Hospital Overcrowding: Motion [Private Members]

I move:

“That Dáil Éireann:


— that so far this year, more than 100,000 patients have gone without a hospital bed, waiting on trolleys in emergency departments;

— that to the end of October this year, 13,466 people over 75 years of age have endured emergency department waits of more than 24-hours, a third more than for the same period in 2018;

— that October was the second-worst month for hospital overcrowding since records began;

— the warning from the master of the Rotunda Hospital that it is ‘only a matter of time’ before newborn babies are injured or die as a result of overcrowding;

— the increase in the mortality rate from sepsis;

— the numbers presenting to emergency departments are rising;

— that emergency department overcrowding is linked to increased mortality and poorer outcomes for patients; and

— that delays in emergency departments result in poor patient experiences, with some patients enduring horrendous experiences, while others leave without being seen;

agrees that:

— the Health Service Executive (HSE) National Winter Plan 2019-2020 provides for no additional acute beds or frontline hospital staff;

— emergency medicine staffing levels are below international comparators, and below the agreed safe staffing levels;

— healthcare professionals in emergency medicine are under unprecedented, unsustainable and unacceptable pressure; and

— there is no funded workforce plan in place to reach agreed safe staffing levels;

acknowledges that:

— hospital bed occupancy rates average 97 per cent, and are 104 per cent in model 4 hospitals, compared to the recommended safe occupancy rate of 85 per cent;

— delayed discharge is significant and linked to a growing waiting list for home care support;

— there is a significant shortage of hospital beds relative to the capacity review; and

— there is no definite timeline for the provision of the additional acute beds needed; and

calls for:

— a clear funded timeline for the provision of additional acute beds to meet 85 per cent occupancy levels, and for step down beds, as set out on the capacity review;

— an immediate assessment of the number of acute inpatient psychiatric beds required;

— increased access to diagnostics for emergency medicine;

— implementation of the recommendations made by the Health Information and Quality Authority (HIQA) in their 2012 report;

— HIQA to investigate the impact of overcrowding on the health of people presenting to emergency departments;

— urgent progress on achieving safe staffing levels in emergency medicine, to include:

— ending of pay disparity for consultants;

— ending of the de-facto hiring embargo for nurses and midwives;

— a funded workforce plan; and

— an overhaul of human resources practices to improve working conditions for healthcare professionals; and

— investment in general practitioner (GP) services, including:

— funding chronic disease management;

— expansion of GP out-of-hours services; and

— appropriate access to diagnostics.”

The following are testimonies received about the health service.

We have been in St. Vincent's for 3 days. 3 days with tea and good nurses but zero doctors.

The 'lucky' people here get a trolley to lie on, lots of very ill and elderly people are actually sitting on chairs.

My 86 year old mum ends up in A&E regularly and has spent days stuck in limbo.

My mam is one of those statistics - 83 years old, 4 weeks after surviving a heart attack, was brought in coughing up blood from lungs ... it was 13 hours before she even saw a doctor.

My mum is a 70-year-old woman. She spent 105 hours on a trolley in Limerick and expressed fears she would die if a fire started.

A woman was found on the floor 'screaming in pain' with a broken hip, having been assaulted by a drunk.

I mopped the blood off the table in the canteen with napkins, blood from my 4-year-old's open head wound.

They go on and on.

Yesterday, 534 men, women and children were waiting on a trolley in an emergency department in one of our hospitals. Today, the number is 577. The figures in August, September and October were the worst on record for each of those months. October, the month just passed, was the second worst month on record. On 2 October, the highest ever daily figure was recorded for men, women and children waiting on a trolley in an emergency department. Last year, by the end of October, more than 10,000 elderly men and women over the age of 75 had waited on a trolley for more than a day. The Government described that as totally unacceptable and said it would not happen again. This year, the figure is not 10,000 but 13,000, having increased by one third in one year. The Master of the Rotunda Hospital warned just a few days ago that it is "only a matter of time" before newborn babies are injured or die as a result of overcrowding. As of the end of October this year, more than 100,000 men, women and children had waited on a trolley. Nothing like this has ever happened before.

What has been the Government's response this year? It is a winter plan that includes no extra beds or clinicians and a hiring embargo that the HSE tells us does not really exist. The Government has arrived at a burning building with a smoke alarm. What of our healthcare professionals? Just today, healthcare professionals have told me they are "overwhelmed", "burned out", "exhausted" and "under massive pressure all the time". Every Deputy in this House who engages with healthcare professionals will have heard the same. They are under unprecedented, unsustainable and completely unacceptable pressure. It is unacceptable for them and for patients and their families.

Why is something so bad happening in our society and healthcare system? There are three big reasons. First, too many people are having to go to emergency departments. Second, when they arrive in emergency departments, they do not always get the help and treatment they need. Third, there are not enough beds. That is pretty much it. I will deal with each of those reasons. Too many people are having to go emergency departments in the first place. General practitioners could treat many of these people in the community but they do not have the resources to do so. They do not have the time they need to spend with each patient, nor do they have access to the diagnostics they need for their patients. They do not have the practice nurses that general practitioners have in other countries where they actively manage the welfare of their patients, keep them healthy and treat them at home, in primary care centres or in GP surgeries. However, we do not have that and, therefore, people get sicker and end up having to go into our emergency departments.

What happens when people arrive in emergency departments? Much of the time they arrive into complete chaos in emergency departments being run by skeleton crews who are heroes trying to keep the system going. The staff who see the patients after 5 o'clock in the evening know they cannot get access to diagnostics. They do not have a suitable treatment room or assessment room. They do not even have a triage room or a suitable resuscitation area. They will do what they can but they will often ask patients to wait on a corridor. If they admit them, they will ask them to lie on a trolley on a corridor where they may be assessed and treated. That is the reality people are dealing with today.

Why are there are not enough beds? First, there are simply too few beds but also the beds we have are not being used properly. What is going on? Patients are being discharged but they cannot leave the hospital because they do not have a home care package to allow them to return home. Interestingly, Deputy Butler and I spoke about this yesterday. She made the point that in Waterford hospital the number of people waiting on trolleys pretty much matches the number of people who have delayed discharges. Let us reflect on that. If there are 25 people on trolleys waiting for beds and 25 people in beds waiting to get out of them, it does not take a genius to work out the solution. Give patients the home care packages they need, free up the 25 beds and get those who are on trolleys into those beds.

Other patients are told that they can go home but that they need a scan and if they do go home, it will be two years before they get it. They are then put in a bed to wait for three days so that they can be put on the hospital's priority list for the scan. A safe occupancy level is approximately 85% but occupancy levels in Ireland stand at approximately 100%. All sorts of stuff goes wrong when the hospital is under that much pressure. If an urgent emergency, such as a big trauma case, arrives, everything else gets knocked out.

We know why this happening, which means we know how to fix it. In this motion, Fianna Fáil has put together a very straightforward plan, which would work. We need to reduce the number of people going into emergency departments by funding GPs to treat people in their communities. This means more GP out-of-hours services, access to diagnostics and funding for care pathways, particularly for the elderly and those with chronic diseases. We need to increase emergency department capacity, ensure safe staffing levels, end the hiring embargo, eliminate pay inequality for consultants and provide better access to diagnostics. We need to free up hospital beds and provide the new beds that are required more quickly. We also need to fund home care so that we can get people out of hospitals when they are discharged.

The crisis we are experiencing in emergency departments has never been seen before in Ireland. It does not exist in any other European country. If we implement this plan, it will not need to exist here.

Emergency department and hospital overcrowding has become the norm. We hear in the news every day of trolley numbers representing the number of sick patients who cannot access a medical bed in a hospital but who may instead have to wait on a trolley, in some cases for days. They have to stay on a corridor with the lights glaring, without privacy and without bathroom facilities, other than the public bathroom in the emergency department. They have nowhere to put their personal belongings.

As of October, 13,466 people aged over 75 endured waits of more than 24 hours for a bed. Never before have so many elderly people waited on trolleys for longer than 24 hours. The latest figures are devastating. Last year's figure of approximately 10,000 has skyrocketed by 35% this year. Many elderly people have told me they are afraid to go to hospital because they fear they will be left on a trolley on a corridor for days, with no privacy as people pass by. They are afraid they will die alone and would prefer to stay in the comfort of their homes, regardless of how ill they are.

The way forward is to tackle the issue of delayed discharges. We need timely transfer of care to the home or, with the correct wraparound supports, to a community respite bed or nursing home through the fair deal scheme. There are 451 patients awaiting approval for that scheme. There were 680 cases of delayed discharge at the end of October. In 2014, the former chairman of the emergency department task force warned that delayed discharges were putting lives at risk. At the time he wrote his analysis, there were 703 delayed discharge patients in the acute hospital system, which he said represented 30 wards at capacity. Frail elderly patients risk hospital acquired infections, falls, pressure ulcers and medication errors while being nursed in busy acute hospital settings for months on end.

As my colleague, Deputy Donnelly, said, I visited University Hospital Waterford on Monday and was advised that there were 21 delayed discharges currently in the hospital. On the same day, there were 23 patients on trolleys. Today, there are 20 patients on trolleys in the hospital and 577 patients on trolleys nationwide. The point I have been making all year is that if we allow 21 delayed discharges at one end of the system while there are 20 people on trolleys in the emergency department, the problem will never be resolved. The dramatic increase in lost bed days in our acute hospitals demands a direct intervention from the Minister.

I am calling for a task force on delayed discharges to co-ordinate timely discharge. We need a centralised, co-ordinated approach to delayed discharges. Each hospital group should have a task force specifically allocated to identify where issues are occurring and to design a plan to ensure timely access to step-down care for these patients. We could vastly reduce trolley overcrowding if we got serious about delayed discharges. I understand that, in some complex cases, this is not always possible but direct intervention is required. I ask the Minister to give serious consideration to that request.

I do not know the Fianna Fáil Members' arrangements but there are only eight minutes left.

So far this year, more than 100,000 patients have gone without a hospital bed and instead waited on a trolley in an emergency department. Almost 14,000 people over the age of 75 have endured waits in emergency departments of more than 24 hours. The plan for winter 2019-20 provides for no additional acute beds or front-line hospital staff. Emergency medical staffing levels are below international comparators and safe staffing levels. Hospital bed occupancy is 97% or higher, and is 104% in model 4 hospitals. Delayed discharges are a significant factor. In County Wexford, 754 people are on the waiting list for a home care package. That is more than in all neighbouring counties combined. Inexplicably, there is nobody on a waiting list in the Carlow-Kilkenny area next door. I would like an explanation as to how that is possible because it is having a very serious impact on the numbers waiting in hospitals. The public health system appears to be broken. These waiting lists are not normal or acceptable.

