Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Nursing Education

David Cullinane

Question:

77. Deputy David Cullinane asked the Minister for Health further to Parliamentary Question No. 84 of 3 November 2020, if an update will be provided on his plans for paying student nurses and midwives; and if he will make a statement on the matter. [42289/20]

I am sure the Minister is aware that there is a strong campaign under way by student nurses and midwives for fair pay in respect of the work they do. I have heard the Minister state that he is committed to resolving this issue, but student nurses and midwives need more than words now; they need action. I have also heard the Minister say he is committed to a review. It must be ensured that this issue is not, as has been the case in the past, buried in reviews but that it is actually dealt with by the Minister. Will he outline what action he intends to take on this issue in the days and weeks to come in order to resolve it?

It is vital that student nurses and midwives complete their essential clinical placements in a safe environment and our senior nurses have gone to great lengths to ensure this is the case. I also recognise the potential hardship that might arise for students on placement due to Covid-19. Student nurses and midwives are not paid salaries for clinical placements in years 1 to 3, when they are supernumerary or additional to the existing workforce. This is the same across Europe in countries that have degree programmes for nursing and midwifery.

Student nurses and midwives do receive allowances, including an accommodation allowance up to €50.79 per week and a refund of travel expenses. They are the only clinical students who receive the allowance. Students are paid salaries of €21,729 or €22,229 in year 4 of their studies. Last week I wrote to nursing unions and advised of the supports made available in 2020 for student nurses and student midwives. These include access to the pandemic unemployment payment, PUP, for those student nurses and midwives who may have lost part-time employment due to Covid-19. This now includes nurses and students who had to give up their part-time jobs in nursing homes, for example, while on placement, in order to limit the potential for cross-contamination of Covid-19. As the jobs still existed, they could not previously access the PUP, but they now can. This is a specific exemption for nurses and midwives, for which I have secured Government approval and which is not available to anyone else.

I have also asked for a short, independent examination of the current travel and accommodation allowance in the context of Covid-19. I also believe a longer-term review of allowances and the fourth-year student salary is necessary and I have committed to that. My Department is engaging with the representative organisations on this matter, and if they give their agreement for the review, my intention is that any recommended increase in allowances related to Covid-19 would be in place in January, as requested by the representative bodies.

I spoke to the Irish Nurses and Midwives Organisation, INMO, yesterday. It is very concerned that what the Minister is considering is a short-term response. If something can be done in the context of Covid-19, that would be of some help. The Minister, however, can also resolve the issue in the medium to long term immediately as well. When the INMO hears about further reviews, it will hear the can being firmly kicked down the road.

In a response last week, the Minister's party, after voting against a motion in the Dáil, stated, "Student nurses in their final or pre-registration year are paid because they are different and do real work on wards that would not be done were it not for them". It is not just fourth years who do real work, however, so too do first-, second- and third-year student nurses. I received hundreds of emails from those people. I cannot read out all of them out in the short time I have, but I hope to read one out in the next round. The Minister must understand, however, that this is not just an emotive issue, this is an issue of justice and one which the Minister can resolve and which he should resolve. Rather than just commit to reviews, I ask that he please deal with this issue for these workers, because they deserve it and I think the Minister knows that.

Every Teachta deserves his or her time, so I ask that the time limit of one minute be observed.

Regarding the short-term review, we are conducting it because that is what the representative bodies asked for. We are finalising that review now. We are also looking at a longer-term review of student placements generally, but the representative bodies asked for very quick action. They asked that any Covid-19-related allowances, if there is to be an increase, would be in place by January. That is what they have asked for, and therefore that is what is being done.

On the payment of a wage, I will refer to what some educators have said. They are concerned about what looks like a push to turn a successful graduate degree profession into an apprenticeship model, which is the case in Germany and some other places around the world. Some comments included references to the fact that if student nurses and midwives are paid and treated as workers, they will not be exposed to the learning they need. It was also stated that they will be doing lower-skilled tasks and that this is not a degree education. It was further stated that it is important that people understand that placement of student nurses is the same as placement for any other clinical student or healthcare student and that what is being suggested by calls to pay student nurses will set the profession back 50 years. Very serious allegations regarding what is happening on the placements have been made. I assure the Deputy and the House that I am taking these deadly seriously. I have instigated a full review and I am meeting the directors of nursing this evening regarding this issue.

