Hospital Trolley Crisis: Motion [Private Members]

I move:

“That Dáil Éireann:

notes that:

— the health service is under huge strain following cuts made to its budgets during the austerity years and a lack of sustained investment to meet the growing and changing needs of our population;

— one of the fallouts of this is a chronic lack of capacity within our acute hospitals;

— medical and healthcare professionals are working, and have been working, tirelessly in hospitals around the country with fewer resources, supports and funding;

— the scandal of patients waiting on trolleys was officially declared an emergency by former Minister for Health, Mary Harney, in 2006 when the trolley count reached 469;

— twelve years later on 3rd January, 2018, 677 patients were left on trolleys, the highest ever recorded number of patients on trolleys in the State;

— throughout the whole of 2017, there were a record 98,981 patients left to spend one night or more on a trolley in hospitals throughout the State, representing the worst ever recorded number;

— the Organisation for Economic Co-operation and Development (OECD) data confirms that our acute public hospitals operate at 95 per cent occupancy, which is way above the acceptable OECD average of 77 per cent needed to provide a safe, consistent and effective standard of patient care;

— intensive care units in our hospitals are operating past full capacity daily;

— the Irish Association of Emergency Medicine has calculated that there could be between 300 and 350 excess patient deaths each year due to the trolley crisis and emergency unit overcrowding;

— Ireland had the second lowest number of hospital beds in the OECD leading to a lower than average hospital stay, 6.2 days, compared to the OECD average of 8.2 days;

— in the past decade acute hospital in-patient bed numbers were cut when they should have been increased in line with the country’s growing and ageing population;

— last May, the Department of Health commenced a national bed capacity review, which was due to be published before the end of 2017, however, the Oireachtas has still not seen the final report; and

— unions representing workers in the health service have been highlighting the issue of a chronic lack of capacity in the health service for almost a decade;

further notes that:

— the recruitment moratorium in the public sector was introduced in the health service two years before all other areas of the public sector;

— there is a recruitment and retention crisis in our health service;

— unions representing workers in the health service have been highlighting the issue of the recruitment and retention crisis in the health service for a number of years;

— the Report of the Public Service Pay Commission identified problems in recruitment and retention, particularly in the health sector;

— in December, 2008, there were 38,108 whole-time equivalent nurses and midwives in the Health Service Executive (HSE) and at the end of September, 2017, that stood at just 36,170 whole-time equivalent nurses and midwives;

— to deal with the shortage of nurses, the health service has an over-reliance on costly agency staff, with the bill for agency nursing running at €1.1 million per week;

— hospital consultants make up less than 2.5 per cent of the overall public health service workforce, which is significantly less than peer countries' health services;

— the 2003 Hanly Report recommended that by 2012 there should be 3,600 consultants, yet at the end of September, 2017, there were only 2,951 whole-time equivalent consultants operating in the HSE;

— to cope with the shortage of consultants, hospitals have been hiring doctors without the requisite specialist skills who are now practising as consultants despite not being on the specialist register;

— the staffing crisis has created a severely challenging working environment, where nurses and doctors routinely work beyond their contracted hours in order to ensure patients are cared for in hospitals, at a significant physical, mental and financial cost to themselves and their families and friends;

— there is another crisis within the health service as Section 39 agency workers, who had their pay cut in line with the public service but have not had their pay restored, have balloted for strike action; and

— this pay disparity is causing gross staff loss, the demoralisation of current staff, which affects delivery of services, therefore placing further pressure on the HSE, and acute hospital sector, which will be further compounded by a possible strike in February;


calls on the Government to:

— ensure the Emergency Department Taskforce works on a permanent basis monitoring the situation nationwide and reports on problems to be proactively tackled;

— reopen all hospital beds closed during the austerity years;

— meet with unions and representatives of nurses, doctors and allied health professionals in order to comprehensively examine the underlying difficulties in recruitment and retention in those sectors;

— establish a commission on pay in the health service for medical professionals and healthcare workers;

— genuinely invest in recruiting more staff to the health service, while simultaneously addressing the key issues for existing and prospective staff of working conditions, facilities, supports, training opportunities and pay;

— invest in co-locating general practices and acute mental health services next to emergency departments so those patients who do not need emergency department care can be treated in a more appropriate setting;

— increase investment for transitional care beds, adequate step-down facilities, home care packages, and home help hours to ensure that all patients who can be moved home, or to a more appropriate care setting, are given that opportunity;

— speed up the move towards primary and community care ensuring that all primary care centres are adequately resourced with new staff and funding;

— expand community diagnostics and shifting non-acute treatment from the acute sector to the community;

— commit to putting in place a plan for piloting salaried general practitioner (GP) posts starting with 2019 graduates;

— commit to graduated pay restoration for staff in Section 39 agencies;

— liaise with representatives of GPs to ensure that proper out of hours GP services can be established and maintained across the State;

— broaden the awareness campaign to ensure that the public are aware of what needs should be met in an emergency department and what needs should be met in general practice and primary care; and

— agree to the full implementation of all the recommendations in the Sláintecare Report.

There is a significant number of strands to the current crisis in our health service, from waiting lists for acute surgery to children waiting more than a year for speech and language therapy and everything in between. However, one of the most scandalous and recurring components of the crisis afflicting our health service is that of patients being left waiting on trolleys in emergency departments across the State. In 2017, a record 98,981 patients were left to spend one night or more on a trolley in hospitals throughout this State. This is the worst ever recorded number of such patients. The health service is under huge strain following cuts made to its budgets during the austerity years and the lack of sustained investment to meet the growing and changing needs of our population. Two of the main consequences of this are a chronic lack of capacity within our acute hospitals and a shortage of staff. For many years now medical and health care professionals have been working tirelessly in hospitals around the country with fewer resources, supports and funding. In spite of the brave work of these medical and health care professionals, the crisis of patients on trolleys has recurred year on year, worsening all the while. The scandal of patients waiting on trolleys was officially declared an emergency by the former Minister for Health, Mary Harney, in 2006 when the trolley count reached 469. Twelve years later, on 3 January 2018, 677 patients were left on trolleys, the highest number ever recorded. These are not just statistics; they are human beings - grandparents, mothers, fathers, brothers, sisters, sons and daughters.

This crisis happens because we have neither the capacity nor the staff to deal with the volume of patients presenting at our emergency departments and acute hospitals. OECD data confirm that our acute public hospitals operate at 95% occupancy, which is far above the acceptable OECD average of 77%. An occupancy rate of 77% is what is needed to provide a safe, consistent and effective standard of patient care. The Irish Association of Emergency Medicine has calculated that there could be between 300 and 350 patient deaths each year due to the trolley crisis and emergency unit overcrowding. In the past decade, acute hospital inpatient bed numbers were cut when they should have been increased in line with the country's growing and ageing population. Last May the Department of Health commenced a national bed capacity review, which was due to be published before the end of 2017. Oireachtas Members still have not seen the final report but sections of the media clearly have seen it. That is disrespectful to people in this House and to those working in the health service.

Accompanying this crisis of capacity is a crisis of recruitment and retention. It is always worth noting that the recruitment moratorium in the public sector was introduced in the health service two years before all other areas in the public sector. Unions representing workers in the health service have been highlighting the issue of recruitment and retention for a number of years now. Indeed, the report of the Public Service Pay Commission identifies problems in recruiting and retaining staff, most especially in the health service. In December 2008 there were 38,108 whole-time equivalent nurses and midwives in the HSE but at the end of September 2017 that stood at just 36,170. The fallout from this is that to deal with the shortage of nurses, the health service is overly reliant on costly agency staff, with the bill for agency nursing running at €1.1 million per week. The Minister has agreed with me on more than one occasion that this does not represent good value for money but not only does it continue, it gets bigger every year.

Similarly, hospital consultants comprise less than 2.5% of the public health service workforce, which is significantly less than the percentage of consultants in the health services of peer countries. In 2003, the Hanly report recommended that this country should have 3,600 consultants by 2012, but there were just 2,951 whole-time equivalent consultants operating in the HSE at the end of September 2017. The practice of hiring doctors who are not on the specialist register to act as consultants is another feature of the chaos in recruitment and retention. The staffing crisis has created a severely challenging working environment in which nurses and doctors routinely work beyond their contracted hours to ensure patients are cared for. This often happens at a significant physical, mental and financial cost to those involved and their family members and friends.

Solutions are required to stabilise the situation in the short term. We need to ensure the emergency department task force works on a permanent basis to monitor the situation across the country and report on problems that need to be tackled proactively. The Government needs to ensure as a matter of urgency that all beds closed during the austerity years are reopened. This has to mean setting targets and putting funds aside to ensure those targets are met. If we are to deal with the increasing population and the changing demographics, we need to start building additional capacity into the acute hospital sector. This should be reflected in the Ireland 2040 plan. The underlying difficulties causing this crisis, including working conditions, facilities, supports, training opportunities, promotion opportunities and pay, must be tackled so we can address the recruitment and retention crisis across all grades in the health service. Workers and their representative organisations must be consulted on how to address these issues. We must find a new way forward to resolve the recruitment and retention crisis. We cannot pretend the issue of pay is not a factor. I suggest that if this aspect of the problem is to be overcome, the Government should establish a commission on pay in the health service for medical professionals and health care workers. If these issues are not addressed, we will not be able to recruit more staff into the health service.

A broader awareness campaign is needed to ensure the public is aware of what should and should not be brought to accident and emergency departments. As part of this approach, the Government needs to hasten the move towards primary and community care and ensure all primary care centres are adequately resourced with new staff and funding. The Minister and I have discussed a primary care centre in my constituency on many occasions. It is not good enough that the HSE has said it will not allocate any additional staff to the centre. It is possible that new GPs will go into it, but I am concerned with HSE staff. Some patients are often left in acute care, which is not in their best interests, when they could and should be cared for at home. It is clear that increased investment in transitional care beds, adequate step-down facilities, home care packages and home help hours would help to ensure all patients who can be moved home, or to a more appropriate setting, are relocated in such a manner. While many of the measures called for in the motion before the House seek to stabilise the trolley crisis in the short term, we also need to address the systematic problems in the long term. This can be done if there is sufficient political will to implement in full all the recommendations in the Sláintecare report.

Health care should be a right for all citizens and not a privilege for the well-off. Need, not means, must be the philosophy underpinning our approach to health. The public health system should be free at the point of delivery, based on need and funded by progressive taxation. The Government is opposed to this. It does not support the duty of the State to provide public services. The approach of the Government and Fianna Fáil involves the privatisation of the health service, or at least those bits of it on which a profit can be made. That is why the health service is in a perpetual state of crisis. That is why the Government does not engage in the essential restructuring needed to provide a health service that is fit for purpose and is free to citizens at the point of delivery. It is no longer extraordinary to hear stories of elderly people, children and very sick people being left on trolleys. These harrowing tales are now part of the everyday narrative of life for ordinary people in this State.

