Emergency Department Waiting Times: Statements

I welcome the Minister for Health, Deputy Leo Varadkar, who will address the House first and will be followed by group spokespersons.

I welcome the opportunity to update the House on what is being done to improve access to services in hospitals. I acknowledge that too many patients across Ireland are still spending far too long in emergency departments waiting to be seen, admitted or sent home. This causes difficulties and distress for patients and families and makes working conditions difficult for staff. That is why dealing with the issue remains a key objective for the Government.

There is no simple quick-fix solution to the problems which are long standing, complicated and have multiple causes. They all need to be addressed and any effort and action must be sustained. I convened the emergency department task force in 2014 to provide a focus and momentum in dealing with the challenges presented by emergency department overcrowding. The Government allocated more than €117 million in additional funding this year to reduce overcrowding; it has reduced the fair deal scheme waiting time to between three and four weeks, thus freeing up hundreds of hospital beds everyday, and it is supporting hospitals to reopen closed beds and add more. Some 197 hospital beds have been opened nationally since October, with a further 44 due to be opened in the next two weeks.

Some 750 more nurses are working in the health service than this month last year. It is important that we compare this figure with that in the same month in the preceding year because there is a seasonal variation in nursing staff levels based on when pregraduate nursing students qualify. At 19,000, we also have more registered doctors than ever, including more in the public health service than ever before. Some 338 non-consultant hospital doctors, NCHDs, and 78 consultants have been appointed this year, many more than last year. In this context, the Irish Nurses and Midwives Organisation's ballot is regrettable, particularly when we are starting to see the emergency department task force's plan taking effect. Industrial action will not get a single patient off a trolley, but it will make life harder for other non-nursing staff.

The significant increases in capacity are being reflected in emergency department performance. While it is still challenging and there is a long way to go, the average number of patients waiting for longer than nine hours on trolleys was 111 in November. This compares with 127, on average, in June and 173 in February. There are 15% fewer patients on trolleys for nine hours, longer or at all than on this day last year. While a number of hospitals were overcrowded this morning, the total number of patients on trolleys for any length of time was 244, 90 of whom had spent longer than nine hours on trolleys. This compares with a figure of 289 on this day last year, or 123 waiting for longer than nine hours. This represents a 15% improvement on the figure for patients spending any amount of time on a trolley and an improvement of approximately 30% for those spending longer than nine hours on a trolley. By 2 p.m. today, the numbers had fallen to 136. For example, the Mater Hospital which was overcrowded this morning with 33 patients, had 12 waiting on trolleys by 2 p.m.

While the Irish Nurses and Midwives Organisation and the special delivery unit calculate the numbers slightly differently, both sets of statistics agree on the following. The level of overcrowding in November 2015 is lower than the level in November 2014. The picture has changed considerably since August, when the situation was 40% worse year on year, to a position where it evidently is not. We are nowhere near the figure of 500 or 600 that we witnessed in the new year. We should all be focused on implementing the task force's plan. It would be regrettable if a focus on industrial relations and talks at the Workplace Relations Commission on how many staff there should be per trolley distracted us from implementing it and getting patients off trolleys altogether.

The number of delayed discharges is reducing steadily. The latest figure is 558 compared with 830 last December. This is the lowest number in nearly seven years. By the end of 2015, we will have provided more than 1,200 additional home care packages, 149 additional public nursing home beds, 24 additional private contracted beds in Moorehall Lodge, Drogheda and 65 short-stay community beds in Mount Carmel Community Hospital and elsewhere.

When it comes to scheduled care, health services are expanding and the level of activity is increasing, with an average figure of 250,000 outpatient appointments and between 120,000 and 130,000 inpatient or day case procedures each month. The public health service provided more than 1.1 million inpatient and day case treatments and more than 2.4 million outpatient appointments up to the end of September this year, an increase of 8% in the number of inpatient and day case treatments or procedures and 2.3% in the number of outpatient appointments compared with the same period in 2014. Anyone who talks about cuts needs to examine the facts.