I think the Minister's response is disingenuous. We got a similar response from the Taoiseach in recent days. Let me be very clear that my party is certainly not looking for a return to the past or an apprenticeship programme. We are supporting the call from the INMO for fourth-year students to be paid the equivalent rate of a healthcare assistant and that there be a fair allowance for first-, second- and third-year students. One student who wrote to me commented that she was infuriated to read the statement from the Minister's party, which she referred to as an ignorant statement. She told me that since her initial placement as a student nurse in first year, she has provided care to many patients and that she knows for a fact that the wards would not function without the help of student nurses, regardless of what year they are in. There are hundreds of those student nurses, so I ask the Minister to not be disingenuous in responding to genuine concerns raised by my party and the INMO. We are not calling for a return to the past and we are not looking to go backwards. We are seeking fairness and a generous and fair allowance for those first-, second- and third-year student nurses.

It is a matter of record that a member of Deputy Cullinane's party asked me directly in a committee about the apprenticeship model and repeated analogies have been made to what apprentices are paid. The example of Australia has been raised in this House, which runs both an apprenticeship model and a degree programme. I assure Deputy Cullinane, therefore, that we are taking this issue very seriously. Two separate issues are being raised and we are addressing both.

The first falls primarily within my remit, and relates to whether students are being asked to do inappropriate practices while on placement. I take that deadly seriously. Neither I nor anyone in the Department has had any contact from the colleges regarding this in the past. I have checked.

I have instigated a formal review. If serious breaches are found, they will be dealt with because students are under the care of the HSE when on placement. We are taking this matter deadly seriously.

With regard to the allowance, if I understood the Deputy correctly, Sinn Féin is not looking for a wage for first, second and third years but it is looking for an appropriate allowance. I welcome and agree with that. To that end, we are doing two things. We are carrying out a short review at the request of the representative bodies to get the allowance in place in January at a time of Covid and we are considering a second review that would deal with the time after Covid.

Covid-19 Pandemic

Gino Kenny

Question:

78. Deputy Gino Kenny asked the Minister for Health if he will provide details of the way in which the Covid-19 vaccine will be rolled out across the country; if a new database will be developed to ensure a professional tracking system for both shots of the vaccine; if the programme will be rolled out by the public health regions; the role that general practitioners will play in this roll-out; if there will be a prioritisation of vulnerable groups; if so, the order of this prioritisation; and if he will make a statement on the matter. [42359/20]

Those who saw the images a number of days ago from Britain of Margaret Keenan being the first person in the world to get the vaccine for Covid-19 would have been heartened because the past nine months have been very dark for everybody on the planet. My question is in regard to the roll-out of the Covid-19 vaccine, including the logistics, the prioritisation of vulnerable groups, the role GPs will play and the tracking system that will be in place for this logistical and difficult situation.

 We can all agree that this is a good week and that last week was a good week in terms of our fight against Covid-19 as we move to prioritisation of vaccines if and when they are approved.

The Government is committed to the roll-out of a Covid-19 vaccination programme as soon as suitable products have been authorised and supplies are available. A high-level task force was established to support and oversee the development and implementation of the programme. The task force is working on a national Covid-19 vaccination strategy and implementation plan which I expect to be submitted tomorrow.

Ireland is taking part in a procurement exercise being operated by the European Commission on behalf of member states to procure suitable, safe and effective vaccines in sufficient quantities. Ireland has opted into five advance purchase agreements, APAs, with pharmaceutical companies and a process is in place to opt into a sixth APA. When we start receiving vaccines, we will have to prioritise who will receive them first. Earlier this week, I announced the vaccination allocation strategy for Covid-19 vaccines following sign-off by Cabinet on Tuesday. The strategy prioritises those over the age of 65 living in long-term care facilities, front-line healthcare workers who are in direct patient contact and those aged 70 and over.

The high-level task force is working intensively to ensure that all necessary elements are identified and addressed in the plans for implementation. Its work includes how the vaccine will be administered, by whom and where.  Planning for an ICT system is in train to enable all necessary aspects of an individual’s vaccination history to be recorded. Further details will be included in the national vaccination strategy and implementation plan, once approved by Government.

We all understand that roll-out will be a logistically challenging undertaking for our health service. A tracking system of vaccinations will be important given there will be two vaccines. Solidarity-People Before Profit spoke to a public health doctor recently who told us that they will find this extremely challenging as they are operating at less than one-third of the resources and staff that will be required to roll-out the vaccine. There are enormous challenges in regard to roll-out. There is another challenge, which is the fears people may have about a vaccine. There are people in society who will seek to stoke up that fear. The Minister and the Government need to allay the fear around vaccine safety and roll-out. This will be important because what we do not want is particular elements stoking up fear in regard to the vaccines.