In 2017, a record 98,981 patients were left to spend one night or more on trolleys in hospitals in this State. This represents the biggest number of trolley nights ever recorded. Last week, there were 126 patients on trolleys at Our Lady of Lourdes Hospital in Drogheda, which is in my own constituency of Louth. There were 31 people on trolleys on Wednesday alone. The equivalent figure for yesterday was 27 and for today it is 29. After seven years in power, Fine Gael has had plenty of time to take account of all of this by preparing a service plan that meets the needs of patients. I listened to the Taoiseach and the leader of Fianna Fáil debating these matters in the Chamber earlier today. I heard two failed health Ministers trying to score points off each other, like two bald men fighting over a comb. They made no sense at all. This country's nursing and medical staff and all the other health workers are doing a tremendous job, but they cannot cope. They should not be blamed for the mess that has been made of the health service by the successive health policies and strategies of Fine Gael and Fianna Fáil.

This crisis will not simply blow over. If this awful mess is to be sorted out in a socially just way, a definite and definitive change in policy is required. That does not mean a patched-up version of the current two-tier system. There needs to be a radically transformed wraparound health service that delivers care for all citizens from the cradle to the grave. As we heard when Deputy O'Reilly outlined some of the propositions she is bringing forward, this must mean ending the trolley crisis in our accident and emergency departments through proper investment and resourcing of community care. It must also involve the introduction of a new single integrated hospital waiting list management system, which allows people to move from one hospital to another to reduce waiting times. It also means recruiting doctors and nurses to reverse the cutbacks in staffing numbers that were introduced by Fianna Fáil, Fine Gael and the Labour Party in recent years. I do not envy the Minister, Deputy Harris, in doing his job. I do not doubt that he is doing his best and will continue to do so. Despite his best endeavours, however, he will not resolve the crisis in our health services because he is looking at the wrong problem. I say that with such certainty because I know the Minister is not trying to create a genuine public health service. I appeal to him to do so.

A number of years ago, harsh winters put increased pressure on accident and emergency departments across the country. The seasonal pressures on accident and emergency departments that were evident some years ago are now a crisis that manifests itself all year round. Why do patients, some of whom are very elderly, have to wait for unreasonable and extremely long times in accident and emergency departments? Why do they have to spend so much time lying on trolleys or sitting in chairs placed around accident and emergency departments? Among the many factors that have given rise to the continuous trolley crisis and the crisis in our accident and emergency departments are capacity issues and the constant brain drain of doctors, nurses and other highly trained medical staff. The lack of consultants and the subsequent cancellation of operations has added to this chaos. It is a scandal that we are exporting our doctors to other countries where conditions and pay are better.

Poor political decisions are important factors in the creation of this crisis. The lack of political will to resolve the growing scandals in our hospitals on the part of this Government and its predecessors has allowed the trolley crisis and the crisis in our accident and emergency departments to grow to the point where they are seemingly out of control. Our health system is poorly organised. When funds and resources are not put to good use, it leads to a reliance on acute public hospitals. This places an additional burden on the shoulders of hospital staff, who are over-stretched, hard-working and dedicated. Poor decision-making has led to a lack of primary health care centres. The development and resourcing of community care would help to alleviate the crisis in our emergency departments. All of this is giving rise to a systematic failure in our health service provision. It is an indication of a health system that is not fit for purpose and is unable to cope with the health requirements of the population. The INMO recently recorded the highest-ever number of patients on trolleys. Apart from the hardship of having to lie on a trolley for hours on end, such excessive delays in accident and emergency departments give rise to additional risks to patients, especially those who are elderly or vulnerable. Political will, leadership and proper resourcing are required to end the crisis in our accident and emergency departments and on our hospital trolleys.

I welcome the opportunity to speak on this important motion. I thank the wonderful staff of our hospitals and our health service across the State. Without the tireless work they do, our health service would be in a much worse situation. Those who experience the stress of having their children or their parents in hospital are having to deal with the added worry that their loved ones will not get a bed and instead will be left sitting for hours on trolleys or plastic chairs in accident and emergency wards.

It may be a new year but, unfortunately, some things never change. As we welcomed the new year, 2018 started with a record 677 patients on trolleys across the State. It is disgraceful and upsetting that children are also being placed on trolleys. I cannot understand how the practice of placing people on trolleys continues or that the Government fails miserably on this issue every year. This Government and that which preceded it have had seven years to get a handle on the problem but instead it continues to worsen.

Solutions have been rehearsed in the House time and again. Closed beds must be reopened, qualified staff must be recruited and retained and adequate step-down facilities must be provided. Home care hours are also needed in order that patients who are in a position to move on can do so. Members of the public have listened to these debates over and over again and they are sick to the back teeth of all the talk and no action. The phrase I use to describe the Government's approach to the health crisis is that it is tinkering around the edges. It appears to me and others that the will to make the big decisions on investment, pay and conditions for staff and the implementation of recommendations such as those in the Sláintecare report is absent. This must change.

Maureen is 76 years old and has small cell lung cancer. On 30 December last, she started to vomit blood. Unable to have a palliative care team provided until 2 January, her daughter tried to contact the general practitioner out-of-hours service. The family was left waiting for 16 hours because of the Minister's failure to put in place a dedicated GP out-of-hours service.

On 4 January, an ambulance was called for Jay who was experiencing severe chest pains. It took two hours for the ambulance to arrive because it travelled all the way from Baltinglass to Arklow where there is no rostered ambulance on Thursdays. Jay's case is another of the Minister's failures. Jay and Maureen are two of the Minister's constituents. Jay's ambulance bypassed St. Colmcille's Hospital, where the 24-hour accident and emergency department has been closed, and brought him to a trolley lined corridor at St. Vincent's Hospital. This is another failure by the Government and the Minister's colleagues in the previous Government, including Labour Party Ministers. At the same time, the Government is railroading through the closure of St. Brigid's nursing home in Crooksling, a critical step-down facility that has provided excellent service to people in west County Wicklow and the Brittas area for many years. The closure of this facility follows the closure of other homes, including the Orchard welfare home in Bray and Wicklow District Hospital.

County Wicklow is a microcosm of what is taking place across the State. The slash and burn policies of the Government and its predecessor are the cause of the current crisis and unless they are changed, we will find ourselves in the House next year debating more cases involving people like Maureen and Jay. There must be change and investment.

Having spent time on a hospital trolley, I can relate to the experiences of many of my constituents and other people around the country.

In the 90 seconds available to me, I will focus on one issue. Last Thursday, security staff entered an area of Tallaght Hospital known as "the pod". Management then arrived and informed those present that the area was being redesignated as an adult area. The staff protested but were effectively asked to go away. They had to complete their work without access to this space. Some were told this was part of a two-day trial but that they should plan for the area to be redesignated permanently as an adult area. During the redesignation, I received reports that space could not be found for extremely sick children who had been brought to the hospital. These included patients with severe neurological conditions and one patient who may have cancer. Other sick children were then shunted out to public corridors. In one case, a five year old on a drip was left sitting on a chair on the main corridor of the department. Will the Minister confirm that this incident took place? Will the redesignation be permanent or is it a temporary measure to address difficulties being experienced in the hospital?

Children should not be left on trolleys. This practice gives rise to safety and personal dignity issues. I once observed a woman dying on a hospital corridor surrounded by family members. It was an awful experience and I am sure Deputies will be able to relate similar experiences.

It does not make sense to close down step-down facilities while cases such as those described by Deputies are taking place. St. Brigid's nursing home, which serves the Dublin South-West constituency and Wicklow, is a fantastic facility that is about to be closed. At the same time, families are telling us they cannot find nursing homes that will take in their loved ones who are in hospitals such as that in Tallaght. The reason for this is the high demand for such services. Much could be done if we sought collectively to address the problem. We must do things differently.

I welcome the opportunity to address the Dáil on the important issue of hospital overcrowding and thank Deputy Louise O'Reilly for facilitating the debate through the motion. I would like to approach this debate in a spirit of finding solutions and forging cross-party consensus. I appreciate that Deputy O'Reilly put forward a number of constructive suggestions. I am also conscious of the need for all of us to work together to reach a sustainable solution for the health service, placing patients and their needs at its heart.

The Government will not oppose the motion because we all want the same thing, namely, to do better by patients and front-line staff. However, there are a number of aspects of the motion that the Government contests and I will deal with these in the course of my address.

Nobody in the House considers it acceptable that we have high numbers of patients on trolleys waiting for long times in overcrowded emergency departments in conditions that are awful for them and the staff looking after them. I do not claim, nor does anyone in Government or the Health Service Executive, that the difficulties that arise immediately after new year are not predictable. We had detailed plans and extra resources in place for this reason. However, we still hit a surge that was extremely challenging for the health system. There is a difference between predictable and avoidable and the latter requires that we break the cycle of overcrowding. This will not be achieved in one year's winter plan.

I will first focus on this year's winter plan. I assure everyone that the Government is committed to investing in health and investment is having an impact. We do not often hear this but some things are going well in the health service. This year, as part of budget 2018, an extra €30 million was made available to respond to winter pressures, with a further €40 million being provided in 2018. Let me share something that Deputies may not have heard this winter. In the face of increased demand, staff across the country continue working to improve performance. The overall number of patients on trolleys over the whole winter so far, that is, from 1 November 2017 to 1 January 2018, has declined by more than 2,000 year on year. While far too many patients spend time on trolleys, staff are making an impact with the extra resources provided. The decline is the result of progress made in November, when the counts undertaken by the INMO and the HSE both acknowledged a significant decrease on the previous year. In December, the HSE's TrolleyGAR also showed a significant decrease on the previous year.

Measures such as expanded access to transitional care have meant 382 patients were approved for such care between 1 and 10 January. This has come about as a result of investment. Additional access to diagnostics out of hours has been provided as a result of investment. Investment in more home care has delivered a significant reduction in the number of delayed discharges. In addition, 80 patients are receiving care in private hospitals as a result of a decision to adopt a proposal made by Deputy Kelly last year to use all available capacity across the health service. While these measures have not been sufficient, they have had an impact.

The Government also provided €25 million for social care, including more home care supports and packages. It also provided €1.4 million for rehabilitation and step-down beds in Limerick and Cork and money to deal with complex case discharges to allow people to return to the community. We have opened additional beds at the national rehabilitation hospital and a day hospital is planned at Cashel. Moreover, the HSE's winter plan included a communication strategy, as called for in the motion. The strategy incorporated a public information campaign to increase awareness of the different approaches to accessing services, including emergency services, over the winter period. I must, therefore, counteract the narrative that there was a failure to predict or plan for what has occurred.

We need more beds to reduce the unacceptable number of patients who are still ending up on trolleys. This winter, we are opening an additional 227 beds and the capacity report will inform our plans for further increasing capacity. As of today, nearly 150 additional beds have been opened in Beaumont Hospital, St. James's Hospital, Naas General Hospital, St. Luke's Hospital, Kilkenny, Our Lady of Lourdes Hospital, Drogheda, and Limerick and Galway hospitals.

We have a growing and ageing population in this country and demand for our health and social care services is only going to go in one direction. In the region of 1.3 million people attended our emergency departments last year and more than 330,000 people were admitted to hospitals from emergency departments during the same period. This represents an increase on last year. In particular, there was an increase in the number of older people, those aged 75 years or over. The figure was up 11.3% last year on the year before.