Additional funding of €51.4 million provided by the Government in 2015 has allowed the HSE to increase capacity across public hospitals and outsource activity where capacity is not available to meet patient needs. These are real actions, implemented at my direction with funding that I secured from the Government. The detached commentators are those on the Opposition benches who have nothing to offer other than criticism that is often based on a poor or limited understanding or knowledge of the real issues and how the health service works.

The latest National Treatment Purchase Fund figures - these are not the HSE's figures - published on 6 November showed reductions in the total inpatient day case waiting list and the numbers of patients waiting between 15 and 18 months or longer than 18 months. Similarly, there was a reduction in the total number waiting for outpatient appointments, which has fallen below 400,000 for the first time this year. Senators shouild bear in mind that this figure includes anyone waiting any amount of time, including three, four, five or six weeks. Some 85% of patients still wait less than one year to be seen.

We are facing into what is likely to be a challenging winter period. It is imperative that we sustain the momentum of the various initiatives under way. In politics the Opposition will try to exploit problems in the health service for political gain. It was always thus, including when we were in opposition, and always will be. When the Opposition has no solutions other than calling on the Government to do what it is already doing, just a little more or a little faster, it resorts to attacking the Minister for Health of the day personally. That is how politics works, but my focus is not on politics but on finding solutions and implementing them. That is what I will continue to do.

I compliment the Minister on one thing: his speech was astonishing in its brevity. It was one of the shortest speeches ever made by a Minister to the Seanad and did not reflect the seriousness of the issue or the approach that needed to be adopted. The Minister used a considerable portion of his time in making such a short speech on this serious issue to attack the Opposition and he referred to himself in the third person.

The only one who gets away with that, as far as I know, is the Pope. I point out to the Minister that there has been no personal attack on him by my party at any stage.

Listen to this morning's Order of Business.

Senator Darragh O'Brien made comments in the newspapers. Perhaps Senator Byrne does not listen to his colleagues.

There has been no personal attack.

Listen to this morning's Order of Business.

The Opposition is very determined. It is determined to ensure this Government does what it was elected to do, that is, to sort out the problems in accident and emergency departments, make life better for patients and not allow nonagenarians - people in their 90s - or, as happened three years ago, a woman in her 100s, to be left on trolleys for hours or more than one day. The Minister has cherry-picked some figures but the reality is that from October 2014 to October 2015, the situation has got worse. In a number of smaller hospitals, the situation has improved, although there are 33 people on trolleys in Our Lady of Lourdes Hospital today.

The Minister has absorbed the criticism of him as a commentator and reflected it back on the Opposition. The reality is he is the commentator in chief and the health policy analyst, which he has set himself up as. However, that is wrong. He is the Minister for Health and he needs to solve these problems. How much political energy and capital was spent by Fine Gael over a period of approximately seven years before the last election promoting universal health insurance, which was called fair care? There were meetings up and down the country on fair care, which was supposed to solve problems in the health service in general but specifically solve the trolley crisis. It is has now bitten the dust, a year after the Minister wanted it to bite the dust. There was a year of pretence, with time and money wasted and with the problems in the health service getting far worse. As I said to the relative of a woman in her 90s who was left in a trolley for more than 24 hours, this is the price Fine Gael is prepared to pay for the budget giveaway that was criticised by the Irish Fiscal Advisory Council. Fine Gael does not mind this happening but the people who are queuing up or are in inappropriate accommodation in our hospitals are suffering badly. The Government is not prepared to deal with the issue. The nurses' unions have effectively said they have had enough. I note the Minister drew them in today to try to back up his argument. By calling for industrial action, the nursing unions have a different view from the Minister. It is a bit cheeky of him to involve them in support of his arguments.

This crisis is absolutely intolerable. It must be tackled but that is not happening. Some of the worst overcrowding was during the summer when traditionally that should not be the case because the winter is often worse. That was a direct result of Government funding cuts and the mismanagement of the Government service. How much energy, time and resources did the former Minister, Deputy Reilly, put into the special delivery unit, which was sending invoices across oceans to enable people not to pay VAT? How much time was devoted to that special delivery unit when the National Treatment Purchase Fund was abolished to pay for it, with no results whatsoever? Everybody in Cabinet, including the Minister, seemed prepared to give the then Minister, Deputy Reilly, a free pass because he was a doctor and knew what he was talking about. It was very clear that he did not know how to handle the problems in our health service.