I agree wholeheartedly with the Deputy. A lot of work is ongoing in the Department and across government on a communications plan. We have a very strong record of vaccinations in Ireland. We will roll out a comprehensive plan. It is about listening to people's concerns and taking them seriously. It is also about providing the medical and scientific experts to engage with people and address their concerns.

Ireland has a very good track record. I refer the Deputy to the roll-out of the HPV vaccine, which will save many lives. Ireland had an uptake of 80% of that vaccine. The anti-vaccine movement then rolled into town across Europe and uptake of that vaccine, based largely on misinformation, fell from 80% to 50%. I am delighted that thanks to an enormous effort across Ireland and some notable advocacy, uptake of the HPV vaccine has increased again from 50% to 80%. This will save an awful lot of lives.

To return to the logistics, what provision has been or will be put in place? Various vehicles have been identified for roll-out of the vaccine, including GP surgeries, primary care centres and so on. Britain is providing portable hubs to which people can go to get the vaccine. Is consideration being given to putting in place out-of-hours services in order that GP services are not overrun because that would not be good for anybody? Is consideration being given to portable roll-out of the vaccine over the next three to six months?

The Minister mentioned vulnerable people. Where in that category do healthcare workers come?

I agree wholeheartedly with the Deputy. The prioritisation and implementation strategies announced this week are identified by the task force as living documents because how the vaccines are rolled out and which country gets them and when is dependent on three factors, namely, when the European Medicines Agency, EMA, authorises them, information that is still to come from the regulatory process in terms of which vaccines are most suitable for different people and, in part, the sequence of the vaccines. For example, the first vaccine on which the EMA is likely to make a ruling, probably on 29 December, is the Pfizer vaccine. It has to be stored at -70oC. There are other vaccines, which we hope will be authorised, which are stored at a refrigerated temperature. In the case of the Pfizer vaccine, GP surgeries and pharmacies do not have the necessary type of storage facilities and, therefore, a strategy is being developed to put in place the types of hubs mentioned by the Deputy. There will be distribution from hubs where there is specialist storage. The other vaccines that just need to be refrigerated can be distributed in a different way.

As of now, we have no authorisation on any of the vaccines but the implementation plan being presented tomorrow is an adaptable plan according to the information we get and the sequencing and timing of when the various vaccines are authorised.

Question No. 79 in the name of Deputy Cullinane is being taken by Deputy Mark Ward.

Disabilities Assessments

David Cullinane

Question:

79. Deputy David Cullinane asked the Minister for Health the average wait time for children requiring an assessment of needs in the context of the legal requirements on the HSE to commence such an assessment within three months and complete it within six months; and if he will make a statement on the matter. [42290/20]

We heard at a meeting of the Joint Committee on Children, Disability, Equality and Integration that the State is failing children in terms of assessments of need. The committee heard from parents and stakeholders. What is the average time a child is waiting for an assessment of need in the context of the legal requirement on the HSE to commence such an assessment within three months and complete it within six months and will the Minister make a statement on the matter?

I thank the Deputy for raising this question and giving me the opportunity to clarify the position. I have been observing the engagements of the Joint Committee on Children, Disability, Equality and Integration with the families, the Children's Ombudsman and other representatives.

The length of time to complete an assessment of need under the Disability Act will vary depending on the child’s complexity of need. The average time from receipt of application to the completion of an assessment of need report in 2019 for a child is just under 20 months nationally but there is considerable variation between and within the different community healthcare organisations, CHOs.

The Disability Act 2005 was commenced for children aged under five in 2007. The intention at the time was that the HSE would provide assessments of need under the Act for this group only while the Education for Persons with Special Educational Needs, EPSEN, Act 2004 would provide assessments for schoolgoing children. However, it is important to note that the relevant sections of the EPSEN Act were never commenced. As a result of a High Court ruling in December 2009, the effect of which was to open eligibility to all children born after 1 June 2002, the number of children aged five and over and, in addition, of schoolgoing age, has increased steadily as a percentage of applications received, increasing from 26% in 2011 to 55% in 2019.

