times on trolleys. When we examine the factors that contribute to overcrowding in emergency departments, it is clear that the response needs to be at a number of levels. All relevant parts of the health service - namely, acute hospitals, social care and primary care - have to work collaboratively and in a joined-up way, so the Government has been driving a response by all elements of the health service.

In December 2014, I convened the emergency department task force to provide focus and momentum in dealing with the challenges presented by emergency department overcrowding. The task force action plan, published in April 2015, contains 88 actions, which are solutions tailored specifically to address the key challenges and causes of overcrowding. I have attended all the emergency department task force implementation group meetings to oversee the implementation of actions arising from the plan, and I can see that the plan is being implemented. The 88 actions consist of a combination of immediate measures to target the pressure areas and long-term sustainable solutions to reduce emergency department overcrowding.

During 2015 and into 2016, a number of initiatives have been implemented to ease emergency department overcrowding and impact on trolley numbers. These include initiatives to increase bed capacity in hospitals for the winter months; reduce delayed discharges from hospitals by improving access to nursing homes, convalescence and home care packages, with, for the first time, the latter being provided to patients awaiting discharge almost on an on-demand basis; recruit more medical and nursing staff into the health service; provide specific care pathways in emergency departments for older and frailer patients; ensure more efficient planning and management of patient discharge from hospitals, including early discharge planning from when the patient is admitted and weekend discharges in order that patients can leave as soon as they are medically fit; improve access to primary care services, particularly nurse-led community intervention teams, to reduce reliance on hospitals; make best use of all the non-emergency department facilities available, such as medical assessment units, surgical assessment units, minor injury units and urgent care centres; and reduce the length of stay for patients who have been admitted by faster access to diagnostics, among other actions.

The Government is committed to reversing the budget cuts experienced by the health services due to the economic downturn that commenced in 2008. This is evident from the extent of funding provided to the health service in 2015 and 2016. In 2016, health will have funding of approximately €13.2 billion for current expenditure and €414 million for capital expenditure, which is an increase of €900 million and €36 million, respectively, on the 2015 budget. These increases to do not take into account Supplementary Estimates. These figures constitute a 7% increase on the budget for 2015 and a 12% increase on the voted budget for 2014. In contrast, in the final three years of the previous Fianna Fáil-led Government, public health expenditure was cut from €14.59 billion in 2008 to €13.73 billion in 2011, a reduction of €860 million, as our population and its health needs grew and aged.

Of the gross 2016 health budget of approximately €15 billion, €5 billion has been designated in the HSE national service plan to services delivered by acute hospitals. As such, roughly one third of health funding is allocated to hospitals, with the remainder allocated to primary and social care, medicines, mental health, public health and disability.

In 2015, the Government made available €117 million to implement specific measures to reduce emergency department overcrowding. This included a sum of €74 million, which has enabled significant progress to be made on reducing delayed discharges, lowering the waiting time for fair deal funding and providing additional transitional care beds and home care packages. The number of delayed discharges peaked at 850 and has declined to below 500. On deeper investigation, the figure is even lower than this, as 80 of these 500 patients are not in acute hospitals and many more are not fit for discharge. The €117 million figure also included €18 million to support acute hospital services over the winter period by providing additional bed capacity and other initiatives to improve access to care. Of the 300 additional beds being funded, more than 200 have opened. The remaining €25 million has been provided for services that provide alternatives to acute hospitals, some of which I alluded to.

It is Government policy to support older people to live in dignity and independence in their own homes and communities for as long as possible. Despite continuing pressure on the public finances, the level of home and community-based services was significantly strengthened last year and this will be maintained in 2016. These services will not be cut back. What this means is that the Health Service Executive will provide approximately 10.4 million home help hours, more than 15,000 home care packages and in excess of 300 transitional care beds. In addition, some 130 intensive home care packages will be provided to support the discharge from acute hospital settings of people with more complex needs, many of whom are individuals who would not be accepted by nursing homes.