The failure of the Minister to take definitive action to solve this problem continues to threaten the lives and safety of particularly vulnerable and elderly patients. It is rich of the Minister to criticise the Opposition and to blame it for criticising him. It is our solemn duty to stand up for those who are on trolleys or who may be about to be left on trolleys and to keep the pressure on the Minister to ensure he is not simply a commentator but does his job as Minister for Health, a post to which he was appointed by the Taoiseach. We must insist that he does that job and that he solves the trolley crisis.

I welcome the Minister to the House and thank him for his statement. I remind my opponent that the health budget in 1997 was €3 billion. By 2007, it was €15 billion but there was not a five fold increase in the services available. There was very little change in that ten-year time period. Since we have come into office and over the past few months in particular, the waiting time for the fair deal scheme has been reduced from 12 to 14 weeks to approximately two to four weeks as a result of opening up nursing home beds, making money available and ensuing applications are processed in a timely manner.

It is important to talk about the numbers when people complain about the health service. We seem to forget the volume with which we are dealing. The total number of outpatient appointments and day case procedures is more than 3.2 million in a 12-month time period. That is a huge number going through the system. In real terms, it is 60,000 people a week attending hospitals. The figure for accident and emergency is 1.2 million attendances per annum, which is approximately 27,000 per week. If there is a 20% increase, that is between 4,000 and 5,000 additional people using accident and emergency departments in any one week. That is a significant increase in a very short timeframe. The Minister is taking the right action in opening additional beds and he has outlined where they will be. He also outlined the fact that 750 additional nurses are working in the service. These are important changes that have occurred.

There has been a great deal of criticism about the number of nurses in this country but the OECD report is quite interesting. It outlines the number of nurses actually working rather than the number of registered nurses and the ratio of nurses per head of population is above average. It is amazing how people distort figures. There is much more that could be done. The main area where we face a challenge is in ensuring we have an adequate number of front-line staff, such as consultants, and adequate availability of space in theatres to do surgical procedures. That is an area on which we need to work.

We also need to engage in long-term planning. We have a hospital which is more than 150 years old and over the past 50 years, bits and pieces have been added on to it without any real long-term planning. Now is the time to start to engage in long-term planning in relation to our health services. We need to put in place plans for the next five, ten, 15 and 20 years. We cannot sort out these problems overnight. The Minister has responded in a very positive manner to the issue in accident and emergency departments. The scare-mongering is uncalled for and is not accurate. It is important we do not give a false impression.

An area we need to examine is the admission to hospital of elderly patients from nursing homes. We need to reduce the number of admissions. I have stated previously that we need to allow nurses to do certain procedures which, at present, can only be done in hospitals but which nurses in nursing homes are competently qualified to carry out. We need to change the regulations to allow qualified nurses, who have the experience, to provide that care in the nursing home without the person being admitted to a hospital.

Someone from a nursing home who needs to see a dietician has to be taken into the hospital and reviewed there. There are some issues we could easily deal with and that needs to be done. Overall, the work that is being done by the Minister, his Department and the HSE has brought about changes, is reducing the waiting times and progress is being made. Long may it continue. There is no difficulty about people highlighting issues, but let us be positive about it and about the changes that have been made.

The only other spokesperson present is Senator Moloney. She has five minutes. The order of the House is that group spokespersons are given five minutes.

I will make it very brief because I know others want to get in and the time is short. I thank the Minister for coming in and for his statement here. The extra nurses, doctors and so on look good on paper. However, nurses do not go on strike just for the fun of it. They are encountering problems in emergency departments and there is a domino effect, because if there are not enough beds in the community and in community hospitals, people cannot be moved out to those and then there are no beds for people in emergency departments to be moved into. I was listening to a nurse on the radio yesterday morning and she said that much of the problem was not just in emergency departments, but about the availability of beds. These patients have been seen by emergency department staff and they are supposed to go onto the wards for whatever care they need, but the beds are not there, so they end up staying on trolleys. There is a domino effect. For example, there is a hospital in Dingle, County Kerry, and beds have been put into a section of it, but they are not open.

