South Tipperary General Hospital has been operating continuously on a full capacity protocol for the last 16 months. According to the hospital manager, they have been unable to de-escalate the protocol given the persistent and chronically high numbers of patients on trolleys. I thank and praise the front-line staff of doctors and nurses and everyone else there.

There are recent and totally unexpected ward closures in the area. Some 18 step-down and rehab beds will be going this Friday in the wonderful geriatric unit at St. Patrick's Hospital in Cashel. The Sacred Heart unit at Dungarvan Community Hospital, which also is an excellent facility, will lose 11 rehab beds, three long-term beds and three step-down beds. This is just increasing the concerns of the staff and families of the patients in those facilities in the county and in west Waterford.

One measure that has been successful in addressing the problems of chronic overcrowding and long delays in our accident and emergency departments has been the introduction of ultrasound diagnostics in local primary care centres. In January 2017 the community healthcare organisation, CHO, area 5 implemented a short-term initiative whereby GPs could directly refer adult medical card and GP visit card holders for X-ray and ultrasound services to a number of identified providers. They are operating successfully in Limerick, Cork and Kerry but there is something wrong that we cannot do it in County Tipperary. This was supposed to be a short-term emergency measure, designed to relieve pressure on hospitals in the immediate post-Christmas period.

The Mary Street Medical Centre in Clonmel is an excellent health care facility and primary care centre that been attempting to implement the use of ultrasound diagnostics to help patients receive treatment faster. In February of this year, after a lot of hard work, examinations and visits from HSE senior personnel, it was awarded a contract by the HSE to carry out such diagnostics. Astonishingly, this contract was only for the duration of 14 days and was subsequently withdrawn after just ten days. It must have been the shortest contract in the history of the HSE. This is despite the fact that it carried out 35 scans in the seven working days making earlier diagnosis possible, which benefitted patients, and prevented referrals to the overcrowded accident and emergency department in South Tipperary General Hospital. Patients and doctors alike praised the service but the HSE has refused to extend the contract, in spite of the detailed analysis of the success of the measure.

One patient who was helped by this ultrasound service was a lady who was diagnosed with a tumour in her womb but who thankfully has since had surgery to treat it. If she had to experience the 12-month delay for ultrasound in the public system, this lady’s outcome would have undoubtedly been far worse. This lady is a General Medical Services patient and would otherwise have had to pay for a scan, which she probably could not afford.

I hate waving things at the Taoiseach on his long good-bye, and I wish him well, but there was a lovely picture of the Taoiseach on billboards all over the State where he said he would end the scandal of patients on trolleys. Is the Taoiseach able to sleep at night when he thinks of this? I ask the Taoiseach to direct the Minister for Health, Deputy Harris - if he will not do it himself - to continue this wonderful service or to at least give it a three-month trial to see how successful it is. There were 35 patients done in 11 days. The Minister is not here. Tá sé as láthair. He is on the road working hard, but he should be here dealing with these issues.

Ar an mbóthar.

I know that, ar an mbóthar. Ag lorg vótaí. I wish him well in that also, but will the Taoiseach ask the Minister to bring some bit of sanity to this? I am getting comments from the side now and I have no earpiece like the Taoiseach. When the Minister for Social Protection, Deputy Varadkar, was in the Department of Health he did not do a whole lot there either.

This is a disgrace. This was a service that had a proven ability to deliver and to alleviate the crisis. It is a wonderful health centre that had made the investment. Will the Taoiseach please ask the Minister to give this a reasonable chance of examination and exploration to give the patients in Tipperary the same chance they have in Cork, Kerry, Limerick and elsewhere?

Sometimes I find it hard to pick up all of Deputy McGrath's words but I think I heard him say that he wanted some insanity brought into this-----

What was that?

I think I heard him say he wanted some insanity brought to the situation. That seems to be what he said.

The Taoiseach gets my meaning.

If I heard him correctly, the Deputy said that the situation requires that insanity be brought to bear.

I said no such thing.

Perhaps the sound is a bit off.

The Taoiseach is hearing things.

