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Dáil Éireann debate -
Wednesday, 24 Jun 2020

Vol. 994 No. 2

Emergency Bed Capacity: Statements

I call on the Minister, Deputy Harris, to make his opening statement. I welcome the Minister. He has ten minutes.

I welcome the opportunity to discuss this matter in the House but, in doing so, I have to take the opportunity, once again, to update the House on Covid-19, our response to it and its impact on the health service because it very much goes to the heart of how we deliver health services in the coming days, weeks and months.

First, and most importantly, I want to express my sympathy to the family and friends of those who have been lost to Covid-19 throughout this pandemic, and most particularly since we last met in this House to discuss this topic. All of us welcome the days when we hear that there were no losses to this disease recorded and I am very grateful that we had one of those days this week. We all want to see a time where we have many more such days. Despite slowly and steadily reopening our economy and reopening society, thankfully, so far we have not seen a rise in cases, hospitalisations or admissions to ICU. In fact, thankfully, all such numbers continue to fall.

I am also pleased to update the House, as I do each week, on the R-number in relation to the virus. I am pleased to say that the R-number has remained stable again this week. Our best estimates from our modelling team put reproduction numbers in the range of 0.5 to 0.8, according to the chairman of the modelling group, and very similar to recent weeks. That will come as good news to everybody in this House.

I should say that the small number of cases makes the reproduction number hard to estimate and the more important number perhaps to monitor in our country at this point in the pandemic is the number of new cases per day and where they are emerging. The average number of cases over the past five days was nine. That average number this day last week was 19. Again, there has been a reduction in the average number of new cases.

Tomorrow, as Members will be aware, the National Public Health Emergency Team will meet to discuss phase 3 and whether it believes it is safe to proceed to phase 3 of our reopening plan. The Government will meet tomorrow afternoon to decide how to proceed. We have all worked so hard to suppress this virus and we look in a strong position to progress to phase 3.

If we progress to phase 3 on Monday, travel restrictions across the country will be lifted. I hope we all take the opportunity to safely explore this beautiful country of ours, help local businesses that have struggled throughout this difficult time and, most importantly, see family again. I am conscious that those who may live in one part of the country and have family in another part have not seen loved ones in so many months. Let us hope next week brings an easing in that regard and a moment of reunion.

We have come through many dark days since this pandemic began. There were days when the fear of this disease was present in every home and every heart in our country and the quietness of our streets and our towns added to the unreality and uncertainty of those days. We have come through those days together but we need to get through the days ahead together. We each now have a greater responsibility to continue with the behaviours that we have all learned to ensure that we do not give this disease any opportunity to come forward again. We must continue to be cautious and clear-sighted about the power of this virus and the damage that it can do if we drop our guard. We do not have a vaccine. We do not have a specific treatment but we have learned how to protect ourselves and, crucially, how to protect others from it. We will, I believe, continue to make safe and steady progress if each day we practise what we now know. We have asked people to take practical public health measures and today, once again, I appeal to people to wear face-coverings on public transport and in enclosed spaces, such as shops, where social distancing is not possible.

Our health service, like every sector of society, will have to operate differently in this new normality. Throughout this pandemic, our GPs, pharmacists, healthcare workers and everybody working right across the health service have shown considerable innovation to continue to provide services in a safe manner. Thousands upon thousands of outpatient appointments are now being carried out in virtual clinics. Over 85,000 outpatient clinics were provided through technology last month alone. Many GP consultations are being conducted remotely. Prescriptions are now being electronically sent to pharmacists. Things I used to ask about in the Department of Health - I was told would take many years - could happen in the space of a couple of days. It is quite incredible that it takes a pandemic. We will need this innovation now more than ever to continue as we navigate our way through this next chapter.

I am pleased that the HSE has today announced its framework document on the resumption of non-Covid care services and given an outline of what the months ahead might look like. Of course, all of it is dependent on the transmission of the virus. The health service faces enormous challenges in the weeks and months ahead and gave an outline of this today.

Covid-19 will have a very significant impact on the delivery of health and social care services and it will require innovative and flexible responses to meet the healthcare needs of the population. It will require: better infection control measures; more and better alternatives to hospitals which cannot be mere lip service and must be real; transition of service from the hospital to the community; healthcare supports in our nursing homes - the crisis emergency teams that we put in place will need to be the norm and we will need to regularise them as part of our health service - and keeping people in their homes for longer, which cannot be a political slogan or a mantra and will need to be a piece of legislation passed by this House. These are no longer options. They are no longer things that would be nice to do. They will become absolute necessities if we are to continue to provide non-Covid care alongside Covid care and address many of the access challenges we face.

In our hospitals, there will be new operating realities such as: greater use of personal protective equipment, PPE, with the associated delay in donning and doffing of equipment; significant additional time for cleaning of beds, theatres and equipment; all aerosol generating procedures will require enhanced PPE and cleaning between patients, all of which will have an impact on capacity; and patients booked for surgery quite possibly will require to be tested prior to that surgery. The health service we know will be different but we must reconstruct it safely and dynamically, and we must use this opportunity to reform. While many in society want it to go back to business as usual, we do not want to go back to business as usual in the health service. We must use this as an opportunity to create a new health service - the health service we all want.

All of which leads me to Sláintecare. The Sláintecare office in the Department of Health and the HSE board are currently considering the priorities for this year and next in light of the challenges, and perhaps the opportunities, posed by Covid. It is clear that the reforms under the programme will be necessary, now more than ever.

Moving care to the community setting will be a fundamental pillar in the post-Covid world. The community care fund, which this House will know about from the budget, is committed to delivering up to 1,000 front-line staff in the community this year. Specifically, this fund will support initiatives such as the hiring of additional dementia advisers and therapists in the community, new initiatives aimed at reducing waiting lists and scaling up the integration fund projects.

Nobody knows what the next few days will hold politically, but whoever holds this office of Minister of Health must continue to drive the Sláintecare reforms forward. Crucially, the new health regions, the new consultant contract and the community fund all become essential elements that a new Government and this relatively new Oireachtas need to progress quickly while that momentum for reform and a new way of doing things is very much alive and well and being demonstrated on a daily basis in our health service.

As I have said previously, nobody knows what the next few days have in store politically. Therefore, I want to take this opportunity to thank colleagues from across the House for their collaboration throughout the past number of years, particularly the past few months. Many people mocked new politics. Many people mocked the way this Oireachtas worked differently. Let them; that is what commentators can do. I think one of the great things to come out of the previous Oireachtas was a consensus on the policy direction for the health service. We now need to build on that because we are at our best when we work together. Whether it is Sláintecare, the committee on which was led by Deputy Shortall, a referendum which even saw Deputy O'Reilly and I agree on a matter, or the entire House uniting against a well-funded vested interest to support the Public Health (Alcohol) Act 2018, we are at our best when we work together.

I wish to put on record my thanks to the wider health family, that is, the women and men who work in our GP surgeries, pharmacies, dentists' clinics, primary care centres, nursing homes and hospitals. I thank them for all they do daily and for their care and compassion. When people highlight problems in the health service, they always tell me they are nonetheless so proud of those working there. I have never heard criticism of those working in the health service, because they represent all that is good about the Irish health service. I also thank those who work in the HSE and the Department of Health, especially the Secretary General, Jim Breslin. Whatever happens in the coming days, it has been a privilege and honour to work alongside them throughout recent years.

The next few weeks and months will be a defining time for the health service as we must continue to try to suppress the virus, save lives and keep one another well while, crucially, resuming non-Covid care. There is, in the midst of this time of significant challenge, a time of opportunity to create the world-class health service that the people who get up and go to work every day want to achieve, and that the citizens of this country deserve.

I am sharing time with Deputies Butler, Brendan Smith and Crowe. This session concerns emergency bed capacity and, for me, how we can avoid an escalating trolley crisis every year. Before Covid-19 arrived, many of us were debating the trolley crisis in the Chamber. More than 100,000 people were on trolleys last year, 13,000 of whom were on trolleys for more than 24 hours. Elderly men and women were on trolleys for days on end, and we were all personally very affected, upset and frustrated by that. In preparation for this session, I looked back at some of the testimony from that time. One person stated they had been in St. Vincent's hospital for three days, with tea and polite nurses but no doctors. Another stated their 86 year old mum ends up in the accident and emergency department regularly and had spent days in limbo. Yet another stated their 70 year old mum had spent 105 hours on a trolley in Limerick hospital and expressed fears she would die if a fire started. Our healthcare professionals, as we all know, were overwhelmed, burned out and exhausted.

However difficult it was going to be to fix that problem, the challenge has become much greater because of Covid-19. There has been a significant increase in spending on Covid measures, including personal protective equipment, PPE, testing and tracing. Waiting lists have increased because of the necessary pausing of elective care, with those for inpatients and day cases increasing by 30% since March, approximately an additional 20,000 men, women and children waiting. Cancer screening services, necessarily, had to be closed but that, again, put a great deal of pressure on the system.

The greatest challenge, however, is probably neither of those issues. It is the fact that while Covid is here, the infection control measures the healthcare system needs to use very seriously reduce the capacity we have to treat people, including, critically, the capacity that emergency departments have to care for people. It is estimated that 20% of the beds in hospitals will now have to remain vacant. Surgeons are estimating in some cases that they will be able to see about half the number of patients in a given operating theatre session. Diagnostic capacity has severely decreased, with some people suggesting that more invasive diagnostics such as scopes could see reductions in capacity of up to 80%. As the Secretary General stated when he appeared before the Special Committee on Covid-19 Response a few weeks ago, it will cost more and take longer to do less. That is in a system that was already at breaking point.

As for what we can do, I agree with the Minister that one step we must take is to hold on to some of the positive changes that happened during Covid-19. Additional hospital beds were opened or reopened, and we should ensure they stay open and accelerate the hospital beds in planning or construction. We need to examine opportunities in presentations to emergency departments. During Covid, the number of presentations fell. Some urgent care decreased, which was bad, but so too did some non-urgent care and we need to find ways of engaging with those people and getting them to a better place than an emergency department. The Irish Association for Emergency Medicine has pointed that some referrals to emergency departments are from GPs sending in non-urgent care. They do not want to do that but it is the only place they can send patients for access to diagnostics or to care that they should be able to access in the communities. A public helpline with clinicians, which is available to many people who have private health insurance, could be excellent in helping people decide whether they need to attend or to bring somebody to an emergency department.