This reflects that the assessment of need process is an accumulative one in terms of the numbers seeking access. The recent welcome allocation of €7.8 million through Sláintecare to address overdue assessments will further support the HSE and its funded service providers in ensuring children access the appropriate therapies as soon as possible. Assessment of need is a nut we need to crack. There is no denying that. The lengths of time families are waiting to access assessments has turned this into an industry.

I thank the Minister of State for acknowledging that because there are real people behind these different Acts and procedures. They are parents and children and this issue has a knock-on effect on the overall family structure, society in general and school. It is crucially important that these children receive intervention and assessment in order that there are no lost opportunities. That is what we are talking about here: lost opportunities for children. Parents face a dilemma when their children do not reach their developmental milestones. Some children are being left behind by their peers, are unable to perform tasks independently, or are totally reliant on the care of their parents or caregivers. We need to start doing something now, today, as soon as possible, to ease the access for parents seeking an assessment of need for their children, when and where they need it. What is being done to make this happen in a timely manner?

I again thank the Deputy for this opportunity to lay out exactly what my plans are and to share them with the House. The funding I received through Sláintecare is being adequately used to address that backlog at this moment in time. Next week, at the Joint Committee on Children, Disability, Equality and Integration, I plan to have all the figures to show exactly how the funding has been spent and how we are achieving that. I also plan to meet the Minister of State, Deputy Madigan, next week to address the issue regarding the EPSEN Act. When we originally brought in the assessment of need tools, they were intended to address early intervention. The Deputy spoke about real families. We should have all our assessments of needs done before a child enters the school setting, where appropriate and possible. I want to move away from assessments and get to intervention. That is the conversation I want to have. I have a plan and we are working hard on it.

I look forward to that conversation at the committee meeting next week. The committee heard from the Ombudsman for Children last week and he basically said it is an old fashioned three-card trick, that children are being moved from one list to another and their needs are not being met. I am glad the Minster of State mentioned intervention because that is another problem. When children get their assessment of need and what they need for their development going forward is outlined, the actual wrap-around services they need, such as speech and language therapy or occupational therapy, are not there. Those services must be put in place, in conjunction with getting the assessments of need.

I have an issue that was brought up by the Enough is Enough group at this week's committee meeting. The standard operating procedure is a desktop examination wherein parents fill out forms and assess their children's needs. Parents are not therapists and they have told me that they are terrified they will miss something that will delay their child's development. Does the Minister of State think this is an appropriate mechanism for assessing children in order that their developmental needs can be met?

The whole idea of the standard operating procedure, or SOP, was to gather information so we could put people on different pathways. However, that only ever got off the ground for approximately six weeks because Covid landed. Again, I am seeking funding from the Minister for Health and am using that funding appropriately to address the backlog. As a new Minister of State in my portfolio, this has given me the opportunity to address whether the SOP is fit for purpose. Will it address the needs of the families and get us the intervention we need in a timely fashion? I hope the Joint Committee on Children, Disability, Equality and Integration will bring in the other lead clinician, Dr. McKenna, to give the balance of the conversation. I am not a clinician and I want to hear from the experts. I hope the committee will also invite the HSE lead to discuss this matter.

Mental Health Services

Verona Murphy

Question:

80. Deputy Verona Murphy asked the Minister for Health if it will be ensured that mental health is part of universal health coverage by including care for mental, neurological and substance use disorders; and if he will make a statement on the matter. [42358/20]

I had a very disturbing conversation with a young man ten days ago. He has 20 friends in a social circle and he told me that 18 of them are using drugs. Unfortunately, the two in the group who do not use drugs are struggling with their mental health because they are being ostracised for not joining in. His younger brother has the same problem. When he tries to join his friends, they just turn their backs on him as if to say he is a spoilsport or self-righteous. It is equally stressful for the parents involved, seeing their children trying to do the right thing but struggling to deal with being shunned by their friends. Will the Minister of State ensure mental health is part of universal health coverage by including care for mental, neurological and substance use disorders?

I thank the Deputy for her question. I know mental health and all the challenges people face are close to her heart. At every opportunity she gets she comes in here and raises these issues in a constructive manner. She was here again yesterday for the Private Members' business regarding mental health. I thank her for keeping mental health front and centre. It is hugely important.

We have never needed to put such a focus on mental health as we do at the moment. The Covid pandemic has come down hard on people and I hear the Deputy's concerns about that group of young people and the challenges they are facing. As we look forward to developing our roadmap to building a world-class healthcare system, including putting mental health front and centre, the Sláintecare vision is to achieve a universal single-tier healthcare system. We have a lot of work to do but much of it has started.