There will always be people who require quality long-term residential care. The nursing homes support scheme, known as the fair deal, is crucial to achieving this. It is worth highlighting that, this year, the budget for the scheme is €940 million, an increase of €35 million on last year's projected spend. This year, the scheme will deliver more than 1.2 million weeks of nursing home care to 23,450 clients per week. This is an increase of 649 clients per week on 2015. In addition, waiting times for applicants approved for funding should not exceed four weeks, as is currently the case. This scheme remains a key component of our supports for older people and involves a very significant financial commitment on the part of the State.

Providing additional bed capacity has also been a key initiative. In July 2015, I introduced the additional winter capacity and closed beds initiatives to ensure additional capacity would be in place in hospitals during the winter peak period. As I indicated, €18 million has been provided to open new beds and re-open beds that had been closed. The HSE and individual hospitals - the voluntary hospitals - have made considerable progress in opening and re-opening beds. As of Friday last, 209 new beds had opened, 112 previously closed beds had been re-opened and a further 127 beds will open or re-open in the first quarter of this year, subject to staffing. The new and re-opened beds have been a crucial resource for many hospitals in allowing them to manage to an extent they would not have otherwise been able to do.

Recruitment of medical practitioners and nurses into the health service has been a major priority throughout 2015 and this continues to be the case. No one can have failed to notice the major recruitment campaigns run by the HSE and hospitals to attract front-line staff. Anyone who used Dublin Airport over the Christmas period will have seen advertisements placed at the airport by Tallaght hospital, which has staffed and opened all of its beds.

Since this time last year, the number of nurses on the health service payroll has increased by almost 900, while the number of non-consultant hospital doctors, NCHDs, has increased by almost 400. Under this Government, the number of NCHDs has increased by more than 1,000, the highest figure ever recorded. The number of doctors registered in the State is also the highest ever recorded, having recently exceeded 20,000.

On consultants, Government policy is to move to a consultant-delivered service. The number of consultants has increased significantly in recent years to 2,700 full-time equivalent posts. Since March 2011, the month in which the Government took office, more than 300 additional consultants have been appointed, including 92 consultant appointments made between January and November 2015. Also, the number of emergency department consultants increased from 56 to 84 under the Government, which highlights our efforts to improve the quality of senior decision making in emergency departments.

Outside of the acute hospital setting, measures are also being implemented in primary care to strengthen existing alternatives to hospital. Community intervention teams involve nurses visiting patients in their homes or nursing homes to administer intravenous medications, monitor bloods, dress wounds, etc. These teams have been expanded, with the most recent new service opening in Waterford some weeks ago.

Other primary care initiatives which alleviate emergency department pressures include expanding general practitioner out-of-hours services; increasing GP access to diagnostic services, such as X-ray and ultrasound; developing minor surgery capacity in general practice; and increasing palliative care capacity in the community to ensure people can die with dignity by providing additional hospice beds, including 24 in Blanchardstown and six in Galway. A further 16 hospice beds have been funded under the service plan and will open in County Kerry later this year. I am disappointed Deputy Martin Ferris did not acknowledge this development.

In November 2015, with the HSE director general, I issued a national emergency department congestion escalation directive to hospitals on how best to deal with emergency department congestion. The framework is intended to ensure that appropriate escalation procedures are in place during high-demand periods in emergency departments. Under the directive, it is compulsory for each hospital to take specific steps to address overcrowding, such as extra ward rounds if trolley figures reach red status on the TrolleyGAR or if a patient has been waiting for more than nine hours on a trolley since a decision was made to admit him or her.

The HSE informs me that the national escalation framework has been implemented in all hospitals and that the special delivery unit is undertaking an audit of the framework's implementation in ten hospitals to ensure it has been implemented. These audits will provide feedback on how effectively the escalation procedures are working in different hospitals and enable further improvements to be made. To respond briefly to Deputy Tóibín's remarks, the budget of the National Ambulance Service will be increased this year by €7 million, which is additional to the extra €5 million provided last year. Needless to say, these increases need to be sustained.

The Minister is using 2014 as a baseline. The Government took office in 2011.

While we are focusing on trolley numbers, we must not lose sight of the importance of effective management of waiting lists because, as we know, today's cancelled operations are potentially tomorrow's emergency department presentations. The health service must balance planned and emergency care needs to prevent delays in diagnosing or treating illness which could result in greater needs for emergency intervention next week, next month or next year.