Equally, however, we have to increase the resources available to the emergency departments. That includes better staffing ratios for clinicians, better access to diagnostics and better access to beds. The problem is that our diagnostic and bed capacity has taken a massive hit, which will stay with us for a while because of Covid-19. To put that into context, a 20% reduction in bed capacity, given that we have to keep open 20% of the beds normally occupied, would see the number of inpatient HSE beds fall from approximately 11,000, which it is now, to fewer than 9,000. That is a catastrophic loss of hospital beds that will be seen at the sharp end, namely, in the emergency departments.

As for what else we can do, we have to source short-term capacity from outside the public system. We can provide additional funding to the National Treatment Purchase Fund and expand its remit to include areas such as mental health and diagnostics. We can establish strategic partnerships with the private providers while the Covid infection measures have to be deployed. If we need to access 2,000 or 3,000 new beds now, with the best will in the world that cannot be done simply from within the public system. These are the kinds of measures we can use in the short term to build capacity.

Second, we need to work with clinicians to get as much as possible out of the existing capacity in the HSE. We have to examine ways of opening the diagnostic suites and operating theatres longer, starting earlier, finishing later and opening at the weekends. We have to identify quickly some of the wasteful practices in respect of bed use. One way that doctors in hospitals are forced to ensure that someone coming through the emergency department gets an MRI scan is to keep him or her in a hospital bed for days, just so that he or she will stay on the priority list, rather than sending the patient home and saying to him or her that he or she is on the priority list and to come back in two days to be scanned. We have to get these issues sorted out very quickly. All of this is well and good but it will require more clinicians, doctors, nurses, midwives, technicians and scientists. We need to identify the blockages. The number of doctors deregistering has been increasing, as has the number of vacant posts. We urgently need to examine the blockages and sort them out. One step we can take immediately is to consider the clinicians going off cycle this summer. My understanding is that we could put job offers in place for them because many of those who might have wished to travel abroad will not be able to do so.

Third, we must accelerate the parts of Sláintecare that relate specifically to capacity, such as the healthcare gap analysis, the workforce planning, getting the new regional organisations and delivery plans in place, and accelerating capital expenditure.

I imagine that every Deputy wants this problem to be solved, and I agree with the Minister that we are at our best when we work together. Getting the kind of radical action and urgent investment we need will need a new Government. It is my sincere hope, therefore, that coming into next week a new Government will be in place that can get stuck in to some of these urgent matters.

Before the impact of Covid-19 on our health service became apparent, significant additional capacity was required in all aspects of care to provide access to high-quality services and to meet the needs of our growing population. I have raised for the past four years the issues of late discharges of care and the number of bed days lost because we were slow in discharging people, albeit through no one's fault.

A pilot project was undertaken at University Hospital Waterford this year. The managing director of the hospital bought capacity at a nursing home in Dungarvan. There was availability in the nursing home because it had been reconfigured, so she bought capacity of 20 beds for 12 weeks. At a cost of €1,000 per bed per week, as against €7,500 in an acute hospital setting, she was able to transfer people deemed fit by a consultant to be discharged but who probably could not go home, or whose nursing home was not ready or did not have the correct wraparound supports.

This pilot approach, of buying capacity in a nursing home, could be rolled out more widely. By transferring 20 patients who were not well enough to go home but who were well enough to leave the acute hospital setting, the director was able to free up 20 beds. There was a great saving. Instead of a bed costing €7,500 per week, it cost €1,000 per week. We must consider everything because we are going to have reduced capacity. We cannot predict the future but we are facing reduced capacity owing to Covid cases, non-Covid cases, the winter vomiting bug and a possible resurgence of Covid. We have to be prepared for this. Has the planning started? Is the Minister confident that challenges highlighted during the Covid pandemic can be addressed?

Through parliamentary questions and in various health-related debates in this House, I raised with the Minister on several occasions the need to upgrade and extend the emergency department at Cavan General Hospital. For a considerable time there has been a yearly increase in attendance at the hospital, which covers counties Cavan and Monaghan. Patients also attend from parts of Leitrim, Longford and Meath. The inadequate accommodation obviously creates additional pressures for patients and staff. That, in itself, puts additional pressure on the delivery of health services at the hospital. Earlier this month, I was glad to learn from the HSE that the project is now at design stage. I would like if the Minister could confirm to me in writing over the next few days that the project will remain a priority. It is absolutely needed.

Alongside the emergency department development, we need major capital investment at the hospital. In view of the additional accommodation requirements arising from Covid-19, there are now particular pressures on other areas, including outpatient, day and elective cases. The current hospital infrastructure is not adequate to meet the current demands for scheduled and unscheduled care. Substantial work was carried out up to 2015 by a design team on a major capital project for the hospital. I am anxious to have that project move to the next stage. What we have at present are unbearable pressures on clinicians and all their support staff in trying to deliver care. They are working extremely hard in difficult circumstances. To be fair to the Minister, he responded in writing to other queries I raised in this format. I would like him to confirm to me that the project in question will be activated and that it will proceed to the next stage for major capital investment.

The endoscopy unit at Cavan General Hospital, with which the Minister is familiar, has been very busy over recent years, taking patients from outside our catchment area. The unit needs a stand-alone facility nowadays to ensure all the requirements can be met and so people will not be traipsing through the hospital to gain access to it. I would like it if the capital project could be progressed because there are unbearable pressures on accommodation.

Since my speaking time is limited, I would appreciate it if the Minister could respond in writing to my questions. I wish to query the HSE's capital infrastructure expenditure, specifically on pre-hospital and acute hospital services. The expenditure on Ennis general hospital this year for the provision of an off-site outpatient unit on the Kilrush Road will be €600,000. This is minuscule compared with expenditure at other hospitals in the mid-west region and elsewhere in the country. Ennis, it would appear, is a laggard hospital insofar as capital funding and new building are concerned.

I understand the new outpatient unit will be fully ready in the early weeks of 2021 but thus far there has been no clarity on what staff will be hired or redeployed to have it fully staffed and up and running successfully from the get-go. I would like the details of the HSE's plans for the provision of consultants, clinical nurse specialists and diagnostics at the facility. The medical assessment unit in Ennis general hospital is known to offer a high-functioning service, with a low admission rate. Notwithstanding that, the unit exceeds daily its agreed expansion number of 26 patients. I am of the firm belief that a higher capital investment in the hospital could pave the way for an overall reduction in trolley numbers in University Hospital Limerick and alleviate the many other problems that hospital experiences daily.

I wish to raise the issue of consultants west of the Shannon. There are very few of them. County Clare has no respiratory consultant despite its having one of the highest diagnosis rates in the country. An endocrinologist visits the county just one day a week and he is so overburdened with his current caseload that he is incapable of taking on new patients and meeting those who have recently been diagnosed with diabetes. I want to know whether the HSE has specific plans to address these shortcomings.

I want to speak about a pressing and worrying issue affecting a constituent of mine, Maria Mead, from the village of Quin. The Ceann Comhairle and Minister will hear a lot about her over the airwaves in the coming days. Maria has just undergone a melanoma resection. In layman's terms, she has had several tumours removed from her scalp. For now, she is cancer free but there is a very high chance it will return. For this reason, her oncologist has recommended strongly that she undergo immunotherapy. Specifically, he has recommended that she take the drug pembrolizumab for a full year. Everyone in this Chamber will recall that this is the drug Vicky Phelan lauded and campaigned to have made widely available to cancer patients. A full year's treatment would cost Maria €150,000, money she simply does not have. She has healthcare insurance with Laya but the company will not cover the cost. The VHI would cover the cost but if she were to switch her policy to it, she would have to wait two years before filing a claim. This conundrum puts her health at great risk and puts her in fear of her life. I asked the Minister to set up a working group in his Department to consider how this life-saving drug can be made more widely available.

If this is Deputy Harris's last term as Minister for Health, I thank him and commend him for his efforts throughout the Covid pandemic.

I am sharing my time with Deputies Gould and Quinlivan, both of whom are to have four minutes. I will cede three of my seven minutes to the Minister because I want to use some of my time to hear a response. I believe the Ceann Comhairle said we are entitled to a response, but maybe not an answer. I feel like I have just stumbled in to some kind of job interview process. I do not know whether I should be commenting on it or not.

Yesterday, Ms Phil Ní Sheaghdha gave evidence to the Covid committee. She spoke about infection rates among healthcare workers. She said she had a call with the International Council of Nurses and that Irish figures for infection rates among healthcare workers - the Minister's figures - are the highest in the world. Last night, An Taoiseach tried to contradict this. He was wrong and should apologise. Perhaps he is just waiting to find a nice, cute quote from a film to help him to find the right words. I do not know what it is but he was wrong. No country in the world uses the infection rate as a percentage of the healthcare workforce. That is not how it is managed. Internationally, we do have the highest infection rates in the world. There may be reasons for that. There may be an explanation but Ms Phil Ní Sheaghdha is owed an apology, as are those healthcare workers who contracted the virus.

With regard to bed capacity, I received from the Minister's office a response to a parliamentary question indicating there are 11,597 beds. This is 1,000 or so more than were identified under the bed capacity review. It indicates that almost 1,000 additional beds were reopened to deal with Covid-19. Could the Minister confirm that, notwithstanding infection-control measures, of which we are all aware, these beds will be kept open and that the necessary workers needed to staff them will be hired?

As we move through the summer, we get closer to autumn and winter. These are often the seasons in which we experience the worst overcrowding in our emergency departments. Does the Minister have a plan for how the health service will deal with winter overcrowding if Covid-19 is still with us? If we lose the projected 20% to 25% of beds that we agreed last week or the week before will be necessary, will the plan include using the additional capacity in University Hospital Limerick and Citywest?

On the issue of staff, why are all non-consultant hospital doctors working or who have worked in the health service dealing with Covid-19 not been offered full-time contracts to encourage them to stay working in the health service where we desperately need them to be?

Dr. Anthony O'Connor, the Irish Medical Organisation and the Irish Hospital Consultants Association have been at the fore in raising this issue. Hundreds of doctors, and potentially thousands, have either come home to work in the health service or have just graduated. We desperately need them. They should not be let go by the HSE. That is absolutely unconscionable. The HSE should be seeking to retrain and recruit all available doctors and healthcare workers. The Government must not continue to force young doctors to emigrate. We have what is literally a once-in-a-generation opportunity. Can the Minister confirm that the non-consultant hospital doctors will be given a contract?