Notwithstanding this rising demand, I wish to comment on something we do not often hear about, which is that some of our hospitals have done rather well. The figures show that Our Lady of Lourdes, Drogheda, Beaumont Hospital, Cavan General Hospital and St. Vincent's University Hospital, to name but a few, have seen a significant reduction in trolley numbers, ranging from 40% to 50%, compared to 2016. The Irish Nurses and Midwives Organisation figures acknowledge that point. We should acknowledge where good practice is in place and demand that it happens throughout the system.

I acknowledge that some hospitals experience specific challenges. The hospitals in Galway and Limerick have capacity issues but they have embraced the national patient flow project and both hospitals have seen improvements in this regard. I wish to thank staff and management in those hospitals.

If we are really to progress this debate, we need to move on to the solutions. What are we going to do to break the cycle? We are going to pursue three key priorities. We are going to increase bed capacity using the evidence and not the cries of those who want more beds for the hospitals in their constituencies. We will use the beds evidence of the capacity review to work out where we need the beds, what type of beds we need and how we are going to get them there. We are going to implement reform through Sláintecare. We are going to increase services provided through primary care by negotiating a new general practitioner contract and having engagements with GPs about how to unwind the financial emergency measures in the public interest legislation.

The first point relates to capacity. We simply do not have enough hospital beds in Ireland to serve our population. That might sound like stating the obvious, but it was not obvious during 2007 to 2011, when policy decisions were made to reduce the number of hospital beds. That was a policy of many people - it is not a partisan point. There was a view that we could do much in primary care, a view held by many eminent people in the health service. Clearly, there is a need to do more in primary care but we still need more beds in our acute hospital setting.

I became Minister for Health at a time when our country was back in economic growth. I want to build more hospitals, provide more beds and staff these beds. I am committed to doing this using an evidence-based approach. That is why we have undertaken a health system capacity review, aligning the needs of our health service now with our demographics out to 2031. The review is now complete and will be brought to Cabinet next week.

Additional capacity cannot be the only answer. Reform must take place as well. We need fundamental reform with significant development of primary and community care. Sláintecare provides a blueprint for this process. I am committed to driving a genuine all-party approach to agreeing a vision for our health service. That is what our country and people deserve. One of the first things this Government did was work with Opposition politicians on the establishment of the Committee on the Future of Healthcare and the production of the Sláintecare report. There is considerable consensus in this regard and I am keen for Deputies to know that I am absolutely committed to delivering on those reforms.

Detailed work will be overseen by a new Sláintecare programme office. The recruitment process for an executive director has commenced and is under way. The advertisement was placed on Friday. It is about getting the right person. That is why we did an executive search through the Public Appointments Service. This will be the largest level of reform ever undertaken in the health service, if not in the public service. It is essential that we get the right person with the right skills and experience. I expect that process to be complete by April.

We have already taken several actions with which Deputies will be familiar, including the preparation of legislation to introduce governing boards to bring back accountability and greater performance oversight. We are looking at the consultation process on how to align hospital groups and community health organisations, taking on board the views of front-line staff and patients. I have set up the Donal de Buitléir group, as the Sláintecare report asked of me, to look at how we can decouple public and private health care. Unlike the assertion of Deputy Adams, I want to see a universal health care system where private practice is decoupled from the public health service.

I wish to briefly focus on primary care. We will do Sláintecare. We are putting in more beds and we will continue to do this. We know we need to work with our general practitioners to do more in primary care. I know they are up for that and that they want to do that as well, but they need to be resourced. That is why, within a week, I will set a date for the FEMPI talks to begin. We can talk to our health contractors, starting with our GPs, about how to unwind some of the financial emergency measures brought in during times of economic recession to make their role more sustainable in future. This will serve to enable the delivery of a new GP contract. Much work has gone on. Talks have been held with GP organisations and there have been negotiations with the IMO in the past year. I believe the FEMPI talks will be an enabler to move those GP contract talks on further.

Earlier, I heard the leader of Fianna Fáil refer to the need to develop more community intervention teams. He is correct in this regard and that is why we are doing it. Budget 2018 provides further funding in this regard. We have seen a significant increase in the number of referrals. From January to the end of November, the figure was 34,452. That figure already exceeded the expected activity for the past year by more than 5%. We need to do more in that regard as well.

Putting more diagnostics in our primary care centres is under way. This is not talk; we have done it. I went to Castlebar, where we have put X-ray and ultrasound machines in the primary care centre. This will ensure that we have more than fine buildings; we will have diagnostics as well. More than 500 people were waiting for X-ray services in Mayo in April. That figure is now down to zero. Expanding the roll-out of diagnostics and access to diagnostics in primary care is clearly an important point.

I agree with Deputy O'Reilly that there are recruitment and especially retention issues. We have a process that the unions are engaging in today under the Public Sector Pay Commission. We have a specific module whereby the INMO, the IMO and my Department have made detailed submissions. The commission will make a final report to the Minister for Public Expenditure and Reform this year. I will certainly make my views clear in that regard.

I wish to acknowledge the hard work done by our front-line staff and management during a very challenging period. This year can and must be the year of reform in the health service. I am committed to working with everyone in the House to make that reform a reality in order that we can build the health service that our citizens rightly demand and require, although we all know it will take several years.

I wish to share time with Deputies Murphy O'Mahony, Browne, Butler, Breathnach, Rabbitte, Murphy and Scanlon.

I welcome the opportunity to speak on this motion. It is timely in the sense that patients and staff in our emergency departments throughout the country have gone through horrific times in recent weeks. Unfortunately, while we have heard talk about planning, I believe most of the planning was around spin rather than the actual implementation of substantial issues to address overcrowding in our emergency departments in the window after Christmas and the start of the new year. Almost every year in recent years we have consistently seen bedlam and chaos in our emergency departments from the first Tuesday of the new year and flowing out through January and February. It is beyond me. I cannot understand why no system is in place other than the pretence of winter-proofing in September and October. Press releases are turned out with claims of winter-proofing and that we are going to be ready for the winter flu and the challenges that are thrown at the health services in January.

We know that if we do the same thing over and over again, we will get a consistent result. That is a failure of management at the most senior levels in the HSE. However, the Minister has to take some political responsibility for it. He is in place in the Government. It must take responsibility for the difficulties with regard to the lack of capacity not only in our emergency departments, but to the flow of patients through hospitals.

There is no point in the Minister publishing a bed capacity review in the coming weeks if he does not immediately start assessing where he can identify in the short term wards in hospitals throughout the country that would be suitable for opening. This should happen with minimal capital investment in the coming short period coupled with the increase in staff recruitment processes to man those beds. There are longer term implications with regard to capital development of new hospital builds in the State over a longer period. There is no point in us being here this time next year and saying that the bed capacity review has highlighted something that we intend to fund in the years ahead. We need immediate efforts to pinpoint the pinch areas in our hospitals that cause overcrowding on a continual basis. The crucial period is the time immediately after Christmas and in the early new year. It is the same period year in, year out. Today, I predict that if the Minister does nothing, as has been the case in recent years, we will again be here this time next year talking about bedlam and chaos in our hospitals throughout the country in 2019. We will talk of patients waiting inordinate periods with poor health outcomes because of those delays.

I urge the Minister to take on board the views expressed in the motion. We understand the constraints the State has in terms of funding. However, there can be quick wins in identifying closed wards or wards that have been converted in hospitals throughout the country. We need to identify them early and we need capital investment to open them up. Long-term bed capacity requirements will have to be addressed over a longer period.

Despite an undertaking by the previous Taoiseach, Deputy Enda Kenny, in 2011 to bring an end to the trolley crisis, seven years later we find ourselves debating this issue in circumstances where the problem has become worse not better. Fine Gael has been in government for seven years and has failed to achieve any health target it has set. It is not rocket science to know that January will be a busy month in the hospitals. Our party spokesman on health issues, Deputy Kelleher, highlighted this to the Minister and the HSE last February when they were before the Oireachtas Joint Committee on Health but here we are again with no apparent plan.

An adequate management system in emergency departments is impossible to maintain given that the recommended waiting times are constantly being overrun. The latter results in emergency departments remaining at capacity levels all year round. This is heightened at this time of the year thus making the situation worse. We have reached the point now where elective surgeries are being cancelled and the problem is extending outside the emergency department.

I spoke before Christmas to the family of a constituent in her 80s who fell and broke her hip. She lay on a trolley in Cork University Hospital, CUH, for 48 hours. This was after waiting hours for an ambulance and travelling from west Cork. Surely a woman in her 80s and in severe pain deserves better than that. I have heard many more such examples in my Cork South-West constituency.

The Irish Nurses and Midwives Organisation annual trolley and ward watch figures prove that CUH was one of the most overcrowded hospitals in the State in 2017. As late as last Sunday, the hospital began to transfer patients out to regional hospitals, including Clonakilty Community Hospital, in an effort to alleviate the pressure on the emergency department in CUH.

Bed numbers need to be increased in all hospitals. On numerous occasions in this House and at the Oireachtas Joint Committee on Health, I have alluded to the fact that many general hospitals, such as that in Bantry, are more than willing to increase their workload and more than capable of doing so should they be given adequate resources. With reports indicating that 2,500 beds are required with immediate effect, it is imperative that the Government and the Minister for Health make this their priority.

I wish to support this motion regarding the record numbers of people on trolleys in our health system. Hospitals across the country are struggling to cope and staff are overstretched, overworked and increasingly suffering from stress and burnout. I thank the staff working in our health system during this very difficult period.

In 2011, the previous Taoiseach, Deputy Enda Kenny, vowed to bring an end to the trolley crisis. However, seven years later and three Fine Gael Ministers of Health later, the problem is worse than ever, with record-breaking numbers of patients lying on trolleys in hospitals throughout the country. What was once an unacceptable winter crisis of people languishing on trolleys is now a year-round experience in some hospitals. Little did we realise that when Deputy Enda Kenny and Fine Gael promised to end the trolley crisis they meant they would do so by normalising it. This has been a persistent problem but year after year the Government has failed to take the necessary steps to tackle the overcrowding crisis. The Government is bereft of ideas and devoid of plans to address this crisis. Instead, it is choosing to adopt the role of the innocent bystander looking aghast and with nodding concern but little understanding or acceptance that they are responsible for averting this crisis. Almost 100,000 people spent time on trolleys in 2017. There was at least one instance of a child sleeping overnight on a chair. Last week, a couple told me that their adult daughter had to sleep on the floor of a ward without even a mattress. Overcrowding results in more delays and cancellations to scheduled hospital treatments and between 350 and 400 deaths every year result from overcrowding. The persistent problem must be tackled once and for all. It has been clear for a long time that there are insufficient beds in the system. It is not just a question of bed capacity in hospitals. We need greater availability of nursing home beds, rehabilitation spaces, convalescent supports and home care supports so that those fit for discharge can be discharged with the supports they need. The lack of availability of out-of-hour diagnostics in hospitals or the availability of diagnostics to GPs is still not being addressed. Implementation of the Sláintecare report, the all-party agreed plan for the future of our health care service, has been dragging. There is still no sign of electronic health records and mental health services are failing. An international assessment of our mental health services, as reported in The Irish Times today, makes for depressing reading. It is time for this Government to stop playing the innocent bystander and to start taking responsibility.

