Yesterday the Taoiseach let the mask slip again in his latest attack on nurses and doctors in what was a vindictive attempt to shift the blame for hospital overcrowding away from him and his track record as Minister for Health, the performance of the Minister for Health and the Government. He attempted to put the blame on the shoulders of front-line staff in hospitals - nurses and doctors. There are moments when we see the true character of the Taoiseach in his attitude to workers and others. We got a glimpse of it when he was Minister for Social Protection. We all recall his welfare cheats crusade which turned out to be a ball of smoke and a publicity stunt, but it hurt many in receipt of welfare payments. We also saw it when he exposed his attitude to workers when he proposed in the run-up to the Fine Gael leadership election a Thatcherite ban on striking. We saw it again yesterday. It was little wonder when he was confronted with his record and that of his party in dealing with hospital overcrowding that he sought to shift the blame away from his performance onto the shoulders of hardworking nurses and doctors.

To be clear with the Minister and the Government, nurses' and doctors' leave is not the problem. It does not contribute to the problem of patients languishing on trolleys and hospital overcrowding. It is not why almost 1 million patients are waiting to see a hospital consultant or why we see record numbers of patients lying on trolleys in acute hospitals every day of the week. There are thousands, many of whom are older people who need support. The problem is the lack of capacity in public health services and the difficulty in recruiting and retaining front-line staff. The majority know that when they get into the system, they receive a very good service. That is because of the professionalism of front-line staff - nurses and doctors - and despite the fact that the Government has not invested in the public health service. It was appropriate and right that nurses and doctors pushed back against the Taoiseach's narrative yesterday because it was deeply unfair.

We all know in our constituencies - I can give the example of University Hospital Waterford - that when there are major problems in the emergency department, the people who must try their best to make sure patients are treated as quickly as possible are the nurses and doctors. The Government should stop blaming others for its failures. The Taoiseach should stop blaming front-line health workers for the problems in the health service. What plan will the Government put in place to deal with overcrowding? It should forget about blaming the nurses and doctors. What is its solution? What are the increased investment strategies which will be put in place to make sure patients will not have to languish on hospital trolleys in the coming weeks and months?

On the contrary, the Taoiseach's comments yesterday were clear evidence that the Government's priority - it is also the priority of front-line staff - was to make sure we would deal with patients in an effective and humanitarian way. It is highly distressing for patients to have to wait for long periods on trolleys in emergency departments. In any business, as I think the Taoiseach said, there are periods when peak demand can be anticipated. For example, in the hospitality sector peak demand is probably in the summertime, while in teaching it is probably when schools reopen. We have known for decades that peak demand in the public health service is in the winter, immediately after Christmas. The Taoiseach's comments were a clear recognition that front-line staff - doctors, nurses and supporting ancillary staff in laboratories, etc. - were critical in resolving the issue. Far from denigrating them, the challenge the Taoiseach posed yesterday was to HSE management.

He did not say that.

We have more doctors and nurses in the service. What we need from HSE management is appropriate management of the most valuable resource in the health service, the human resource, to make sure it is deployed in the most efficient way possible to deal with patients in the most humanitarian and effective way.

There is another issue - capacity. We have been reversing the trend, the result of a decision taken by a previous Administration to reduce hospital capacity at a time when the resources available to the State were plentiful. Since 2014 we have been reversing it and increasing hospital capacity. It is not, however, like flicking a switch to open hospital beds. When hospital beds are opened, doctors, nurses and other supporting staff are needed. We have opened and will in a short time open additional acute hospital beds, all of which, collaboratively, will I hope address the issues to which the Deputy has referred.

The Minister's response does not address the questions I put. What the Taoiseach said yesterday was very clear. It was not what the Minister has repeated today. The Taoiseach did put the blame on front-line workers. I sat here yesterday and listened to what he said and it was 1 million miles away from the response the Minister has given today. He was not talking about managers in the health service but about leave for nurses and doctors. In the view of nurses and doctors, whom the Minister admits do a wonderful job in the health service, it was clear that the Taoiseach was putting the blame and responsibility on them. We all know that it is not like flicking a switch, but the Government has been in place since 2011, since when record numbers have been trying to get into the system to see hospital consultants to be treated and too many have been left on hospital trolleys. It is not that long ago when the Taoiseach launched another attack on health workers when he said there had been no corresponding increase in activity in the health service. That is a falsehood because the Department of Health has noted that attendances at emergency department are up, that the level of surgical day case work is up by in excess of 70% in the past ten years and that the number of outpatient assessments has reached 3.3 million annually. The level of activity is up, but the Government is not putting in the resources to make sure there is capacity. It cannot blame anybody but itself. The Minister for Health and the Government need to take responsibility and stop putting the responsibility for failures in the health service on the shoulders of front-line staff.