With regard to mental health, we have had report after report on overcrowding in our mental health services from the Inspector of Mental Health Services. A couple of weeks ago, a 16 year old spent 40 hours in the emergency department in University Hospital Waterford. He spent 24 of those hours on a chair with a blanket over his head to hide from the light and noise, which were distressing him. That is totally unacceptable. We have also seen reports of what overcrowding has done to the department of psychiatry in Waterford. People are sleeping on floors and chairs. This is totally unacceptable. When will hospital overcrowding be addressed?

I thank Deputy Donnelly for raising this issue. On Monday, there were 38 people on trolleys in Mayo University Hospital, yet there are unopened beds in Ballina, Swinford and Belmullet district hospitals. If these beds were opened and properly managed, they would allow for a proper step-down facility for Mayo University Hospital.

Our community services are under tremendous pressure. The Minister maintains that he is investing money in community services but the extra investment in home help hours in six counties in the midlands resulted in only 20 extra home help hours. We have not been provided with the figures for other areas. Some 20 extra hours will not make much of a difference. As I have said before, the Minister needs to follow the money. Is the extra money resulting in extra home help hours or is it being spent on extra administration costs?

The Minister and the HSE have declared war on a key component of primary care, our pharmacists. The pharmacists' contract and the withdrawal of funding for phased dispensing are causing enormous difficulties for pharmacists. The Minister is impairing their ability to play a part in resolving this issue. The moratorium that is not a moratorium is impacting on replacement appointments for positions right across the service. If the moratorium that is not a moratorium was not in place, we would have personnel in position to reopen the beds that need to be opened.

I noted the cases mentioned by Deputies Donnelly and Browne. We are hearing about similar cases all the time. We have become anaesthetised to their impact. I believe the Minister hopes that is the case. The people of this country just cannot get their heads around the fact that this is happening day in, day out in every hospital despite the phenomenal efforts of staff. The Minister has to take control of the matter. It is only November and every one of the winter records is already being broken. Will the Minister please wake up and take control?

The overcrowding in hospitals is causing massive issues but the Minister, the HSE and the Department have to look at where money can be saved. I have raised an issue privately with the Minister in recent weeks. I gave him a file on it. We have still not got any response. Families of patients are being fobbed off. They want to be able to bring their family member home and are committed to doing so. A home care package has to be put in place. They were told three weeks ago that there is no funding for the home care package they seek. That would help people. It would free up beds in the system.

It is happening all over, and I know that other Deputies have experience of it also, where families are waiting for assessments and are being told that the patient first has to come home from acute settings. There is a crisis in this regard that is causing overcrowding.

I ask the Minister please to look at the file I gave to him last week and come back to me on it this week. The family needs answers. They are hoping to be able to help themselves and help their loved ones and to help the system by freeing up a badly needed hospital bed.

Emergency department and hospital overcrowding does not have to be an accepted and inevitable reality. While it is a difficult problem to solve, it can be solved. It requires leadership from the Government and the HSE management, so that all HSE staff understand what direction the health service is going and what is the ultimate destination. It is said that a ship setting sail without a destination is destined to drift and ultimately flounder. Unfortunately, this is where the Government is taking our health service; on one long, tortuous journey with no destination in sight.

In any organisation that is lacking leadership one will have discontented staff and lack of productivity, which in this case is ultimately being reflected in hospital overcrowding and the endless crisis in our accident and emergency departments.

There are solutions, however. We need to empower our GPs through primary care centres and with access to efficient diagnostics, so that more patients are treated in the community. We need a focused and efficient home help service to keep older people living at home for longer. We need effective step-down facilities to eradicate the problem of bed blocking. We also need an end to the embargo on recruitment and an acknowledgement that we are operating in a world market where we are trying to recruit the best nurses and doctors available.

As other Members have said, we are just entering into the winter months and figures are at a record level. We must get solutions. Things have to change.

I move amendment No. 1:

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

“notes that:

— the population aged 65 and over has increased by 35 per cent since 2009, with the result that there have been increasing levels of demand for health and social care services;

— there has been an increase of 29,000 attendances and 2,600 admissions to emergency departments in hospitals in 2019, as against the same period last year; and

— the Health Service Executive (HSE) has published its National Winter Plan 2019-20, which identifies mitigating actions to bring down the number of patients on trolleys, and reduce waiting times in emergency departments, notwithstanding the growing demand for its services;


— the allocation of an additional €26 million to fund the implementation of the National Winter Plan 2019-20 to support egress from hospitals;

— the establishment of nine Winter Action Teams aligned to Community Healthcare Organisations and associated acute hospitals which have prepared integrated winter plans that will focus on demand management and reduction;

— that an additional investment of €52 million has been made to bring the total funding for home supports to €487 million in 2020;

— that over the last two years an additional €45 million has been provided to the Nursing Home Support Scheme (NHSS) budget, and in 2020 the NHSS will see a further investment into its budget of €45 million, bringing the total annual budget for the NHSS to €1.03 billion;

— the sustained focus in recent years on reducing delayed transfers of care and enabling patients to be discharged from hospital in a timely manner;

— the increased investment of €210 million per annum to be made by 2023 in general practitioner (GP) services set out in the Agreement on Contractual Reform and Service Development of May 2019;

— the establishment of a fully-funded chronic disease management programme to be delivered by GPs from January 2020;

— the commitment to comprehensive patient care on the part of GPs including the improvement of out-of-hours services;

— the steps being taken to introduce diagnostic facilities at community level;

— that the Minister for Health is engaging with the Rotunda Hospital, RCSI Hospital Group and the HSE in relation to the scope of interim works necessary to address the infrastructural challenges in the Rotunda Hospital, pending its relocation to Connolly Hospital Blanchardstown;

— the increased investment in the health services, including the increase of over 250 whole-time equivalents of medical and dental staff and over 370 in-patient and client personnel since the beginning of 2019, and 800 nurses and midwives since September 2018;

— the HSE has established a Medical Workforce and Patient Safety Oversight Group to agree and oversee implementation of actions in relation to recruitment of consultants and non-consultant hospital doctors;

— that engagement with the consultants’ representative bodies has commenced and further engagement is planned;

— that Project Ireland 2040 provides €10.9 billion for health capital projects including 2,600 acute hospital beds and 4,500 social care beds

— that the Government will provide record levels of funding of €18.3 billion in revenue and capital funding for the health services in 2020; and

— the publication of the Sláintecare Action Plan 2019 progress report this week which will show that the Government is on track with its implementation; and agrees:

— with the Sláintecare vision of a universal single-tier health and social care system where everyone has equal access to services based on need and not ability to pay;

— that as part of the Sláintecare Action Plan 2019 reducing waiting times for patients in hospitals and for community services is a key priority for the Government;

— that the Government, through its policies and funding for the health services, is addressing the issue of capacity in the healthcare system by enhancing community services, improving patient flows and providing additional capacity in line with the recommendations of the Health Service Capacity Review; and

— that the most effective way of achieving the Sláintecare vision is by backing the Government’s continued implementation of the Sláintecare Action Plan 2019, which has the support of all parties.”

I welcome the opportunity to address the range of issues raised in the debate. The pressures facing our health service are a deep concern for all of us. None of us wants to see patients, especially our older people, and staff enduring overcrowded conditions and none of us is immune to that. We are working very hard to try to improve the situation but in an honest debate it is important to acknowledge that there is no policy panacea, but rather a variety of reforms and measures are required. I believe this is why all parties in the Oireachtas agreed on the need for a long-term plan, which is Sláintecare. In that context, I hope we can have an honest and truthful debate this afternoon. There is no single solution that I am sitting on and refuse to deploy for some unknown reason. That is just lazy and partisan politics. I heard Deputy Donnelly outline a Twitter plan yesterday and I heard him outline some of it again this afternoon. With respect, I have to say it is very familiar. The Deputy calls for more resources for GPs and the Deputy is aware that we have just negotiated a new GP agreement, of which 95% of GPs voted in favour. The agreement reverses the FEMPI cuts, most of which were imposed by Deputy Donnelly's party. The Deputy also calls for bed capacity and he knows that we are delivering more bed capacity. While Deputy Donnelly was not in Fianna Fáil at the time, any honest look at the graph shows the number of beds his party took out of the health service. Fianna Fáil is calling for a taskforce on delayed discharges. I welcome that point but it does exist. The Minister of State, Deputy Daly set up that cross-divisional oversight group after he published the independent expert review on delayed discharges. I take the point, however, that Deputy Butler raised.

I shall begin with GP services. As Members are aware, in May we concluded an agreement on contractual reform and service development with GPs. This agreement will see an increase in expenditure on GP services of €210 million per annum on a phased basis. This will help to make general practice sustainable and an attractive option for medical graduates. Members do not have to take my word for it; 95% of GPs voted in favour of the deal. The measures included in the agreement are made up of an increase of 40% in the capitation payments to GPs for General Medical Services patients. In return GPs are committed to co-operating in a series of new measures. These include e-health developments, medicines reviews, the implementation of community healthcare networks and the management of hospital waiting lists. Crucially, there will also be an increase of 10% in the rural practice allowance - I know this is an issue of concern to Members - and for the first time ever there is the introduction of a €2 million per annum support for GPs working in areas of urban deprivation. Improvement in supports for maternity and paternity leave for GPs are also provided for to help attract new and younger GPs to the career.

From January next year we will be doing exactly what the motion calls for, which is the implementation of a chronic disease management programme that will help to move services from the hospitals into general practice and deliver structured care to patients through their local doctors, an approach which has been shown to improve health outcomes and reduce the need for hospital admissions.

The agreement signals the commitment of Government to general practice and the partnership that is required between GPs, patients, the wider health system and the HSE. The 2019 agreement also includes a commitment to a strategic review of GP services that is intended to examine how best to ensure the provision of GP services in Ireland for the future. This review on the broader new contract will commence in 2020.

We are also continuing to work on developing our diagnostics services in the community. This is crucial. It ensures that people do not have to go to a hospital to get an x-ray or an ultrasound. The HSE is making progress on a range of options across community healthcare organisations to increase access to radiology services, including publicly provided and outsourced models. Some 67,000 ultrasound and 79,500 X-rays are planned to be delivered by the end of this year through direct GP access to radiology services.

