The Government is re-announcing funding for a winter package in the Department of Health today and across the health service. The reality is that this appointment will make very little difference against a background of chaos in our emergency departments, and hospitals and of a lack of GPs being available. Right across the health system, there is a sense of absolute chaos. Crisis management is the core to the Government's health strategy, not resolving the difficulties or understanding where patients are at, or the experiences of staff across the health service. Some 100,000 patients have been treated already this year in our emergency departments ahead of the really cold part of this winter. Together with the announcement of the spin-fest that will be the winter plan today, one should look at this morning's edition of The Irish Times, in which Professor Fergal Malone, master of the Rotunda Hospital, who is not a political figure, wrote of lives of newborns being at risk because of overcrowding in the hospital. He wrote of a critically ill newborn child who was choppered into the Rotunda a number weeks ago from a regional hospital and who then had to wait four hours - in the life of a newborn child - because no critical care bed was available. The condition was serious enough to merit a chopper being used but when the child reached the Rotunda, there was no bed and treatment was delayed for four hours.

We also read in this morning's edition of The Irish Times of an increased number of patients dying from sepsis, an infectious disease the incidence of which had been improving in this country but in 2018, the number of cases rose by 10% in hospitals nationwide.

There also was the incident in University Hospital Galway some weeks ago when an elderly 74 year old lady on a trolley was assaulted by an aggressive patient in the emergency room. She fell off it, broke her hip and unfortunately, following treatment, has passed away. Her family is absolutely devastated and the devastation of their loss is compounded enormously by the circumstances in which that happened. They are looking for answers as to why this sort of thing is happening in emergency rooms across the country. This announcement is not going to change anything.

The Minister, Deputy Donohoe, and I this morning have already discussed and differed on whether there is a moratorium on staff recruitment. One has only to read any of today's reports or submissions from Phil Ní Sheaghdha of the Irish Nurses and Midwives Organisation, INMO, as to how that is impacting. There are 350 consultant vacancies and 350 consultant posts that currently being are held by non-consultants.

I ask the Tánaiste what today is about. Is this another spin-fest and attempt by the Government to pretend that everything is normal and we then have this carry-on - which I passionately believe it is - or is this something of substance? Will this make a difference in hospitals and GP surgeries across the country this winter?

I thank the Deputy for raising these issues again. I assure the House that the Government is more than aware of the pressure that hospitals and their staff are under, as well as the strain and stress that many patients experience, particularly in overcrowded conditions in hospital accident and emergency departments. That is why we are launching the detail today of a winter plan to ensure that the health services are ready for the extra pressures associated with the winter period, such as a prolonged holiday period, severe weather, seasonal influenza, and the spread of infections. Under the winter plan, nine winter action teams, each aligned to hospital groups have prepared integrated plans that will focus on demand management, staffing, timely access to the most appropriate care pathways for patients and appropriate, timely discharge from acute hospitals. The HSE winter plan is supported by an additional €26 million in winter funding, which will support access to the fair deal scheme and the availability of home and transitional care in order that patients can leave hospital sooner, as well as to reduce congestion in the emergency departments. Additional medical, nursing and therapy supports, pharmacy and laboratory staff to improve patient experience time, improved senior clinical decision-making, reduced length of stay and the facilitating of weekend discharges, are all part of the plan that is being published today. Additional aids and appliances to facilitate more timely discharges, additional home support hours to facilitate hospital-to-community transfers, communications to facilitate hospital avoidance and public health awareness are all also part of this plan. There also will be the implementation of frail intervention therapy teams for admission avoidance and reduced admissions of patients over the age of 75.

In other words, as the Deputy would expect, we understand only too well the pressures that winter will bring to our healthcare system, as everybody in this House does. We are trying to keep people out of hospitals and are trying to discharge people in a more timely manner and into an appropriate setting or at home, whether they be step-down facilities or with home supports. That is what we are looking to do with this winter plan. There is nothing dramatically new about that. It is about better management, more efficiency and resources, and ensuring we keep people out of hospital who do not need to be there.

