It is my duty as an opposition spokesperson to raise the issue of health services and the dire straits in which the services being provided across the country or not being provided are. We now have a situation where community, hospital, primary care and mental health care services across the country are simply not able to cope with the demand. Some 7,781 admitted patients were on trolleys in the month of August alone. That is up 27%. There were over 440 people on trolleys in our emergency departments yesterday, admittedly down today to 345, but still an extraordinary figure for this time of the year. Over 65,000 people were treated on trolleys during the first six months of 2017. By any credible stretch of the imagination, the Tánaiste now has to accept that this Government, despite giving itself applause and claps on the back about the biggest budget it has provided for the health care services, is not providing the health care services that are required.

Will the Tánaiste accept that this Government has been lethargic, at best, in trying to deal with the challenges in the health care services, and primarily in the acute hospital setting? We now have a situation where, week on week, we have record after record being broken with regard to overcrowding in our emergency departments and the number of people in outpatient and inpatient services is now nearly at 700,000. Our acute hospital system is in crisis. Couple that with challenges in primary care and we are going to have a winter in which there will be an awful lot of pressure on our emergency departments. Elderly people in particular will be waiting inordinate periods to be admitted to hospital. Is it now time for the Government to accept that its winter-proofing systems that have been in place for the last number of years have been an abject failure and that it requires a hands-on approach from the Minister and Government along with the Department of Health to deal with these challenges? I do not think it is good enough for the Taoiseach, Tánaiste and others to stand up and say they are providing the largest budget in the history of the State for health care. If they are, they are failing, because it is simply not providing the services that are needed and required across the major areas, namely, the acute, primary, community care and mental health areas. By any credible yardstick, this Government's health system or health services are failing on a daily basis.

Will the Tánaiste accept that there needs to be a refocusing by the Minister for Health and the Government to prioritise the key areas of the acute hospital, the emergency departments and our primary care setting to ensure that, come the winter, we will not have hundreds of people on a daily basis in our emergency departments across the country, and primarily elderly people, which seems to be the case at the moment?

I thank Deputy Kelleher for observing the time. He has set an example for others.

The Government is focusing on the priority areas in health. For example, reducing waiting times for the longest waiting patients is one of the Government's key priorities. It is for that reason that €20 million was allocated to the National Treatment Purchase Fund, NTPF, in the budget, rising to €55 million in 2018.

In order to reduce the numbers of long-waiting patients, the Minister for Health, as the Deputy will be aware, asked the HSE to develop waiting list action plans for 2017 in the areas of inpatient care, which the Deputy mentioned, and also scoliosis and outpatient services. The inpatient, the day-case and the outpatient plans focus on reducing the number of patients who are waiting 15 months or more for inpatient and day-case treatment or for an outpatient appointment by the end of October.

Working very closely with the HSE, the NTPF has been implementing waiting list initiatives to provide treatment for those who are waiting longest on the inpatient day-case waiting list. The August 2017 day-case and inpatient waiting list figures which were published at the beginning of September show that the total number of patients waiting has fallen by over 2,000. Every case of a person waiting is one too many but the Government is focusing on the range of initiatives which are making a difference and will make a difference in the long term. These include, of course, the bed capacity review which is really important and the GP contract so that we can have more focus on primary care centres.

Let me give Deputy Kelleher the statistics. Some 23,000 patients have come off the inpatient day-case waiting list and over 81,900 patients have come off the outpatient waiting list. Also, 237 scoliosis surgeries have taken place. The NTPF is rolling out the day-case initiative as well. That is focused on those waiting longest for day-case treatment. Right now, 2,000 patients have accepted an offer of treatment from the NTPF. All those initiatives are beginning to have the kind of impact we want to see.

Deputy Kelleher also mentioned the winter initiative. There is a range of initiatives to deal with the very real increase in referrals that takes place in the winter period. Following on from last year's winter initiative plan, the HSE, in conjunction with the Department of Health, developed a roadmap for improving the patient experience and to reduce the number of patients waiting for admission on trolleys in order to provide a better response. Each of the hospital groups has been working to progress a very proactive integrated approach around winter resilience planning for 2017-2018 to ensure that specific plans are in place for those predictable peaks of pressure that the Deputy has spoken about.

The day-case reductions are because of the National Treatment Purchase Fund and the intervention which is part of the supply and confidence arrangement. That is one part of policy that is working. Unfortunately, it was a policy the Government did not want to pursue, but it is there. It is proof that if there are imaginative ways, issues can be addressed. When one looks at the day-case waiting list, there is a reduction solely because of the National Treatment Purchase Fund.

The difficulties are in the emergency departments on a continual basis. The reason I raise this is we are now in September and if the trends continue, we will have significant problems in December, January and February - during the winter months. We know that but there is little being done to address these particular pressure points.

The Tánaiste can talk about the overall budget but I refer specifically to emergency departments, the acute hospitals and primary care. We now have a situation where the primary care services across the country simply cannot cope. The idea that one would get an appointment the same day with one's local GP is now a thing of the past. They are overwhelmed and under-resourced. If the Tánaiste could, she might just revisit the two issues of addressing the pressure points in the acute emergency departments and to try to come up with imaginative solutions to support primary care, primarily the GPs, so that they do not have to refer patients to hospitals as much as they are forced to at present due to lack of resources.

I repeat that the development of new primary care health centres is a priority for the Government. As Deputy Kelleher will be aware, funding has been allocated. The Deputy will have seen the centres that have already opened.

Clearly, that has to be a huge part of the focus in making sure there are appropriate referrals to emergency departments. The renegotiation of the GP contract is a key part of dealing with the pressures that are very evident in GP practices throughout the country. Attracting and retaining staff in GP practices must also be a focus in order to ensure we will have local primary care centres. There is an absolute focus on the development and opening of new primary care centres throughout the country to deal with the pressures. Appropriate referral is obviously one of the key parts, but there are also the initiatives that have been taken in different hospitals. I point to what is happening in Beaumont Hospital as an example in that regard. It is very clear that there are hospitals which are dealing with the huge pressures they are under by developing new systems of management. They have also been given extra resources.