It is shocking that 7,630 people were on trolleys across the hospital network in September, which was just last month. That figure represented an increase of 17% on the number of people on trolleys in the same month in 2014. As patients and front-line staff face into the winter period, it looks as if this crisis is certainly going to deepen. Front-line practitioners have said that patient safety is being compromised. Hospital staff are working under unacceptable pressure in a health system that is severely under-resourced. The real cause of this is an ever-increasing lack of confidence.

While the budget debate was taking place here on Tuesday, 13 October, nurses at St. Vincent's University Hospital in this city were protesting over the appalling conditions they have to work in and that patients are forced to endure. A severe shortage of nurses is a major contributory factor to the current crisis. Nurses are choosing to go abroad because of poor working conditions and a lack of career prospects at home. A survey of 2,000 students across the six medical schools conducted by NUI Galway found that almost nine out of ten trainee nurses and those who have come through the process plan to leave when they qualify. That is a very worrying fact and we must face up to it. Career opportunities, working conditions and lifestyle were the top three reasons given by those surveyed.

The INMO estimates, and its figure is confirmed by a comparison between the number of nurses in 2007 and at the end of 2014, that more than 4,000 additional nurses are required in order to return the workforce to a realistic level, one that is capable of meeting the needs of our people. Does the Tánaiste accept that the existing recruitment package is not sufficiently incentivised and will not attract the necessary number of nurses needed to service our health system? What will she do, as Tánaiste and leader of the Labour Party in government, to address this very serious matter?

Deputy Ó Caoláin spoke about the understandable concern about delays and overcrowding in accident and emergency departments. As has been made clear on a number of occasions, dealing with delays in emergency departments is a priority for the Government. The Minister for Health commissioned the emergency department task force last December to provide focus and momentum in dealing with the challenges associated with emergency department overcrowding. The task force last met on Monday, 12 October, and significant progress has been made with all of the relevant parties, including representatives of the nurses organisations, involved in the preparation and delivery of a plan. Delayed discharges are reducing steadily as we speak. The waiting times for funding of packages has been reduced from 11 weeks at the beginning of this year to between two and four weeks now. Transitional care funding has supported approximately 2,000 people who have been approved for the fair deal scheme to move from acute to non-acute care while awaiting a long-term care placement. Over 1,200 additional home care packages will have been provided by the end of this year. Deputy Ó Caoláin and most other Deputies will know from speaking to the relatives of patients that the improvements in the delivery of home care packages have been very widely welcomed and appreciated. In addition, 140 additional public nursing home beds, 24 additional contracted beds in, for instance, Moorehall in County Louth, and 65 short-stay beds in Mount Carmel have all opened in 2015. These provide a mixture of rehabilitation and transitional care for patients who require assisted convalescence before they return home or enter long-term care.

The director general of the HSE is now co-chairing the emergency department task force implementation group from now until March 2016. He has taken that decision in order to ensure that all of the relevant parts of the health services, including acute, social and primary care, are provided with the optimum resources in order to deal with the particular challenges associated with the winter months. Additional funding of €74 million was provided in April of this year. Deputy Ó Caoláin will have seen a very significant additional supplementary allocation for the HSE and the Department of Health in the context of the budget. He will also have seen a significant additional allocation for next year. In addition to the aforementioned measures, an extra €25 million has been invested in support services which provide alternatives to, or relieve pressure on, our hospitals.

The second part of the Deputy's question related to recruitment of nurses by the HSE. I certainly hope that those who are currently completing their nursing degrees and training will give full consideration to a career in nursing in Ireland. I am aware of people who are taking that option but it is not for everybody. It has been traditional for many nurses and other health professionals to go abroad, either for a protracted or limited period of time, to develop their careers. That is understandable and that model has operated in Ireland for a long time. The HSE has been sending out recruiters and using social media and other methods of communication to attract nurses who left the country when there was a moratorium on recruiting public health staff, other than front-line staff. I am glad to say that we are now past that situation because of the economic recovery and this year there are between 400 and 500 extra nurses working in the HSE.

I agree with the Deputy that much progress is still to be made but we have come a long way from where we were at the height of the economic difficulties that befell the country.

Nobody knows better than I the complexity of all of the issues involved in this. It is not just a matter of delayed discharges. The points the Tánaiste has made illustrate the Government's piecemeal approach to the overall difficulties. It is very important to recognise that capacity is critically impacted by the number of nurses available and the current number is nowhere near what is required even to deal with the situation in the here and now.

A key contributor to the shortage of nurses is the excessive delay in the processing of registration applications. Incredibly, the registration process in this jurisdiction can take anything between six and 18 months, whereas on the neighbouring island it takes three to four weeks. While I accept that there can be difficulties in ensuring that all of the necessary documentation is to hand, it is very clear that the combination of the low levels of nursing provision and the delays in the processing of registration applications from nurses coming from overseas is creating what the INMO has described as a perfect storm in our health services. We must respond to this. It is very clear that despite the warnings to the Minister for Health and his Department, the response to this situation has been wholly inadequate. A relatively small additional complement of staff for the Nursing and Midwifery Board is simply an inadequate response at this time.

The Tánaiste made reference to the HSE's so-called "bring them home" campaign.

This campaign is not enticing the necessary numbers of Irish-trained nurses to make the return journey home. That is what the issue comes down to.

I ask the Tánaiste, as leader of her party in the coalition partnership, what she will do to ensure the recruitment package is sufficiently incentivised. We must bear in mind the reasons many young trainee nurses gave for opting to leave Ireland. While money was not the only issue, the cuts of recent years under the financial emergency measures in the public interest legislation were most certainly part of the reason they chose not to stay here. It is October and in no time the crisis that has extended from the summer period through last month and into this month will multiply. If we do not act now, we will come into very serious times.

Again, I appreciate the Deputy's concerns. As he will know, active recruitment is taking place of as many as possible of the young nurses who are currently graduating. My understanding is that a significant number of these nurses are opting to stay in Ireland. Equally, some of them are leaving. Ongoing arrangements are in place to relocate 456 people to Ireland. A relocation package of approximately €1,500 is on offer to attract nurses back and one year of nursing registration fees will also be paid. Those returning will also be eligible for permanent positions and will be given credit for service accrued while abroad.

What else is in the budget to attract people home? A key element of attracting young people such as recently qualified nurses to return, one with which Sinn Féin disagreed, is the reduction in the universal social charge. The reduction will assist people at the beginning of their career who are on lower incremental rates and have not reached the top of the scale. People returning home will face a universal social charge regime under which those who are on part-time earnings of up to €13,000 will be removed from the USC net, while those who are eligible to pay the lower rates of USC will receive a reduction in the rate. People taking up a full-time position will benefit most because the higher rate of 7% has been reduced to 5.5%.

I am aware that Sinn Féin, in its pre-budget submission, did not opt to prioritise reducing the universal social charge for people coming home.