In January 2015, I set maximum waiting times for inpatient and day case treatment and outpatient appointments of 18 months by 30 June and 15 months by the end of the year. The HSE was provided with additional funding in the region of €50 million to facilitate achievement of these maximum wait times. It was acknowledged throughout that this may not be possible in the case of some sub-specialties due to the non-availability of specialist staff in the public or private sector and that some patients would decide to wait for a particular consultant, rather than be sent for private treatment.

The National Treatment Purchase Fund waiting list data, published on Friday last week, show significant progress was made in 2015 in reducing the numbers of patients on waiting lists. The data show that the numbers are at their lowest point in more than one year.

At the end of December 2015 the HSE achieved 95% compliance for the inpatient and day-case waiting lists and 93% compliance for the outpatient waiting lists against the 15 months maximum wait time threshold. It is particularly evident from the data that progress has been made in addressing the needs of those patients who are waiting longest. On the inpatient and day-case waiting lists, the number of patients waiting over 15 months reduced by 77% during December and the number of patients waiting over 18 months reduced by 70%.

Minister, I am afraid your time has expired.

I will just be two minutes more, if that is okay. For the outpatient waiting list, the number of people waiting over 15 months fell by 54%. Of course we cannot compare outpatient waiting times with those of the last Government, as those involved chose not to count or include them in official figures, even though they account for three quarters of all those waiting.

Concerted efforts have been made to reduce the scoliosis waiting list as well. At the end of December, no active patients were waiting 15 months or more for spinal surgery at Crumlin hospital. In total, 50% more operations were carried out in 2015 versus 2014 with the assistance of hospitals in Cappagh, Temple Street, Blackrock and London. New theatre capacity will be provided in Crumlin as well.

Health will never be a good news story. In a Department and a system with over 104,000 staff, there will always be groups that have a grievance, often a legitimate one. With over 1,000 hospitals, primary care centres, health centres and community nursing units, there will always be a number in difficulty. With 6 million individual hospital attendances per year, there will always be individual cases that shame and embarrass us. Even 0.1% of 6 million amounts to 6,000 cases. Sadly, this means many of the improvements go unacknowledged or unrecognised, but progress is being made. In Ireland a patient is more likely to survive cancer than ever before. A patient is less likely to have a heart attack, but, if he or she does, he or she is more likely than ever to be at home within a few days. If a person has a stroke, he or she is more likely than ever to receive thrombolysis treatment and survive or avoid disability. If a patient has HIV, he or she will be treated and live a full and long life. If a patient has hepatitis C, he or she will probably be cured.

Nonetheless, we all agree the patients are still waiting too long and staff have to work in difficult conditions. It is unrealistic to believe that the situation can be transformed in weeks or months. Yet it is not intractable and health is not a black hole. With sustained effort, additional resources, clinical leadership and management focus, we can make improvements. It is important to remember that high-quality care is provided to many patients in our emergency departments throughout the country. The vast majority of patients who present at emergency departments - some 83% - receive timely care and are either discharged or admitted within nine hours. I can assure the House of my ongoing commitment and interest in this matter and that of the Government. My apologies for going over time.

Seven and a half minutes remain. Deputy O'Reilly and Deputy Mulherin can share the remaining time.

It is important at the outset to establish what has been achieved to date and to acknowledge the proactive leadership role of the current Minister, Deputy Varadkar, and that of the Minister of State, Deputy Kathleen Lynch. For 2016, health will have funding of €13.195 billion for current expenditure and €414 million for capital expenditure. This represents increases of €900 million and €36 million respectively. There has been a 10% improvement on the overall number on trolleys as against the same date last year. The nursing home support scheme has been augmented with an extra €35 million down to a three or four-week waiting list. Some 649 additional clients per week are dealt with. There is additional winter capacity and the closed beds initiative has been introduced. Some €18 million has been made available to support the opening of 321 beds, with a further 127 due to be opened in the coming weeks.

Under the HSE national service plan, an additional €20 million has been provided to maintain the 2015 outturns of 10,437 hours of home help. That is critical. A sum of €153 million has been provided for 15,450 home care packages and €6 million has been provided for 313 transitional care beds. This has delivered 109 places. An additional €200 million for refurbishment or replacement of older persons units has been provided and we have seen the extension of general practitioner care to under sixes and over 70s as well as 900 more nurses. That is the context of the debate.