As the Minister is aware, we have an ageing population. We are living longer, healthier lives which is very welcome. However, when the older generation require hospitalisation they are anxious, nervous, frightened, bewildered and mostly in pain. The health service is overstretched. The emergency department, the part of our acute system that never says no, is the place where patients come up against access block and are unable to access an acute hospital bed.

I want to refer to the son and daughter of a 75 year old man who was admitted to the accident and emergency department in University Hospital Waterford on 1 December 2017. They articulate what we all know is happening all over the country. The trolley figures confirm this and I welcome this motion from Sinn Féin to briefly address this issue. The man's children said their main concerns relate to the clear overstretching of resources within the emergency department. They witnessed not only their father but many vulnerable patients on trolleys in corridors where the lights were on 24 hours a day seven days a week. Accordingly, sleeping was not an option and neither was a call for assistance. They witnessed patients needing to assist each other at times with only one accessible toilet for many to use. Alternatively, people were obliged to leave the unit out of view of the health care professionals. This was not an environment which promoted patient safety, dignity, privacy or confidentiality. Their father was unable to sleep. Placed at the end of the corridor he was frequently asked to push a door release button through a busy area as needed or staff had to lean over him to do this. The attention given by the nursing and medical staff was impeccable despite these difficult circumstances but to have vulnerable people on trolleys at 75 years of age in an open, unsafe area for three nights is not acceptable.

The reason this family went public was that they wanted to point out that the staff were fantastic but the circumstances in which they were working were very challenging. Unfortunately, this gentleman died on 17 December and the family said that while they were more than aware that the outcome would most likely have been the same the initial period in the emergency department delayed active palliative treatment and allowed additional suffering that was not necessary.

The persistent problems in emergency departments must be tackled once and for all. It is simply unacceptable that the trolley crisis remains. The blockages will have to be removed. I was very interested to hear Mr. Tadhg Daly of Nursing Homes Ireland state during the Christmas period that there were approximately 1,400 beds available in nursing homes. This is an option to improve throughput of patients and quicker discharges of people from hospitals.

Lip-service does not help to provide hip services or any other health service. I commenced in local politics in 1991 and became intimately involved in the old health boards. The changing of their name to HSE in 2004 has done little to recognise the demographic growth of our population. I have no doubt that services and outcomes for those who get into the health system have dramatically improved and should be acknowledged by me and all Members of this House. I compliment the various members of the staff of the health service on their great work.

In my lifetime of involvement with health boards, waiting lists have continued to grow and every service under successive governments has been trying to put a gallon into a pint cup. The health services are running to a standstill despite that huge growth in population, particularly in the past 30 years. The Taoiseach stated earlier today that if it was just a matter of funding, this issue would have been resolved by now because there has been an increase of over 20% in funding. Ireland has one of the highest levels of expenditure on health services of all OECD countries but it also has one of the poorest outcomes. The trolley figures, which Deputy Adams mentioned, were 29 today in Our Lady of Lourdes Hospital and were at an all-time high of 607 for the month of November. The latter was despite the fact that, as the Minister indicated, a 60-bed unit has been opened at the hospital. We expect the bed capacity review next week to say that 2,500 extra beds are required.

The Minister should dust down the proposals on the regional hospital for the north east in that respect. There is a 12 acre site at the Louth County Hospital that is ripe for development and could take much of the load and relieve the difficulties for the eastern region.

Finally, I refer to the good people who are not coming in to work in our health services. There is a serious need for the Minister to look into an incremental increase for those who stay for a given duration in the medical profession. That increment could be rewarded on an initial basis with an additional increment the longer one stays in the system. It is clear to me that we have a major issue. I do not want to go over all the other issues that have been raised in respect of better community services and all the rest of it. In accepting this motion on a cross-party basis tonight, we in this House should be making sure that we deliver to those who are waiting for us to stop paying lip service.

I call on the Minister to reopen hospital beds. Those waiting on the trolleys are sick people who need to be in hospital. One reason they are on trolleys is there are no hospital inpatient beds available to them. All acute hospital beds need to be reopened immediately and appropriately staffed and resourced. Health care professionals in emergency departments and acute hospitals nationwide have been telling us this for years, as has the annual crisis. I disagree with the Minister. I do not think we need a bed capacity review to tell us what is already obvious. What we need is more hospital beds.

Health care is a continuum. The overcrowding and backlog we are seeing in the emergency departments at present are the result of problems throughout the entirety of the health care system, which are made visible when the system is at crisis point. The flow of patients from emergency departments through the hospitals and safely home again needs to be facilitated. We need not only more beds but also more rehabilitation and support services for patients in hospital, in the transition period from hospital back to their homes, and into the community. We need more nursing and medical staff, undoubtedly. However, we also need more health care professionals, physiotherapists, occupational therapists, speech and language therapists, social care workers, dieticians and psychologists.

Adequate home care packages need to be provided if people are to return home from hospital and recover fully. Placing people on a waiting list for home care packages and discharging them without any support while they wait for this service is totally unacceptable. Galway is a very good example if the Minister wants to check this. We should also consider working with the non-profit organisations. The Parkinson's Association of Ireland's branch in Galway caters for over 700 members. Unfortunately, before Christmas, funding fell short and three of its members had to attend an accident and emergency department. Prior to that, in its five years of existence it has never had to use an accident and emergency department.

As my time is limited, I will have to omit some of the material I was going to use this evening. We all accept that the Minister is a decent man and that he wants to do his best for the health service. At the moment, however, that simply is not good enough. As Deputy Rabbitte and more of my party colleagues and the Sinn Féin Deputies have said, we need to reopen those beds. In this House earlier today, the Taoiseach said 2,500 beds would be added by 2031. That is 13 years. We will have an older population. Furthermore, I see that a number of services that were being provided in various towns and counties are being closed down. The beds are not being used. These include services for people with Alzheimer's, dementia, and some mental health issues. I am aware of a service in Castlerea, which I will bring up with the Minister another day. I know he is aware of it.

I will give the Minister one or two very brief examples as I am sharing time with Deputy Scanlon. A 90 year-old woman was left on a trolley at Portiuncula Hospital in Ballinasloe for seven hours recently. She was brought in for a minor X-ray. She was moved to the accident and emergency department and left on the trolley there for seven hours. At that stage it was decided they were going to do nothing with the lady there and they gave her an appointment for Merlin Park the next day. When she went to Merlin Park, it was something very minor and she is now home and well. During that period, however, her blood pressure rose and other problems arose. Luckily, one family member was able to come in and help settle her down. That should not be happening. Why was that lady left in the accident and emergency department for seven hours after coming in for a minor X-ray?

The staff members in all those hospitals are working hard and are trying to look after people. We all want to make that clear. The staff members are doing their best. I have another constituent who is desperately ill and cannot get a bed in Tallaght. He is in Sligo hospital at the moment. That man is very ill. His family and his doctors are very worried about him. I urge the Minister to look up that case as well and see if he can help that man.

I have very little time but I want to comment on what I feel is a serious problem at the moment. We should recognise the work that is being done by the medical staff at the coalface in dealing with all the different issues and problems. The Taoiseach spoke about the 2,500 beds by 2031. Unfortunately, those beds are needed next week. That is what it is going to take to resolve the problem, from what I can gather. There is another way. While we need the extra beds, a decent home care package should also be put into place. That needs to be considered seriously. We have people in nursing homes under the fair deal scheme and the beds are costing from €900 to €1,100 a week. If there was a decent home care package such that people could buy in the care that they require to keep people in their own homes where they want to be, it would be a massive improvement in trying to resolve some of the problems.

Because of all this overcrowding, there are many people waiting for operations at the moment. They are waiting to get into hospital. I am referring to people who might be suffering from cancer or other serious issues, or who might not even know yet whether they are. They are being deprived of their opportunity to get into hospital to have tests carried out. It is very unfortunate.

I thank Deputy Louise O'Reilly for raising this issue again. I agree with every single thing that has been said here tonight. I think we all do. There is political consensus that we have a crisis. I am not going to bother with the tit for tat political rubbish. We are in a crisis situation when it comes to health care. The problem now for us all is that it is like talking about the weather. Solutions do not arrive when there is a discourse that emanates and passes through people as a matter of form and norm. In the middle of all this, we have incredible people working in the service. We all acknowledge that. They are the best people one could ever meet. Like everyone else in this House, I have had to deal with them. All the stories we have told about people waiting and, of course, when people are in desperate straits they come to the likes of us and we try to help out. Incidentally, that should not be the way it works. I have had to do it myself on numerous occasions over the holiday period. It is at the stage now where, as politicians representing all the various views, we need to come together and pull together instead of pulling apart. We know what our strengths are: our resources and our people. We have significant decisions to make in the short, medium and long term.

I want the Minister to support the Sláintecare report. I welcome what he has done in respect of advertising the position at the head of it. I know he has commenced some of the reviews that were requested. The issue of private practice by consultants in public hospitals is something I was determined about as one of those who helped draft the report. I welcome all of that. That is long term. However, we are behind schedule already.

What are we going to do in the short to medium term? While the bed capacity review is critically important, I agree with Deputy Kelleher that it is one thing doing a report. How are we going to ensure that the stock arrives and quickly?

I do not expect the Minister to wave a magic wand. It is impossible to wave a magic wand and have the beds appear. We need to identify where, in the short term, we can make beds available in hospitals throughout the country where there are wards and capacity. In the medium term, we obviously need a capital plan. I believe that everyone in the House will support the Minister in respect of the capital review and getting as much money as possible to deliver that.

Some 96 beds have been promised in a new unit in University Hospital Limerick. Limerick is on one side of me and south Tipperary is on the other. The two hospitals with the biggest accident and emergency department issues in the country are located in the area. It will be four or five years before the new unit is in place. What will people do in the interim? We need to be innovative and find solutions.

Everyone has spoken about demographic changes, people having greater expectations and all of that. Of course people have higher expectations because they are living longer and there are treatments now for many things which we could not treat ten or 15 years ago. Has it come to a stage in this country where in the case of a very simple issue, such as a double cataract, people are told they are lucky to get one eye done? That is the state we are in in Ireland in 2018. People are being told that they are lucky to have one eye treated, and not to be selfish and look for treatment in the other eye in case they could drive a car or go to work. It is incredible.

We need to change the way pathways are working across the hospital network and hospital groups. I wish to make one recommendation which could improve the situation in the short-term. Our ambulance service is under major pressure. I have raised this issue for years, as the Minister knows, but I will repeat myself. There is no reason that intermediate vehicles cannot operate across hospital networks and transport people from grade A to grade B hospitals in order for them to be treated in step-down facilities or avail of aftercare treatment or monitoring. There are people in University Hospital Limerick rather than Ennis or Nenagh because there is no transport to move them. Sometimes vehicles are not available or do not operate. The same happens across the country. This is a low-cost solution and all of these things would help. People can be brought to Ennis and Nenagh, where there is capacity and wards could be extended or opened.