In any event, the Deputy's comments about primary care centres are in the context of a full programme of primary care centres being provided throughout the country. The theory is that people will be able to go to primary care centres to have medical needs which do not require treatment in accident and emergency departments dealt with and that this will help to reduce overcrowding in accident and emergency departments. When primary care centres are up and running they are required to be staffed and to have GPs available. There is little point in building them if they are going to be closed at 5 p.m.. The theory is that a person should be able to go to a primary care centre on a 24-hour basis, as is the case in so many other countries. This issue forms part of the discussions which the Minister for Health is having with the GPs in terms of their contracts and the types of facilities that they require in primary care centres.

According to the HSE TrolleyGAR system this morning, there were 331 patients on trolleys in acute hospitals nationally. While this causes distress to patients, their families and to front-line services, the recent data indicates that the national situation is improving, with approximately 5% fewer patients waiting on trolleys at the end of April this year as compared with the same period last year. Notwithstanding this improvement, these figures are still too high and the Department is working assiduously with the HSE to identify measures to reduce overcrowding in our hospitals and to provide key improvement measures that will continue to reduce trolley numbers and improve patient experience. Several hospitals were under pressure this morning, including the Mater Hospital, Beaumont Hospital, St. Luke's General Hospital, Kilkenny, Letterkenny General Hospital and University Hospital Waterford. Lessons have been learned over the last number of years. The winter initiative introduced in an effort to reduce emergency department overcrowding, in respect of which an additional €40 million was provided, brought about an improvement. Lessons have been learned from that and will be implemented into the future. A range of practical measures were included in that initiative, including the provision of 90 additional beds, aids and appliances for approximately 5,000 patients, 1,000 additional home care packages and 615 additional transitional care bed approvals.

In regard to the particular issue raised by Deputy Mattie McGrath, I will ask the Minister to follow up on the matter for him.

I thank the Taoiseach for his response. If I did mention the word "insanity", I did not mean to do so. However, what is going on in the HSE is definitely bordering on insanity. It is proposed to close two facilities, one in Cashel, which is north of Clonmel, and another in Dungarvan, which is south of Clonmel. Both are excellent care facilities. The Taoiseach's spiel of announcements is all waffle. We know from the National Association of General Practitioners conference held at the weekend that local GP services nationwide are at crisis point and on the verge of collapse. FEMPI cuts of up to 38% and the massive number of GPs emigrating are having an impact.

On the Taoiseach's point that the primary care centres will have to be open 24-7, the facility I am speaking about was not allowed to do that when it had a contract, albeit it was only a 14-day contract. That contract was withdrawn after eight days despite the huge success of the facility in terms of reducing pressure on the local accident and emergency service. If that was not an insane decision, then I do not know what it was. According to expert analysis, the facility provided expert treatment services. Having recruited additional GPs and staff who were told on a Friday evening that they were to start work the following Monday, the contract was withdrawn. That is a waste of money and resources.

The Mary Street Medical Centre is a wonderful facility. Other facilities in Clonmel have invested hugely in equipment to enable them to provide diagnostic services. These services could help to reduce overcrowding in accident and emergency departments, provide people with quicker access to results, thereby reducing long-term damage to people's health, result in huge savings to the State and also reduce stress on families. The HSE is confused. Will the Taoiseach ask the Minister to allow this centre a three-month trial of operation? There are similar services in Limerick, Cork and Kerry and they are operating successfully. What is wrong with Tipperary? It is the biggest inland town in the country with, consistently, the highest number of people on trolleys at South Tipperary General Hospital, better known as St. Joseph's hospital. The Mary Street Medical Centre can provide this service. We need to allow the people in the primary care centres to do their work without having one hand tied behind their backs. These people want to do the work and they are able to do it. They are professionals who have invested and they have all the staff required to carry out the service.

There is nothing wrong with Tipperary or its people but I am sure they are a little disappointed after Sunday.

A little.

They will try to come back at the Reds the next time.

Deputy Mattie McGrath did not turn up.

We are at the job a long time.

I will ensure that the Minister for Health, Deputy Harris, comes back to the Deputy about the particular issue he raised. When facilities are provided, either by the taxpayer or through PPPs, they are provided for a particular purpose. It is up to management to make them work in the best interests of all the people by giving the best level of service. I take the Deputy's point.

The priorities are backwards.

If all the facilities are there, they should be made to work in the interests of people. I will ensure that the matter is followed up with the Minister for Health.