By the end of this year, we could witness over 100,000 people having been on trolleys during 2018. So far this year, more than 10,000 people aged over 75 have been waiting for more than 24 hours in our accident and emergency departments and we have lost approximately 136,000 bed days through delayed discharges. That is only in the first ten months of the year. We know the extraordinary impact this has on patients and people, as well as on mortality rates in our hospitals and the worsening of illnesses that people have as they present to accident and emergency departments. This is not to mention the major problem of people waiting for more than 500,000 outpatient department appointments, with 16,000 children waiting for more than a year for an appointment in the three Dublin hospitals alone. Yesterday, there were 449 patients on trolleys and there are 508 patients on trolleys today. This places enormous pressure on the staff of our accident and emergency departments and hospitals.

A document leaked to The Irish Times this morning examined lessons to be learned from the winter crisis of 2017 and early 2018. One of its most basic observations is the need to plan in advance and have all winter plans completed by the end of July 2018. We are now in November and we still do not have a winter plan announced.

We have also learned through a leaked report via Martin Wall, who makes up for the absence of transparency within the Government and the Department of Health on health issues by revealing confidential letters on a regular basis, in a confidential letter from the Department to the HSE, that €50 million that was to be spent on additional beds last year was not spent but was instead used to deal with the excessive spending of 2017. That is incredible and it strains Government credibility on the health issue, particularly in terms of emergency departments, to the very limit when it now emerges that despite all of the announcements from the Minister, Deputy Harris, throughout the year that money would be made available for extra beds and capacity, we learn that this money was never spent on extra capacity or beds. We know from many sources, the most recent being the former HSE director, Tony O'Brien, that the inability to recruit quality consultants and the paucity of applicants for consultant posts is adding to the consultant crisis.

The need for a winter plan is basic. It is to enable people to have time to build up physical capacity in terms of beds and recruitment of staff in terms of the hospitals. That did not happen last year. It came too late and the money was not spent optimally and, as a result, we had a crisis reaction which was very poor and ultimately disgraceful. There is the potential for the same issue to arise this year due to a lack of planning.

Will the Taoiseach explain to me why that extra €50 million allocated last year was not spent on additional beds and capacity? Will he indicate to me when the plan for the forthcoming winter period is to be announced by the Government?

I acknowledge that we have a long-standing problem with overcrowding in our emergency departments which we have faced for probably two decades at this stage. As a doctor and a grandson, I certainly do not want to see any citizens or patients spending prolonged amounts of time on trolleys waiting for hospital beds. There were 391 patients on trolleys this morning at 8 waiting for admission to a bed. While that is an increase of about 28% on last year, it is much the same as it was two years ago and most of those patients will be in beds by this evening.

As is always the case, there are big variations from hospital to hospital. There are as few as two or three patients on trolleys in Portiuncula, in Mullingar, in Connolly Hospital Blanchardstown and as many as 36 in St. Vincent's University Hospital. We see huge variation from hospital to hospital, notwithstanding the fact that the same issues and challenges arise in every hospital. We see once again that the RCSI hospital group which includes Beaumont Hospital, Our Lady of Lourdes Hospital, Drogheda, Connolly Hospital Blanchardstown and Cavan General Hospital is outperforming all of the other hospital groups. The number of patients on trolleys in that hospital group is at a record low if not a ten-year low and that shows the extent to which this is about clinical leadership and management as much as it is about resources and other issues.

To answer the Deputy's question on new beds, 240 new beds have been opened. That consists of 22 in St. Vincent's University Hospital, 29 in Our Lady of Lourdes Hospital, Drogheda, 17 in University Hospital Limerick, 28 in University Hospital Galway, 19 in University Hospital Waterford, 20 in Beaumont Hospital, 23 in St. James's Hospital, 24 in the Mater Misericordiae University Hospital, Dublin, 11 in Naas General Hospital, 30 in Cork University Hospital, and 14 in St. Luke's General Hospital, Kilkenny. It was not possible to spend all of the money for many different reasons but much of the money was spent in opening those 240 beds.