We all know what happened with regard to the Hanly report and other reports, whereby services were closed without adequate services being available in other hospitals. Let us not go down that road with Portlaoise. We also have to ensure that the pathways between hospitals outside networks are improved.

Last week, I heard about a young 12 year old boy who has liver failure. He was brought by his parents to University Hospital Limerick, and was then referred to a hospital in Dublin. Everything was supposed to be fine and a bed was supposed to be available for him in the hospital. However, when he arrived yesterday, it was not available and the family were told to come back at lunchtime and again in the evening. The bed was still not available and last night the family slept in a hotel. They went back to the hospital today and the bed was still not available. The family spent the day at a service station, with their sleeping child on the back seat of a car. He was sick and jaundiced. They waited for hours at the service station, hoping and praying that they did not have to drive to Limerick to get drugs for the child. They cried to me on the phone, looking for help to get into a hospital in Dublin. Luckily, after a lot of phone calls, the child got a bed in hospital tonight. The child was in the back seat of the car with his twin - they go everywhere together. That type of thing is not the practice we need in 2018 and is not an example of the pathways which work in this country. The pathways do not work. Children, of all people, should not be affected.

I have said to the Minister on numerous occasions that we have to develop more home help hours and home care packages. The simple fact of the matter is that it makes financial sense. Home care packages and home help hours keep people in their homes. It is cheaper and more cost effective than nursing homes or spending €6,000 to keep a patient in an acute bad. This is not rocket science; we just need to roll out such a policy as quickly as possible. There is an issue in terms of getting staff.

I wish to recommend long-term, medium-term and short-term solutions, because we have to come up with solutions. In the long term, we need a significant amount of investment on the capital side in IT because that will save money. In the medium term, the roll-out of home care packages needs to be enhanced and quadrupled. In the short term, I ask the Minister to examine transportation.

When the unacceptable becomes acceptable we have a major problem not only in our health service, but in society. I know the Minister said over the Christmas period that the trolley crisis is unacceptable - he said the same last year. It is somewhat Orwellian to say it is unacceptable but it is acceptable. It is similar to the housing crisis, whereby the Taoiseach said it was normal. It is abnormal to have 8,000 people in emergency accommodation.

Over the past decade, previous Ministers for Health have described the perennial health crisis as the trolley crisis. People want to know why this is happening. There is a reason that everything happens. Due to the fact that we are politicians, there is a political reason that there is a trolley crisis in our health service. That political reason is a political choice on the part of Fine Gael over the past six years and by Fianna Fáil in previous years. Politically and ideologically, thousands of beds were taken out of the health service. As a result, we now have a health crisis.

I have worked in the health system alongside some amazing and fantastic people. However, the demoralisation of health service staff is pretty bad. Front-line staff are demoralised by the ongoing crisis. It is a plague on the houses of Fianna Fáil and Fine Gael that the crisis is ongoing. The debate earlier today was nauseating. The Taoiseach sparred with Deputy Martin about which beds were taken out of the system in the decade during which Deputy Martin was a Minister. Nobody really wants to know that, rather people want to know that their mothers, fathers or brothers are not left on trolleys. People do not forget that. Seeing one's mother suffer stays in one's mind forever. I know the Minister does not want to see that, but this is the system that has been created as a result of ideology. There is an answer to every question.

In 2018, not one person should be on a trolley, never mind 600. We have a system that the Minister believes in and perhaps he is coming around to Sláintecare and so forth, which is fine, but we have a two-tier health system. Once there is such a system, there will be a perennial crisis such as this. It is not acceptable and normal for anybody to be on a trolley in 2018. If it becomes normal, we can all walk out of this place.

We have seen chaos in accident and emergency departments. The trolleys have been jammed together. The patients are toe-to-toe.

The scandal of closed public wards has already been mentioned but no Deputy has yet mentioned that there were cases of other empty beds during this crisis too, sometimes just hundreds of metres away from the chaos in the accident and emergency departments. I am talking about the empty beds in private hospitals and in private wards. What a scandal that this is so when public patients suffer.

When Cork University Hospital, CUH, purchased ten private beds at the Mater Private Hospital in Mahon on 7 January it made national headlines. There were ten beds to buy and the same was done elsewhere. One could ask how many beds lay idle during the crisis over the past fortnight. We do not know because the private hospitals are under no obligation to release the information. However, we have anecdotal information. In an interesting article in the Irish Examiner, Fergus Finlay described how a majority of the beds in a private ward in which he spent time recently were empty.

We must reverse the austerity health cuts of recent times. That means thousands of new beds in public hospitals, but we also need a planned, rational use of resources to meet the challenges of public health care, including emergencies. It also means putting all of the country's health resources at the disposal of society, which in turn means nationalisation of the private hospitals and of those private beds. We must fight for every bed.

At Bandon Community Hospital, County Cork, there are currently 13 beds not in use because of a dispute over staffing levels. If the HSE were to simply hire one extra nurse and two extra health care assistants, those beds could be brought into play more or less immediately. The three extra staff should be hired immediately.

At Cobh Community Hospital, County Cork, 44 beds are currently in jeopardy because of the hospital's financial viability under a section 39 model. If the hospital is upgraded to a HSE hospital then the beds would be guaranteed, but the HSE will not do that as it would mean increasing pay rates. It is ludicrous to put 44 beds in jeopardy for that reason. The hospital should be made into a HSE hospital, the wages should be increased and those vital 44 beds should be saved.

The European Commission says there will be a global shortfall of 1 million health care workers by 2020 and that 600,000 of them will be nurses and midwives. Nurses and midwives are part of a globalised labour market and the Union of Students in Ireland, USI, recently found that 92% of student nurses and midwives were considering emigration, largely for reasons relating to pay. Last year, according to the INMO, 1,400 of 2,000 nurses and midwives who left the HSE did so because they resigned. Many went to Britain, Australia or Canada while others went to the private sector where pay is higher to the tune of thousands of extra euro per annum. It is clear that we will continue to have a crisis in terms of the retention of nursing staff until such time as they are granted very significant pay rises.

As a Solidarity Deputy, I consider myself a workers' representative in Parliament and have made a point during this crisis to talk to hospital workers and listen to their point of view. In Cork I have listened to stories of wards crammed full of potential flu victims with just three or four thermometers at hand for the entire ward. I have heard stories of Dinamap monitors so frayed and worn that attempts to take accurate blood pressure readings were hampered. I have spoken to ambulance staff who have completed 14-hour shifts without time to break for a proper meal. In general, I have heard stories of front-line workers under pressure from a crisis but then put under even greater pressure by a shortage of resources, including human resources.

I believe this crisis has made the case more clearly than words could ever do for an Irish national health service unshackled by cuts and privatisation. For sure there is a crisis in the NHS in the UK but that must be addressed by going forward to the original principles of its founders, not by going back to the public-private model which we have here. In conclusion, I urge the Minister to reverse the bed cuts, pay the nurses and health staff a living wage, invest in primary care and establish an Irish national health service unshackled by cuts or privatisation.

I wish to share time with Deputy Michael Fitzmaurice. We will have six minutes and two minutes.

Is that agreed? Agreed.

I thank Deputy Louise O'Reilly for bringing this motion before the House. I have no hesitation in supporting it. I also thank the Minister for confirming that he is not opposing the motion. In addition, I congratulate the Taoiseach today for his announcement that there will be an increase in bed capacity. That is certainly a change because up to now successive Governments have confirmed that we needed fewer beds, which I never accepted.

The accident and emergency crisis and the trolley crisis are simply a symptom of a health system that is under enormous pressure. That is the case due to a sustained policy of reducing resources. I was a proud member of the health forum for ten years. Back in 2006, before the financial and banking crisis, we had closed wards and closed beds in the regional hospital in Galway. Different language was used at the time such as "cost-containment measures" and "bed refurbishment" which was a new one on me. The crisis has been deliberately created by successive Governments, which opted for private medicine. They did that in a very blunt way through various initiatives. They systematically ran down the public system, leaving beds and wards closed.

As the Minister is aware, before Christmas we discovered that a brand new ward, St. Finbar's, was closed in a centre of excellence in Galway. I hope that came as a surprise to the Minister. It came as a surprise to me. One of the initiatives in response to two theatres closing in Merlin Park due to water ingress was to open up the closed St. Finbar's ward. I did not hear the Minister or any Government politician express shock or ask the management why the ward was closed in the first place in the centre of excellence.

We have had various initiatives that actively promoted the private health system. The National Treatment Purchase Fund was introduced as a temporary measure but it has become a long-term measure. The special delivery unit was a temporary measure and as a consequence of that money is going into the private system. The then Minister, Mary Harney, declared an emergency at a time when there were just 495 patients on trolleys. While she was declaring that emergency she was simultaneously actively promoting co-location of private hospitals on public lands. The trolley crisis did not happen yesterday. It has happened over a period of years as a result of the policies of various Governments which believed that private medicine is better than public medicine and one way or another have actively supported that system.

If we come back to Galway city, there is a congested site and very bad decisions have been made that have added to that. The Minister knows the answer is to start planning for a new hospital in Merlin Park where we have 150 acres of land. In New York, Central Park has 800 acres for a population of approximately 12 million. We have a population of 80,000 and we have one park with 150 acres yet we cannot see fit to build a hospital there. We have allowed bad decision after bad decision to add to a congested site in Galway. As a result of that the helicopter service moved and took over a public park for three to six months. Can one imagine that? Over three years later it is still in the public park.

Wards are closed and in addition there is a complete absence of primary care facilities. There is no primary care facility on the west side of the city in Galway and we have no mental health primary care facilities whatsoever. We have an ambulance service working from containers in Merlin Park. There was a recent scandal involving a child on a visit to Connemara who almost died while waiting for an ambulance that did not arrive for more than an hour. I could mention many other decisions.

The only thing that disappoints me about the Minister tonight is that he talked about giving a counter-narrative. There is no need for that. We know that nurses and doctors are doing their best on the ground. What we want are solutions and a recognition that the health service is sick. It is sick not because of the staff on the ground but because of what I have outlined, a sustained plan to undo it.

As a result of that plan, mistake after mistake has been made. Unfortunately, I know this, professionally and personally, as a result of my family's experience. The cost of reviews, tribunals and independent case reviews is a matter I will raise again with the Minister in the future.

Let me return to the numbers on trolleys. Galway has the highest number today, that is, 38 out of the 541 people on trolleys. When the emergency was declared by the then Minister for Health and Children, Mary Harney, in 2006, there were, as already stated, 495 people on trolleys. On 3 January this year, 677 were on trolleys. Two years ago, the Government negotiated with the Independents in respect of a heartbeat in Waterford being more important than a heartbeat in Galway or any other part of this country rather than having them make a commitment based on what we all knew at that point, namely, that the health service is not fit for purpose.

I support the motion and commend Deputy Louise O’Reilly on introducing it.

I have been a Member of the Dáil for approximately three years and this is about the 30th debate on health during that time. This Government and its predecessor, led by Fine Gael, have had seven years in office. The Minister talks about a ten-year plan. We are three-quarters of the way through that period and circumstances are getting worse. There are people waiting for appointments, amounting to 670,000 or 680,000. Circumstances are getting worse despite the best will in the world.