I wish to ask about the lack of staff, the lack of capacity and the way in which these affect care in our emergency departments and lead to overcrowding. As the health service and non-Covid-related care get back into full swing, those who normally end up in accident and emergency departments will need to be treated.

They are going to need surgery and care, and this simply cannot be done without staff. The waiting lists were paused but they have not gone away.

This is not just about offering student nurses a contract. This is about ensuring all the people who were here to help and "on call for Ireland", as the Minister put it, would be offered the opportunity to do the work we so desperately need them to do. We are not doing them a favour. I note the conversation I had with the Minister earlier concerning individual cases. I will wait for the response.

I have asked the Minister a few times about screening services. Will he commit to a catch-up programme and confirm that the lab capacity exists to allow that? Will the Minister commit to a publicity programme? I appreciate the Minister will probably have to write to me on the next matter. Has any progress been made in reviewing the case of the group home in Carrickmacross as raised last week by my colleague, Deputy Matt Carthy? The Minister undertook to have a look at it.

I know my time is tight and I am not leaving the Minister much time to respond but I will take the replies in writing. I have a letter from Ms Patricia King that was sent to the Minister for Business, Enterprise and Innovation, Deputy Heather Humphreys, relating to the recording of Covid-related illness. With respect to section 58 of the Safety, Health and Welfare at Work Act 2005, Ms King is asking that an amendment be made to provide that occurrences of Covid-19 in the workplace be notifiable to the Health and Safety Authority. This absolutely makes sense as it is a notifiable disease and this is a public health matter. This landed on the desk of the Minister but she indicated she is not minded to resolve the matter. I have written some very simple legislation and I intend to publish it tomorrow. My hope is we will not need it and the Minister will see sense but I ask the Minister for Health to use his good offices in whatever time remains to ask the Minister, Deputy Humphreys, to take action. It could be years. This is a really serious workplace issue.

I thank the Deputy for the range of questions and I will write to her on the answers I do not reach. I received a letter from Ms King of the Irish Congress of Trade Unions as well and either I have written or am about to write to the Minister, Deputy Humphreys, about it. I had a meeting with representatives of the Irish Nurses and Midwives Organisation about it as well. There seems to be logic in what they are trying to achieve with respect to the capture of data, and I would like to see engagement with them to see how best to do that. We will read the Deputy's Bill when it is published.

The Deputy is asking a couple of questions that will, in truth, be a policy matter for the next Government. We will need the extra capacity in beds and staff as well. I spoke to Mr. Paul Reid, the chief executive of the HSE, about this today. It is possible we have a once in a generation opportunity for doctors - not exclusively doctors, as we are also talking about nurses and others - who came back to be on call for Ireland to stay here. Let us keep them here. Perhaps some are planning to leave to go to Australia or America but have not done it yet because of Covid-19, and we have a chance to keep them. I note the comments made by Mr. Paul Reid at his press conference today. This must be addressed and I think he is of a mind to do it.

My position remains the same with respect to catch-up programmes for screening, etc., and these will be clinical decisions made in the programme. I welcome the fact that from 6 July, screening letters will start going out from CervicalCheck. The Deputy pushed for switching to a HPV test as well and there will be an information awareness campaign about these processes. I spoke to Dr. Colm Henry about that today.

With regard to the Deputy's question on winter planning, there must be a real focus on the community network along with community measures and the flu vaccine campaign. I will write to the Deputy about the rest of the questions. I will come back to Deputy Carthy on the Carrickmacross matter.

I intend to speak for three minutes to allow the Minister a minute to respond. If he does not have enough time to respond he might write to me with the answers.

The matter of accident and emergency department capacity is now crucial. I was elected by the people of Cork North-Central to fight against and reverse the neglect of the north side of Cork city. For 20 years a new hospital has been planned for Cork and there were meant to be numerous announcements about this. There was supposed to be an announcement last year, either before or after Christmas, and in this time both Fianna Fáil and Fine Gael have been in power. Cork still has not got its new hospital. I am standing here for the people of Cork North-Central and, in particular, those people on the north side. There are 125,000 people living in the area with no hospital or accident and emergency department. It is an absolute disgrace. This hospital is included in the national development plan and it is seen as a requirement by medical experts.

We desperately need a hospital on the north side of Cork city not just for the city but for the north side of the entire county. Currently there are areas like Curraheen and Bishopstown with significant congestion and development issues but on the north side there is a lack of facilities. There are a number of sites that have been suggested by me and my colleagues. Unfortunately, Fianna Fáil closed the Cork North Infirmary hospital and Fine Gael closed the orthopaedic hospital. We have the orthopaedic hospital site and the site of the Our Lady's Hospital, which is owned by the HSE. We have the Sarsfield Court site in Glanmire, which is 100 acres of strategically located land.

Will the Minister give a commitment to me and the people of Cork that he will carry out a feasibility study to locate the new hospital for Cork on one of those sites or a site on the north side that could be ideal for people? We desperately need a hospital and an accident and emergency department on the north side of Cork city.

I will raise a second matter, which is home help services. I was contacted by a constituent who has sought an increase in home help hours since 2011. The request has not been granted. That person is paying for additional assistance because it is needed. This person is not in a financial position to do that any more. The HSE now has a roadmap for the reintroduction of home help services so will the Minister give me and the country a commitment that he will review the recruitment policy and hire additional home help staff so we can run a proper service?

We are talking about bed capacity in hospitals but we know if we had proper wrap-around services and home help, people could go home from hospital sooner and release hospital beds. We also have other people who are at home now but do not have enough support. They will only end up in hospital because there is nowhere else for them to go. It makes sense to invest money in home help carers. I will allow my colleague in but I look forward to the Minister's response.

The Minister will not be surprised that I raise the matter of University Hospital Limerick, as 2019 was a really difficult year in the hospital. There were 13,941 people on trolleys in 2019, which was an increase of 22% on the terrible year of 2018, when 11,000 were on trolleys there. In a recent interview in the Limerick Post, the chief executive officer of University Hospital Limerick was quoted as saying that the group was short of 150 beds. A 96-bed block is being designed but is awaiting funding before proceeding to planning. I have spoken about this 96-bed block since I was elected in 2016 and it is distressing to hear we are awaiting funding before we even get to planning.

Today there were 35 people on trolleys in University Hospital Limerick, and this was the highest number in the State. Unfortunately, the facility has had the highest number on an almost daily basis. We saw a 25% increase in the numbers on January of the previous year, and in February we saw a 32% increase in the numbers for the previous year. March was headed that way again until Covid-19 came and the numbers on trolleys collapsed. These people disappeared but did not get better. They are still out there and we will still have a problem. There is a big concern about whether the hospital will cope next winter if there is a resurgence of flu or Covid-19. We cannot go back to the position of 2018 and 2019. There were incredible scenes, with 92 people on trolleys one day at the hospital, which was an absolute disgrace.

The staff in the hospital have done a tremendous job before and during the Covid-19 crisis, and I hope they will continue to do it after the pandemic. I understand the new 14-bed block will be completed in July and a 24-bed unit will be completed in August.

Those are very welcome. In terms of my questions, will they be operational and completed? What additional staff were recruited for these units? Have job offers been made? What is the status of another build, a 60-bed modular unit? When does the Minister see that being completed, staffed and operational? What is the status of the 96-bed unit I mentioned? Is there any update on that?

I am relying on my memory but my understanding is that the 60-bed block is due to be completed and hopefully operational by the end of the year; November is in my mind in that regard. There is funding agreed with the HSE to ensure that that opens. I will follow up on the 96-bed block and ask that the HSE responds to the Deputy directly but I would be eager that it does progress at least to the next stage. I have accepted that the mid-west has a shortage of beds. That is the reason we had sanctioned the 60-bed block. I welcome the fact that we have gone ahead, as the Deputy rightly said, and acknowledged that with the 14-bed and the 24-bed blocks. We want them opened as quickly as possible. I will check if the recruitment campaign has started and I will revert to the Deputy in writing.

To answer Deputy Quinlivan's colleague, Deputy Gould, I will write to him both in regard to the capacity for Cork, particularly on the north side of Cork, and the delivery of a new hospital for Cork to which we are absolutely committed, and also in regard to the issues he raises about additional home help, which I believe will require this House passing a statutory home care Bill, hopefully in the not too distant future.

I am sharing my time with Deputy Dillon - six minutes and four minutes. Once again, I want to express my sympathy to the families, loved ones and friends of those who have been lost to this awful disease.

I welcome the Minister's update on the Covid-19 disease, our response and its impact on the health service. It is reassuring that this week nobody passed away from the Covid disease and, as the Minister rightly said, we had only a small number of new cases. It makes the reproduction number difficult to estimate but, importantly, we need to monitor the new cases. The average number of cases over the past five days was nine. This day last week it was more than twice that amount.

Tomorrow, the Minister will meet with the National Public Health Emergency Team to discuss phase 3 and the Government will then decide how to proceed tomorrow afternoon. There is an area of my constituency of Sligo-Leitrim, north Roscommon and south Donegal which effectively covers six dioceses - the dioceses of Killala, Achonry, Elphin, Ardagh, Kilmore and Raphoe. Those are just the Catholic dioceses. There are other dioceses that interlink those. People are deeply disturbed by the report that churches will not be allowed resume masses on 29 June if the numbers exceed 50 people. The new restrictions were not part of the information we were given a few weeks ago. We were told they could open for mass on 29 June. That makes no sense whatsoever because it bears no reference to physical distancing. Some churches such as St. Anne's cathedral in Sligo town, the church in my town of Boyle and those in Carrick-on-Shannon, Ballymote, Ballinamore, Ballyshannon and Bundoran are very sizeable. They actually say that some churches in rural communities could not and should not have 50 people attending mass even if they are observing the 2 m rule. We need to look at the larger churches in the larger towns. This is coming from the bishops themselves.

