The crisis in our health system is getting worse. This morning, we learned that 99% of members of the Irish Nurses and Midwives Organisation in Beaumont Hospital in Dublin have voted for industrial action. This is not a dispute about pay; it is a dispute about patient safety. Nursing staff levels have been decimated on the Government's watch. Nurses would tell the Tánaiste, if she cared to listen, that it is impossible to provide a safe level of care to patients. Those are not my words; they are the words of the professionals. They tell us that staff are close to burnout, that their workloads are impossible and that they have been highlighting serious concerns with management for some time. However, nurse numbers continue to fall and the situation continues to deteriorate.

Beaumont Hospital is short 45 nurses in the medical and surgical divisions alone. Today, 22 patients in that hospital are on trolleys. Here in Dublin, my local hospital, the Mater Misericordiae University Hospital, is 100 nurses short. Today, it has 29 people on trolleys. In fact, as we speak, the Mater is on the verge of triggering the full-capacity protocol. That is how bad things are. Why is this? The answer is quite simple. Today there are 4,500 fewer nurses in the health service than when the Government took office five years ago. This is the result of the Government's health policy and its refusal to invest and reform. It seems the Government prefers to give tax breaks to the rich than invest in more nurses, more home-help hours or more nursing home beds. The Teflon Minister for Health, Deputy Leo Varadkar, has abandoned the Government's big idea and now the Government has no plan and, worse still, it has no clue.

My question is straightforward. Given the scale of the crisis, does the Tánaiste still have confidence in the Minister for Health? How can the Government tell staff and patients at Beaumont Hospital and beyond that it will ensure patient safety?

The State industrial relations machinery is at the disposal of the parties to the dispute. It is at the disposal of the nurses and their representatives as well as the management of the HSE.

I sincerely hope that if those mechanisms are used there will not be industrial action. It is to be hoped such a situation could be avoided with the use of industrial relations machinery.

On the Deputy's point on overcrowding in respect of emergency departments, the emergency department task force implementation group is co-chaired by the director general of the HSE and Mr. Liam Doran, the general secretary of the INMO. It has already implemented a range of measures and other measures to improve the situation are in train as we speak. The emergency department task force has provided funding for the opening of an additional 300 beds to allow patients in emergency department beds to move to other, more appropriate, units within the hospital and has provided significant funding for step-down facilities, in particular for older people who may need nursing home respite care or longer-term nursing home care.

As the Deputy knows, the waiting time for funding for the fair deal has dramatically and positively improved. Additional funding has been provided for the fair deal scheme,-----

Why do they want to go on strike then?

-----173 extra community beds have been opened and 65 beds have been opened in Mount Carmel, which is now the first public community hospital in Dublin.

This is the same answer the Taoiseach gave yesterday.

The question of emergency departments requires widespread constructive and positive action from hospital management, consultants, senior management and nurses. Some 700 more nurses are employed in the public health service than one year ago.

The Government came into office in 2011.

There are a total of 35,163 whole-time equivalents, compared to 34,404 whole-time equivalents in October 2014. As recently as a couple of days ago, an OECD report, which was widely circulated in the media, indicated that we have one of the highest ratios of nursing employment among all of the OECD countries.

We need extra resources, but we also need to improve management. The emergency department task force comprises the people at the heart of the issue, namely, the chief executive of the HSE and the general secretary of the nursing union. They are working together to resolve the situation, which also requires additional resources, beds and staffing. Anybody who has experience of being on a trolley, in particular the elderly or those who have had relatives, children or parents who have been through that experience, know it is a difficult situation. Through the provision of all of these resources, the situation is being invested in and improved upon. A significant number of extra nurses have been employed this year.

The Tánaiste has some cheek to call for constructive engagement from nurses who are at the end of their tether. They are stressed out of their minds and managing an impossible and utterly chaotic situation in our hospitals. It takes gall of the highest order for the Tánaiste to appeal to them to be constructive. They are more than constructive. Every day they are managing the chaos the Government has caused in our hospitals.

I referred to the Mater Hospital, which is about to invoke the use of the full capacity protocol. This involves taking people from trolleys and moving them to different wards - the Tánaiste knows the protocol. Does she know that on any given day seven hospitals trigger that protocol? That is how dire the situation is, but that seems to pass the Tánaiste and Minister by.