There is clearly a staff shortage there and while I appreciate that there are 750 more nurses we still do not have enough, so we need to concentrate on that area. I will give the Minister one example of a nurse I was dealing with. I think I have written to his office about it. An Irish woman who went to America and trained as a nurse there came back home to live with her family and decided she would take up nursing in Ireland. Lo and behold, she has to go back to college in Ireland for four years before she can nurse here. That cannot be right. She has been nursing in America but she has to come back now and do four more years in college. She has to start at the very same place as someone coming out of secondary school. There are places we could look at to bring in some extra nurses.

The home care package has been increased and I can see that, but it is vital to help people keep the patient in the home. As I spoke on the Social Welfare Bill yesterday on the Order of Business, I complimented the carers who care for people in their homes because emergency departments and hospitals would be far worse off if these people were not caring for people in the home. The home care package is vital to help those people. I wonder if it would help if GPs could send people directly for an x-ray without having to go through emergency departments. I know there will be x-ray machines in the primary care centres when they are up and running, but if one sends someone over to an emergency department, they must wait there before being sent on for an x-ray, so that is using up more time.

I could keep talking about it, but I know others want to get in and the time is very short. The spokesperson on health sends his apologies because he could not be here to speak on this, so I will let others have their say and we will wait to hear the Minister's responses.

I welcome the Minister to the House. Looking at the notes on this issue prepared for Members by the Oireachtas Library and Research Service and updated on 15 February, the Minister inherited a situation where Irish expenditure on health is actually higher than the OECD average: $3,890 as against an average of $3,484 for the OECD. The United Kingdom figure is $3,289. There are resource allocation issues. That is a big budget. Most recent Ministers for Health have been an endangered species. They are pursued as if they were Scrooges, looking for new ways to grind down the sick and the poor.

There is a budget, which seems large. Other commentators would say that if one takes into account that the Irish population is younger than typical in an OECD country, there are genuine questions about what is happening here. I welcome the Minister's contribution on this. Is there excessive hospitalisation? That is expensive. Have outpatient appointments replaced GPs? I have heard people, including the Minister's predecessor, say there is evidence that GPs are deskilled in the neighbourhood of major hospitals. It is easier to refer a patient on to a consultant at the hospital rather than tackling the problem oneself. I am worried that we have been running down GPs to some degree and giving away their services for free to the under-sixes and over-70s, regardless of income. I would not have implemented either of those policies. Do we have hospital wards that are designed for nine beds but which the people upstairs only allow eight into, putting pressure on emergency departments? Senator Moloney has mentioned care for patients in their own homes. Can we have clinics attached to pharmacies, for example, and break down the huge hospital monolith, of places with huge premises, many of which were built relatively recently at huge capital costs? We need step-down facilities. Since I raised it with the Minister recently on a Commencement debate, many people would say Baggot Street Hospital is there to replace a number of beds as a step-down facility. It would probably cost about €40 million. We have these facilities. That is a shortage in the system. We have highly-trained and skilled consultants and nurses.

It raises the question of whether the Irish inpatient hospital population needs to be there, whether there is something wrong and whether management can do something in co-operation with doctors and nurses. The numbers prepared by the World Health Organisation, WHO, and the OECD, which the Minister's Department publishes each year and which the Oireachtas Library and Research Service has updated, show there is a big budget, which is generous in comparison with OECD countries. It should always be more, but that reminds me of a definition I read a long time ago. The WHO definition of health was that one should feel perfectly splendid all the time. I am afraid that is not the real world and the Minister has scarce resources over many competing uses.

Now is the wrong time to ask, when strikes are pending, but is there a way that very big budget could be turned into more healthcare with the co-operation of nurses and doctors? Are there excessive layers of administration? Every time somebody makes a comment like that, each of the groups involved says that it is not responsible, but overall the budget is high per head, as those numbers show, at $3,890 in 2012 compared to an OECD average of $3,484. The United States is outstandingly high - that is the way it has decided to go - but many other OECD countries are able to run a health service without the kind of political agitation and distress caused to people by ours. Could we do better out of that budget? If the Minister can, I wish him the best of luck with that and every success and support, but I do not think the problem is entirely one of budget.