The Tánaiste reminds me of the conductor on the Titanic orchestra who keeps playing music when the ship is going down. He has talked about extra home supports. Deputy Troy has just informed me what this means in the midlands, which is 22 extra hours for six counties. They were lucky because they were informed, whereas the rest of us have not been given that divide yet. There are beds closed right across the country because support and staff are not available to staff them. Peamount Healthcare hospital has 55 beds but cannot get the staff because of the moratorium that the Tánaiste says is not in place. Has the Tánaiste not read the inputs from Phil Ní Sheaghdha from the INMO throughout this week? Deputy Rabbitte has raised the issue about public health nursing services which are about to be curtailed in Galway because public health nursing vacancies cannot be filled. There is a moratorium and it is affecting service. What we are going to get today is the only place where is not a moratorium, which is in the spin department in the office of the Minister, Deputy Harris. There will be brochures and fancy videos. The Minister, Deputy Eoghan Murphy, wears high-viz jackets for his announcements and the Minister, Deputy Harris, will probably have a white jacket on during his. This is where there is no moratorium, namely, the area of spin. I challenge the Tánaiste to visit a hospital this weekend. Talk to a GP, a nurse, or consultant and get the real story.

The Deputy is better than his comment on spin just now. There are real issues here and are not about money that is being spent on public relations. It is about applying significantly increased resourcing to healthcare to provide better services for patients, to bring about better management of our hospitals, and to fund improved discharge in order that people can move out of hospital when they do not need to be there.

Every week we have this debate around a moratorium on recruitment in the HSE. People are being employed in the HSE but it has to be employment that has funding. The Deputy would be the first to criticise this Government if we commit to spending money that we have not budgeted for. For many years now, we have had huge overspending in health. The Government has been criticised for that. We are, however, employing extra people in a way that is consistent with the extra resources that have been made available. We cannot go beyond that. People in this House keep calling for more and more money to be spent that has not been budgeted for and at the same time are criticising the Government for potentially overspending. One cannot have both.

Earlier the HSE published its winter plan in an attempt to tackle overcrowding and deal with faster patient discharges. We are at the point where every day is winter in our hospitals because of overcrowding, patients on trolleys and undervalued staff trying their best on the front line. That is the state of the health service every day of the year. Patients face another difficult winter in already difficult circumstances and I have serious doubts whether this winter plan will be able to tackle the issues at the heart of the system that blight the health service. As the general secretary of the Irish Nurses and Midwives Organisation, INMO, stated yesterday, it will be impossible to staff more in the middle of the recruitment freeze the Government introduced in May of this year. The Government cannot staff additional beds without additional staff. It is as simple as that. The recruitment freeze is crippling emergency departments and patients are suffering as a result. Nurses regularly report that inadequate staff levels are dangerous for patients in the hospitals. The front page of a newspaper today stating that the lives of newborns are at risk from overcrowding in the Rotunda Hospital. That is how bad the situation has got.

The stupidity of the recruitment freeze is laid bare in Portiuncula Hospital Ballinasloe. Where public health services once had six nurses, they now have four vacancies which cannot be filled because of the recruitment freeze. Staff have warned the Government that these services, which provide care to the community and inpatients in their homes, face closure this month unless these vacancies are filled. This closure would prevent hospital discharges and increase admissions to hospitals. This is while the Government's new winter plan seeks to reduce overcrowding and increase discharges. It does not make sense. That is only a snapshot of the Government's reckless mismanagement of the health services. According to the latest HSE figures, there are 308 fewer staff nurses and 37 fewer public health nurses now compared to this time last year. In August, 1,300 nursing and midwifery posts were vacant and unfilled. The UK's national statistics institute for health found that when staffing levels fall the risk of death on wards increases.

Besides inadequate staffing levels, we now have a situation where this year alone more than 100,000 patients have been admitted to hospitals that did not have a bed available. What does all this mean for communities? In Limerick University Hospital, almost 12,000 patients have gone without a bed. As my colleague, Deputy Quinlivan, stated only two weeks ago, the crisis has been going on in Limerick for some years now and the Government has done nothing to address it. In Cork University Hospital, CUH, 9,500 patients have gone without a bed so far this year.

The human impact is clear to see and it was laid bear last week after Mrs. Evelyn Crowley tragically died on the corridors of CUH. That hospital currently has 16 vacancies and the Tánaiste will stand and tell me that there is no recruitment freeze.

I thank the Deputy. The time is up.

In my constituency - I will finish on this - 4,500 patients so far this year have gone without a bed, despite the fact that ten beds in that hospital cannot be opened because of the recruitment.

