There are 446 people on trolleys in our hospitals today. In my city of Cork, there are 43 people on trolleys in wards and in the accident and emergency departments of Mercy University Hospital and Cork University Hospital, CUH. Tuigeann an tAire gur inniu an 28 Mean Fómhair. The weather is still fine and it should be a time of relatively low pressure on the system, yet we are looking at numbers on trolleys equivalent to over 40% of the record numbers. I am sure I am not alone in having grave concern and trepidation as to what will transpire this winter as pressure intensifies.

There were record numbers on waiting lists this summer, at well in excess of 600,000. The most recent figures for August show an increase of 3,500 on public outpatient waiting lists. For example, the number of people waiting for gynaecology appointments in the maternity hospital in Cork for over 18 months has jumped by more than 500% in the last year, numbering over 1,000 women. The lack of full cover for 20 to 22 week scans means cases are missed, with very serious potential implications for women. The facts are plain. Since the Government took office and the Minister for Health, Deputy Harris, undertook his role the number of outpatients waiting for a hospital appointment has grown continuously. All Fine Gael and this Government have achieved in health is to allow the crisis to escalate to a point that it has become almost normalised.

Many people in hospital could return home much earlier if they were confident they would receive the supports and assistance they need. However, they have not been available for some time. Home help and home care packages were decimated during the crash and the current Government has entirely neglected this area. The under-resourcing of home help has meant that not only are people fearful of returning home but it has also affected people's confidence and reduced their quality of life. Workers are hassled, harried and under pressure, through no fault of their own, trying to manage 15-minute slot after 15-minute slot when the slot really requires half an hour. The vast majority of older people prefer to live their lives in their own homes if possible, a desire shared by their families. We spend €490 million on the fair deal scheme. In comparison, we spend €251 million on home help hours and €149 million on home care packages. There must be a shift in policy and a new focus on what older people want.

Yesterday, Sinn Féin launched a document outlining how we would invest an additional €72.65 million in this area, including in respect of 2.1 million home help hours and 2,500 home care packages.

This investment would significantly enhance the quality of life of older people, the ill and disabled persons and reduce the burden on hospitals which are positively creaking under the pressure. Will the Government commit to ensuring the scandalous under-resourcing of care at home is addressed comprehensibly in the forthcoming budget or will it prioritise tax cuts for higher earners above the needs of an elderly woman who needs assistance to get out of bed to begin her day at home?

As the Deputy is well aware, the announcement on budgetary matters will be made in due course, namely, on 10 October, and no decisions will be indicated until that point.

As a result of the re-investment the Government has made in the health service, the number of patients being treated across the system increased by 250,000 per annum in the past four years. This means almost 7,000 patients are treated in hospital every day and most return home with their life prospects considerably improved as a result of their treatment. We are, therefore, delivering a quality health service.

As the Deputy knows, problems at certain access points have been in the system for many years. It is encouraging, however, that trolley waiting, the very issue the Deputy raises, has reduced considerably across a range of hospitals, including Beaumont, St. Vincent's, James Connolly and Mayo university hospitals. The reductions in trolley waiting in these hospitals range from 40% to 68%. These significant improvements show that the Government's focus on trolley waiting is having an impact. This year, numbers waiting on trolleys across the board are lower than they were last year. The exemplars of good practice show that the policy of focusing on trolley waiting is working. We must continue to roll out this policy and there must be a clear focus on ensuring vulnerable people who enter hospitals through accident and emergency departments are given priority in the hospital service. As I stated, this is happening in many hospitals.

In terms of provision for people to live in at home, we are assessing the need for a more comprehensive home care support package. The Minister of State, Deputy Jim Daly, is examining this issue and consultations are under way to determine how best this can be achieved. The Minister for Health has made increased provision for home help and home care packages. According to a report in yesterday's newspapers, he reported a 10% increase in activity in these areas. Investment is being made all the time to try to make the experience of our hospitals better for every patient.

It is worth paying tribute to those who work in the health service and successfully treat 7,000 people every day, either as inpatients or day cases. This is having an impact on quality of life. While we have problems at discharge and admission, these must be resolved over time.

The Minister will obviously make investment plans for the future. We have the first investments in a new maternity hospital, a new children's hospital and a new hospital providing forensic psychiatric care. These are real investments that will improve quality of life.

It is difficult to credit the statement of improvements in individual hospitals. In reality, there are 446 people on trolleys and even ten years ago, this would have been unacceptable at a time of year when pressure on hospitals should be low. We have reached record numbers of trolleys in winter and extremely high levels in summer and this is putting our system under incredible pressure.

I will certainly pay tribute to those who work extremely hard in the health system and are under severe pressure, in particular, home helps who have to rush across cities and counties to try to do half an hour's work in ten or 15 minutes, which is utterly unacceptable.

The position on the ground is that in April last, 350 people who had been allocated home help in South Lee had not received it specifically due to financial constraints on the Health Service Executive.

It was not down to any delay in processing. This was not helped by the fact that the home help co-ordinator is doing three days per week in the area. Many people have left the system because they have not been able to get the hours. While a consultation may be happening on a statutory scheme or whatever it may be, there is no excuse for this underinvestment in home care. It is a reflection on the Government's wrong priorities and the more expensive cost of home care provided through for-profit agencies compared with direct hires through the HSE.

I must call the Minister.

The Deputy has to reflect on what the Government has provided in the past two years. In that time, an additional €1.3 billion has been invested in the health service. It has been the greatest recipient of any resource at a time when we are now able to reinvest. Priority has been given to health by the Government. The Deputy must also recognise that we had a lost decade. I will not go into the origins of that, but investments that everyone would have liked to have made were not possible. Now, however, we are returning to a position in which we can make prudent investments. The national children's hospital, the national maternity hospital and the national forensic psychiatric hospital are in the building pipeline and will provide increases.

We are ensuring that the extra €1.3 billion is spread judiciously across all demands. Everyone recognises that there are demands, but the Deputy must also recognise that there have been genuine service improvements. Consider hospitals such as Beaumont, St. Vincent's, Cavan, Connolly, Mayo and others, which are delivering improvements. They are exemplars. The Minister is determined to ensure that good practice in those hospitals is mirrored in others where there are continuing difficulties.