I now call on the Minister to respond.

I would like the Chair to clarify whether other Members will be allowed to speak.

My hands are tied by the Order of Business. What was decided this morning was that group spokespersons would contribute to the debate, with contributions not to exceed five minutes.

It does not say group spokespersons only, it says group spokespersons. Surely it is very unusual in a debate such as this in this House that only they speak. No other debate I have attended has been confined to spokespersons. This discriminates against any Senator in the House who is not in a group and is a mechanism to gag other Senators who want to speak and who have stayed here until 5.40 p.m. on a Thursday evening so that we could take part in the debate.

I can only go by the order of the House. My hands are tied.

I am asking for a ruling. I have listened carefully to the Acting Chairman but there is no reference to group spokespersons only being allowed to contribute. May other Senators speak to the issue?

On a point of order, the Order of Business from this morning allows 40 minutes for debate and we have not exhausted that time.

Perhaps the Acting Chairman could use that wriggle room to allow other Members to speak and we could hear the Minister's response as well.

I have a point of order as well. As I have been refused access to any group, I am, as such, debarred from having my views passed through a group. I agree with my two colleagues. I have not come here to have a pop at the Minister but rather to place a few issues on the record. I am really getting tired of being excluded from debate in this House.

With respect, the appropriate time to object to this was this morning.

At no stage this morning were we told that we would be excluded.

It was indicated this morning that statements on emergency department waiting times would be taken and would conclude no later than 5.40 p.m., with the contribution of group spokespersons not to exceed five minutes and the Minister to be called upon to reply no later than 5.35 p.m.

That is usually what we hear and in the normal course of any debate I have listened to which has been ordered similarly, after the group spokespersons, others are allowed to contribute. It does not exclude anybody else or refer to group spokespersons only. That is misleading. I call on the Acting Chairman to make a ruling on that.

The order has already been breached in allowing the debate go past 5.40 p.m. so with that in mind, perhaps the Acting Chairman could allow colleagues to speak.

Three more Senators wish to speak so it is hardly the end of the world.

My hands are tied and I can only vary it on the recommendation of the Leader or Acting Leader.

Senator Colm Burke is Acting Leader.

My understanding is the Minister has prior commitments and, unfortunately, cannot stay longer than the time allocated. I do not think we can extend the time at this stage. I am sorry and I would like to accommodate my colleagues but the Minister has a prior commitment.

I am not involved with organising the business of the House.

We need a nod from the Minister.

I cancelled a visit to Tallaght hospital today - which would have included a trip to the accident and emergency department - in order to be here. That was on the basis of a 40-minute debate. If the House arranged its business for a longer debate, I could have made alternative arrangements. I cannot do so now.

I respect what the Minister has said and I fully appreciate that this is not of his doing. I acknowledge his coming to the House. He will not know the number of times I have gone through this issue in the Seanad and it is unfair to involve the Minister in my grievance. I thank him for coming and I am sorry about this.

I absolutely have to leave by 6 p.m. but I would be happy to waive my time to allow others to speak up to 6 p.m., if permitted. I cannot organise the business of the House, Senators must do that. This is a regular occurrence.

It is well organised by the Opposition.

Bearing in mind the Minister's comments, I ask the Acting Chairman to allow the two remaining speakers to contribute.

I must take direction from the Acting Leader.

In fairness, the Minister needs an opportunity to reply. I would have no problem with the speakers having something like three minutes. That would allow time the Minister to reply. In fairness, the Minister needs five minutes to reply.

I thank the Acting Leader and the Minister for their generosity. Perhaps we could move on rather than discussing the order. Senator Craughwell's views on health would more usefully take up the time that the Acting Leader and Minister have so generously provided.

I propose that we extend the debate to 6 p.m. but the Minister should be allowed five minutes to reply.

Is it agreed to provide three minutes to the speakers? Agreed.

I have come to congratulate the Minister on the work he is doing. He is dead right that we hear much talk about this every year, no matter who is in government. I recall, as a ten-year-old, being lined up in what we called "the long ward" in the regional hospital in Galway because it did not have enough beds. That was a long time ago - 52 years ago to be precise. Every year since, I have heard of the problems of overcrowding. I married an accident and emergency department nurse and I know the Minister has worked in those departments. They are a disaster zone as far as I am concerned.