Many people who have waited patiently for churches to reopen are very disappointed. They have been working very hard within the Government guidelines to prepare for a return to mass. I just looked at the Diocese of Elphin website which has the Full Guidance Document with Resources. They are as follows: Resource 1 - Parish Support Team and Volunteer Roles; Resource 2 - Risk Assessment; Resource 3 - Training; Resource 4 - Cleaning; Resource 5 - Use of PPE; Resource 6 - Stewarding; Resource 7 - Distribution of Holy Communion; Resource 8 - Communications and Signage; Resource 9 - Human Resources incl Return to Work Form; Resource 10 - Parish Policy Statement; Resource 11 - Responding to an Outbreak; and Resource 12 - Church Readiness Form. In addition, there are many training videos on the website. These people have worked extremely hard and they are very disappointed. I hope that we can come up with a resolution tomorrow that we will work with the various dioceses and churches. We need to clarify the matter. They want to be allowed do what they have been working towards, with expert advice, for the next two months. I hope the Minister will take that into consideration and he might comment on the matter.

Alongside the Ceann Comhairle, the Taoiseach and many previous speakers in the Chamber, I also wish to extend my sympathies to the family and friends of the late Detective Garda Colm Horkan, a proud Mayo man from Charlestown, in my constituency. I knew Colm. I played against him on many occasions. He was one of those people who got along with everyone and was so well respected. He was a leader in so many ways within his community - on the pitch with Charlestown Sarsfields GAA and also in his chosen career with An Garda Síochána. It is testament to his resounding character that the communities of Charlestown, Castlerea, the GAA family and An Garda Síochána rallied around his family in the ultimate show of strength and unity over the past few days. Ar dheis Dé go raibh a anam dílis.

I appreciate the comments made by the Minister, Deputy Harris, in the Chamber earlier this month when speaking about Mayo University Hospital in Castlebar. I note that a new energy centre and other energy efficiency works for the hospital have since gone to tender. Mayo University Hospital is an important hospital for the people of Mayo, serving the entire county from Belmullet on the Atlantic coast to Ballinrobe or Ballyhaunis on the other side of our county. Approximately 40,000 patients present annually to the emergency department within the Saolta Group at Castlebar. Regrettably, the emergency department at Mayo University Hospital is over capacity, having been built originally to cater for 25,000 patients per annum. The Minister visited the emergency department in 2016 and is familiar first-hand with the situation and the requirement for additional physical space at this hospital. Despite the hard work of the staff and management at overcoming this problem, action is required now. This has been going on for far too long and is a serious issue.

We have seen substantial investment in healthcare around Mayo recently, with new expansions to the Sacred Heart Home in Castlebar as well as new primary care centres in Castlebar, Ballina, Westport, Ballinrobe and Claremorris. While plans are progressing for a modular extension to the hospital, until a brick and mortar solution can be developed the challenges resulting from Covid-19 have only increased the urgency of this matter. This very much relates to increasing physical space in order to increase bed capacity. I would appreciate, therefore, if the Minister would provide an update on the expansion plans for the emergency department at Mayo University Hospital.

I thank Deputies Feighan and Dillon. I thank Deputy Feighan for raising the issue in regard to churches. This is an issue where common sense needs to prevail. It is an issue that myself and the Taoiseach have asked the National Public Health Emergency Team to give some consideration to at its meeting tomorrow and to provide some advice to Government before we make our decisions tomorrow as to how to proceed to phase 3. I feel very strongly about this issue for a couple of reasons. First, religious freedom is very important and, whatever one's faith or creed, one's ability to practise one's religion, and proclaim one's religion, in one's place of worship is something I know we all hold dear and take very seriously. Second, I know how much their faith has mattered to many people at this very difficult time for our country, for people individually, for families and for communities. I know how many people are reliant on their faith at this time and are looking forward to returning to mass, church or whatever service they attend in regard to their faith. As the Deputy said, the churches have been very proactive in terms of putting measures in place, and he read out a long list of preparatory works. It is about recognising that not all churches are the same size, as the Deputy rightly said. It is about making sure that churches can safely socially distance. We do not want anyone getting sick at mass, at church or at a place of worship. I hope NPHET can provide further guidance tomorrow that can help rectify the important issue the Deputy highlighted. As I said, commonsense needs to prevail.

I join Deputy Dillon in extending my sympathies to the family, friends and community of Detective Garda Colm Horkan. An attack on a garda is an attack on every single person in this country and I know that as a country we are all grieving his loss. I extend my sympathies to Deputy Dillon also, who knew Colm Horkan personally, and to his community also.

I thank the Deputy again for raising the issue of Mayo University Hospital. As he said, I visited Mayo University Hospital with the then Taoiseach, Enda Kenny, and I was very impressed by how well it is run. The Deputy is right.

Through no fault of anybody in the hospital it simply needs more capacity, a larger physical footprint. I have been eager to see the work to increase the size of the emergency department commence and for the next phase to begin. On foot of the Deputy raising the issue tonight, I will send a transcript of this debate to the CEO of the HSE and ask him to respond to the Deputy directly. Providing that additional space will become all the more important in the context of Covid-19, which makes things like infection control, ensuring space between patients and staff and avoiding overcrowding all the more important. The HSE is doing much work in that regard. I am pleased to note that since we last discussed the issue in this House the energy works have gone to tender. During our time in government we have made very a significant investment in health services. I was delighted to be in Mayo with the Deputy for the opening of the hospice. It is an incredible community project that we are very happy to support fiscally. I look forward to progress on Mayo University Hospital and to keeping in touch with Deputy Dillon and working with him on that.

I would like to start with a question about queuing in emergency departments. The acute hospitals emptied during the pandemic. There was a determined effort to make space available in case of a surge, the discharge of patients into long-term residential care was encouraged and funded and meanwhile patients were not admitted because they were not presenting for fear of catching coronavirus.

That has changed. It is now reported that nine acute hospitals in Ireland are full, including St. Vincent's University Hospital. When the acute hospitals fill up, queuing starts to happen in the emergency departments. This is a situation we are used to. It is a bad situation but it is the normal one. There is a particular problem at the moment, however. We are telling people that when they are out shopping or pursuing leisure activities they need to socially distance and follow various practices. It is absolutely unacceptable to tell people who are immunocompromised or very sick that they should be piled up together in a corridor, waiting for admission to the acute hospital. The question that the emergency doctors will ask is this. Once they have finished treating the patients, why are they still kept in the emergency department rather than in some part of the acute hospital as the emergency doctors would prefer? I am sure the people running the acute hospital have a different perspective.

We need to do something to change this arrangement whereby people are physically lined up in a corridor while waiting to enter the acute hospital. Is it possible to set up a temporary ward or some sort of admission lounge in the acute hospital as an adjunct to the emergency department, so that patients are not left in a risky and dangerous situation where infection control cannot be managed?

Deputy Smyth is entirely correct. As our hospitals and health service get busier again, people in this House rightly ask me how we are going to resume non-Covid-19 care alongside Covid-19 care. That will present real challenges for our health service, but also opportunities to do things differently. Today the HSE published the framework which includes the criteria it is sending out to the system. It outlines the things the management of hospitals or community care settings must be conscious of and asks how they intend to respond. Requests along the lines the Deputy has outlined will come from that. Management will ask for additional physical space and additional resources to do things differently. Deputy Smyth knows this from his own experience. When I talk to people in the health service I often find the movement of a patient from one place to another is to do with the need for a bed. Sometimes it is to do with the need for more porters or healthcare assistants. As a result of publishing the framework today, the HSE will receive many requests from across the health service. It will collate them and present them to my Department in the coming weeks.

Emergency department attendances are increasing. They have gone up by 31.9% in the past 30 days, albeit from a very low base. As we move towards the winter, this will become all the more important.

Given the recent history, people in an acute hospital are naturally reluctant to be discharged to long-term residential care. That is now more true than ever. A particular problem arises with discharges. Elderly people are sent back to live with other elderly people. Someone who is cocooning will worry that somebody coming from the hospital may have coronavirus. It has become very difficult to discharge elderly people from acute hospitals. That will add to the pressure on emergency departments. Is there a plan to do something at the community level to allow elderly patients to be discharged so they are not stuck in beds in the acute hospital?

Yes. By way of assurance I should say that very strict protocols have been agreed in respect of both admissions to and discharges from long-term residential care facilities for the reasons Deputy Smyth mentions, namely, infection control and the need to prevent clusters from re-emerging in nursing homes that have thankfully now been Covid-19-free for a significant period of time. More than 190 nursing homes that had an outbreak of Covid-19 are now Covid-19-free, which means they have not had a Covid-19 case for 28 days or more.

I find myself agreeing with Deputy Smyth on this. The answer has to be broader than just moving a patient from the nursing home to the hospital and from the hospital to the nursing home. We have to address the massive gaping hole in healthcare policy in this country, which is a statutory home care scheme. Everybody says they are in favour of it but nobody in here has ever bothered passing a law to implement it. It is in the draft programme for Government and work is ongoing in my Department to deliver it. Passing that quickly should be a priority for a new Government so that we can provide the kind of additional supports to the community that Deputy Smyth suggests.

I am talking about the physical constraints in emergency departments where people are too close together or do not have beds or wards while they are waiting to go into the acute hospital. Beyond the physical constraints, however, are the recruitment problems. It is no good having a bed and a ward without staff. In the event of a second wave or another infection or coronavirus, we will need more staff. Is there a plan to redeploy or retrain staff from other areas? Could theatre nurses be redeployed to intensive care units, or could dermatologists be redeployed as front-line staff as needed? Those areas tend to get very quiet during a pandemic because people do not want to go near the hospital for elective services and those staff members are needed elsewhere. Some redeployment occurred but is there a general plan for redeployment in the event of a second wave?

I know Deputy Smyth will agree that our health service workers and their unions have been incredibly flexible where redeployment is concerned. I have never seen co-operation like what we have seen from all the unions and representative bodies during the Covid-19 crisis. That issue arises as we begin to deploy people back to where they originally came from. People want to get back to their day jobs where it is safe and appropriate to do so. We will need to have a discussion about what an agreement for redeployment in a second scenario should look like. I have had some initial informal discussions with some unions in that regard and I know the HSE intends to progress that more formally.