The Tánaiste has bragged about 700 extra nursing posts. As of 8 November, the figures from the HSE's staff management analysis show that in terms of staff nursing positions we are in a minus situation. We are actually down 274 posts. The Tánaiste can play with figures in terms of recruitment, but she cannot get away from the fact that there are 4,500 fewer positions, the moratorium has buckled our hospitals and something urgent and immediate needs to be done.

I ask the Tánaiste to answer the questions I put to her initially. What of the Minister, Deputy Varadkar? He is presiding over a disaster that is putting the safety and, God forbid, the lives of patients at risk. That is the reality.

Hear, hear. That is true.

Does the Tánaiste maintain a position of confidence in him? I refer to those who attend Beaumont, the Mater, Our Lady of Lourdes Hospital in Drogheda and hospitals across the State. I ask the Tánaiste to tell them how she will ensure patient safety.

Beaumont needs more beds.

As it happens, I know the Mater Hospital extremely well because I have been with people who have used its services, in particular elderly people-----

On trolleys.

-----on many occasions throughout the decades, and not just today or yesterday. I do not know whether the Deputy has been in the Mater Hospital recently, but it probably has one of the best emergency departments in Europe, which is situated in a very fine, improved, refurbished and rebuilt hospital.

I do not deny for a moment that there are very serious stressors for very hard-working nursing staff. I have said that the Minister, Deputy Varadkar, brought the task force together, which is headed by the head of the HSE and the head of the nurses' union. They have been given-----

He passed the buck.

There are a lot of heads.

That is a crazy answer.

If we are interested in solutions-----

We are.

If the Deputy knows anything and has ever spent nights in an emergency ward or emergency department, she will know one solution which most hospitals could adopt, and which is available in a number of hospitals at the moment, is an urgent assessment unit. Older people can go to a special facility, which the Deputy needs to go and see in operation. I can tell her-----

It is the fault of the nurses and doctors.

I know how it operates.

The Deputy needs to talk to staff working in emergency departments, nurses and those who work in hospitals with such facilities.

The Government has vandalised capacity for the past five years.

It is one of the best innovations that has happened in our health system in recent years because it allows chronically ill older persons with medical conditions to be checked out over a number of hours or longer, as required. People do not have to be in the queues to which the Deputy referred. The Deputy is shaking her head. Obviously she has never seen-----

In disbelief.

Obviously she has never seen these urgent assessment units. We have some of the best staff in the world working in our hospitals.

We have some of the best crises in the world.

It is in everybody's interests to come together and resolve the situation using the industrial relations machinery of the State. The Deputy hardly wants to see nurses going on strike.

No. I want the Government to make the right investment in staffing.

She is not suggesting that she wants that. I accept she does not want to see nurses who work hard going on strike. We want to resolve this issue, which we will do by providing more beds and employing more nurses.

By cutting more taxes for the wealthy. Read the report of the Irish Fiscal Advisory Council. The Government is vandalising public services.

Some 700 extra nurses have been employed this year and 400 nurses are currently in the recruitment process for additional staff. We are in favour of reducing USC for low-paid workers.

The Government is also in favour of vandalising public services.

I call Deputy Mick Wallace.

It is in favour of more patients on trolleys.

Order, please.

We have had a complete reversal of all Labour Party principles. What it is doing is unbelievable.

I have called Deputy Mick Wallace. Order, please. I ask Deputies to settle down.

Independent analysis and vandalising public services. That is what it stands for now.

Could we have some order, please? Deputy Mick Wallace has the floor.

That is why Sinn Féin voted against tax cuts for lower paid workers.

The Tánaiste will get a good tax cut and a good pension increase, fair play to her. She has given herself that.

There is no need for this disorder. I have called Deputy Mick Wallace.

There is every need for this disorder.

Well done. Look after yourself and your buddies.

This is disgraceful carry on. Go away out of that.

Deputy Durkan, please. I call Deputy Wallace.

It is disgraceful.

Back to Fianna Fáil policies.

Deputy Doherty, please.