I saw the Minister on the television during the Christmas period offering an apology. The Taoiseach also made statements. Apologising will not cure someone waiting on a hospital trolley for a few days, nor will it help the front-line staff who are trying to fight a fire day in, day out because the necessary infrastructure and system have not been put in place.

The GP contract has to be tidied up. This matter has gone on for so long. The Department is weaving in and out. I spoke to a doctor some days ago who explained very clearly the fact that he cannot pay staff to be going around the country and that this is why patients are sent into hospitals. One has to understand that position because the Department is trying to get away with murder.

In the programme for Government, there is a reference to an air ambulance but the Minister has not even carried out the review yet.

As the previous speaker pointed out, the infrastructure in Galway is inadequate. Two years ago, the Taoiseach admitted that Galway hospital, as a centre of excellence, is not fit for purpose. There are 150 acres of land available nearby. I attended a meeting a few months before Christmas at which the problems at Merlin Park were discussed. What is being done? Nothing. I am not blaming the Minister because there are people with responsibilities in the HSE who do not man up and take the decisions. They will not do the work that has to be done.

We also need help from unions. We need the machinery in place to ensure that primary care centres cater for more people. If one compares the hours of work of X-ray machines in private hospitals by comparison with public hospitals, one will note there is a totally different ball game.

It is worrying when one hears consultants saying that they have to decide who is the worst case in an intensive care unit, ICU. I accept that the Minister does not have a magic bullet to use. Unless a genuine effort is made, however, this matter will not be addressed. Unless the people in the Department making the decisions - and not only the Minister - step up to the mark, the problem will never be solved. People are dying because those to whom I refer are not making decisions.

I thank Sinn Féin for bringing forward this motion and I thank the Minister for sitting through the entire debate. The main issue in trying to solve the problem in our health service is trying to achieve political drive and buy-in. It is a huge problem and nobody underestimates the challenge to be faced in solving the problems in our health service. It is a considerable challenge but the Government must start to address it.

We have produced the Sláintecare report and have spoken about it many times at meetings of the health committee. The report contains the answers to our problems. Rather than haranguing the Minister, I wish to propose two solutions that could resolve the problem in a speedy manner. The first is to introduce elective-only hospitals. We have spoken about them at meetings of the health committee and we have spoken about how they work in Scotland. Building elective-only hospitals is a crucial solution to the health service crisis because it means people will be guaranteed planned procedures. They will have their procedures carried out and will not be competing against people from casualty and those requiring urgent care for beds. Building elective-only hospitals would streamline services. The hospitals would be attractive places to work. One would be able to attract staff, including nurses. The hospitals could be iconic features of the Irish health service.

The second point is that our model-two hospitals are being under-utilised. All the resources are being poured into our model-four hospitals. Our model-two hospitals could be diagnostic hubs. Unused theatre space in our model 2 hospitals is not being used. Outpatient departments in our model 2 hospitals are not being utilised fully. Certainly, they could be used as diagnostic centres. When the Minister is considering his reform programme, I ask him to concentrate on model 2 hospitals and maximise their capacity. He should also introduce elective-only hospitals. A hospital bed costs approximately €1 million. If we built three 100-bed elective-only hospitals, it would make a serious indent in our waiting lists. Waiting lists are the biggest problem facing the health service. The Minister should concentrate on those two issues.

The Minister said last week that it might be a good idea to build more hospitals. How long will that take, particularly in view of the planning process and everything else? Many of the people who need assistance and medical attention today will have passed on by the time those hospitals are built, I am sorry to say.

Kenmare Community Hospital, a new community hospital built a short few years ago, is only half open. Why? Dingle Community Hospital is only half open. The land for that hospital was given free of charge. Why is it not fully open? These are the questions the Minister needs to ask the HSE. Some of the rooms in Dingle hospital have offices where beds should be.

Why can we not pay more doctors, surgeons, nurses and staff in times of need to work through the night and over the weekends to clear the backlog? We are sending buses to Belfast in the North so patients can have cataract procedures. A second bus went up last week. Another is to go next week. Thirteen patients had procedures last Sunday. The patients, from Cork and Kerry, had to go from one end of the country to the other for a simple procedure. The staff involved are working over weekends and through the night. Why can we not pay staff to do the same here and utilise the hospitals we have?

In Tralee General Hospital, there are many wards closed for a long number of years. Why are they not being opened? What is the matter? Is it a question of staffing? We are being told today all our newly qualified nurses are going abroad. Many of them are going to England. The English health service is advertising for and taking on Irish nurses.

Almost 700 people were on trolleys in hospitals throughout the country on the same day, which is ridiculous. In the middle of last May, there were 17 people on trolleys in Tralee. That is not right. The Minister needs to get an answer to these questions.

There was a man in Tralee General Hospital last week who needed to step down to Killarney Community Hospital but his family would have had to sign a fair deal application form before he could do so. He was ready to go but it is a big step for a family to sign the fair deal application form because it may mean the patient will not be coming home anymore. I need an answer to this question to know why this happened.

The craziest statement a Minister for Health ever made was made by the current incumbent in the recent past. He said he wants to build more hospitals. He said he wants to make more beds available and that he will have to build more hospitals. I want to reinforce my argument. The Minister should come down to Kerry and we will show him the hospitals that are completely under-utilised. We have excellent people working in excellent hospitals but they are not being used to their maximum capacity.

I am trying to introduce a new consultant to Kerry University Hospital in Tralee, County Kerry. It is ridiculous when we have an excellent surgeon who wants to perform procedures every week but is not allowed to do so. As my brother, Deputy Danny Healy-Rae, highlighted, Kenmare Community Hospital, one of the finest hospitals in all of Ireland, is completely underutilised. Instead of using Dingle Community Hospital for beds, which is what it was meant to be used for, offices were put into it. It is disgraceful. Elderly people from the Dingle Peninsula do not want to be in Killarney, Tralee or Kenmare. They are Dingle people and want to stay in their local community. Nobody can blame them for that.

I thank Sinn Féin for bringing this important motion before the House this evening and for highlighting this matter. We must talk about the underutilisation of our services. Yesterday, again, I had to explain to a person in chronic pain who needed a knee operation the procedure of introducing them to a hospital in Belfast for that operation and how, when they come back, the Minister will give them the money for that treatment, meaning it will not cost them a penny. Does it make sense that the Minister will give a person the money to have a procedure done in a hospital in Belfast while, at the same time, it cannot be done in the South? It does not make sense.

The Minister has myriad managers and people below him. Will he get them to cop on and use the brains God gave them? They are supposed to be intelligent, with billions of euro at their disposal, but they are making a fine mess of it again. Does the Minister want to go down the same road as other Ministers and be dubbed as yet another person who could not make a hand of it? We expect better of the Minister. He has the opportunity and resources. Will he please use them properly?

I call on Deputy Catherine Murphy who is sharing time with Deputies Eamon Ryan and Healy.

As winter arrives every year, so does the annual trolley crisis. By virtue of its definition, a crisis is something that cannot be predicted, yet nothing is more predictable than the annual wringing of hands while people at their most vulnerable face horrific conditions in our hospitals. It is not a crisis. It is as certain as a rainy day in January. We must stop describing it as a crisis. Instead, it must be seen as a symptom of the failure to properly build a functioning health system.

Today's trolley watch informed us that there are 5,041 people on hospital trolleys, lined up beside each other, positioned in corridors, doorways, cupboard spaces, kitchen facilities, etc. That is just not on. These are already stressed patients at their most vulnerable who are very often in places where they cannot get to sleep due to noise and interruptions. It must be acknowledged there are fantastic staff in the health services, doing their absolute best in unacceptable conditions. This is not a criticism of the staff.

If funding for home care packages and home help services were provided, it would certainly help people to get out of hospital quicker. Nursing Home Ireland, in a survey of its sector, identified 1,400 beds across 440 private and voluntary homes. On a temporary basis, this is the kind of initiative that could be taken to discharge people when they continue to need care in transition before they go home.

My colleague, Deputy Shortall, was the initiator of the Sláintecare report which offers a complete overhaul of our health service. It offers a vision for a functional health service in which we will not see such scenes with hospital trolleys. However, it has to be done in an ambitious way with the resources put in quickly to ensure we see some returns. The Minister could be the one where people look back and say he made the difference by being ambitious about this ten-year plan in the Sláintecare report. However, I do not see that ambition. All I see is this constant crisis of doing small pieces and gingerly moving things around the chessboard. It needs much more ambition to get this up and running.

The Green Party supports the Sinn Féin motion. I also want to specifically thank Caitriona O'Neill and William Gallagher who wrote a letter to the Minister for Health on their father's tragic and sad case. I believe they did a huge public service in that regard. It is easy when one thinks of numbers to think in the abstract. When one brings it back down to the personal, which Caitriona O'Neill and William Gallagher did in describing what happened to their father, it makes it real, tangible and urgent. We all have seen it in our families, even if in different circumstances. The fact that Caitriona and William have real medical expertise in cancer and nursing care gives them real authority when they say it is not acceptable or right that a 75 year old man had to spend three days on a hospital trolley when he required palliative care and certain basic procedures but was unable to get them in that time. It is something by which we are all shamed and it should end.

It is about the provision of physical infrastructure and beds. However, we have to be careful and consider what kind of beds. Should they be respite, long-term or hospital care beds? We have to be strategic and smart in how we respond. We have to promote and advance investment in ehealth to ensure we get the best use of our resources. The lack of measurements and understanding is a problem. I have been told the HSE still operates in a fax-and-letter world. To ensure we use resources well, we have to embrace digital technologies, as well as the sharing and use of digital information, to be efficient in what we do. We need to do everything differently. We need multi-annual budgets, not annual budgets where there is a fight and tussle with finance. We need new commissioning groups to ensure the move towards primary and preventive care, which we all agree is the cornerstone of Sláintecare. This will mean it is not just hospitals running the entire system, but that there is oversight of how we allocate resources across the system to make it work. The trolley emergency crisis is the pinch point of an overall dysfunctional system. We need to change the entire system to get rid of that pinch point and ensure there are no further cases where the likes of Michael Gallagher are left for three days in a condition which no one can accept or allow.

I support this Private Members' motion on hospital trolleys. I also welcome the approval for the 40-bed modular unit for South Tipperary General Hospital announced last year. That unit is expected to be up and running before the end of autumn 2018. The county lost 90 beds in various cutbacks, including 50 beds when St. Vincent's hospital in Tipperary town was closed. We need another 50 beds in the county to cater for the demand for health services. We hope this will be addressed in the capital programme to be announced shortly.

Step-down and hospice facilities are vital to deal with the trolley issue. The Minister visited St. Theresa's District Hospital in Clogheen in September last year. There is a proposal for additional hospice room and step-down facilities in the hospital, for which the Minister indicated his support. That development was spearheaded by a local family whose father had passed away at the hospital. Massive fundraising activities took place with friends, neighbours, local and surrounding communities involved. Up to €400,000 was collected by the local community through Boston Scientific, the Friends of St. Theresa's Hospital and South Tipperary Hospice Movement. Plans for the development have been drawn up and approved. Planning permission has been granted and tenders have been advertised, submitted and approved. The builder has been appointed. This development is shovel-ready with €400,000 available for it. It would help deal with the overcrowding in the accident and emergency department of South Tipperary General Hospital.