I have a deep-seated problem with the way the personal dignity of some patients in accident and emergency departments is constantly on the line. I had a relation who was in such a department and she was placed between two men and the beds were so close together, I could not walk between them. Another relation, a young woman, was moved from the accident and emergency department to a ward, for which we were grateful, but there were three men in there. That is totally wrong.

The Croke Park agreement - that was before the Minister's time - and the Haddington Road and Lansdowne Road agreements have all cut resources in hospitals and made them very difficult places in which to work. I fully support my colleagues in the nursing unions on the stance they have taken. I am not so sure the Minister could solve this problem tomorrow morning. He is not working in every accident and emergency department in the country but he is the Minister responsible. He is trying his best and I am not 100% sure he has the full support of the HSE right across the board. I compliment him on what he is doing and I thank him for taking the time to allow me to speak this evening. I would like to see the Minister trying to put an end to the industrial dispute that is about to confront us in the very near future with respect to nurses. We have a problem recruiting them. I do not know what else the Minister can do, as he has offered training money and payment for registration. We lost many of these young nurses to Australia, New Zealand, Canada and various other places and I do not know how they can be encouraged to return.

This is not the first Minister for Health to have this problem on his plate and something tells me he will not be the last. I appreciate his efforts and I wish him luck. I thank the Acting Chairman for giving me those few minutes to speak.

I thank the Minister for coming to the House and making time for this issue. Mark Twain spoke about statistics being pliable and the facts being stubborn. The facts are that the position regarding accident and emergency departments is disastrous. I know the Minister said we are resorting to personal attacks but we are doing our job as members of the Opposition. We are pointing out where the system is failing, so we are not being personal with the Minister. We are asking the Minister to do his job. We are not asking him to be the commentator-in-chief or an apologist for the HSE, which seems to be the role he has assumed. That was pointed out on "The Late Debate" by all four commentators of varying hues, with one saying that if only he was a Deputy and a member of the Cabinet, he might be able to fix the system. We are asking Deputy Varadkar to be the Minister for Health. We are not saying that what he is doing in his capacity is good enough and we think he should do more and do better. He is not the victim and the victims are those on trolleys. This is not a personal attack on the Minister but we do not want him to be the victim-in-chief either. We want him to fix the system.

The victims are on the trolleys or waiting for emergency ambulances. A HSE report pointed out that because Ireland is such a rural country, it is accepted that ambulances will not get there on time. Senator Moloney and I know that happens in Kerry, as every month there is a story about an ambulance not arriving in time. It happens in Kerry and Roscommon and we see it every day of the week. Ambulances are not showing up, let alone getting to an accident and emergency department. Sometimes they show up too late and the patients are the victims. This is not a personal attack and our job is to be the Opposition, highlight what is going wrong in the system and seek solutions. We are not the people who can make the solutions happen.

Accident and emergency departments are not working. January is approaching and we all know what happens in January. The HSE is hiding the problem. When the Minister visited Our Lady of Lourdes Hospital, they moved beds out of accident and emergency departments into the wards and returned them to the department when he left. Any Government with its own health service hiding beds when the Minister arrives would be straight out of "Yes, Minister". It is happening, which is a sad reality. Not only is the HSE hiding the facts, it is hiding patients when the Minister visits a hospital.

I am sure one hell of a job was done at Tallaght Hospital when he visited. Everybody was put into a broom closet and hidden away. If he went back-----

It happened in Drogheda, too.

The victims are the patients on trolleys.

I apologise to Senator Thomas Byrne for making a short speech. Sometimes, it is possible to say what one wants to say concisely without repeating the same things ad nauseam all the time, as if it would achieve anything. Solutions are not found in long speeches, commentary or analysis. That is why my job is to be in HSE headquarters, where I was today, in my Department, where I was yesterday, and on the ground in places such as Tallaght hospital, where I had intended to be this afternoon. I will reschedule my visit. I accept, however, that it is the duty of Opposition Members to put pressure on me to do my job, but they also have a duty to proffer solutions and I did not hear one in the entire debate from Fianna Fáil Members, which says much.