We all agree that more care needs to be provided in the community and in particular the need to support homecare. This was clearly recognised by all of us with the increased investment in this area for next year as provided in the budget. We have not just started next year, however, and have provided additional funding from September this year to improve access to home support and the fair deal scheme. As a result, we can see the number of delayed transfers of care falling - formerly known as delayed discharges. The average daily number of delayed discharges in October was 682, which is down from 757 in the previous month. This is still far too high but it is now beginning to reduce and I expect that to reduce significantly further.

The HSE published its winter plan last Thursday, which is earlier than before, and I secured an additional €26 million of taxpayers' money to support its implementation. The additional funding is being used for a range of services to help relieve demand for emergency department services and to support discharge and other initiatives to help hospitals deal with the challenges associated with winter.

Specific funding has been allocated to nine winter action teams to support initiatives at local level including additional staff to improve patient experience time, improve senior clinical decision making, reduce length of stay and facilitate weekend discharges; additional aids and appliances to help get elderly people in particular back home; additional home support hours; the implementation of frail intervention therapy teams to help avoid and reduce admissions of patients who are more frail; and additional flu-testing kits to improve patient experience times.

I agree with Deputy Donnelly that we need extra bed capacity. We have published the capacity review and provided funding for the addition of 2,600 acute beds and 4,500 community beds, in line with the plan. Progress has been made on increasing capacity. An additional 267 acute hospital beds were opened under the winter initiative 2017-18. The provision of an additional 75 acute beds and 75 community beds was a component of the winter plan 2018-19. The modular facility to expand Clonmel Hospital by 40 beds is nearing completion and will open shortly. The much talked about 60-bed extension to Limerick hospital, promised for years but not delivered by anybody, is now well under way. While it will not be open this winter I have viewed it, it is under construction and is under way. As part of an agreed capacity programme, the number of available inpatient beds is expected to increase to above 11,000 for the first time since 2009. In 2009, 2010 and 2011 Deputy Donnelly's party reduced the number of hospital beds. From 2007, under Fianna Fáil, more than 1,500 inpatient beds were lost until Fine Gael began to reverse this trend in government with the Labour Party in 2012. Since then more than 600 beds have been added and we are continuing to work to reverse the damage done by Fianna Fáil. The truth is that Fianna Fáil left this country with fewer acute inpatient beds when it left office in 2011 than when it started in 1997. I have a graph here, published by my Department and available for all to see, called the open beds report August 2019. I encourage everybody to view this report. One graph shows a decline during Fianna Fáil's tenure in the Celtic tiger era when it closed beds and built motorways instead of hospitals. I agree with the Deputy's comments about not properly using beds and I hope in his reply to this debate he will stand up, as have Deputies O' Reilly, Kelly and I, to say that he believes it is inappropriate that private practice is taking place with public hospital beds. We want to see an end to that, but we have yet to hear Deputy Donnelly's party commit to that.

One issue was raised in Fianna Fail's motion that I specifically want to address on the Rotunda Hospital. I am fully aware of the concerns that have been raised in relation to the hospital by the Master of the hospital, Professor Fergal Malone. I have met with Professor Malone and other representatives from the Rotunda as well as the HSE to discuss potential interim works at the hospital.

It is important to recognise that we want to relocate this hospital to the Connolly Hospital campus and funding for this relocation project is in place in our capital plan. This is a longer-term plan and we need to look at current infrastructural difficulties. There has been engagement with the HSE to try to agree a proposal with the Rotunda and I look forward to meeting the Rotunda and the HSE to see how we can proceed.

I am happy the motion gives me an opportunity to talk about workforce planning. I want to make it clear there is no national recruitment embargo in the HSE. If there was it would be the only organisation in the world that could see 2,630 more staff working this year than last year despite an embargo. Fianna Fáil would know all about embargoes because it cut the number of health service staff. There are more doctors, nurses and therapists in the health service this year than last year. However, what we do have to do is what every public service has to do. Managers can only recruit funded posts. I am sure there are school principals who would love to hire more teachers. I am sure there are lots of people in the public service who want to do so but it has to be done in line with the budget. That is a fair and equitable way to do it.

There has been a constant increase in the number of staff in the HSE. There has been an increase of more than 250 doctors since the beginning of this year. The number of whole-time equivalent nurses and midwives has increased by almost 800 since September 2018. The recent nursing agreement, despite Deputy Donnelly telling the health committee he believed our nurses are well paid, includes additional measures to help with the recruitment and retention of nurses and puts more money back in their pockets. With regard to consultants, I am pleased that engagement has started with their representative bodies. With this engagement and with taxpayers' money must come reform. We cannot have a situation where patients are waiting in an overcrowded emergency department and just because they cannot afford private health insurance they cannot access our hospital beds while a patient in a private bed is upstairs in our public bed with a private health insurance company making money. That is not on. That is not equitable. I heard Sinn Féin talk at the weekend about an Irish NHS and I am up for that. That is what Sláintecare is all about. However, I am not sure Sinn Féin is up for it if it refuses to rule out private practice in our public hospital beds. I ask Sinn Féin to tell us its position. If, God forbid, it ends up with the health Ministry will it take on the vested interests and say no more private practice in public hospitals? Will it deliver on the Sláintecare commitments? I will and I will work with any party in the House that wants to do it.

The emergency department task force meeting this afternoon and obviously I cannot be there because I am here in the House accounting and talking about these important issues. I look forward to it monitoring the work of the winter plan. I welcome the debate. I want to work collaboratively to find solutions but be wary of anyone who stands up in the House and says there are three simple things we could do to fix it. If there were three simple things we could do to fix it we would have done it. It is a complex issue that requires massive reform and the delivery of Sláintecare. In the interim, it requires investment that we are putting in place this winter to try to alleviate some of the pressures.

I could play the game as to which one of Fianna Fáil and Fine Gael is worse all day and it is great craic but it does not really resolve anything, let us be fair.

The issue of overcrowding has been a constant for well over a decade now. It did not start eight years ago and people are well aware of this. Only last January, we in Sinn Féin passed a Private Members' motion on this exact issue, including pretty much all of the same solutions. However, as has been the case with this Dáil, votes do not matter and the expressed will of this house is ignored.

The scandal of patients waiting on trolleys was officially declared an emergency by the former Minister for Health, Mary Harney, in the Fianna Fáil Government of the day in 2006 when the trolley count reached 469. Fianna Fáil now claims this has never happened before. Indeed, it has happened and it has continued to happen because the policies of Fianna Fáil and Fine Gael are virtually indistinguishable. The total of 469 patients on trolleys hardly even surprises us any more and it certainly does not warrant a headline, although it was considered a national emergency at the time.

Fine Gael has had eight years to address the overcrowding crisis but the number of patients on trolleys has got worse year on year. In 2012 the number was 66,308, in 2013 it was 67,863, in 2014 it was 77,091 and in 2015 it was 92,998. Is anyone noticing a pattern? We know that this year the number is already more than 100,000. In 2016 to 2019, inclusive, Fianna Fáil has been in a confidence and supply arrangement with the Fine Gael Government and has agreed and facilitated the Fine Gael budgets which have had a catastrophic impact on our health service. Their cause for celebration in those budgets has been the hiving off of public money for the private health sector through the NTPF. Only two organisations welcome this measure each year. They are Fianna Fáil and the Private Hospitals Association. Make of that what you will.

The Irish Association for 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. We only saw in the past number of weeks the harrowing story of Evelyn Crowley dying on a trolley in Cork University Hospital. In Limerick hospital, which staff describe as an ecosystem of chaos, a 70 year old woman spent 105 hours on a hospital trolley. How has this came about? It is because of a lack of hospital beds throughout the State and a staffing crisis. The cause of the staffing crisis in the health service has it roots in the recruitment moratorium in the health service brought in by the Fianna Fáil Government in 2007, two years before it was introduced in any other Department. Deputies can talk to staff working in the health service or to me and I will tell them about it as I represented health service staff at the time. I can tell them that the moratorium was introduced in 2007 by Fianna Fáil and we have not recovered from it. This staffing crisis has been escalated by the recruitment freeze implemented by Fine Gael. Be it a freeze, a pause or a moratorium, whatever the Minister wants to call it if he is not hiring it is effectively a recruitment embargo.

Pay inequality for new entrant consultants and the failure to unwind FEMPI fully for consultants has crippled the public health system and has caused staff losses, demoralised current staff and has left the health service with around 500 consultant vacancies in various specialties, many in emergency medicine.

We have a lack of beds. Hundreds that closed during the austerity years have not been reopened and cannot be reopened because of a lack of staff. I keep saying this and as long as there is an overcrowding and trolley crisis I will continue to say it. To tackle the trolley crisis we have to address the issues causing it and focus on addressing them through increasing recruitment and retention, reopening closed beds, delivering more step-down facilities, increasing home help hours and having proper investment in primary and community care, including diagnostics.

Fianna Fáil facilitates the Government and the Minister for Health holds his office because Fianna Fáil abstained in a motion of no confidence. Fianna Fáil has the power to change things at any stage and push through progressive policies at budget time and other times but it does not. It can line up to pile in on the Fine Gael Government but it knows its part in this crisis and must acknowledge it.

As we debate another Private Members' motion on waiting lists, it is important to remember that regardless of the waiting figures associated with each motion I for one cannot say that I, in my more than 22 years as a Dáil Deputy, have ever seen a Government sufficiently shocked and shamed into action. It has never happened. Put simply, if the severity of the October overcrowding figures were accepted by Government and Fianna Fáil, the outcome of this evening's motion would be change. But Fianna Fáil is only here for the shock and not for the action, as the record demonstrates.

We must remember what remains constant in our debates on hospital overcrowding. That constant is the lived experience of those who linger on trolleys or hospital chairs. As of this morning, I am told there are ten people on trolleys without a bed at Cavan General Hospital in my constituency. The relatives and friends of those patients will no doubt be worried and distressed that their loved one may be experiencing more pain and discomfort than is necessary. The fact there are only ten makes not a whit of difference to each of those families and those ten people. For them, it is exactly the same distress and suffering as if it were 100 and we had ten times the number of people in that experience.

I also want to point out the distress that this causes front-line staff in our hospitals. Many staff put in long hours and go above and beyond to try and attend to all patients presenting. I can imagine how disheartening it must be, leaving the hospital after a traumatic and hectic day, only to see those very same patients placed overnight in corridors. Nurses have said this to me.

Their work and dedication deserve better. They have the right to be able to leave work having cared for patients to the best of their abilities and knowing that those same patients and others who will present will be afforded hospital beds long before they return to work on the following morning. All too sadly, however, that is not the case.