We need the Minister and the Department to come in behind that development and to fund its balance. Hopefully the capital programme, which I understand the Minister is about to announce in the next couple of weeks, will provide for this development at St. Theresa's Hospital, which is a very important local project, fronted by the local people, families and the local community. It is well worth supporting and we certainly hope that will be supported in the capital programme.

Ba mhaith liom cúpla ráiteas a thabhairt don Aire mar gheall ar an mhéid atá ag titim amach i gContae na Mí. I have been given a couple of statements recently relating to the difficulties with the trolley count in Navan. I hear that people are stuck in the waiting room of the emergency department in Navan without getting access to the hospital itself. They are being forced to wait for long periods in that waiting room after having been triaged and treated. They are forced to wait with needles left in their arms while waiting for X-rays and for blood tests. Those people are forced to wait on their feet because there are no seats left in the waiting rooms for people trying to get into the hospitals. I heard a report about Drogheda to the effect that it was like a cattle market at the time. One man was obliged to sit in the waiting room for five hours after being triaged. The report stated that the waiting room was full to the brim, that three ambulances had just arrived and they were being forced to wait because they could not leave their patients behind unattended. Dr. Tom Ryan, president of the Irish Hospital Consultants Association, said that the HSE is rationing intensive care unit, ICU, beds. That means that staff members are forced to prioritise patients in serious need over other patients. The Irish Association for Emergency Medicine stated, on the trolley crisis and waiting list, that up to 350 people would die in Ireland in 2018 because of those two factors.

The trolley count in Navan has quadrupled in the space of one year from 500 people to 2,500. One should put those three sentences together and then consider that it is the objective of the Government and of the HSE to close the ICU and emergency department beds in Navan. I have only a couple of seconds left so I will make a point on the issue of there being no step-down facilities in County Meath whatsoever. Some years ago, I found that a person was forced to wait for 24 months after being clinically discharged from Navan. That person was left in a hospital bed for two years after the doctors said they could not help that person anymore because of blocked pathways. I found out in the last months that another person was forced to spend one year on a trolley after being clinically discharged. We had 24 people in hospital beds in our hospital this year who were clinically discharged. That is an entire wardful. We need step-down facilities in Meath to alleviate this crisis.

The figures are stark. Some 98,981 patients spent one night or more on a trolley last year. In Portlaoise alone, 3,203 people spent one night or more on a trolley. On Monday night of this week, 15 people were on trolleys in Portlaoise. There is a plan before the Minister to close Portlaoise emergency department, forcing patients to go to Tullamore, where there were 35 patients on trolleys on Monday, or to Tallaght, where there were a further ten, and that was one of the best recent days in Tallaght. Any proposal to close Portlaoise hospital and push people to other overcrowded hospitals will not work and these figures show it. The Taoiseach committed today, and I hope I heard him correctly, that no emergency department would be closed. I hope he adheres to that and I welcome that if that is the case. The people of Laois, Offaly and south Kildare who depend on Portlaoise hospital deserve better and the people of the State deserve better. Action is needed in four specific areas. We can all see what the problems are and we have to say what the solutions are. Sinn Féin is constantly putting forward costed solutions. There are 162 fewer hospital beds now than there were in 2008, yet the population of the State has increased dramatically.

We propose to immediately increase the number of beds by 500 at a cost of €153 million. That is in our alternative budget. There is a shortage of general practitioners, GPs, in the country, with a huge shortage in Laois. Sinn Féin would focus our health service more on primary care, catching people before they have to go to hospital and providing care in the community. We provide for the recruitment of 200 extra GPs in our budget. We would recruit 500 additional nurses each year over the next five years, and 800 consultants over a five-year period. We know it will take time and that we cannot do it in one or two years. We would also increase home care packages. I will say a quick word on this issue. We want to increase home help hours by 20% and we budgeted for that. It is in our costed proposals. We put forward those solutions in those four areas. Step-down facilities need to be utilised, such as at Abbeyleix hospital in my own constituency. The Minister is aware of this. We are meeting the committee for Abbeyleix hospital on Thursday night about this. As elderly patients in Portlaoise hospital could be discharged to that facility, Abbeyleix now needs to be expanded and upgraded.

My final words are on home help schemes. I had a case in my office this morning where a woman was granted one hour, seven mornings a week, to keep her in her home in a rural area on the side of the Slieve Bloom mountains. If that woman does not get that help, she will be in hospital. She was granted it in May and still has not received it. She has been put on a waiting list. Employ some of the unemployed people on the dole for home help and let us keep people in their local areas and local communities. It would cost approximately €100 a week. To put people in a home would cost €1,000 a week. Those are the economics.

My constituency holds a shameful record as the location of the most overcrowded hospital in the State in 2017. University Hospital Limerick saw 8,869 people lying on trolleys last year. That is an absolute disgrace. University Hospital Limerick has been suffering from severe overcrowding for years. The situation is not just being caused by the flu outbreak. It has become a permanent feature in Limerick. The Government is doing nothing to help the patients in my constituency. The core of these problems stems from the downgrading of Ennis, Nenagh and St. John's hospitals and the establishment of the so-called centre of excellence in University Hospital Limerick, which has not worked. In May, I expressed my concern that the opening of the emergency department would see the overcrowding levels transfer to a new part of the hospital. Unfortunately, this has come to pass. I raised a topical issue at the time with the Minister of State, Deputy Finian McGrath. I told him that the nurses on the ground were concerned that there was a plan to have 24 patients accommodated on trolleys and chairs from the get-go in the new emergency department. The Minister of State completely rebuffed this and rubbished my claims, dismissing any such suggestion, suggesting that there was no basis for the idea that 24 patients would be accommodated on trolleys in the new emergency department. This was wholly untrue. More than 24 patients are accommodated on trolleys and chairs in the new emergency department every single day. It is often double that number. It is a shocking situation. It is ongoing, shameful, and exposes a health service in crisis. I asked the Minister to intervene in the summer. Instead, he wrote an email to the manager of the hospital, outlining his unhappiness. That does not solve the problems. We do not need studies, reviews or investigations. We need extra money and extra beds to accommodate the patients. It is that simple. I hope the Minister is listening and that his Cabinet colleagues will reflect on this the next time they sit down and see how much tax they give away. They should think about the €335 million they gave away in October's budget and how that would help to address the crisis.

Today, 29 people of all ages who were in need of medical assistance were left lying in the corridors of the emergency department of Our Lady of Lourdes Hospital, Drogheda. Staff in the emergency department had to run the equivalent of an inpatient ward in the corridors of the emergency department, on top of all the patients presenting to the emergency department 24-7. Staff also had to endure this on top of staff shortages. Every single winter, the Government feigns shock and promises to tackle the situation, states it will not happen again, that it will do better the next year and how this year was the worst year, as well as stating that it intends to improve next year. Why does the Government do that? I will give the history of why it happens repeatedly in County Louth.

In 2010, the previous Fianna Fáil-led Government closed 97 acute beds in Louth County Hospital. It would not listen to public concern and warnings that Our Lady of Lourdes Hospital in Drogheda would not be able to cope and there would be overcrowding. That Government bulldozed ahead and closed the beds. Only 40 beds were opened in Drogheda to compensate for this. I acknowledge that additional beds were provided there recently. However, that only gets us back to the position we were in 2010. Despite that, in 2012, the Fine Gael-Labour Party Government again targeted public provision of beds in County Louth. They removed the long stay and respite beds in the college hospital in Drogheda and ignored massive public opposition to that move. A total of 10,000 people took to the streets of Drogheda to protest about it and the Government was told that it would compound matters. To this day, elderly who are medically fit cannot be discharged from Our Lady of Lourdes Hospital because no home help, respite care and home care packages and housing adaptation grants are available. One problem has compounded another. To add insult to injury, we were promised a 100-bed unit in St. Mary's, Drogheda, after the hospital was closed. Six years later, not one brick has been laid. The Government should not feign shock every year at the trolley numbers. They are the result of policy and until that policy changes, nothing will improve.

I am sorry the Minister had to leave but he has asked me to make the closing contribution. I thank Members for their contributions, some of which I listened to before I arrived in the Chamber. The Minister and I have taken notes.

It is clear from the debate that the House shares our commitment and determination, and that of the Government, to do better for our patients. Despite the genuine efforts of politicians, health service managers and front-line staff, our emergency departments are under pressure this January. What we are seeing in our hospitals right across the country is a symptom of long-standing and fundamental deficits within our broader health system. I have listened carefully to the debate and I believe we need to move forward now and implement the three key priorities of Government: implement the findings of the health system capacity review; progress the reforms set out in Sláintecare; and make a decisive shift to primary care.

While improving hospital services is essential, we cannot underestimate the importance of moving away from a hospital-centric model of care. We need to recognise the interrelated, interdependent nature of the environment within which public hospitals operate. As the Minister pointed out, the Government is committed to delivering more non-acute care within the primary care sector. This means that better care which is close to home can be provided for communities around the country. To this end, we have invested significantly in our primary care infrastructure providing modern well-equipped primary care centres. This will allow our primary care teams and GPs to be located together and will enable the delivery of a wider a range of integrated primary care services. Currently, 110 centres are operational, with a further 18 expected to become operational throughout 2018. There will be a continued focus on advancing those 60 locations which are under construction or at various planning stages. Significant investment in additional staffing and service reorientation has also been made in the primary care therapy areas. Dedicated funding since 2016 is supporting the recruitment of additional posts in speech and language therapy provision and psychology services, both with a particular focus on children. Most recently, budget 2018 provided funding for additional occupational therapists. The new primary care centres are equipped to facilitate the new primary care staff that are being recruited. The centres will, into the future, be capable of facilitating additional new staff that may be required as the plans for further shifts of activity to primary care are implemented.

Another measure outlined by the Minister is the importance of greater access to diagnostics in the community. Access to diagnostics for GPs in the community will alleviate some pressures on the hospital system to provide such services. That is why we have put in place enhanced community diagnostic programmes for ultrasound and X-ray. Since 2015, the HSE developed a service whereby a GP can refer medical card and GP visit card adult patients for ultrasound scans currently in ten primary care sites across the west and south. By the end of November 2017, more than 19,000 scans had been undertaken, which exceeded the expected activity in 2017 by nearly 15%, and the onward referral rate to a hospital setting for further radiological-medical investigations increased by between 15% and 20%. This low onward referral rate demonstrates the success of the initiative and highlights the effectiveness of having direct access to ultrasound available for GPs and is further relieving pressure on hospital services and decreasing waiting lists. Currently four primary care centres have on-site X-ray facilities available and the Minister has previously highlighted the success of the Castlebar centre, for example, where the services are run under the governance of the radiology department in Mayo University Hospital. There are now no waiting lists in Mayo for X-ray services which are a vast improvement on the waiting list figure of 517 for this service in the county in April 2017 before the start of the service.