I would like to ask the Minister about visitors to residential care facilities. Many people have not had a chance to have physical contact with their parents or grandparents since March. They can now see them through a screen but it is not quite the same thing. There is a balance between quality of life and infection control. None of us will live forever. The idea of keeping people physically separated from their children and their grandchildren is very difficult to bear. Is it possible for the Minister to go back to the National Public Health Emergency Team, NPHET, and ask if there are ways we can reduce the risk while allowing people to have physical contact, or at least to be physically close to each other? For example, could people meet outdoors in the summer? Could they meet while wearing personal protective equipment, PPE? If they cannot actually hug each other, they could at least get closer than a screen will allow. Could the Minister talk to the NPHET about that and see if some progress is possible?

Lastly, I wish to raise the question of recruitment of staff. This is a general problem to which the Minister has already referred today. We train medical staff and they leave Ireland. That has not been a problem in the last few weeks because nobody is allowed to leave. At the same time, we do not have the intake of staff from other countries that we would normally have. Is somebody working on a plan to retain the Irish staff members who have decided to get jobs within the Irish system, which are presumably available because nobody is coming in from abroad? Would it be possible to launch a campaign to retain staff so that they do not all fly the coop once the flights start?

There are two parts to that issue, namely, the people who very kindly came back from abroad to help our country and the people looking in the other direction, who were thinking of going abroad but did not do so because of the travel restrictions and the desire to help their country. I spoke to the CEO of the HSE about both groups this morning. He and I are of a mind that we need a specific campaign to keep those people. This is a once-in-a-generation chance to break the cycle by which really highly qualified people leave our shores to work in somebody else's health service. We need to address that.

Regarding long-term residential care facilities, I am really pleased that as a result of the work of the Irish people we were able to lift the blanket ban on visitor restrictions earlier than we originally envisaged and we were able to do it in line with public health advice.

However, it is still a very fragile situation and we have talked often about the very vulnerable people in nursing home settings. I am delighted that we are now seeing reunions of family and friends but I am conscious of balancing that with making sure we keep the virus out of nursing homes. We published a significant public health guidance document, Covid-19 Guidance on visitations to Residential Care Facilities, on 5 June to assist and support long-term care services management, residents and families, and we will keep that guidance under review.

In terms of the specifics of the Deputy's question, it will all very much depend on how weak we can make the virus in our communities. The signs are good in that regard but it needs continued watching.

I have quite a few questions for the Minister but I will try to be quick so that there is time to come back in after he responds. This pandemic has illustrated the importance of healthcare delivery at the point of need. Before, during and after the Covid-19 crisis, an issue of extreme concern for people in west Cork is the potential downgrading of Bantry General Hospital to a model 2 facility. The hospital provides vital healthcare services for the population of west Cork, some parts of which are more than a two-hour drive to Cork city. Downgrading the only acute hospital in this large geographical area will result in people's chances of survival being lower simply by virtue of living in west Cork. It is hard to believe we are even talking about this. Not only is this facility crucial to the local population but, without it, there will be a catastrophic knock-on effect on bed capacity in Cork University Hospital, which is already overstretched at the best of times. As things begin to return to normal, it is essential that this issue of fundamental importance to the people of Cork South-West is not forgotten about. What reassurance can the Minister provide that Bantry General Hospital will not be downgraded to a model 2 facility?

At the start of June, representatives of the Irish Medical Organisation, IMO, told the Special Committee on Covid-19 Response that between outpatient, inpatient and day case appointments, there are now approximately 800,000 people on waiting lists in Ireland. Cancer screenings are yet to restart and GP access to diagnostics and referral pathways is closed. There is now a very serious delay in accessing non-Covid care. The IMO predicts an inherent reduction in capacity in our public services of up to 50% following the implementation of new safety measures. This is in the context of a health service that normally operates at close to 100% capacity. The hospital capacity review in 2018 advised that the public health service needed an additional 2,590 hospital beds. That recommendation was made in the context of reform measures under Sláintecare, which is being pushed back under the new programme for Government. Funding for Sláintecare will only begin to be looked at ahead of budget 2022, meaning that the predicted bed capacity requirement will be too low. In fact, the IMO now believes we need some additional 5,000 beds to meet future demand. In light of new restrictions for health settings, what are the implications for bed capacity and the capacity review published in 2018?

Critical care staff have raised concerns about intensive care unit, ICU, bed capacity, which was already short of the review recommendations and below the European average before Covid-19. This crisis has underlined just how important ICU capacity is. The critical care community has made an enormous contribution to staff reallocation to ensure a temporary increase in ICU capacity at this time. However, this is a short-term surge and is not sustainable. Can the Minister outline his plans for additional recruitment of critical care staff and the provision of long-term, sustainable ICU bed capacity?

Despite the premium paid by the State for the use of private hospitals, they have remained at a very low bed capacity of approximately one third on average over recent months. These private beds were opened on a temporary basis during the crisis but they need to be retained for public use to ease the recovery of our health services as routine care resumes. Will the Minister comment on what the new agreement with private hospitals will look like after the current agreement ends next week?

Hospital capacity is not reliant on beds alone, as other Deputies have noted. It depends on a range of factors across the health system, including primary care services, social care provision and staffing. There are calls to open up more positions for non-consultant hospital doctors, NCHDs. Many junior doctors answered Ireland's call to return home during the crisis. As the Minister said, this is a once-in-a-generation opportunity to effect real change. We now have more junior doctors in this country than there are vacancies but getting people to come home is only half the battle. Many who did return are facing the prospect of unemployment because there are not enough positions and they cannot emigrate because of the travel restrictions. We need to ensure that junior doctors are encouraged to stay by opening up more positions in NCHD training programmes so that every person who returned to work in our hospitals during this crisis can be hired. Will positions be offered to those junior doctors and will more places on training programmes be offered to ensure longer-term job security and progression?

Social care provision is equally vital to improving our overall hospital bed capacity. Before this crisis, on any given day there were around 700 people across Ireland in delayed discharge from hospital while awaiting home care packages. Will we be reverting to this same mismatch? Will the Minister commit to bringing forward the long-promised work of introducing a statutory right to home care provision? Will he provide an update on the timeline for that process having regard to any changes caused by the Covid-19 crisis?

I thank the Deputy for her questions. In regard to Bantry General Hospital, I am pleased to give her a commitment that I have no intention for the hospital to be in any way downgraded. I had the pleasure of visiting it a year and a half or two years ago and it is a superb facility. In fact, I would like it to be busier. It needs to be busier. I do not say that as a criticism of the people working there, who also want to see it busier. Indeed, what we need to do with hospitals other than the level 4 facilities is make them busier. We need to look at which services we can take out of the level 4 hospitals and provide safely in the level 2 and level 3 facilities. It is my plan and intention to see an investment programme for Bantry General Hospital and I know there already are ambitious plans in that regard. I want to see it busier. I assure the Deputy that I will not forget about it. I am sure she will not allow me to do so.

I listened to the contributions of the IMO representatives at the Oireachtas committee and had met them before then. They are right to highlight the issues they did. I will not use up all the Deputy's time responding to this as I dealt with some of it in my opening statement. I will say that there is going to be a real challenge in how we provide healthcare in this country. People talk about how we will reopen schools, pubs, restaurants and other businesses, and the same challenges present themselves in the health service. The question is how we can deliver non-Covid care in a way that is safe for patients, respecting of social distancing and safe for staff as well. That will have an impact on capacity and the Deputy is right that it will involve the provision of more beds. The HSE is working its way through figuring out that impact. It published a framework in this regard today and is asking each hospital and area to respond outlining the impact for them. A safe reopening of health services will also require new and better ways of doing things. The fact that we delivered 85,000 virtual clinic outpatient appointments last month alone is unheard of. We need to look at how we can open out that service and how we can provide more outpatient appointments appropriately in primary care centres.

On cancer screening, I am delighted to inform the Deputy that a restart plan was published today. CervicalCheck will recommence on a phased basis next month, with letters going out from 6 July to some 15,000 women a week, and a new HPV programme will commence.

In regard to critical care, the temporary capacity to which the Deputy referred effectively needs to be made permanent. We need to take the opportunity now to address what has been a historical shortage of ICU beds.

Negotiations on the question of access to private hospitals are still ongoing, but there are three pillars I would like to see in any agreement reached. First, if there is a second wave of infections, we must have the ability to step up again and use that capacity. Second, there should be local arrangements whereby cancer services, for example, in some parts of the country might be transferred from the public hospital to the private hospital. Third, there should be a facility for the State to purchase private services for elective procedures, recognising that there will be a shortage of capacity as a result of Covid in some of our public hospitals.

Regarding NCHDs, I fully agree with the Deputy's proposal, as does the CEO of the HSE. I met him this morning and heard his comments later in the day regarding opportunities to open up more training programme places. I share the Deputy's view that this is a once-in-a-generation chance.

In regard to a statutory right to home care provision, I fully support such a right, which I note is included in the new draft programme for Government. It will be a matter for the new Government to decide when to progress the matter but I would like to see it progressed quickly. From memory, the proposed timeline is that the legislation could be brought forward towards the end of this year or the start of next year, with an implementation in 2022. However, that timeline is subject to my recall and the priorities of the new Government.

Is there a plan to use private hospital beds as part of the reopening of public non-Covid health care?

"Yes" is the short answer. We have already seen some services move from public hospitals to private hospitals because of capacity issues. We need to retain that facility and I also see an opportunity to secure some capacity in private hospitals for elective work, recognising the Deputy's point that there are significant waiting lists and access issues which have been exacerbated further by Covid.

Does the Minister have an update on introducing a statutory right to home care provision?

As I said, it will be a matter for the new Government to decide the timeline in that regard. A huge amount of preparatory work is being carried out in the Department of Health, including a massive public consultation in which many thousands of people gave their views.

I do not want to tie the hands of a new Government but I would like to see that prioritised by this House. It would be possible to bring forward legislation towards the end of this year or at the very start of 2021. Being realistic, this would have an implementation time of 2022. In the meantime, we need to look at what we can all do in future budgets to increase the number of home care hours but it is a massive reform and a Government that prioritised it would be a very wise one.

I hope the Minister will also tie its hands on the Bantry hospital issue.

I think the Deputy certainly will. It is a great hospital and has a very bright future.

I thank Deputy Cairns.

We now move to Deputy Boyd Barrett who is sharing with Deputy Paul Murphy.

I saw the Taoiseach on "Prime Time" having fun at Sinn Féin's expense and referring to it as-----

I think it was "Spin Féin". We have all learned it.