I note the tendency of the Fianna Fáil spokesperson on health to refer to 2011 as if all was grand up to then and everything started to go bad after that year's general election. The reality is that the NTPF was used extensively in the years 2009 to 2011, inclusive, before being suspended. We have seen the NTPF put to use more recently to reduce waiting lists for surgeries and other inpatient procedures. I hope that Fianna Fáil is not advocating a return to such temporary measures. What we need immediately is for action on the complete implementation of the Sláintecare report. If that were implemented, we would not have to rely on short-term, knee-jerk reactions. Many patients, such as those on the ever-increasing cataract treatment waiting list, have benefitted from the NTPF. I wish them well, but they should not have had to wait, then board buses to travel north, if that was their mode of transport, to receive what was their due in this State as of right.

I wish to refer to those shocking October overcrowding figures. Members of the public who sometimes struggle to understand the current political arrangements in the House often ask how large a scandal would it take for Fianna Fáil to withdraw from its support arrangement with Fine Gael. It will be obvious after tonight that, among the many other scandals of how our citizens are being treated, including in our health services, having more than 100,000 patients without hospital beds so far this year is not shocking or outrageous enough for Fianna Fáil to put an end to this sell-out arrangement and pull the plug, which is what should happen.

I thank Fianna Fáil for moving this motion, although I will be forgiven for feeling like this is Groundhog Day all over again. We go around and around debating this. Unfortunately, I do not believe that we, as a collective political institution, are taking one another seriously enough. There is a lot of politics, but I am not sure that there are many solutions.

Talking about the situation with trolleys and emergency theatres is like talking about the weather now. It is that neutralised and socialised, which is awful. The county I come from has the worst issues proportionately with admissions to hospitals. We have Limerick on one side and south Tipperary on the other. Although they get beaten the odd time, those two hospitals usually have the most number of people trying to get into them. For us in Tipperary, it really is like talking about the weather. This is not an issue of staff or management, whom I support in both locations. They dread going into their respective hospitals. Imagine being a public representative whose constituents dread going into their local hospital. That is what my fellow Tipperary Deputies and I live with every day.

Just like others, a number of members of my family were on trolleys in University Hospital Limerick, UHL, in recent weeks. The circumstances people are being left in are disgraceful. The discourse that emanates from that goes against all of the good work being done in health, for example, cancer strategies, maternity strategies and other public health strategies. We must fix this. Surely it cannot be beyond the capacity of the body politic to do so. I say with great sincerity that the Minister is going to wish that the election was this month. Unfortunately for the general public, if we have a flu epidemic, or even if we do not, it will be hell. It is already hell where I live, so it will be an even worse form of hell. The situation is that bad. I do not say this with any political glee.

We know about the more than 100,000 people on trolleys this year and the record levels of overcrowding. What gets to me is the volume of elderly people who are being left on trolleys. I am not unique - other mid-west representatives are present. The amount of times one must fight to have elderly people, who are obviously more vulnerable than others, prioritised is ridiculous. Since starting in politics, the proportion of my time spent fighting for patients to get access to hospital services has multiplied on a scale that I cannot even estimate. I did it today. I have been fighting for people all this week, all last week, all last month, every week and every day. That is not the role of a Deputy, but because of how the system is failing, we are left in a scenario where probably all Deputies must try to intercept and fight those parts of the system that are falling down.

I will tell the Minister a story - I have the lady's permission; her name is Deborah - as an illustration of how bad things are. Deborah needed an operation on her gall bladder, which is not the most significant of operations but is quite painful. She was admitted to UHL. The people there first believed that they could take her as an outpatient, but she was then brought in. The consultant switched views on this after a number of weeks and realised that the operation could not be done in UHL and she would have to be transferred to St. Vincent's. St. Vincent's could not take her, though. I had to intercept the issue, call St. Vincent's and ask why the consultant was not doing more procedures. Obviously, he has private and public practices. He is going under the tunnel on a Tuesday to work Wednesday, Thursday and Friday, and on Monday and Tuesday he is working in the public practice. More than anyone, I am with the Minister as regards private practice in public hospitals.

I, a politician, had to fight to get Deborah transferred to St. Vincent's. Just before she actually got there, she got a letter from its outpatient department telling her the date for an outpatient appointment for a bloody operation that she did not even have arranged yet. I had to tell the CEO's office in St. Vincent's that this was happening. The hospital had given an outpatient appointment to a lady who was in UHL awaiting transfer to St. Vincent's for an operation that the latter could not provide because she had not even been transferred yet and the consultant could not take her. After the appointment at St. Vincent's was cancelled a number of times, she eventually had the procedure. This came 11 weeks after being admitted to UHL to have her gall bladder removed. For 77 days at a conservative figure of €1,300 per day, that is more than €100,000, not counting additional costs like medicine. By the way, she was given the wrong medicine twice. Spending €100,000 to have a lady's gall bladder removed is the situation that this country is in. It is crazy. Is it any wonder that we talk about the amount of money we are investing in healthcare when it costs €100,000 for a lady to get her gall bladder removed?

I have asked the director general of the HSE, Mr. Paul Reid, to look into this matter, which is a scandal.

What the Minister said about the embargo is rubbish. There are many examples of recruitment not happening. I know of a person who was offered a role but who is now emigrating because the appointment has not been made.

I will not talk about the HSE's winter plan because it is effectively a case of putting a finger in a dyke. The overcrowding situation is so bad in some hospitals that one clinical lead told me in recent weeks that it will lead to a catastrophic event, if not multiple such events, in the coming winter period. This very experienced person is effectively saying, and it is not said lightly, that people will die unnecessarily. The Minister has challenged everybody here to provide solutions. I wrote to Mr. Reid about the issues at UHL and requested answers regarding how it is proposed to deal with the situation there in both the short term and the medium term. I was not happy with the response. I have undertaken a comparative analysis of UHL versus Beaumont Hospital, which are two similarly sized hospitals with similar catchment areas. It is bad enough that UHL is €40 million in deficit in its current funding but when it comes to nurse numbers, there are 1,016 in that hospital compared with 1,294 in Beaumont. That is a substantial difference, especially when one considers that Beaumont does not treat as many patients. I can share all these data with the Minister.

We must deal with the issue of consultants, as the Minister is well aware, and that requires tackling the embargo. Bed provision is another issue. The Minister visited Our Lady's hospital in Cashel three years ago but the unit there is still lying idle. That represents an absolute waste of resources. There are issues with model 4 hospitals and problems with care pathways. Nenagh and Ennis hospitals, both in the mid-west, should be used more. Their minor injuries units, for example, could be utilised to widen the pathways. There are issues to deal with in regard to intermediate vehicles and making sure patients are transferred more quickly. Another issue is that I do not know why we are not giving the flu vaccine to more people for free. There would be a saving for taxpayers in doing so because fewer people would end up in the acute system. The Minister is well aware of the issues concerning home care packages.

Solutions are being put forward. I urge the Minister, as we move into late November, to examine the four or five really bad hospital situations and work with the director general of the HSE to put in place plans that are specific to those hospitals and which give far more detail than is in the winter plan. Otherwise, what I described at the beginning of my contribution will, unfortunately, come to pass.

The Sinn Féin Deputies have four minutes remaining in their slot and Deputy Martin Kenny has indicated. With the permission of the House, I will allow the Deputy three minutes. Is that agreed? Agreed.

I thank the Leas-Cheann Comhairle and promise to confine myself to the time allocated. The problem of hospital overcrowding stretches to every part of the country. Most people's experience of it is that it is a direct result of under-staffing in hospitals. That is the nub of the issue. I was contacted this week by a nurse who is employed in a hospital through an agency. She applied for the same job directly with the hospital, was approved and a contract was drawn up. However, because the job was advertised last July and more than three months have since passed, she must seek to have her application reapproved. The people responsible for the procurement of staff told her she needed to seek someone out to get her own appointment approved. When I spoke to the people concerned, who are based in Manorhamilton, they told me that there are hundreds of health service staff around the country in the same position. There is no additional cost in securing this appointment. In fact, it is costing more to employ staff such as this nurse through agencies.

The argument is often made that the health service is in a mess because it costs so much. The reality is that it is in a mess because people are not doing their job. The Minister is the person at the very top and it is his job is to make sure other people do their job. That is not happening, however, as the experience of many people shows. If we are to get a grip on this situation, we need the Minister and the senior people in the Department to have the backbone to stand up and ensure that others do their job. I have raised concerns on numerous occasions, during Topical Issue debates and other discussions in the House, with both the Minister and the Minister of State, Deputy Catherine Byrne, that people in senior management in the HSE are swinging the lead. Unless something is done about this, we are all wasting our time. People are being left on long waiting lists and in queues in hospitals and, in some cases, they are ending up in the graveyard. The state of the mental health service, in particular, is a cause for serious concern. We must take control of the situation. I challenge the Minister and the Government to tackle the situation finally, four years into its current term of office and following its previous term in government. Failure to do so will be a huge indictment of the Minister and his legacy.

The Minister focused on two themes. First was the argument that Fianna Fáil did it first and, second, there is the notion that no policy change will alter the situation facing people who are waiting on outpatient lists or on trolleys in hospitals. The first thesis is accurate. Fianna Fáil did indeed do it first, but that does not reduce the responsibility of the Minister or of this and the previous Fine Gael Government for the current state of the health service. There has been almost a doubling of the numbers of patients on trolleys over the eight years of Fine Gael rule. It is true that we are still struggling with the legacy of the horrific cuts in the 1980s, when 3,000 beds were lost. Despite there being some subsequent movement towards recovery and improvement, that deficit was never dealt with properly. The onset of the economic crisis saw the introduction of a massive programme of austerity by Fianna Fáil and the Green Party, which was continued by Fine Gael when it entered office.

A 2014 study conducted by Trinity College showed that €2.7 billion was taken out of the health service between 2009 and 2014, resulting in 12,000 fewer staff, 21,000 fewer inpatient appointments, 30,000 fewer day cases and almost 1,000 fewer beds. We have had decades of under-resourcing, which is the responsibility primarily of Fianna Fáil and secondarily of Fine Gael, compounded by austerity since the crash. Fianna Fáil and Fine Gael have continued to pursue the same policies. The consequences of those austerity policies are seen in the huge waiting lists and the patients on trolleys but also in the entrenchment of the two-tier nature of the health service, which is at the root of many of its problems. Public hospitals were forced into financial dependence on income from private patients who were allowed to jump the queue ahead of poorer and sicker public patients. Even when the latter finally access treatment, the care they receive is generally inferior.

