This morning on "Morning Ireland" emergency medicine consultant, Dr. Fergal Hickey, said, "people are going to die as a result". He went on to say, "that is not scaremongering, it is a prediction of what is going to happen". Only six weeks ago, a €40 million winter initiative was announced and it was targeted to ensure there would not be overcrowding in our emergency departments throughout the winter months. However, as we face into the winter, which is only starting, we find this initiative is already failing, given there were 528 people on trolleys in emergency departments across the country yesterday.

In the past number of years, there have been consistent winter initiatives and each and every one of them has failed to make a meaningful impact on the number of people who are lying on trolleys in emergency departments. The HSE is at present involved in a bed capacity review. I would like the Minister to consider the idea that this would be independently assessed due to the fact the HSE is carrying it out for its own purposes. Will the Minister consider the independence of that review being verified given there may be ulterior motives due to the HSE addressing it itself?

Does the Minister agree that, over the coming weeks, further initiatives have to be put forward to ensure bed capacity is enhanced and there is a reduction in overcrowding in our emergency departments? It is a fact there is very low morale across the whole of the health service, particularly in emergency departments. There were 45 people on trolleys yesterday in Letterkenny and 45 in Cork, and the emergency department in Galway is consistently overcrowded and chaotic. Overall, in the past number of years, there has been a consistent downgrading of the ability and capacity of our emergency departments to function. Dr. Fergal Hickey outlined this quite clearly when saying that people will die. This is nothing new. I urge that we do not have a third disappointing Minister for Health in a row and that something serious and tangible is brought forward on this issue.

To turn to the broader issue of the funding of the health service, while there has been a substantial increase, there are difficulties in the context of management bringing forward plans that can be implemented and have a meaningful impact. Will the Minister insist that the bed capacity review is independently verified and assessed? More importantly, in the short and medium term, I ask that there is a revisiting of the winter initiative, which has already failed, given it is November and the burden months will be January, February, March and April. If it does not work in November, it will certainly fail in those four months.

I thank the Deputy for raising an issue that I know is of great concern to all Members of the House. This is precisely the reason that, in budget 2017, as the Deputy acknowledged, the Government put in place a substantial increase in the amount of funding going into our health service. As he will be aware, it now stands at €14.6 billion. It is the highest level of funding that has been made available to the Department of Health and the HSE in our history.

It is a €900 million increase compared with where the Department and the HSE stood a year ago. All of that has been done precisely because this Government recognises the need for investment in our health service to ensure that a stable economy is capable of delivering benefits to those who need them the most, patients and those who need to avail of the emergency departments. It recognises too the huge work of the 100,000 front-line staff working for the HSE.

In respect of the particular issues the Deputy raises, we should consider what that investment is capable of delivering from a bed capacity point of view. The Deputy referred to the investment in University Hospital Galway. That is facilitating the building of a 75 bed ward. In Kilkenny and Limerick, the investment is facilitating the construction and opening of new emergency departments. In Our Lady of Lourdes Hospital in Drogheda, the same level of investment is facilitating the opening of a new extension to deliver the kind of investment and support the Deputy refers to. This is on top of the investment in Wexford General Hospital and the opening of a new accident and emergency ward in the Mater hospital which has had to deal with so much difficulty in recent years regarding the numbers presenting at the hospital particularly at busy times. The level of investment by this and the previous Government facilitates the kind of improvements I have referred to.

The Deputy referred to a bed capacity review which is taking place in the context of that improvement. Whether it should be independent is a matter for the Minister for Health but I will relay this to him. He will be aware of the Deputy’s views. I have confidence in the ability of the HSE to do that work well. In addition, the Government has put in place a fund of €40 million to respond to the kind of pressure the Deputy refers to, which peaks in winter.

We can put this investment in, but in return what we need most is that all those working in the health service, from general practitioners to nurses and those involved in running hospitals, work in an integrated way that will ensure this investment delivers the benefits the Deputy is calling for.

There is a certain amount of live horse and eat grass in the Minister's response. This investment in the future is not addressing the immediate problems of patients waiting on trolleys in our emergency departments. The winter initiative was to address the problems of overcrowding in emergency departments through the winter months. In November, there are 528 people on trolleys. There will be huge difficulties in January, February and March of next year. The winter initiative has already failed to address those key difficulties in our emergency departments. I am not making this up. These are the figures and statistics, backed up by senior clinicians across the country who are saying people will die if there is consistent overcrowding in the emergency departments. Between now and January, will the Minister ask the Minister for Health to revisit the winter initiative and to address the delayed discharges in our hospitals? Over 600 people are still in delayed discharges from acute hospitals across the country. That may assist in addressing the problems in the emergency departments.

A single person on a trolley is one too many. I had to refer to the improvements and investment under way that aim to address these matters over the medium term and into the long run. The Minister for Health will continually review the winter initiative with the HSE. There is a Cabinet sub-committee on health that will review the status of that plan regularly. That is the plan that has delivered an additional 950 home care packages, an additional 58 transitional care beds and is expanding community intervention teams that are at the heart of making sure the pressure the Deputy refers to does not reach an even more acute level in the early part of next year.

I have acknowledged that the bed capacity the Deputy referred to needs to be improved and I have pointed to the improvements that we are making. That winter initiative is going to put in place an additional 55 acute beds and 18 step-down beds to deal with the matter the Deputy is referring to. Of course, this is something that will always be reviewed by Government because we want to ensure that the investment under our plans is in place and delivers the improvements that people need. Whatever progress is being made, and progress is being made, we want to get to a situation in which fewer and fewer people are experiencing the kind of pressure that we acknowledge they are experiencing.