Yes, "Spin Féin". Listening to it, I thought that it was ironic. I thought it was even more ironic when I listened to the Minister and to Deputy Donnelly today. Frankly, the performances by the Taoiseach on "Prime Time" and those of the Minister and Deputy Donnelly today suggest that it is more about "Spina Gael" and "Spina Fáil". I mean that in all sincerity because there is almost nothing I disagree with in the Minister's speech. It was a great speech, heaping praise on our health workers, saying we must never go back to where we were. It was absolutely brilliant. I do not know if the Minister wrote it or a speechwriter did but I could not agree more.

I am feeling uncomfortable.

Then the truth is revealed when Deputy Donnelly gets up to speak and it is very clear that the party with whom Fine Gael has just agreed a deal, and the deal itself, make a clear and explicit commitment not to go forward, but to go back. That commitment is to reopen private healthcare and to source the additional capacity that we now need more than ever. We needed it badly before Covid but we now need it even more badly. More capacity is required, but is going to be sourced through the NTPF where we are going to rent it from the profiteers in the private healthcare sector rather than move immediately forward, and not back, as the Minister suggested he wanted to do, to a national health system which would be a single-tier universal national healthcare system. We can have all the aspiration toward Sláintecare with words like "in ten years" and "accelerate", but in actuality the plan is to immediately move back to the two-tier system and to source additional capacity by renting it at extortionate cost from Larry Goodman, Denis O'Brien and all the people who make a fortune out of this stuff. There is the spin.

Is it not the case that the heaping of praise on healthcare workers in the same context rings deeply hollow and is, in fact, hypocritical? What is capacity in the Irish health service? Before Covid we were running at 100% capacity. In the case of ICU capacity, we were 50% below where we needed to be and now we need even more. In the general system, we need an increase in capacity of at least 20% and with social distancing, we need more than that. If we are going to have a single tier health system, it should be permanent capacity and not rented from the private sector. We need more ICU capacity.

What then is that capacity? It is the staff. It is not the beds because we can get the beds pretty quickly. How are we treating the staff? We know the answer. Some 70,000 people who the Minister lauded and on whom he heaped praise, and who deserved to be praised, volunteered to come back and work in the health service but the Government will not recruit them.

The Taoiseach then says on national television that anyone who wants to work in the health service will be hired - this is the spin - if there is a post. It is brilliant. Of course, the number of approved posts is nowhere near what is necessary to give us the additional permanent capacity because the Minister will not approve the posts. Is that not the truth?

Instead we recruit people on agency contracts, hire them and fire them contracts, and we can throw them back out. By the way, the fourth year student nurses can be thrown back out there as healthcare assistants and so on. There is no real commitment to the permanent increases in capacity. I will give the Minister 20 seconds to answer that.

I have a little bit of time to respond. Unfortunately the word "spin" does not fit as well into the name of the Deputy's party but he gave it a fairly good go there. I genuinely get a little bit upset when somebody suggests that anyone is being hypocritical praising healthcare staff. No political grouping owns them. They are all our families, friends, members of our communities and constituents and we are all very grateful for what they do.

It is possible to create a universal healthcare system like the NHS and still live in a country where there is private healthcare and that is what we are trying to do here. We are not trying to ban private healthcare but create a universal healthcare system. I am committed to it, and I signed up to Sláintecare. I do not know if the Deputy's party did, and I do not mean that in a smart way. We have signed up to Sláintecare. If the Deputy looks at the draft programme for Government, it mentions hiring a thousand hospital consultants who can only carry out public work. Paying them a decent salary but having them do only public work is how to create a public health service. Other ways to create a public health service is to have a statutory home care scheme and elective hospitals to drive down waiting lists. We are going to deliver Sláintecare and to accelerate it but we will debate that another time. We are going to hire a significant number of additional staff, and the Deputy will have heard Mr. Paul Reid's comments today about broadening the number of training schemes. As I said, we have a once in a generation chance to keep these people in Ireland.

To follow up on Deputy Boyd Barrett's point I give the example of Tallaght Hospital, where consultant Dr. Anthony O'Connor has reported that the hospital is full. It is one of the hospitals that has no free beds between Covid and non-Covid cases. He has highlighted the heroic work done by staff there, including those who have answered the call to come home and help support our health service and society in its hour of need. He has pointed out that many of these staff are in the process of being thrown away. Junior doctors on his team contracted Covid-19, fought it off, returned to work on the front line and he reports that many of them are facing unemployment and perhaps emigration.

These are people who answered the Government's call, who signed up to work in the health service hoping for permanent contracts and who are now being let go and are not able to find a job in our health service. We all stood here and applauded. Is the Minister going to say to them "So long and good luck" and say to them that they helped us out for a few months in our hour of need but now we are going back to our two-tier health service? What is also in the programme for Government is an explicit positive reference to providing choice between public and private. If there was not a problem with the public health service, the private health system would simply go away. Why would someone pay for extra private healthcare if he or she could get just as good care with public healthcare? What is contained in the document is a continuation of the two-tier health service and the rationing of access to healthcare which the Minister said he was against in the case of the coronavirus but unfortunately where other healthcare is concerned the programme for Government signs up for it continuing.

I have a very simple question. Are jobs going to be provided for all those people who came home because it certainly is not provided for or mentioned in the programme for Government?

I have been in touch with Dr. O'Connor who I have a lot of time for. As I said on a number of occasions, the plan for the doctors and other healthcare professionals who came home - and the category who did not come home but were planning on leaving and could not because of Covid - is to try to offer as many of them posts in the Irish health service as possible. That does not mean - I cannot be disingenuous here - people will be required in the posts that they are currently in. However, there is an opportunity here to hire a significant number of non-consultant hospital doctors, NCHDs, and to increase the number of training places. I believe there are currently more people here than there are training places available. The CEO of the HSE said very clearly this afternoon that he wanted to look at providing additional training places for them to pursue whichever career they wish to in the Irish health service. I assure Deputy Murphy that I really want to keep them here. I very much welcome Mr. Paul Reid's comments on that today.

The devil is in the "as many as possible" phrase, which determines whether these people are going to be just left-----

We cannot hire them on the floor of the Chamber.

If we want to build a proper one-tier national health service, then we will need a lot more staff.

I have another question which is topical. It is good that the advice of the Government and NPHET has become pro-face masks.

It was unnecessarily delayed and confused but now it is pro-face masks and I welcome that. The 41% figure is, empirically from our own experience, very high relative to reality. We are far from that. A recent report, which will be welcomed by the transport workers' unions, states that making face coverings mandatory on public transport will be discussed at Cabinet tomorrow. In that case, the drivers cannot be made responsible for enforcing it. It points to the need for extra staff, otherwise one is putting drivers in potential conflict situations, which has arisen in Britain already as something to be considered.

I cannot pre-empt what Cabinet will decide tomorrow but I think that there is a very strong case for looking at how we can further promote the wearing of face coverings in particular settings. One often does that by changing a law or regulation and that in itself creates such an environment. I take the Deputy's point about not wishing to put drivers in difficult positions and I will certainly reflect that to the Department of Transport, Tourism and Sport.

I note the very sad passing of Detective Colm Horkan and send condolences, on behalf of the Regional Group, to his family and the families of victims of Covid.

As we appear to be exiting this crisis, we may well be heading into another. In this present respite, we have yet to address the expected winter surge and the possible re-emergence of Covid-19, mindful of the reduction in bed capacity and procedures output due to increased infection control protocols. Portiuncula University Hospital in Galway has seen a 10% reduction in its bed numbers. We are seeing a significant increase in waiting lists as a result of lost months of elective activity due to the Covid lockdown. Some of the recent deferment of patient procedures could have been avoided if full-time private consultants in private hospitals were allowed to continue to treat both public and private patients under the recent private hospitals agreement. The imposition of a type A contract during this agreement was rooted in Department of Health ideology and not in the practicality of trying to treat as many patients as possible at every opportunity.

We need a renewed sense of urgency to be brought to bear in our hospital services plan. We need clear targets to deal with the impending bed crisis. System rigidity with respect to existing custom and practice must be set aside. Collaborative, innovative thinking should be encouraged across all grades to decide new work practices. Most importantly, resources must be guaranteed to get the job done. Resources have proven not to be a problem when allocating €330 million for a three-month agreement that delivered 40% bed occupancy. Similar financial resolve is needed to properly support our front-line healthcare workers in the battle ahead and to deliver additional measures.

Among those, I propose that the Minister opens up the recruitment of additional clinical posts, that he provides additional homecare packages to free up the long-stay patient beds, and that he asks hospital management to reserve surgical bed capacity pathways, with supporting ICU and high dependency unit bed assists. We provide mandatory testing and dedicated Covid patient management in assigned group hospitals. After-hours diagnostic imaging sessions seem to be something that we can easily contemplate. I propose flexible rosters to support public consultants providing activity in private theatres. I believe that we need significant engagement and new contracts through the National Treatment Purchase Fund. Additional capacity in the private sector must be immediately negotiated through service-level agreements and contracted bed or procedures purchase through the NTPF. We must not see a repeat of employment conditions in public contracts which are designed to exclude full-time private practitioners, thereby reducing value to the public purse. Additionally, to match the latest scientific understanding, I call for mandatory temperature testing of all hospital workers, which is now commonplace in the industrial manufacturing sector.

Regarding a new ethos, I will revisit the issues at University Hospital Waterford's cardiac care centre. Despite the Minister's welcome recent assurances to me that we should see no further slippage of the second cath lab development promised from September 2018, I confirm to the Minister that the construction timeline has extended by a further three months, and construction may not begin until spring of 2021. This extension of time is wholly unacceptable. This is while we continue to operate in the south east for 39 hours per week, with just one cath lab for the whole of the south east's population, while understanding that the mobile diagnostic cath lab facility which was on site at University Hospital Waterford since 2018 was removed in recent weeks, as the Minister knows.

The remodification of our existing cath lab, which we previously discussed, has also been suspended for many weeks. Despite the new laboratory equipment being in storage in the hospital for a considerable period, engineers required to install and commission it will not travel from abroad because of our two-week isolation requirement for travellers. Such requirements could have been dispensed with by a means of a Covid test on-site at University Hospital Waterford and a managed accommodation agreement. Where there is a will, there is a way. However, it appears that senior officials responsible for delivering this project could not demonstrate a single ounce of wit to consider how these delays could be advanced and this vital work progressed. Every day that the Waterford cardiac service operates without two laboratories means that diagnostic tests that could prevent a heart attack cannot be undertaken, with obvious implications.