The Deputy has referred to the fact that we have been in government for several years. That is the case, but he cannot divorce where the health service is at from the economic catastrophe that befell the country for several of the early years when we were in government. Because of sound public finances we are now in a position to rebuild the public health service and increase capacity within it. There are 22 additional beds open today in St. Vincent's University Hospital, 29 in Our Lady of Lourdes Hospital, Drogheda, 17 in University Hospital Limerick and 30 in University Hospital Cork, with more to come on stream in the last quarter of 2018 and others early in 2019. We are recovering. We acknowledge that we need to do more to increase capacity, but the point the Taoiseach made was that in terms of the issues that were predictable in providing care in the period immediately after Christmas, we needed to make sure the HSE would manage the resources at its disposal in that critical period such that we would not have to deal with the consequences of having a backlog in emergency departments by having the appropriate quorum of critical staff - doctors and nurses - scheduled to work in that critical period.

After 39 years, the Taoiseach made the startling discovery yesterday that Christmas comes every December. There may indeed be scope to change rostering at Christmas time, but the Taoiseach should not blame hospital staff, as he did, whatever the Minister says. He mentioned staff taking their annual entitlement to leave. Rostering and ensuring the presence of sufficient staff, as the Minister has said, is a management issue and should be addressed through constructive engagement with trade unions and not with abuse of people, either in this House or on public airwaves.

Another annual phenomenon in the health service is that, towards the end of the year, a number of budget lines run out. I am aware of several cases where people cannot access a home care package because the budget has apparently run out. They are told to reapply in January. That is ludicrous. If the Government is serious about using hospital resources effectively and efficiently, including very expensive acute beds, to take the pressure off the busy Christmas and winter period, surely it makes sense to provide step-down beds and home care packages to patients in acute hospital beds who are awaiting transfer home. Many patients are most anxious and could more appropriately be cared for at home. They want to be at home. In the budget of €17 billion just allocated by this House to the Department of Health, we know the money will be there in January. It is purely an administrative decision not to issue home care packages now. Telling people occupying economically acute beds which are very inappropriate with regard to health to apply again in January is madness. The decision will worsen our bed capacity and the capacity of hospitals to respond to emergencies in the critical winter period approaching. The Government management of the home care package budget makes no sense to anybody.

Will the Government undertake to unblock the delays in giving home care packages to the list of people that anybody in this House can provide? They are waiting to go home to a more appropriate and less expensive setting. Will the Government ensure that patients who need home care packages, such as those who are contacting my office in Wexford, whose details I can give, will be home for Christmas?

I am sure the debate on this matter has familiar tones for the Deputy as a former Minister for Health and for Public Expenditure and Reform. It is not simply a case of throwing money at the issue. We need to make sure that the additional resources that we provide are used appropriately. In budget 2019, we provided a fund of €10 million for spending in the latter end of this year to facilitate appropriate discharge through an appropriate care setting of people who are in an acute hospital bed but who are deemed no longer to be in need of that level of care. We are taking steps to improve capacity in the health service. That is not to say that we are not responding accordingly. We are providing additional resources. The Deputy alluded to the resources provided for in 2019 being significantly increased from 2018. We also made provision in the budget for dealing with the issue of appropriate discharge, which itself frees up acute hospital beds for people who are awaiting admission.

The Minister talks about throwing money at it. I am a former Minister for Public Expenditure and Reform. I am talking about value for money and much better health outcomes for people. Will the Minister not concede that it is ludicrous for somebody to be in an acute bed at enormous cost in an acute hospital when that person is willing, able and anxious to go home but community care cannot provide the money for a home care package? Much more money is available within the HSE to keep them in an acute bed than would be required to provide them with the dignity of going home for Christmas. If the Government cannot solve that conundrum, there is no management, no system and it is dysfunctional.

I am informed by the Minister of State, Deputy Jim Daly, that the HSE and the Department commissioned a report on that issue of appropriate discharge to appropriate step-down facilities. That has just been completed.

I am talking about home care.

The Deputy chose to ignore in his supplementary question that we provided an additional €10 million to be made available-----

It is not enough. Why would the Government spend more on acute beds?

Let the Minister answer.

We are responding with resources to address the issue of people who are inappropriately in an acute bed but who do not have the facility to be discharged because of a block in the system.

It is not doing that.

That €10 million should go some way towards resolving that issue.