I am very proud that the emergency department in Cavan General Hospital is 27 years open this year. It has an average of 80 patients per 24 hour period. Since 2011, the hospital's performance has steadily improved with patient volumes and waiting times reducing significantly. During the period from 1 October 2013 to 1 April 2014, Cavan General Hospital was one of the best performing emergency departments in the country and was rated green throughout this period on trolley ratings, with an average of approximately two patients waiting at 8 a.m. each morning. It is a great story for Cavan General Hospital, of which I am so proud. This is due in part to significant initiatives brought in by the Government since 2011. There has been an overall expansion of emergency departments. I wish to remind the Minister of the need for a new emergency department in Cavan and a new capital spend. There has been an expansion of the renal dialysis unit and we have seen the development of the paediatric assessment unit. These services have diverted patients from the emergency department, thus alleviating the pressure. There are new short-stay and stroke units and we have seen enhanced relocation of day ward services. There is a new cystic fibrosis suit with additional rooms for paediatrics and we have seen the establishment of a genitourinary medicine centre in Monaghan hospital. The story in Cavan is great and I am so proud of it. Monaghan hospital is augmenting that and doing an extraordinary job.

The issue of overcrowding in emergency departments cannot be resolved by emergency departments alone. A collaborative approach is necessary and must involve social care and primary care. I urge the Minister to be extraordinary, as he is in every Department, and to keep a major focus on this. I do not believe the potential of primary care has been fully exhausted yet. Apart from the number of primary care centres, I believe there is more potential within existing centres to have situations hived off. We need a collaborative, combined, holistic approach.

The emergency department task force was established to tackle the problem of overcrowding. A total of 88 actions were identified and these have to be worked through. Of course none of us is happy with the status quo. We want no one on trolleys. However, significant efforts have been made. I believe that should be acknowledged and the work needs to be kept going.

I compliment the management and staff of Mayo General Hospital. Trolley numbers are down from this time last year by 15% although, of course, trolley numbers continue to be far too high. I can vouch for this myself because I liaise closely with management and staff and I deal with patients. It is on account of mammoth efforts and a multifaceted approach on the part of management and staff that we have seen these results.

Notwithstanding this progress, Mayo General Hospital has experienced a continuous surge in demand in the accident and emergency department in recent months, dating back to August when traditionally the numbers in the accident and emergency department would be few. However, this year there were considerable numbers. It is really pressurised in the accident and emergency department.

A number of measures have been implemented, including a change in bed management practices, extending diagnostic services such as radiology and cardiac investigations and the introduction of an elderly frail care team under the winter initiative fund, for which the hospital received €250,000. The use of additional step-down beds at Ballina and Swinford district hospitals has helped and the provision of additional funding for the fair deal scheme has helped delayed discharges. These measures can only go so far. They are short-term measures and they show some benefit but in the longer term there is a serious capacity issue in the emergency department at Mayo General Hospital. There is also a deficit in medical beds.

The emergency department was designed to cope with 20,000 patients per annum. In reality, it receives 35,000 patients per annum. Without a doubt, it is operating far beyond its capacity. I know the hospital board has sent a business case to the Saolta health care group for funding to increase the capacity of the emergency department. I fully support this and I call on the Minister, as part of the suite of measures and the multipronged approach he has described, to urge the Saolta health care group to prioritise Mayo General Hospital as it considers its priorities for infrastructural investment for 2016. I understand the immediate provision of an additional six clinical spaces and 15 medical beds would make a considerable difference to patient flow through the hospital. It would afford dignity and quality of experience to the patient and reduce trolley numbers and the waiting list for elective procedures.

I understand that the possibility of modular building is being considered, but the reality is that we cannot get away from the capacity issue and the stress and pressure that people working in the emergency department are experiencing. I can vouch for that fact. I have been to the emergency department on a number of occasions in my official capacity and with some patients. It is a very small emergency department, and a very modest proposal could realise real benefits and an alleviation of the trolley problem in County Mayo and the wider area it serves.

Debate adjourned.