The second theme the Minister set out is the idea that there is no single policy change that can turn things around. It is part of the propaganda and argumentation of successive Governments and Ministers to suggest there is nothing that can be done about the health sector. No matter who goes in and what they do, it will always be in crisis. No matter how much money is spent, it will remain a funding black hole. In fact, there is a simple policy change that would transform the situation, which is to adopt a policy of building a properly-funded national health service. That service would have one tier rather than two, would not require people to pay out of pocket for medical expenses or private medical insurance and would ensure that everybody has equality of access to the health services they need. That is the policy change we require and it would transform people's lives. Unfortunately, Government policy points in the opposite direction.

I will focus on a discrete area of the health service, the ambulance service, to illustrate the point I am making. I got an answer from the HSE last week to a question regarding its expenditure on private ambulance services in the first eight months of 2019. I was informed that €7 million was spent filling the gap in hospital transfers, which involves the use of taxis.

It is there. It is relatively small in the grand scheme of the health service but it is a clear example of an underfunded ambulance service, made up for by paying for private operators to step in. That happens at the same time as the disgraceful union busting treatment of the ambulance workers, personally directed by the Minister for Health against those who want to be members of the National Ambulance Service Representative Association, NASRA, and who are told after seven days of strike action they cannot join NASRA and the HSE will not deal with NASRA. Every time they protest outside the Dáil, we raise it in here and we get the same answer from the Minister every time, which is basically saying the Government thinks there are enough unions currently organising for ambulance workers and paramedics and therefore they should not be entitled to have a union of their choice. It is utterly scandalous but it is replicated in the treatment of workers across the health service.

That is one area but I mention the creeping privatisation, although the word "creeping" might understate it at this stage. The expansive but not openly declared privatisation of our health service takes place throughout the service. It takes place in the National Treatment Purchase Fund, the payment of agency nurses as opposed to employing people directly to work as part of the health service, private consultants using public hospitals, and people being able to jump queues and so on. It is everywhere. The alternative is to invest in a national health service. That would make a huge difference in people's lives and health outcomes and in equality in our society. Health inequality is huge in Ireland and statistics continually come out about that.

It would also make a difference to people's pockets. I got an answer from the Minister this week about the amount an average household spends on private healthcare and private health insurance each year. The Minister confirmed the average household spends €960 per year on medical expenses, covering things like GP, dentist and hospital visits etc. The household budget survey gives a combined figure for medical and dental insurance in the same period of more than €1,200 annually. As we do not have a national health service, households in this State are already spending over €2,000 on average to try to access the healthcare they need.

The consequences for this underfunding are very clear. They are spelled out by Phil Ní Sheaghdha and the Irish Nurses and Midwives Organisation, INMO, in the various press releases put out about the coming winter crisis. The HSE predicts nearly 4% more patients will attend emergency departments, but that will be with 400 fewer staff nurses and midwives in the coming crisis if the recruitment pause is not ended and if there is no proper staffing of our health service. The most extreme consequence of this underfunding is the estimated 300 to 350 people who will die as a consequence of overcrowding and of being stuck on trolleys etc. between now and next year. It is horrific, and that goes on top of the experience of sitting on a trolley, the experience of a family member being on a trolley, and the experience of one in ten of the population sitting on outpatient lists, unable to access the healthcare they need. We need a national health service. A national health service is a part of a green new deal for Ireland. Employing the proper number of staff to resource our health services properly means creating thousands more jobs, and those are low carbon jobs. They are low carbon, high quality and high value jobs for our society.

It also means taking on the power of the pharmaceutical companies. We regularly deal with scandals here with people seeking to access necessary pharmaceuticals and medicines, often for their children, and being unable to do so because of the ransom these pharmaceutical companies are attempting to extract from people. It points to the need for public ownership of the pharmaceutical companies, and in the meantime there is a need for a programme of generic production through publicly owned pharmaceutical companies to ensure life-saving drugs can be accessible to all. It means taking private hospitals and healthcare companies out of the hands of profiteers, and in that way building a national health service that is equitably accessible to all who live here.

I am sharing time with Deputy Broughan. The Minister is probably tired of hearing this discussion in the Dáil. It gets a bit depressing having to come in here and say it all the time but it deserves to be said. Everybody has their local hospital and every hospital is in the same level of crisis. It comes down to a lack of management. It has started from the wrong place. I agree with a lot of what Deputy Paul Murphy has said. We are always starting in the wrong place, and as long as we do that, we will always be in this situation. If Fianna Fáil jumps over into power, it will have the same problem, it will say the exact same things the Minister is saying now, the Minister will be on the Opposition benches saying the exact same things Fianna Fáil is saying, and it will be the same crap.

The reality is this started with Mac the Knife back in the late 1980s and that process was continued by Fianna Fáil. The Minister has continued it on hell for leather. When will they learn it is not working and it can never work? The reality is we cannot keep cutting and expect it to work. The reality is we cannot keep focusing on budgets and expect to get more for it because it will not happen and it cannot happen. The reality is we have to bite the bullet and decide to provide more money for the health services so the service can deal with the problems it has. We have an ageing population, we have an increasing demographic that needs the treatment and we need the proper home care services so people can get services at home. That will help our hospitals and that has to be done. Unfortunately, this Government is not doing it, Fianna Fáil will not do it and no Government in this State will do it if it only concentrates on funding and budgets as a way of doing it because that will not make any difference.

The way the Government is focusing on the problem has led to 49 people waiting on trolleys in Letterkenny University Hospital this morning. That is up four from yesterday when it was 45. It remains the second most overcrowded hospital in Ireland for the third consecutive day. For the month of October, the INMO confirmed a total of 693 people were either on trolleys or waiting on wards in the hospital over the four-week period, making it one of the most overcrowded hospitals in the country, and this could be repeated across the board. At Letterkenny University Hospital, there were 19,108 people awaiting inpatient or outpatient treatment at the end of June. That is up 1,906 from June 2018, an increase of 11%. In Letterkenny University Hospital, over 2,000 more people are awaiting an outpatient appointment. A total of 1,783 women are waiting for a gynaecologist appointment at Letterkenny University Hospital. That waiting list has been growing for the past five years. The recruitment embargo has prevented management at Letterkenny University Hospital from recruiting the nurses, doctors and support staff required to reopen the hospital short stay ward fully. Those are the facts of the matter and that can be repeated across the board. In Letterkenny University Hospital we also have an ambulance service that is run for a big county but where most of the ambulances are sitting at the hospital waiting to discharge patients into it. That is fucking ridiculous. This has gone on and on and we are here all the time talking about it. It should not continue but the Minister is not dealing with the problem properly because the problem is a funding issue and that is where the solution will be. If the Minister is constantly talking about doing more for less, he will do less for less. That is the reality of the situation and that is all that will happen.

I personally have a problem with the €1.5 billion we give in VHI tax breaks. Why do we not put that into the health services? That would raise €1.5 billion straight away. Instead of giving people tax breaks for having private health insurance, and I pay for other people to have private health insurance, we should put that money into the health services and make sure they are responsible towards our people. Then we might see some difference. However, it will go the way the Minister is going, we will go into an election with the Minister in crisis mode, Fianna Fáil will say it is terrible, it will go into government, it will do the same and Fine Gael will say it is terrible. That is all that will happen.

It is laughable that Fianna Fáil has brought forward the motion when it and Fine Gael have been joined at the hip in deliberately capping health expenditure over the past 12 years or so. They have reduced the number of badly needed acute hospital beds and, disgracefully, the number of HSE staff under the three austerity Governments since 2007. We on the Committee on Budgetary Oversight have year after year examined the budgets and, inspired by people such as Fr. Seán Healy and others who have appeared before the committee to give us evidence and ideas, have found that health budgets are consistently too small. That is the bottom line. Budget 2020, which was announced a few weeks ago, outlined Estimates for the health Vote, Vote 38, of €18.3 billion for 2020, €18.4 billion for 2021 and €18.5 billion for 2022. Where did the Department of Finance get those suspiciously similar figures? What about the delivery of Sláintecare or of additional services? Everyone in the House and all our constituents know that these Estimates are significantly too low to address the crucial needs outlined in the motion. Even in the case of the additional funding the Minister brought forward for Sláintecare, there was a €20 million integration fund and a €12 million core redesign fund but we have not received reports of what is happening in that regard or how it will help. All the new expenditure, such as the €25 million for the NTPF he mentioned, the €10 million for palliative care and so on, are simply too low, or at least too low together, and they leave out crucial sectors of the health service. Most members of the Committee on Budgetary Oversight have consistently sought realistic, sustainable budgets for a well-functioning health service in order that we will not keep reverting to crisis after crisis. The Minister for Finance, Deputy Donohoe, and Deputy Michael McGrath of Fianna Fáil have together agreed four budgets over the past four years which have simply failed to deliver that, which is why it is ironic to hear the health spokesperson of Fianna Fáil so upset by the matter.

At 8 a.m. today, 360 people were on trolleys around the country, with 174 people waiting on wards, which included ten people on trolleys at Beaumont Hospital. There were 30 people on trolleys at the Mater Hospital, eight at Crumlin hospital, 23 at Tallaght Hospital, 25 at Cork University Hospital, 23 at Mercy University Hospital, 27 at University Hospital Galway, 25 at University Hospital Waterford, 30 at University Hospital Limerick and so on. One of the most despicable aspects of the statistics is that it was reported in October that 107 children had been forced to wait on trolleys for beds to become available. Professor Malone, the master of the Rotunda Hospital, whom others reference, has told us graphically that overcrowding contributed to one premature baby dying and two others being infected with meningitis because of beds being so close together and that approximately 4,500 premature babies are born each year. He seeks an additional €50 million for the neonatal intensive care unit.

Ms Eilish O’Regan, the distinguished correspondent of the Irish Independent, reported yesterday that waiting list surgery will have to be scaled back in December and January to free up hospital beds for patients on trollies in overflowing accident and emergency departments. Service plan targets set by the Minister to reduce waiting lists to below 500,000 and surgery waiting lists to below 60,000 will reportedly be abandoned. Will the Minister confirm this? Like other Deputies, I have contacted Mr. Paul Reid, the CEO of the HSE, and the Minister since the spring about reports on health service constituents who briefed me on the 2019 embargo on staff appointments. The Minister has denied that the embargo is happening, as have the Taoiseach and Mr. Reid, but I have learned of appointments made last April for which the new workers, whether front-line or support staff, will be taking up their jobs in January 2020. That is clearly based on financial and administrative grounds. The embargo did happen. It was disgraceful and it should not happen again because there should be a realistic budget for 2020.

In general terms, the motion lays out the horrendous aspects of the health system. We must support urgent action on it.