I understand from the HSE that future primary care centres will have rooms that meet radiology specifications and may provide X-ray services to patients. Further phased expansion of the community diagnostic programmes in primary care sites will be undertaken in 2011. We must continue to build on these developments and we must further seek to expand our primary care provision. A key element of this will be negotiation of a new modern responsive contract for GP services. As the Minister for Health stated earlier, the provision of a €25 million primary care fund from budget 2018 reflects the commitment of the Government to ensuring that primary care sector now and in the future is equipped to deliver modern, responsive and effective health care provision for all in our society.

With the Sláintecare report, for the first time, we have political consensus on the vision and direction of travel for our health services and as such a solid platform for reform. The Government has affirmed its commitment to implementing a significant programme of reform, as outlined in the report, and this will set out our ambitions for the next decade and concrete plans for the immediate years ahead. As outlined by the Minister earlier, this detailed work will be overseen by a new Sláintecare programme office.

I am delighted that the health system capacity review is complete and will be brought to Government next week. This will provide the evidence we need to make important decisions regarding hospital capacity at individual, regional and national level. The analysis carried out as part of the review indicates that given current capacity constraints and demographic projections for the next 15 years, we will have to invest in capacity across all aspects of the health service, including beds in acute hospitals and across the community. It is important that there be full appreciation of our demographic profile. The rate of increase in the cohort aged over 65 is considerable. This increase is happening quickly and steeply and will become even more pronounced over the next 15 years. The following are key headline projections from the analysis of the period 2016-2031. There was a 12% growth in overall population, with a 59% growth in the age 65 and over population and 95% growth in the age 85 and over population. We will, therefore, need to put the supports in place for much greater numbers of older people in the future, both home care and residential care. We will need better supports in primary care to manage chronic disease and multi-morbidity.

Without significant reform of and investment in community-based services, acute care will continue to be the default option for the majority of care needs, and our hospital services will become even more unsustainable. The Minister asked me to point out that more than 750,000 additional home care package hours will be provided this year. The findings of the review will provide a basis for determining both the extent of capacity requirements over the next 15 years and the type of capacity that is needed. It is important that this be undertaken in a planned way and the new national development plan will give us the vehicle for doing this.

Reform alone will not fix all the problems that exist. People are living longer and are healthier than ever before, as many Members have said, and this is something to be celebrated. In addressing the many challenges facing our hospitals, we must not lose sight of the fact the best way to address these challenges is to ensure that citizens have as healthy a lifestyle as possible. In 2013, the Government launched the Healthy Ireland framework. The vision of the framework is to address the threats to public health posed by issues such as obesity, smoking, alcohol abuse and physical inactivity. Significant progress has been made in implementing the framework since its launch, with the development of a suite of national policies and strategies, including A Healthy Weight For Ireland, the national obesity policy and action plan, and Get Ireland Active!, the national physical activity plan.

It is vital also to remember that health is not just the responsibility of the Department of Health and the HSE; it requires a whole-of-Government and whole-of-society approach. Since the launch of the Healthy Ireland framework, we have established a number of cross-sectoral partnerships with other Government Departments, agencies, NGOs, business and the private sector, and the voluntary sector in order to drive the Healthy Ireland agenda. We are seeing the results of this work on the ground in the success of national and local initiatives such as Operation Transformation, park runs, the Great Dublin Bike Ride and a host of other initiatives. I can assure the House this progress will continue in the months and years to come.

I know we all wish for a better health service and improved hospital services. I would like to reassure my colleagues this remains a priority for this Government and we will continue to work hard and stay focused on this issue. I have listened carefully to the concerns and issues that have been raised by Members this evening. As a public representative in my constituency and in my work as a politician, I have heard individual stories and listened to the individual problems on the ground. I think it is beholden on us all, no matter what party we are in, or for those in no party, to do our utmost to continue to work together to resolve many of the issues that have been highlighted in this debate. I thank Deputy O'Reilly for raising this very important issue. I am delighted the Government has decided not to object to the motion.

On a personal note, I ended up in accident and emergency on Christmas Day with my husband, who was taken very seriously ill. I have to say I was overwhelmed by the care given by the nurses and doctors, and even more so by the general staff who were there to give out the tea and the sandwiches, and so on. In general, we have a fantastic health service with fantastic people working in it. It is unfortunate that, in 2018, we still have people on trolleys filling our accident and emergency units and maybe not getting the service they deserve in a timely manner. It is time to put political views aside and to work together to resolve any issues we have into the future. I know Deputy Harty, who is a doctor, and the other Members present all feel the same.

I thank Members for their participation in the debate. I again thank Deputy O'Reilly. I want to express the Minister's sincere apologies that he could not remain until the end of the debate.

I take the opportunity to express the hope that the Minister of State's husband makes a full recovery and that he is in good health. I echo her comments in regard to the hospital staff. There is no doubt about it and all Deputies have reflected on the fact the quality of staff in our health service is extraordinary right through the ranks.

The Minister of State said we need to set politics aside. I have always been opposed to that idea. People sometimes equate partisan point-scoring with politics but they are not the same thing. I and my party have a political analysis of our health service and what is wrong with it. We make no apologies for that and we will not be setting it aside for anyone. This does not mean we cannot co-operate with Government and Opposition Deputies in trying to find areas of common ground. However, I believe we have a different analysis of the manner in which a health service should function.

It is likely that the Minister of State, Deputy Catherine Byrne, and the Minister, Deputy Harris, have heard many Deputies from across Ireland speaking about the situation in their localities regarding people on trolleys. The Ministers, with the Department and HSE staff, will be particularly aware of the situation in Cork given the landmark and significant decisions that were taken there in recent weeks. The scale of the trolley crisis in Cork is enormous. Some 9,150 people spent time on trolleys in Cork from January to November of last year. On stopping somebody on the street in Cork, one would be as likely to find they had been on a trolley in the last 12 months as to have been at a county final or at any number of big public events. The numbers we are talking about affected every community in the city and county, and probably nearly every family. Even today, there are 31 people on trolleys in Cork University Hospital and another ten in Mercy University Hospital, and it was quite a bit more than that on other occasions, with the number reaching 60 at times in recent weeks.

This is nothing short of a national scandal. An item that underlines this is that we learned in recent weeks that 30 patients were transferred from Cork University Hospital to a private hospital. This is a clear mark of the failure of the HSE to deal with the crisis and the failure of its policies. The problems in our health sector have risen to extraordinary levels and our public system is at or beyond breaking point. Léiríonn sé an faillí inár gcóras sláinte, an faillí i bpolasaithe an Rialtais agus an faillí i ndéileáil leis an ghéarchéim inár gcuid oispidéal. It also means that further funds will have been diverted from the public system to the private system which, in different guises, has been a reliable pressure valve for the Government in recent years. Of course, I am glad that people were treated but this is akin to the HSE declaring it can no longer cope and that the public system can no longer cope.

There is a cost to this, however, and we need to know from the Minister what this is going to cost the public system. There are budgets but these have been exceeded in recent years. Already, in January, we are spending money on private care in private hospitals. Clearly, it is essential that people get the treatment they need but it is utterly shocking that the authorities have essentially accepted that the capacity does not exist in the public system. Indeed, the fact there are private hospitals operating and thriving is further proof that the public system is in crisis. Business people have seen a gap in the market and they see the public system is beyond creaking and is collapsing, and they know that people do not have confidence in it. That is truly an indictment of Government policy over many years.

I commend Deputy O'Reilly on what is a very detailed motion which outlines the actions that need to be taken. While I welcome that the Minister intends to support it, nonetheless, I do not believe the Government when it says it will implement Sláintecare. That is not to say I do not believe the Minister of State, Deputy Catherine Byrne, or the Minister, Deputy Harris, but I simply do not believe that Fine Gael and the Government will ultimately throw their weight behind this and make the changes that are necessary. This is not a new problem. Twelve years ago to this day there were 380 people lying on hospital trolleys and that was under a Fianna Fáil Government with plenty of money. Fianna Fáil and Fine Gael have had almost a century to establish a proper health care system, free at the point of access, but they have not done so. For me, that is a point of ideology and due to the fact they have simply never truly believed in the kind of public system that I believe the public demands and deserves.

I remember very well former Minister for Health and Children Mary Harney declaring trolley numbers a national emergency - a crisis to be faced with all the resources and resolve possible. That was in 2006, when trolley numbers reached a record 469, and I was here, as my party's Dáil leader and spokesperson on health, shadowing Ms Harney. On 2 January of this year, two weeks ago today, the trolley figures reached a new high, of 677, across our public hospital network.

That says everything about the "resolve" of a succession of Fianna Fáil and Fine Gael-led Governments regarding our health services over all those years. Almost 100,000 people experienced at least one overnight stay on a hospital trolley in 2017. Many of these were aged and infirm, some were children and all were in hospital for bed admissions.

I note the recent acknowledgment by the Minister, Deputy Harris, that more hospital beds were needed, hopefully with all of the staff and other resourcing that any worthwhile increase would require. I remember a series of former holders of his portfolio throwing cold water on that obvious need when I raised it on the floor of this Chamber time after time. It is bizarre to me that some voices in quarters have felt compelled to welcome the Minister's recent commentary but that is where we are - a Minister for Health has at last recognised or at least publicly acknowledged that more beds are needed and, judging from his remarks, more hospitals.

In the short time available to me, might I urge the Minister to consider re-examining the potential of some of the smaller hospital units that his party and Fianna Fáil before it stripped of key services? The potential of these hospital sites to contribute to the overall address of current inpatient numbers and the access difficulties presenting is obvious to some of us, including qualified practitioners.

I am particularly mindful of the hospital where I was born, where my wife was born and where our four daughters were born. Monaghan hospital and hospitals like it can play a greater role in the overall provision of hospital services, relieving current stress points in related hospitals and elsewhere within the system.

Our motion calls for the reopening of all hospital beds closed during the so-called austerity years. We also call on the Government, within a comprehensive list of actions, for increased investment for transitional care beds, adequate step-down facilities, home care packages and home help hours to ensure that all patients who can be are moved to more appropriate care settings or safely returned home.

I commend the Sinn Féin motion, not just for the Minister's support this evening, but for his acceptance and implementation at the earliest possible time.

It falls to me to close the debate. I thank the Deputies who contributed, both those who spoke in support of our motion as well as those who, while not necessarily supporting it, did not speak in opposition to it either. In particular, I thank the members of Fianna Fáil and other parties for lending their support to the Sinn Féin call for a pay commission to deal specifically with health service workers. That monumental and fantastic decision sends a clear message to health care workers about who is on their side.

The main enemy to progress on this matter is the notion that the crisis is somehow inevitable. It is not. I urge the Minister to speak to people in his party and ask them to put their weight behind the public health service rather than the private sector in other countries, to stop producing leaflets asking people to go abroad and to fight for a decent public health service. There is an alternative and Sinn Féin has that alternative. We have worked it out and it is fully costed. We have set aside more money than has the Government because that is what is necessary. I will keep saying that for as long as the Taoiseach keeps getting it wrong. It is my pleasure to correct him.

Question put and agreed to.

As the motion is agreed unanimously, comhghairdeas.

The Dáil adjourned at 10.15 p.m. until 10.30 a.m. on Wednesday, 17 January 2018.