Our refreshed mental health policy, Sharing the Vision, is complemented by a national implementation and monitoring committee, NIMC, which will hold its inaugural meeting tomorrow at 11 a.m. We had a fantastic document previously in A Vision for Change but not all of it was implemented and this time will be different. The NIMC will hold both me and the Minister for Health to account, as well as the HSE and the Department. This is the first time we have had clear oversight. To give the Deputy an overview of the independent make-up of the committee, it will be chaired by Mr. John Saunders, who is known from the Mental Health Commission. Mental health reformers are included, as well as psychologists, psychiatrists, social workers, family representatives, minority groups, service users, representatives of Sláintecare and NGOs across the board. The most important thing we can do is to keep the issue of mental health front and centre at the moment.

I thank the Minister of State for her co-operation on yesterday's Private Members' business. It was greatly appreciated. This is a very serious matter and it can be difficult to leave a group of friends or to stand up to peer pressure. It is a stressful situation for those directly involved, as well as their parents. It is alarming that of one social group of 20 young people, 18 are regular drug users. It is hard to imagine the scale of the mental health issues caused by drug use across the country. We might be able to treat or deal with the physical health issues associated with neurological and substance use disorders but any strategies adopted must include mental health provisions as well. This problem exists all over Ireland and we can be pretty sure that similar scenarios exist in every constituency on the island. We need to update our schools drug policy. Funding for mental health services is required in this regard but we need to make that provision as well.

I could not agree with the Deputy more. Our schools policy needs to be updated across many sectors but especially in regard to drug abuse. Sharing the Vision advocates for additional universal supports to provide care to individuals with complex mental health needs, including those presenting with co-existing mental health supports such as addiction or dual diagnosis. This is where it gets very complicated. As regards the dual diagnosis national clinical programme, a draft model of care is in place, which takes account of service users' views and ascribes the clinical pathway for patients with substance misuse issues and significant mental illness.

The draft model of care will not be published until it is finalised by the national clinical lead. We are awaiting approval from the Office of the Chief Clinical Officer. I take on board the Deputy's point. Education is key.

I will diverge from my question slightly to read a letter on some of the issues relating to maternity services:

I am writing to you in regard to the refusal to allow birth partners into the hospital until the labour has progressed to certain levels and the limitations placed on visitation rights after birth. There is also the issue with not having a partner there when receiving bad news.

[...]

The evidence to date from the World Health Organisation states that birthing people need birthing partners as a part of their maternity care service ... It’s not just about visiting rights, it's about compromised care, its delivery of devastating information to birthing people without support, it's making important decisions without your support person, it's about navigating early labour and induction processes alone, it's the experience of post birth trauma and early postpartum struggles from behind a curtain.

Is anything being done to minimise the damage? What can be done to facilitate both parents.

This falls more under the remit of the Minister. I am very familiar with the situation, and I am a mother of three. This week, there was a move to allow partners to attend the 20-week scan, which had not been allowed until now as a result of Covid. It has been challenging. We are talking about hospitals and maternity wards which are home to young babies, including the most vulnerable. The most important thing we can do is keep Covid out of these facilities. The Minister is constantly monitoring this and being updated. He has spoken with maternity hospitals across the country. It is very challenging and difficult for expectant mothers who might not be hearing positive news to have to sit by themselves. I welcome the decision that from this week partners will be allowed to attend the 20-week scan, which is the anomaly scan.

Hospital Facilities

Catherine Connolly

Question:

81. Deputy Catherine Connolly asked the Minister for Health the engagement he has had with the HSE regarding the plan to develop a new emergency department at University Hospital Galway; the status of the development of the planned emergency department; if the HSE has to date completed its consideration of the feasibility report regarding the inclusion of the maternity department in the new block; if so, the planned next steps; and if he will make a statement on the matter. [42331/20]

I am sure the Minister is familiar with the emergency department in the hospital in Galway. At what stage is this project? When will planning permission be submitted? Prior to the 2016 general election, the former Taoiseach, Enda Kenny, stated that the exiting department was not fit for purpose. Deputy Varadkar, who later became Taoiseach, stated that it was not fit for purpose. The current Taoiseach said it was not fit for purpose. Between feasibility problems and business case design, I have no idea what stage the plans have reached.