I call Deputy Michael Healy-Rae.

I thank Deputy Donnelly and his colleagues in Fianna Fáil for bringing forward this important motion-----

My apologies. Deputy Naughten wished to share time with the previous group.

That is not a problem.

We all make mistakes.

I have three suggestions for the Minister in respect of the issues at accident and emergency departments across the country. First, we need to better utilise our injury units, which can provide for quick diagnosis and discharge back into the community and ensure that people do not have long stays for tests that can be provided there. Currently, people go directly to accident and emergency departments rather than to injury units and an effort needs to be made to encourage people within the catchment area of injury units to go there in preference. If they do present at an injury unit, they should be considered as having been admitted to an accident and emergency department and get credit for when they go there. To send a clear message on the matter, I ask the Minister to make one change, namely, to reduce the charges for people presenting at an injury unit. One pays the same charge for presenting at an injury unit as at an accident and emergency department. There is no incentive there. If the policy is to encourage people to go to injury units, which it should be, we should not charge them the same fees as for going to an accident and emergency department. There are state-of-the-art equipment, diagnostics and even staff on call in many of the injury units, yet the doors are locked at 8 p.m. Surely it would make far sense if the GP out-of-hours service based beside such facilities operated out of them and had access to the diagnostic facilities.

Second, we need to utilise vacant nursing home beds available throughout the country to assist with the discharge of patients from hospital.

Third, we have to lift the embargo on critical appointments. I flagged in the Chamber last week the issue of vacant posts for public health nurses in Ballinsaloe and it is welcome that we have made progress and two of the posts will be filled. Nevertheless, two community nursing posts that could assist in the discharge of patients from Portiuncula hospital remain vacant, and it makes more sense to make that investment now.

I compliment the people working in accident and emergency departments at University Hospital Kerry in Tralee, Cork University Hospital and the hospital in Limerick. These people are at the coalface, working very hard, but they are not happy with the management of the HSE, the Minister or his Department because of what they see as failings in the system. I was grateful to the Minister in the past when I brought the management of what we will call the private hospital in Tralee to meet him to discuss very important issues such as how we in Kerry could use a model that is second to none in Ireland, given that a public hospital and a private hospital are located within 1 km of each other. The two hospitals could work far better together to achieve a reduction in waiting times. Solutions at the time were given to the Minister and his officials. The HSE, both in Kerry and Cork, knows how we could better utilise the services of the two hospitals but I am still looking for that to happen. Both are excellent hospitals in their own right, but by putting them working together, we could help dramatically to reduce the waiting times. It is inhuman to think of a person, whether old, young or middle-aged, going to an accident and emergency department and wondering whether he or she will be there for one, two or three days. It is outrageous. It should not happen at any hospital in the country that an old person would sit on a trolley and wait for hours or days. I ask the Minister, once and for all, please to try to sort it out.

Like the previous speaker, I compliment Fianna Fáil on tabling the motion. I thank the Minister for visiting places in Clonmel, such as the hospital and the doctor's surgery at Mary Street Medical Centre, which has fabulous diagnostic equipment. He worked hard to secure a contract to allow the medical centre to provide diagnoses privately.

It was the shortest contract in the history of the State, a 14-day contract that lasted for eight days. There is bedlam in the HSE.

I thank the Minister of State, Deputy Daly, for coming to see us in Tipperary recently. What will it take for the Minister to resign? There is nothing personal about this; he can laugh if he likes. What disaster will be sufficient to make him think that he is perhaps not up to the job? It is one of the great mysteries of Irish politics that he has managed to stay in his position despite the unique and catastrophic leadership he has displayed in respect of his brief.

Could I carry on without the Lord's name being take in vain from some inadequate people behind me? There is cursing and swearing.


If they have to resort to taking the Lord's name in vain, what else is there?

The Deputy should not-----

It is unbelievable. I am trying to concentrate. I have a script.

Apologise to Deputy Rabbitte.

On a point of order-----

It is not a point of order.

May I interrupt? Deputy Mattie McGrath has said I am insulting. He is showing no respect whatsoever to the Minister.

The Deputy should not cast stones because there are times-----

Apologise for-----

I will remind the Deputy of this before the night is out when she is talking to her colleagues. Let us move on.

I would like to continue without being interrupted.

The Deputy was not being interrupted.

The Deputy was using the Lord's name in vain within earshot of me. To date this year, 100,000 patients have gone without hospital beds and have had to wait on trolleys in emergency departments. To the end of October last year, the numbers were the worst in the world. They have increased this year. I am out of time, but I appeal to the Minister, Cabinet and Taoiseach to do something because there has been failure after failure. Front-line staff are at their wits' end and cannot cope or continue because they are under appalling pressure. The same is the case in mental health services. Let us not mention the waste in the saga that is the national children's hospital. It is a black hole which is being filled every day. The failed project is continuing. It cost €3 billion-----

The Deputy should travel out to have a look at it.

I and my colleagues have been out to see it.

He has never been.

We know what is happening. I ask the Minister to check his conscience. A 102 year old recently spent three days on a trolley in University Hospital Waterford. Does the Minister have any moral compass or fibre? Does he think about the people who are waiting and being neglected and abused? I ask him to think of the staff.

I am glad to have the opportunity to talk about this issue, but in the couple of minutes I have I cannot cover what I should be covering. The people working in the accident and emergency department of University Hospital Kerry in Tralee have to be complimented. Oireachtas Members had a meeting with officials from the HSE a couple of weeks ago and I highlighted the fact that people in Tralee who have letters from doctors stating that they need X-rays still have to go through the accident and emergency department despite the fact that GPs have told me they should not have to do that. This policy is clogging up the system. People aged 92, 93 and 94 years of age are waiting on trolleys in the accident and emergency department for hours and hours. Many go home without being seen.

I have highlighted the need to fully open Kenmare Community Hospital. For the minute I have available to me, I would be very grateful if the Minister would listen, but he does not want to listen.

I am listening.

He will listen to the people on the doorsteps and he will listen to them when he comes to Kerry. It is a fact that only half of the hospital in Kenmare and half of the beds in Dingle are open. At the same time, people are crying out loud to get into hospital. The Minister is doing nothing about that. He said he has advertised for staff, but he will not pay them or give them fair conditions.

Are we not paying staff?

It is the same for the GP services in Milltown, Rathmore and other places. The Minister should not make faces or make fun of me.

The Deputy said we are not paying staff.

I will tell the Minister the truth. Deputy Mattie McGrath called for his resignation a long time ago. I am calling for it now because he does not deserve to be in office as he is a shame and a downright disgrace. He is not listening; he is laughing, grinning and making faces at us. He has no realisation of what he has done to the people in Kerry and the services he is not providing to them. It is not fair that people who are almost 100 years of age have to stay on trolleys for two or three days. The Minister is out of order.

Thanks for coming to the Dáil today.

He is a shame and a disgrace.

The Minister is not going to-----

I mean that from the bottom of my heart.

Thanks for coming to the Dáil today. A rare appearance.

The Minister is not going to have-----

He is a disgrace.

Inequality lies at the heart of this motion. Health inequality is a major factor in disease development and inequality is now built into our two-tier health system. Inequality is also built into our public health system and health inequality kills. There is no argument about this statement. It kills patients worldwide and Ireland is no exception. Political policy and inaction regarding health inequality kills.

There are 577 patients on trolleys today, according to the IMO and INMO, 75 of whom are in Limerick Regional Hospital. According to the HSE's TrolleyGAR figures, there are 39% more people on trolleys today than on this day last year. We do not have a flu epidemic and are not yet in midwinter. As Deputy Kelly said, the mid-west is under-resourced by 20% compared to catchment areas of a similar nature. This is a €40 million under-investment in the mid-west per year. This institutional inequality kills people in the mid-west

Health inequality needs to be addressed immediately and urgently by the Minister. He has data and blueprints, but lacks the will to properly implement Sláintecare and address the core issues, namely, capacity and consultant and GP vacancies. What the Minister said bears no resemblance to reality. He is not addressing the core issues and is not listening to front-line staff or people who deliver services. That is why we have health inequality, and health inequality kills.

The health service is in chaos and crisis, whether it be the hundreds of thousands of people who are waiting to be seen as outpatients, those on inpatient waiting lists, the 100,000 people who have been on trolleys to date this year or the 300 elderly patients who will die unnecessarily this year on trolleys in our overcrowded hospitals. I raised this matter with the Taoiseach recently on Leaders' Questions and was shocked to hear him respond as if this situation was normal or acceptable. It is not normal or acceptable. In fact, it is the result of a deliberate policy pursued by successive Governments. It goes back quite some time, to the Hanly and Fitzgerald reports. Those reports were not accepted at the time. The policies underpinning those reports and their recommendations had been implemented on an ongoing basis by successive Governments. They took every opportunity to implement the recommendations, including during recessions. The saying is that one should never waste a good recession.

These policies were sold on the basis that big is best, centralisation is good and centres of excellence were needed. Big is not always best. Centralisation is not always good. All of our hospitals should be centres of excellence, and they can be if they are supported, funded and resourced properly. We need specialist hospitals to provide specialist services, but general medical services, such as general surgery, paediatrics, maternity care and accident and emergency departments can and should be provided locally to a standard of excellence. This is being done despite significant pressures on staff who work above and beyond the call of duty on an ongoing basis.

We can see the results of the policies pursued by this and previous Governments in our health service. There is absolute chaos, with severe overcrowding in hospitals and some 100,000 patients already obliged to wait on trolleys this year. At UHL, as many as 70 patients are often on trolleys, while nearly 50 patients are in a similar situation in South Tipperary General Hospital. That is the situation as it stands, and those are two of the worst hospitals in the country for overcrowding. However, every hospital is suffering as a result of that problem.

The overcrowding in our hospitals is inhumane. We have to remember that patients on trolleys are human beings and are entitled to service and respect. They are not getting that from the health service today. We know from professionals who have brought this matter to public attention, that this year and every year some 300 elderly patients will die in our hospitals unnecessarily, because of overcrowding, time spent on trolleys and the general chaos in the system. This situation has arisen due to the policies of successive Governments. My area includes Limerick and the mid-west, as well as what was formerly the South Eastern Health Board area and is now the South/South West hospital group area and these policies started to be implemented there way back in 1988. That was when the Government of the day closed 50 beds in St. Vincent's Day Hospital in Tipperary town. Taking those 50 beds out of the system immediately put great pressure on the other hospitals. That policy was continued when Our Lady's Hospital in Cashel was closed and another 30 beds were lost. That is a total of 80 beds having been taken out of the system in the south Tipperary already.