Senator Marie Moloney is correct that overcrowding in emergency departments is caused by a number of factors, most of which are outside the emergency department. It is not a simple function of bed capacity. If it were, we would have had the problems in Drogheda solved by now, given that there are 24 additional nursing home beds and 12 out of 24 open in the hospital. There are other issues, including how beds are used. A hospital in which the average length of stay is eight nights needs twice as many beds as a hospital in which the average length of stay is four nights. It does not get any more work done; it just does it slowly. The same applies to admission rates. In some hospitals 25% of patients who attend the emergency department are admitted, while in others 50% are admitted. The hospital that admits twice as many patients needs twice as many beds. There are many reasons a hospital admits more patients. Although I would love to be able to personally manage every hospital in the country, I cannot. I can give policy directions on how things should be done and try to fund them.

I can check the issue of the American nurse. Nurse training in America is different and not equivalent to training here. Our nurses earn BSc degrees, whereas American nurses are still trained in the old way. I am sure this applies to other professions also. GPs often have direct access to X-ray facilities. Although such access may not be available every day, it is available in most cases. On the western seaboard, we have a pilot project to give all GPs access to an ultrasound service within five days for urgent cases and ten for non-urgent cases. Expanding GPs' access to diagnostics in the coming years is part of the solution.

Senator Sean D. Barrett mentioned spending. It is important that we always compare like with like. Much of what the health service does in Ireland such as in providing social care services for older people is done by local authorities in the United Kingdom. Our spend includes both public and private services and the money spent on private services is probably not spent in the same way as it would be by the State. We are not an outlier in spending. We are somewhere in the middle and do not get the value we should. We have corresponded on Baggot Street hospital. I was there on Tuesday night to check out some of the sexual health services offered. There are no inpatients in the hospital; there have been no beds in it for 25 years. As it is used as a day facility, we are not losing beds.

I thank Senator Gerard P. Craughwell for his very measured comments. As he said, the issue of emergency department waiting times has plagued us for a long time and occurs in all countries in different ways. I want to do the best I can to alleviate the problem. There is variability in implementation and co-operation from site to site.

On ambulance service response times, the target is 80% or 60%, depending on whether it is an echo or a delta call. They have not been invented in Ireland because we are a rural nation; they have been taken from other jurisdictions. It is accepted worldwide that it takes longer for an ambulance to reach a remote location and it always will. No matter how many ambulances we have or who the Minister for Health is, an ambulance will not always get there on time. That is the truth of real life and people who think they can change it by changing the Government or the Minister are mistaken. We are increasing resources for the national ambulance service. During the recession spending was not cut back but increased. An air ambulance was provided. Last year the budget was increased by €5 million and it will be increased by €5 million next year.

Senators may not be aware that I visited Our Lady of Lourdes Hospital twice. I visited it once on the way home from the funeral of the garda who was murdered. I telephoned reception from the motorway to say I would be there in 20 minutes. I do not know how many patients they managed to move in 20 minutes, but it was probably not many, particularly in a crowded hospital.

Given the accident and emergency department crisis, they are not moving them fast enough.

I visited a second time officially. I regularly visit hospitals at short notice. I can do so, given that I know many people who work in hospitals and can walk in. I have visited, without notice, Connolly hospital in Blanchardstown, St. James’s Hospital, the Mater Hospital, Tallaght hospital at 8 p.m. and St. Vincent’s University Hospital and will do so again. Any time a Minister, an important person or a VIP visits anywhere, there will be those who will want to put their best foot forward and make things look as good as possible. If Senator Mark Daly ever has the opportunity to be a Minister, he will know this. The reverse also happens. At a union meeting a nurse admitted to having moved a patient out of a cubicle to a corridor in order that I would see what the hospital looked like on a bad day. Therefore, it happens both ways. When people know the Minister is coming, they organise protests and confront me with issues that might not arise on the day. I did not come down in the last shower; I am not that stupid, which is why I make visits at short or no notice, as well as planned visits.

When is it proposed to sit again?

At 2.30 p.m. next Tuesday.

The Seanad adjourned at 6 p.m. until 2.30 p.m. on Tuesday, 1 December 2015.