The time is up.

When will the Government get to grips with the real issue here, make the proper investment, and lift the recruitment freeze that is crushing our hospitals and putting serious pressure on front-line staff and patients?

I outlined in response to Deputy Calleary what the winter plan aims to do. There are two different issues here. The first is the ongoing pressure on emergency departments that we have seen through the summer and into the autumn, particularly in hospitals such as the university hospitals in Limerick and Cork. I am more than familiar with that. The answer there is increased resources and capacity over time, and the capital resources to go in to deliver that increased capacity are being delivered. What we are trying to do in the winter plan, which is being published today, is to anticipate increased pressure on top of what is a difficult situation for many staff to manage, to alleviate pressure, to keep people out of hospital, and to ensure that we can move people on from hospital care into community care, step-down facilities or back into their homes with home care packages. That is what the €26 million is about. They are two separate issues.

We continue to have serious political debate about how broader health reform needs to happen and how we can spend what are limited, but at the same time significant, increases in resources. This year, we will spend €17.1 billion on health, which is €1 billion more than we spent last year. When planning for additional beds, one cannot simply plan for the cost of building and delivering those beds in terms of capital expenditure without factoring in the cost of staffing them as well. At present, we have increased recruitment across different elements of the HSE and we must have a management system that plans for increased beds but also for the cost of staffing them so that we do not have requests coming back from the HSE to Government for dramatic increases in expenditure at the end of the year that have not been budgeted for, as one cannot run a health system like that.

As the Deputy will be aware, we are committed to significantly increasing the number of available beds. Unlike healthcare policy under previous Governments when there was lots of money to spend, they were reducing bed capacity, we are now back to the bed capacity at the height of the last boom. We need to do much more. What we are focused on today is the additional interventions that we can make to alleviate pressure on hospitals with the extra pressure that comes through the winter months, which I detailed in response to Deputy Calleary earlier.

The Tánaiste simply does not get it. He does not get the scale of the crisis. Professor Malone, the master of the Rotunda, summed it up well in speaking to The Irish Times today when he stated, "The dignity of patients doesn’t seem to resonate with decision-makers."

The Tánaiste can give us the spin all he wants. Last year, Ministers announced the opening of 20 beds in Letterkenny University Hospital where we have on average 30 patients on trolleys every day. Ten of those beds are lying empty because there is a recruitment moratorium in place. That is the reality of it. The position is the same in Cork, Limerick and throughout the country. It is not rocket science. The Government needs to open beds that are available in the public health system. The Government needs to lift the recruitment embargo so that there are the proper staff in nursing, midwifery and consultants to staff those beds, and it needs to adequately resource home care packages. The package that the Government announced in the budget will not even clear the waiting lists that have accumulated as a result of the moratorium that it introduced in home care at the beginning of the summer.

The time is up.

What we need is less spin and more action. We do not need more debate.

We do not because the time is up.

Patients who are lying on trolleys and their families want action from the Government and less spin.

On home care packages, we are providing for an additional 1 million hours next year.

It would take 2 million hours to clear the waiting lists. The Government is planning to fail.

Will the Deputy allow the Tánaiste to reply?

We are significantly increasing resources for home care packages. In terms of developing service plans, we are also asking the HSE to make sure that it anticipates the full cost of opening beds, including staff, as well as the required capital expenditure. That is how one manages a health system to ensure that one spends the funding available as efficiently as one can. One cannot at the end of the year say that we must get more resources to take on more staff. We are budgeting for significantly more staff throughout the health system but we must operate within budgets, otherwise the health budgets will be out of control.

There are fewer nurses and fewer midwives.

Both Deputies mentioned the Rotunda Hospital. I assure people that following what Professor Malone stated in the media the Department immediately sought reassurance from the hospital that safe and appropriate care was bring provided for infants cared for at the neonatal intensive care unit, NICU.

The Tánaiste should not blame the messenger.

In addition, the Department sought information regarding the immediate and medium-term actions being taken by the hospital and hospital group to address any concerns. The Minister for Health will get a report on that shortly.

Did the professor withdraw his assertion that the lives of newborns are at risk in the hospital as a result of the Government's policies?

The Deputy is being disorderly.

That is what we are getting the report on.

That is the reality.