Turning to the mid-west, on the basis that big is best, that centralisation was needed and that an excellent service could not be provided in our local hospitals, which we can now see was incorrect, the Government of the day closed Nenagh Hospital, Ennis Hospital and St. John's Hospital in Limerick. We know and see the result of those closures daily in UHL. To give a concrete example, in South Tipperary General Hospital in 2011, when Fine Gael came to power first, some 700 patients were on trolleys. Some 6,000 patients on are now on trolleys in that hospital. It is a similar story in every other hospital.

South Tipperary General Hospital operates on the basis of 120% occupancy, while the medical department there operates on the basis of 150% occupancy. The generally accepted safe level of occupancy is 85% to 90% at most, so there is great pressure. We have to come to terms with the policies that various and successive Governments have been pursuing for years. We also have to face up to the fact that these policies were wrong, should not have been implemented and should now be reversed. The accident and emergency departments at Ennis and Nenagh should be reopened, because there is no doubt that the situation at UHL has been gravely exacerbated by the closure of those departments. Thankfully, we are eventually going to get our 40-bed unit in South Tipperary General Hospital. We hope that will be before the end of January 2020. Overall, however, we lost 80 beds in the area and we need at least another 40 or 50 in a new block.

The Minister was in Tipperary two or three years ago and he visited Our Lady's Hospital in Cashel, which is a state-of-the-art facility. Some €14 million was spent on upgrading that hospital, but there is not a single bed in it because it has been vacant for the past ten years. It is definitely time for that hospital to be opened because it can and should be able to provide step-down facilities. The expenditure on the hospital was intended to provide district hospital beds, palliative care beds and step-down facilities, but it has been vacant and left in pristine condition for the past decade. The hospital should be opened immediately.

As other speakers indicated, the moratorium - and that is what it is - on recruitment of staff must be lifted. General nurses tell us that 400 staff are needed in their area, while psychiatric nurses estimate that there are approximately 500 unfilled posts. The moratorium on home help hours must also be lifted. The recent increase in the funding for home help hours, well and good as it is, will cater for less than 50% of the existing backlog. Another area in need of urgent attention is GP services and availability. I also want to state that I support the comments of Deputy Paul Murphy and I would also like to see a proper national health service.

We move next to Deputy Aylward, who is sharing time with Deputies Niall Collins, Dooley, Murphy O'Mahony and Lawless.

We have two minutes each. I listened with interest to the Minister earlier as he blamed Fianna Fáil for the current state of the health service. I remind the Minister that his party has been in power for more than eight years and each and every year during that time the number of people languishing on trolleys in our accident and emergency departments has risen. Fine Gael has broken the wrong kind of historic records in respect of the numbers of people on trolleys annually. Some 28 people are languishing on trolleys in my local hospital, St. Luke's, in Kilkenny, and another 20 are on trolleys in University Hospital Waterford.

In the south east, we are still fighting for equality of cardiac care. It is the only region without 24-7 cardiac facilities and people are fearful that recent overspending in other areas of the health service could keep us waiting even longer for those essential lifesaving services. The situation in our hospitals is scandalous and unfair on our hardworking staff, as well as our sick and vulnerable citizens. There is a major problem with GP retention in rural Ireland and the Government must focus on this issue and incentivise GPs to avail of contracts in rural practices. It must also be ensured that these practices are adequately equipped, resourced and staffed.

If we can treat more people in GP surgeries, we will then have fewer people being admitted to accident and emergency departments. The Government must also address the many issues relating to delayed discharges. This is a major problem in Kilkenny and home care packages are needed to facilitate care and healing in the comfort of people's own homes. Too many beds are being taken up by people who have been officially discharged by hospitals but who cannot go home as they have no home care packages in place or are awaiting approval of their applications.

The Minister owes it to the hardworking staff in our hospitals, who have held the health system together in recent years, to ensure that he does not continue to preside over such chaos. I ask him to take the seriousness of this situation on board, given that we are not even near the end of the winter yet. We have another month to go during which there may be sickness, such as that caused by flu epidemics. The conditions in hospitals will get worse unless and until we do something about them.

The situation with accident and emergency care in Limerick, as the Minister knows, has gone beyond the point where we just condemn it and express outrage. We now need action. People in Limerick and the mid-west region are aghast and afraid to go to that department. It saddens me to have people describe that department as a cattle mart and the last place in the world to which they want to go. People should have confidence in that accident and emergency department. I know the Minister is due to visit shortly and he really needs to focus, through his office and Department, in addressing that issue.

On primary care, the Minister has concluded a deal with the GPs and that deal has been accepted. We need to continue to energise, recruit and qualify GPs, however, because that is a critical pipeline. Within five years, half of County Limerick will not have a GP service available.

The way in which primary care centres are structured in relation to the HSE in terms of placing the risk in developing them onto both developers and general practitioners is counterproductive and is simply not working.

In the few seconds remaining, I will refer to the embargo. I received an email from a nurse who works in an accident and emergency department in London. Having been offered a position in Galway, she has been told she cannot take it up because the funding has been held back. To give another example, a constituent of mine who applied for home help hours for her parents, both of whom have a critical need for the service, was told by the local public health nurse that there is an embargo in place. Her parents cannot avail of the service as a result. I also received an email from a nurse who took a career break to go to Australia and has since returned. She has not been allowed a pathway back into her job because of the embargo. The Minister contends that there is no embargo but it is in place.

If we could unwind financial emergency measures in the public interest as they apply to pharmacists and get rid of the pay inequality that applies to some doctors, particularly consultants, it would go a long way towards attracting and retaining staff in front-line health services.

Like other Deputies who represent the mid-west, I draw the Minister's attention to the crisis at University Hospital Limerick. From an accident and emergency perspective, it is wholly unacceptable. I do not want to fan the flames or personalise this matter. The whole political process and a whole-of-Government approach are needed here. I will cite a couple of cases that I have found striking. One relates to a woman who spent five days on a trolley in the past week. That case has been well versed in the local media and I am sure the Minister has heard about it. In another case, only last month, a farmer in his 70s who collapsed on his farm was rushed to the accident and emergency department in Limerick where he spent two days on a trolley in his dirty farm clothes. He was squashed beside a patient with ulcerated legs. If that does not flag a serious crisis in terms of cross-contamination, what does? A fantastic new facility accident and emergency facility has been built at the hospital but there are enough beds in the hospital or in the catchment area to get patients through the system. That is a serious issue.

On waiting lists, I understand the reason for the focus on accident and emergency departments because that is the front line. I will give the Minister three examples of constituents who are on waiting lists. A 70 year old woman, who is incontinent, has been waiting for three years to get an appointment. To date, I have been able to get an appointment date for her. There was much talk last week about the respect and dignity that was not afforded to a prisoner who had to slop out. What kind of respect or dignity has been shown to a woman who has been waiting for three years to have an issue with incontinence addressed? Can the Minister imagine what that does to that woman? It beggars belief. In another case, a 55 year old woman with an arthritic condition has been waiting three years for an appointment. Even using the parliamentary questions process, I have been unable to get a date for her. Another woman of 65 years of age has been waiting for a year to see a consultant about a hip complaint. She was told via a parliamentary question that I tabled that she would wait for at least four years. Somebody in the health service wrote to her informing her she would get an appointment within four years, after which she will have to go back on the list to have surgery done. I could go on but I am giving the Minister a flavour of the issue.

The Minister is also an elected politician who meets people every day. This problem is not his fault per se but he has the responsibility to try to find a solution. I ask him and his Government colleagues to develop a process to end to this outrageous situation which people must encounter.

In 2011, the then Taoiseach, Deputy Enda Kenny, vowed to bring an end to hospital overcrowding. All these years later, that vow has still not come to fruition. Many other promises made at the time did not come to fruition either but today is not the day to go into all of that. Never before have so many people been waiting on trolleys. Never before have so many old people been left waiting on trolleys for more than 24 hours. This is only the start of the winter. We have not had a flu epidemic or major crisis, yet there is an overcrowding crisis. What will it be like if there is a problem further down the road?

There are ways to deal with this, including addressing delayed discharge and providing more home supports and financial help for general hospitals. I have spoken to the Minister many times about Bantry General Hospital in my constituency. Rural general hospitals could ease the pressure on hospitals in Cork city. I ask the Minister to do his best and sort out this overcrowding problem.

We have had a number of fake news election slogans in recent years, including "Make America Great Again" and "Take Back Control". Who would forget the former Taoiseach, Deputy Enda Kenny, standing beside a billboard stating he would end the scandal of hospital waiting lists? Deputy Murphy O'Mahony alluded to that promise. Enda has been and gone but the waiting lists are still here and are, in fact, worse than ever.

Naas General Hospital in my constituency serves a large hinterland of County Kildare and west County Wicklow. In September, the number of people on trolleys at the hospital fluctuated between 25 and 32, making it the most overcrowded hospital in the eastern region, including the Dublin hospitals, on a number of days in the past two months. We are disappointed that a regional hospital is more overcrowded than hospitals in the capital city.

I have raised previously with the Minister the issue of a new endoscopy unit in Naas hospital. There have been a number of false starts. The hospital, which serves a large hinterland and population, has one endoscopy unit located in a prefabricated building adjacent to the hospital building. Many promises and commitments have been made and there has been talk of a funding announcement. Every year, it is déjà vu when we hear yet another announcement and commitment. The hospital is still waiting. Patients are having endoscopies performed in what is effectively a prefab, which is often cold and where there is a serious lack of privacy. To be practical about the issue, the throughput and volume cannot be managed because only a single patient can be treated at one time. The hospital is crying out for a new, upgraded endoscopy unit. One has been in the pipeline for some time but it has not yet arrived. I ask the Minister to put that on his radar and take action on it.

The Lakeview psychiatric unit at Naas hospital also needs significant attention. A project has been in the pipeline for some considerable time but it has not come through. People cannot wait any longer. Almost ten years after the then Taoiseach, Deputy Enda Kenny, made a promise in 2011, we need to see action on these projects.

This has been an important debate this afternoon and the contributions demonstrate the importance Deputies attach to the health services. It must be acknowledged that attendances at our emergency departments are growing year on year. As the health service capacity review indicates, Ireland has among the highest acute bed occupancy rates in the developed world. It must also be acknowledged that there has been an increase in delayed transfer of care and that there are challenges in ensuring timely discharge of patients who no longer need acute care. Given the challenges, my Department is engaging extensively with the HSE this year to identify mitigating actions to bring down trolley numbers and waiting times in the emergency departments. The €26 million in additional winter funding secured by the Minister for 2019 will help to relieve demand for emergency department services, support more timely discharge of patients and deliver other initiatives to help hospitals deal with the challenges associated with winter. This will be achieved through the provision of additional transitional care beds, increased funding for the fair deal scheme and provision of additional home care packages.