Why was it not possible?

There are different reasons and different issues why beds cannot be opened. Much of it has to do with planning, for example, but if the Deputy will let me answer his question I will do so.

I have itemised the 240 beds that were opened. Another 79 beds will be opened. They have been delayed but they are planned for this quarter and the first quarter of 2019. That includes an additional 30 bed ward in Our Lady of Lourdes Hospital, Drogheda and a 40 bed modular ward block in South Tipperary General Hospital, which was due to be open by now but is under construction. There will also be four additional high-dependency beds in the Mater Private Hospital in Cork.

On the numbers of patients experiencing time on trolleys, it is important to point out that the official numbers show that the numbers of patients who have had to spend time on a trolley waiting for a bed has been down month on month. It was down in May compared with May of last year and it was down in June, July, August, September and October.

The reality is that the small number of beds promised for 2018 were simply not delivered by the Government. The modular unit in Clonmel has been promised for over two years, if not longer, but it still has not been delivered. Yesterday the Minister for Health could not give specifics for additional bed capacity in 2019. He used the phrase "early in 2019." To be fair, the Taoiseach's predecessor, Deputy Enda Kenny, gave a whole new meaning to the term "early". Normally, it meant "at the very earliest", "the middle of the following year", if not "the end of the year." Therefore, the Taoiseach must forgive me for being somewhat sceptical when Ministers talk about "early next year" because invariably it means the end of next year and sometimes it will drift into early the following year. The problem is delivery and the absence of same. Too many people, particularly the elderly, are suffering far too much in emergency departments because of the absence of planning. The lesson that was supposed to have been learned from what happened last year was that winter plans must be concluded by the end of July, but again, that did not happen this year. We are facing into another winter crisis in emergency departments, with a chronic absence of any planning and a lack of confidence in the capacity of the health service to deal with the issues that will undoubtedly emerge in the coming months.

The facts are that when Fianna Fáil was in government with the Green Party, it took a decision to reduce the number of hospital beds in the health care system. It did not do so because of austerity. It did it during the boom because it decided that there would be a shift towards day care and primary care services. As a result, it started to decrease the number of beds in acute hospitals. We reversed that decision in 2014-15 and have been adding beds ever since. I have listed for Deputy Micheál Martin exactly where the 240 extra beds opened this year are located. There are 79 more on the way that will be delivered at the end of the year and the early part of next year. We are getting it done and delivering. We are putting new beds in place and reversing the Fianna Fáil policy which was to reduce the number of hospital beds in the acute hospital system.

Fine Gael is reversing its own policies too. It reversed its policy on universal health insurance.

Please, Deputy.

The Taoiseach is talking about reversals, but there are a lot of reversals.

When it comes to winter planning, we have had a winter plan every winter for ten or 15 years and it has not worked.

It has not worked very well.

News flash - we had a winter.

May we have order for the Taoiseach, please?

If the lesson in winter planning is that the standard winter plan that we have had for ten or 15 years, including additional home help, additional home care and transitional care, has not worked, the last thing we need to do this year is have yet another winter plan that will not work.

It is in the Government's own document.

That is what is going to happen. Between 22 December-----

May I speak?

Yes, you may. Please, Deputies.

Between 22 December this year and 3 January next year there are 12 days, seven of which will be Sundays, Saturdays or bank holidays. What has been happening in the health service for ten or 15 years is that hospitals effectively closed for seven days out of 12.

Why?

Christmas comes every year.

We need to change that. We need to make sure, for the first time ever, that during that period radiology departments and laboratories will be open and working at full whack, that consultants will not be on holidays in the first week of the year, particularly those who work in emergency departments, and that nurses will not be on leave in the first two weeks of January. We need to make sure that every bed will be open. That is the kind of winter plan we need; not the kind we have had for years and years that does not work.

The Taoiseach has been in government for eight years. He needs to go and do it.

I ask Members to be aware of the clock and try to adhere to the rules of the House.