It is a further source of angst to me that a commitment to future provision of a 24-7 cardiac care service for the south east is not contained in the present programme for Government. As the Minister knows, University Hospital Waterford is the only designated national cardiac centre which does not provide a 24-7 cardiac care service. I know that for the Minister, the south east's 24-7 cardiac care issue may soon be in his rear-view mirror. I highlight to the Minister, his party colleagues and those who sit on the other benches in this House that this service refusal remains a stain on the Department of Health and HSE's national planning with respect to acute clinical care. All lives matter, including those of us who live in the south east. We will not continue to be treated like serfs on our own land. The timelines proposed to deliver these two urgent cath lab projects must be given the highest priority in the Minister's Department and the ground lost must be recovered. The sad reality to date is that the urgency of NPHET has not been extended to the lives or clinical needs of cardiac patients living in the south east.

This debate mirrors the challenges facing the next Government. The problems are known and widely flagged. Solutions are possible but questions remain. What actions will those in leadership in the next Government take to address these issues? Will the commitments they espoused be forthcoming and brought to bear? Will resources be equally distributed across this country in the future?

I thank Deputy Shanahan. I know he has raised the matter of cardiac care in the south east, as did the Acting Chair, Deputy Butler, earlier today. I know this is an important issue in the south east. I accept that we are not yet where we want to be, but I also acknowledge that there has been significant focus on trying to improve the outcome. We have had a mobile unit for a significant period. We gave sanction for a second cath lab since 24-7 coverage cannot be provided without a second cath lab. There is also a national review because, in any country, there is a limit to the number of services that can be provided 24-7. The question is whether there is a fair distribution and the people in the south east make a strong argument that there is not, but we need a national clinical review to determine how we best distribute that in a safe, appropriate, fair and equitable way across the country. The chair of that review is Professor Philip Nolan who has become well-known to all of us through his work with NPHET. I take the Deputy's point that this is an issue regardless of whether I may or may not be in government. I will continue to give it my attention. I suggest that we got a lot done in the last Oireachtas by Oireachtas Members from the south east coming together for regular meetings. I think we should do that again. I will send a transcript of this exchange to the CEO of the HSE and ask that he provide an update, particularly about the important issue the Deputy raises about slippage and delay in construction timelines.

On the use of private hospitals, in my view, there was not an ideology involved. There was pragmatism, since we needed to get every bit of extra capacity that we could for a massive surge that thankfully, due to the incredible efforts of the Irish people, did not come to pass in the way that it could have. I have figures here that show 11,531 public patients benefited from inpatient procedures. Some 46,298 public patients benefited from day case procedures. Some 71,967 patients benefited from diagnostic procedures. Some 44,865 public patients benefited from outpatient appointments. Tens of thousands of public patients utilised hospitals. Bizarrely, I am pleased that there was vacant capacity in private hospitals. In other words, it was an insurance policy that we did not need.

Was it ideal? No. Are there lessons to be learned? Yes. Do we now need a better deal in future? Absolutely, and we should be honest and humble enough to admit that. Deputy Shanahan's point regarding extra posts was well made and I think I have dealt with it already. I welcome the comments of the HSE CEO on that today. There is a once-in-a-generation opportunity to try to ensure we provide the additional posts so that those who came back to Ireland to help and those that did not leave Ireland because of the travel restrictions can work in the Irish public health service. We very much need them. I also agree with the Deputy's point regarding the need for new contracts for consultants, building on the GP contracts, but also for pharmacists. Whomever is the Minister for Health in the new Government will have much work to do on contractual reform if we are to deliver the health service that we envisage and want through Sláintecare.

There was also the issue of temperature testing.

My apologies. I know several hospitals are now beginning to do temperature testing. I do not believe that it is yet mandatory, but I will contact the HSPC, get some clinical guidance and then write to the Deputy.

We now move on to the Rural Independent Group. I call Deputy Mattie McGrath, who is sharing time with Deputy O'Donoghue.

I am indeed. If the Minister does not get time to answer my questions during my five minutes, he might please write to me with the answers.

That is no problem at all.

I congratulate an Teachta Butler on her elevation. I wish her well.

I hope we will not have any spats.

There were 35 people on trolleys in Limerick hospital today. There was none in Clonmel, thankfully, but we are facing that prospect and Limerick, which also serves Tipperary, has the highest numbers in the country on trolleys most times. I refer to St. Brigid's Hospital in Carrick-on-Suir. How many more times must we plead with the Minister at least to reopen the hospice beds, that were mainly provided by the people of Carrick-on-Suir, west Waterford and south Kilkenny, who fundraised for those beds? We could never use St. Michael's mental health unit in Clonmel because it was closed, yet it is now done up and open for the Covid-19 crisis, but with no patients. Will it now be possible to use it for mental health patients, because we do not have one long-stay bed for mental health in Tipperary?

Cardiac care in the south east is just not good enough, as my colleague from Waterford mentioned. All lives matter to us in the south east as well. I also refer to the whole situation regarding BreastCheck, cervical checks and many more screening services that are so badly needed. A woman contacted me this evening about BreastCheck. She has two young children, is 34 years old and is hugely concerned about her husband while waiting for that test. The Minister might quote figures for procedures that are being done, but they are only a symptom of the waiting and what will be waiting. I am sure all the Deputies here have people in contact with them every day of the week.

I turn to the whole scandal of the private hospitals and the facilities in Citywest. That is ongoing and the Minister is going to keep it going. That is why people are so annoyed. I turn to the scandal of the 170,000 people, I think that is the number but I do not have the exact figures, who applied to Be On Call for Ireland. I think a minuscule number, some 74, were employed. We hear the Taoiseach going on about spin. He is the biggest spinner. One of the biggest fertiliser spreaders in the world would not be as good as him to spin. He spins and spins. Sinn Féin has been referred to as "Spin Féin", but there will be plenty of time, because eventually those spinning around on a spinning top fall off and get hurt. I refer to the situation of leaving these people waiting and the associated worry, angst, anxiety and trauma.

As I stated previously, we need a new wing on South Tipperary General Hospital. Where is that in the planning? Cardiac care in Waterford is pushed back repeatedly and is now to start in the second quarter of 2021. It is just not good enough. All the people, such as third and fourth-year nurses and care assistants, who answered the call are now contacting all of us. We are hearing that people who came home from Australia, Canada and wherever cannot get jobs. The Minister, however, glibly said to David McCullagh, that if posts are available, it will be ensured that they get them. The phrase "posts are available" is key, as other Deputies pointed out earlier.

All lives matter to me, from the womb to the tomb. I have written to the Minister and asked him when he is going to publish the lists of unborn babies that have been aborted in 2019. He is due to do that before the end of June this year. What is the delay? I have written to the Minister and I want an urgent answer. The destruction of human life is just shocking and why will the Government not publish the figures, as it is obliged to in the draconian legislation that was passed? I want answers to that question immediately.

I also want to state that there is great angst regarding the churches. Are we going to be driven back to the mass rocks, like we were in the penal days? People of all faiths have been more than compliant. I visited the Saints Peter and Paul Church in Clonmel, and Fr. Toomey and Canon Crowley, during the week. There are many other churches as well, but I refer to all of the efforts they have gone to in that church and all of the stages, as another Deputy mentioned. They are horrified that people would be pitted against people, such as the caretaker in the church or the sacristan, or whoever is going to stop the people coming in beyond the fiftieth person and tell people "sorry" and the church cannot take any more people. That is just not doable.

The Minister should take control from NPHET. For the time being, anyway, Deputy Harris is the Minister. Perhaps he might be here next week as well. I do not wish that he will, to be honest, because his record in health, as far as I am concerned and it is nothing personal, has been abysmal. I hope, therefore, that he will not be in the same position as Minister. I do not wish him any ill health. I wish him well, and his wife and child as well. However, we have to be allowed to have our faith. Spiritual nourishment is vital to people. The bishops are annoyed over this and rightly so. They have fought the good fight and have been the good servants to the Government and the country.

I called this a scamdemic some time ago. I am not going back on that, because the longer this goes on and the carry on with the churches, it is more like a scam than anything else. It is possible to have a pub packed, while a church with high ceilings, higher than in this Chamber, like Saints Peters and Paul's, that can hold 680 people, is only allowed 50 attendees. It is time the people were allowed to go back, or they will be forced to go to the mass rock. We have a very good anniversary mass every year out in Newcastle in the Knockmealdown mountains. We will have to go out there again and we will. I urge the people to go to mass in large numbers if they want to. To hell with the diktat from NPHET. I am not a lawbreaker, but there is no law now because the pandemic, if it ever was there, is gone, and they are not breaking any law. Deputy McNamara pointed that out to the Minister two weeks ago. If it is a pandemic, we do have emergency legislation, but if it is not a pandemic, there is no legislation and the Minister is on very thin ice.

I thank Deputy McGrath. I call Deputy O'Donoghue.

I congratulate Deputy Butler on her elevation. I congratulate the front-line staff who put the patient at the heart of everything that was done during the Covid-19 crisis. Having contacted the press office today in our area, I am delighted to say that the 68 emergency beds did not need to be used due to the early control of Covid-19. As we have just heard, however, some 38 people were on trolleys today. We have 68 beds, for Covid-19, free in Limerick and we have 38 people on trolleys. When are we going to open the clinics? It seems that all that is happening is a virtual clinic, that is acting, and the can is being kicked down the road. Consultants are in the hospitals, but why are the patients not being met and referred for surgery in the hospitals where there are HSE beds?

In my maiden speech, I stated that the management of hospitals need to treat it like a business. The responsibility lies not only with the Minister, but with the CEOs of each hospital. If there is a public private partnership and a structure is worked out for throughout the year concerning the number of operations that each part will do, it is up to the CEO to control the consultants and to see that they release the beds, or otherwise they do not get new beds in future. That structure can continue throughout the year and a public private partnership, but it needs to be controlled by the CEOs. If those people are not doing their job, they should be accountable to the Minister. They should run it like a business and treat people properly. The consultants, however, have to get better. Before the election, I saw that some 33 operations were due to happen in a hospital in one week. Some 31 of those operations were private and two were public. That is not a public private partnership.