The nine winter action teams have been in operation since the beginning of October 2019 and are responsible for the co-ordination of a range of integrated hospital and community actions on a daily basis. Each winter action team reports weekly to the winter oversight group, with enhanced reporting by sites in particular difficulty or at times of exceptional pressure. The winter oversight group is chaired by the chief operations officer of the HSE and its membership consists of senior HSE staff across the relevant divisions.

Improving timely access for patients is at the heart of Sláintecare. Building upon the progress made in recent years in this area, the Sláintecare Action Plan 2019, published by the Department of Health, includes a specific work stream on access and waiting lists. In addition, many of the other service reforms and enhancements included in the action plan will support timely access to care for patients in the coming years. Progress has already been made in implementing the Sláintecare action plan's access actions this year.

We all acknowledge that the challenges we face are significant. Of that, there is little doubt. However, it is my firm belief that all of us want to find the right patient-centred, evidence-based, results-focused and sustainable solutions to the challenges facing our health services. Investment alone will not deliver the health service we aspire to, and nor will reform or productivity improvements on their own. All three efforts, including additional capacity, must be delivered in tandem if we are to achieve the vision set out in the Sláintecare report of a universal single tier health and social care system where everyone has equal access to services based on need and not ability to pay.

I repeat the point that the most effective way of achieving the Sláintecare vision which has the support of all parties is by backing the Government's continued implementation of the Sláintecare plan.

Deputy O'Rourke is sharing time with Deputies Breathnach, Rabbitte, Ó Cuív and Donnelly.

I thank Deputy Donnelly for bringing forward this relevant and important motion. I will focus on the delayed discharges and the impact they are having on families and the patients. I can offer some statistics for the Minister as he leaves the Chamber. From January 2019 to date, Naas General Hospital has lost 5,883 bed days due to delayed discharges. This figure is one of the highest for a hospital outside Dublin. Another statistic relates to people over 75 years of age. In October, there were 69 people over 75 years of age on trolleys in the emergency department for more than 24 hours. From January to date, the total was 851 people over 75 years old on hospital trolleys in the emergency department for 24 hours or more. That is just a flavour of the reality on the ground. We are all trying to work together but the Government must bring forward solutions to improve these statistics for the most vulnerable.

The main reasons for delayed discharges are the lack of access to appropriate step-down care, such as the home care that we have discussed with the Minister of State, Deputy Daly, on a number of occasions, and the lack of housing adaptation grants, particularly for local authority houses. For example, €450,000 was allocated to Kildare County Council to provide housing adaptation grants for its housing stock. That is not nearly enough and discharges are being delayed as a result. People cannot go home because they need adaptations carried out in their houses. With regard to home care, people are assessed in the hospital but what they require cannot be delivered because the funding is not available. That is causing them to stay in hospital, thus leading to bed blocking and so forth in the hospital.

These are two fundamental areas that require attention and delivery. People want to be at home in their houses because that is where they are happiest and can live independently. That frees up the health system for the treatment of other patients. The home care team in community healthcare organisation, CHO, 7 has told me that it cannot approve home care packages due to the lack of funding. That is leading to bed blocking and has the knock-on effect of patients being unable to access hospitals, including the National Rehabilitation Hospital in Dún Laoghaire, due to delayed discharges. The solution is clear. We must put further resources into the home care area, in which the Minister of State is involved, and housing adaptation grants. That combination will facilitate discharges and help people to live independently at home. Along with the housing issue, this is the single biggest crisis that all Deputies deal with in their constituencies each week.

Christmas may be coming and the geese may be getting fat, but so are the numbers relating to delayed discharges, the trolley crisis and the bed crisis in our hospitals. Like Deputy O'Rourke, I wish to focus on the home care supports that would go some way towards alleviating the growing problems with delayed discharges. Our Lady of Lourdes Hospital in Louth has 14,941 lost bed days, the second highest number in the country outside of Dublin. These lost bed days mean that there were people who were eligible to be discharged from hospital but they did not have access to appropriate step-down facilities. The almost 15,000 bed days lost to delays are outrageous. The simple fact is that there was nowhere else for those people to go. A total of 296 people over the age of 75 years spent more than 24 hours on trolleys or chairs in Our Lady of Lourdes Hospital since the beginning of this year.

Overcrowding, cramped wards and the trolley crisis will continue unless urgent funding is provided for step-down facilities, home care packages and creating a speedier fair deal process. I am dealing with a number of cases where a person is in a hospital and the family is awaiting finalisation of the fair deal. They can be waiting up to 12 weeks for the process to be completed. Surely the person could be given a cheaper facility in a nursing home in the meantime while the decision is made on the fair deal.

The issuing of crisis medical cards is taking seven to eight weeks. With urgent cancer cases there should be a mechanism whereby somebody who has a serious diagnosis could have a consultant sign a form and be urgently provided with a medical card, rather than it taking six to eight weeks to happen.

I thank Deputy Donnelly for bringing forward this motion. I am a Galway Deputy and University Hospital Galway is always in the limelight for the wrong reasons with regard to trolleys. Today, there were 40 people waiting on trolleys in University Hospital Galway. On 4 November, there were 71.

The Minister addressed the embargo and I wish to follow up on that. At present, we are waiting for Saolta University Health Care Group to release the funding for 24 consultant positions to ensure that those consultants can properly engage in the function of running the hospital. It is very hard for hospitals to function and to expect the staff who are there to operate with 24 fewer consultants. Twenty of the positions are permanent and four are temporary. The embargo is affecting the position of dietician in the endocrinology department. Not having a dietician in that department has mammoth ramifications for all patients. This year there have only been ten surgeries. With bariatric surgery the band that is required can only be put in place with the assistance of a dietician. The dietician was awarded the contract last February, but because of the embargo she has not been given the opportunity to take up her position. The same has happened with a number of physiotherapy positions.

To refer to the public health nurse position for Ballinasloe and Portumna, it took a number of weeks to resolve that. The nurses were expected to work with one third of the staff. It was resolved last week when we got two public health nurses, but we are still awaiting the approval of two community nurses. We are talking about step down facilities. These are the people in the community who will integrate people coming home from cancer treatment or after having an accident or surgery to ensure they are cared for and to avoid the blocking taking place.

St. Brendan's Community Nursing Unit in Ballinasloe has 24 vacant beds at present. The unit is for older persons' care. I am sure that if we could release some of the people in UHG it would take serious pressure off the number waiting on trolleys.

I do not have enough time to do justice to these issues, but I am grateful to my colleagues for raising them. The large number of speakers on this side of the House demonstrates the scale of the crisis. As my colleague, Deputy Rabbitte, said, University Hospital Galway is a disaster. The latest dream is that we are going to get a brand new hospital. I would love to have a new hospital in Merlin Park, but in the meantime we must solve the problems there now. We want no reneging on the commitment to Newcastle Road in respect of the emergency department that we have been repeatedly promised since 2011, although it is no further forward since then.

There are many issues we could discuss. One of the extraordinary ones was the fact that after training nurses in Galway, UHG did not offer them contracts. They can be taken back on a contract but they are not getting permanent jobs in the hospital. We are constantly being told that there are not enough nurses to take up the jobs. That was an extraordinary decision. When I ask the Minister about the policy on this or something else, I get an answer from the HSE. It appears that the Minister and the Department do not have any overriding policy. I always thought that the idea behind a semi-State agency was that it implements Government policy, but time and again this Government tells us that it does not have a policy and that the agency has the policy. Most of those policies are negative.

One of the problems with getting into hospital is that the hospitals are critically short of beds. The other problem is that people cannot get into the hospital because people cannot get out of it. They are waiting for the fair deal. It is an enormously costly wait because every week costs almost €1,000. If a person is waiting 12 or 14 weeks between the assessments and the approval being given financially, it is a huge amount of money. Another problem is the critical shortage of home care. If people being discharged require a high level of care, it is not possible to facilitate them.

We could be here all evening on this but I hope the Minister of State gets the message. We are in a crisis and it is only the beginning of winter. I hate to think what faces us over this winter, particularly if there is a flu outbreak.

We will hear some brief concluding remarks from Deputy Donnelly.

So passionate are my colleagues that they forgot to leave time for a wrap up. That is a reflection of how seriously we take this issue. I will speak briefly. I will not waste too much time talking about Sinn Féin's nonsense. Its contributions spent more time talking about Fianna Fáil than they did about the patients waiting on trolleys. Deputy Ó Caoláin said that Fianna Fáil was here for the shock and not for action. This from the party that in 2016 ran away from Government talks in Dublin and in 2017 collapsed Stormont and keeps it closed. In 2018 and 2019, its representatives sat in their offices in Westminster hiding while wafer-thin Brexit votes were won and lost, with abstentionism in one hand and the Queen's pound in the other.

All right, Deputy.

I will take no lectures from Sinn Féin on action from political parties. I will address the remarks of the Minister, Deputy Harris. Unfortunately, he has left the Chamber, but he said that Fianna Fáil's plan is very familiar. That is good because it means that he understands what needs to be done. However, I found his speech very familiar. It contained no apology to the 100,000 men, women and children who have waited on trolleys.

The Deputy is out of time.

There was no acknowledgement of his Government's failures, yet he was somehow trying to blame Fianna Fáil and Deputy Micheál Martin. One might as well talk about Deputy Michael Noonan as health Minister or Erskine Childers.

I will make one final point if I may, and I appreciate the Ceann Comhairle's indulgence. Many speakers from the Opposition were saying, "Arrah, Fianna Fáil, Fine Gael, it has always been thus." I say to every Opposition Member of this House, every time they state publicly that Fianna Fáil is the same, they are letting Fine Gael off the hook and they are factually incorrect.

Thirty seconds please, a Cheann Comhairle. As I listened, I went back and looked at the trolley figures. In 2005, it was 230; 2006 it was 198; 2007 it was 250-----

All right, thank you.

In 2007 it was 250. Then it went into the 300s and 400s, and today it is 577. We must never conclude that the way patients are being failed is inevitable - it is not - and that it has always been thus.

Thank you, Deputy.

It has not. If the Government withdraws its amendment, votes for the motion and implements Fianna Fáil's plans, those patients will be off the trolleys.

Amendment put.

In accordance with Standing Order 70(2), the division is postponed until the weekly division time on Thursday, 21 November 2019.