I acknowledge the Deputy's advocacy for this essential healthcare infrastructure for the region in question. I had a very productive meeting with the Saolta group some days ago regarding ongoing projects at University Hospital Galway, including this one, and a discussion on elective facilities in the region.

I am happy to say this project for a new emergency department at University Hospital Galway, which is part of a larger development incorporating maternity and paediatric services, will be included in the capital plan for 2021 along with funding to progress the business case for elective hospitals. The design for the main block, incorporating a full fit out for the women and children's service, has been finalised and the cost-benefit analysis is to be updated for this development. The design for a temporary emergency department, which is to be constructed, has been signed off in the past week. This is an enabling work to clear the site for the main block development. A procurement process is being progressed as part of this project. It is expected that these works will commence in the first quarter of 2021. Other site enabling works are ongoing in preparation for the main emergency department and women and children's block development, including road and services realignment. Covid-related winter works for the emergency department are currently in progress and expected to be completed in this month or January.

I asked for a response in plain English. Where is the planning permission at? When will the planning application be submitted for the emergency department in Galway? In 2017, then Minister for Health, Deputy Harris, told us that a new emergency department for University Hospital Galway was being designed with a view to planning for construction being provided as part of the 2017 capital plan review. This hospital serves almost 1 million people from Donegal right down along the west coast. That is six or seven counties. The entire hospital is not fit for purpose. I wish I had time to go into that matter. There should be a brand new hospital at Merlin Park, not just the elective facility that is planned. After talking to the HSE and after years of delay, when will planning permission for the emergency department be submitted to the city council for approval?

I will get a specific answer. That specific query was not included in the question the Deputy submitted, which seeks an update on the totality of the works. The latter is what I endeavoured to provide. I will revert to the Deputy very quickly with the timeline relating to her additional specific question on planning permission.

On the new hospital, I had a very constructive meeting with the Saolta group this week. It has a plan that would incorporate a more ambitious project than simply the elective day case hospital which is under consideration. It includes inpatient beds, additional operating theatres and so on. It would be very favourably disposed to that being on the Merlin Park site. We are progressing that. This week, the Department has received a report on all the potential sites for this really important development.

The most important information regarding when construction on the emergency department will start is that it is being included in the capital plan for next year. That has not happened before. It is very important work.

My question was specifically on the Minister's engagement with the HSE regarding the plan to develop a new emergency department. Given the history of this matter, it is quite obvious that planning permission was the main thing.

I have a slightly different opinion. I believe that a brand new hospital should be built on the 150 to 180 acres of the Merlin Park Hospital site and that both facilities should be used as sister hospitals. I am no expert, however. The options appraisal did recommend a brand new hospital. The decision was to take a small part of that and to build an elective hospital at Merlin Park. I would welcome change on that. If there is a move to having a brand new hospital at Merlin Park to serve a population of over 1 million and rising, I welcome that. However, I am tired of the scripts about feasibility studies, business cases and examining things relating to a hospital that is not fit for purpose. It seems to be driven by certain elements in the medical community rather than a proper appraisal of a need for a new hospital which the options appraisal has gone some way to do. If we keep going like this, a new hospital will be built before there is a new emergency department. It makes sense to build a new hospital, not to have parallel buildings and a waste of money.

In defence of University Hospital Galway, I think it is fit for purpose. The staff there do exceptional work. I visited the hospital when I was in opposition.

The staff do exceptional work, it is the building I am concerned about.

They do indeed do exceptional work. The proposition of elective hospitals is one being deployed in Cork, Galway and Dublin. It is international best practice and is going well where it is used. Tallaght has secured an elective-only site in its area. The idea is to separate scheduled and unscheduled care as that has good outcomes.

I take the point about having a more ambitious plan than just building an elective hospital. The Saolta group shares that view and we had a detailed discussion about the matter during the week.

To finish on a positive note on emergency departments, when I was in opposition, last year and in previous year, the Deputy and I had pushed hard on the issue of trolley counts and people, particularly older individuals, waiting on trolleys, sometimes for days, including in Galway. It is only the second week of December and still early days, but I am glad to report that so far this year while 90% of people are coming to emergency departments and 90% being admitted relative to last year because of the good work done on the €600 million winter plan, including investment for Galway. The trolley count is at less than 30% week for week compared with last year. Many of those on trolleys are for shorter and shorter times and are in more appropriate conditions suitable to the Covid environment.