I have commended the Minister for the work he has done throughout the Covid-19 crisis and I have no problem commending a person who has tried his or her best. We have a chance now, however, to get our hospitals into a situation where we make the CEOs responsible and have contracts put in place with all of the consultants, so that if they have a partnership, they have to deliver and stick by what they have. If they manage to do enough operations in the year and they run short by three months, extend the contract with the same pro rata. Until they get to that point, however, we would not give them the extra beds. That would mean the consultants would have to get more efficient with their patients, from a public point of view, and not leave patients sitting in beds.

I have seen a person who came in for a scan on a Tuesday, who was told that the person doing that scan will not be back in until the following Tuesday, but the patient was admitted. The consultant was getting a full week with a person waiting for a scan and that bed was held up. The woman in the bed alongside, and she has all of the paperwork to prove this, told me that the person waiting for the scan left with her daughter during the day, went shopping and came back into the hospital bed because she was told that it was not possible to guarantee that the bed would be held. She was waiting for a scan until the following Tuesday. We could have treated somebody else in that bed, but the consultant was being paid for this person for a week.

That is fraud. We need to stand up and ensure that the CEOs are accountable to the Minister. I am asking for a new structure to be put in place and I would much appreciate anything that the Minister can do.

I will reply in the short time available to me. Whatever role I am in next week, if I am in any, I hope that Deputy Mattie McGrath and I can find another forum in which we can continue to exchange our views. We have had lots of ding-dongs during the time I have been Minister for Health. I respect the job that the Deputy has to do.

We can meet at the seaside in Bray.

Let me shock the Deputy by agreeing with him on something because I think he is entirely right about the issue of churches. I take religious freedom very seriously. I also take the health and safety of people very seriously. The pandemic is real and has taken more than 2,000 lives on this island so far. Let us try to strike a note of harmony. The pandemic is real but people's faith is important. We must find a way for common sense to prevail. Some churches and cathedrals are large and I expect guidance tomorrow from NPHET on how we can safely open them.

The Minister is the one who makes the decisions.

I will get the public health advice and the Government will make a decision tomorrow. I will fulfil my statutory duties in line with any laws in terms of any report I have to publish. I will come back to the Deputy about St. Brigid's District Hospital.

Anyone who has a concern should not wait for a screening service but should go to see his or her GP today. The dates for the resumption of screening services were given earlier and that is important to people.

I agree with the point made by Deputy O'Donoghue about non-Covid-19 care. We need to get things back up and running. The way to get more public work done in public hospitals is through the new Sláintecare contract where consultants sign up to only provide public work in a public hospital. The regional health authorities will bring greater local oversight and accountability into the running of the health service.

I will write to Deputies Mattie McGrath and O'Donoghue so as not to take any of Deputy Connolly's time.

I have run out of steam and am tired of the spin.

I do not think there was any spin there.

The Minister did not give any spin there but there has been spin about public health medicine provided through private hospitals. There is certainly spin there. How many hospitals signed up to the deal at a cost of €150 million per month for three months? Was it 17 or 18? Exactly how many hospitals did so and is there a service level agreement in place with all of those hospitals?

I think the figure is 18 hospitals. If that is not the number, I will write to the Deputy, but that is my memory. My understanding is that service level agreements are still being finalised.

We are almost at the end of that period and I thank the Minister for not renewing those contracts. I understand he has stopped it and is going to look at the whole thing.

That is right.

However, after three months of those deals being in place, we have no service level agreements in place and do not know precisely how many hospitals signed up. The State paid €150 million per month to leave the hospitals empty, by and large.

There were 19 hospitals involved.

To take an example, the rehabilitation unit in Merlin Park University Hospital was stopped. Patients were transferred to the private hospital. Inexplicably, the nurses were sent to University Hospital Galway where they went from ward to ward. I do not know who was behind that decision and who will be held responsible for making it. Luckily, that has now been undone and the rehabilitation unit is moving back to Merlin Park. The Minister can understand my scepticism about all of this.

I come from a city with two public hospitals, Merlin Park and University Hospital Galway, and two private hospitals. I have watched the systematic running down of the public system and the building up of the private system. At a point when quite a lot of the private hospitals were in trouble, we jumped in to bail them out and insisted that the hospitals were kept semi-empty. It is absolutely mind-boggling.

I have one more practical question before I make some general comments. I understood that the Minister was making progress towards the private hospitals coming under the remit of HIQA. Where does that matter stand? When will the private hospitals come under the remit of HIQA?

I will have to revert to the Deputy. That will be done under the Patient (Safety) Licensing Bill but I will have to revert to her on that matter.

I appreciate that. It is a matter that quite a number of Deputies have raised. I understood that it was almost at the point where it was to be done a year ago. Here we are now, having done all of this and given out public money, and those hospitals are not under the remit of HIQA. I found myself in the unusual position of supporting the private consultants' misgivings about this deal, the way they were treated and the fact that they could not see their patients. I fully understood those points and supported the consultants.

I am now very concerned that the Government is going forward with a spin, with the active help of Fianna Fáil. The speech made earlier by Deputy Donnelly worried me as to the direction we are going with public money. We are going to build up the National Treatment Purchase Fund and use more and more private hospitals.

The Minister may recall the 2016 election when various leaders went to Galway and said the accident and emergency department at University Hospital Galway was not fit for purpose. The future Taoiseach, as he then was, Deputy Varadkar and the Taoiseach at the time, Enda Kenny, told us it was not fit for purpose. It is still not fit for purpose and no progress has been made. Is the Minister in a position to tell me what is the status of the project relating to the accident and emergency department at University Hospital Galway? Has planning permission been granted? Is a new department going to be built?

When I last inquired about this matter, which was before the pandemic, the situation was that the papers for planning permission were due to be lodged with An Bord Pleanála. The capital plan is funded. It is badly needed, as everyone has said. I am waiting for planning permission to be granted. The funding to deliver it is in place and the intention is to build it.

I left the Chamber earlier to check on that. I saw a press release from the organisation stating that planning permission was about to go in. That press release was from 2016. It is now 2020. I obviously forgive management for not progressing the matter over the past few months but it is inexplicable to me. There are 150 acres available in Merlin Park, or at least that is what I thought. I recently heard representatives from Saolta hospital group state that there are 180 acres available. It makes absolute sense to build a brand new hospital. We saw the options appraisal and I attended a meeting in the audiovisual room in and at which it was suggested that there was very little difference between the time it would take to build a brand new hospital and the time it would take to build a new accident and emergency department. It seemed an utter waste of public money to be going down two parallel roads. I ask for sense to prevail and suggest that the Government looks at building a new public hospital on the grounds of Merlin Park University Hospital where there are 180 acres available.

The working title of this session of the Dáil sitting is emergency department bed capacity. The following are some things that Dr. Fergal Hickey said in May 2019. He told us about structural inefficiency in the health service, including 29 emergency departments for a population of 4.85 million and the employment of agency staff at a cost much greater than that relating to regular staff, particularly when agency staff do not possess the requisite skills. Those were just some of the issues he raised and he was only one of many consultants. He works in Sligo University Hospital. In the case of a person over the age of 75 waiting on a trolley for a period of over 12 hours, this doctor says that there is little chance of that 75 year old returning to pre-admission function level and, therefore, will most likely need long-term care directly as a result of being on a trolley for a particular period. The doctor also said that emergency departments have become warehousing departments for all conditions which is a move away from what the department was supposed to be. He told us that every year, 350 people will die prematurely as a result of overcrowding in accident and emergency departments. Their deaths will be directly related to their time on trolleys. We know all these figures.

Dr. Hickey made another announcement recently to the effect that the health executive is passively allowing a return to the status quo. Dr. Hickey stated:

The concern is that we are seeing a rise in patients on trolleys at a time when there is still very little elective activity happening in the summer. God knows what's going to happen when winter comes. This should be a cause of major concern to the public. To have anybody on a trolley past the point of admitting the patient to hospital is a cause for concern.

Dr. Hickey went on to state that we should have zero tolerance and so on.

Consultants have also called for an urgent response to what is happening in our hospitals akin to the manner in which the Government responded to the Covid-19 crisis. One of the advantages of speaking at the end is that I have listened to the entire debate. I am afraid that I am not filled with hope. In fact, I am more convinced than ever that the Government is going down the road of further privatisation by buying more space in private hospitals through the National Treatment Purchase Fund as opposed to putting the necessary beds into hospitals. That number of beds is approximately 2,500. We should be filling posts, employing doctors and nurses, and improving their conditions. It might take a little longer than I want for that to happen but I do not see any evidence that it is happening at all. There is absolutely none. Instead, I see a commitment to privatisation. I ask the Minister to tell me I am wrong. I will give him a chance to tell me that.

The Deputy is factually incorrect, and I say that respectfully.

Every single year that I have been the Minister, the number of beds in the public health service, both inpatient and day case, has increased. I will not waste the Deputy's time reading the figures out. Every single year I have been Minister, the number of nurses and doctors in the public health service has increased. I take the criticism, which I think is valid, that it may not have happened at the pace we want. I will also take the criticism, because it is the truth, that we have never gotten enough new beds into the system to get ahead of the legitimate issues that Dr. Hickey presents. On what could be my final time exchanging with the Deputy in this role, I would say the challenge is that as the rest of society tries to move on from the pandemic, which is entirely understandable, we need to continue to talk about health as an emergency and we need to continue to approach it in the same way that we are approaching the Covid emergency.

In fairness to everyone working in the HSE, the hospitals and the doctors and nurses, there is a willingness from all of those people to do things differently. I received a letter from Dr. Emily O'Connor, the president of the association of which Dr. Hickey is a member, with suggestions as to how this winter can be different, and it really could be. That is going to involve addressing questions such as why, in the Deputy's own city, so many residents from a nursing home end up in an emergency department every winter. That is not a criticism of the nursing home but we need to put the supports in to stop that. There are things that will need to be done differently. Bed capacity is definitely one.

On Merlin Park, which is a big issue in Galway, my view is that it is not either-or. I genuinely believe a city like Galway and a region like Galway is going to require a purpose-built hospital on the Merlin Park site and is also going to require Galway University Hospital, an elective hospital for the city and a new emergency department.

The Dáil adjourned at 9.42 p.m. until 10.30 a.m. on Saturday, 27 June 2020.