This morning's newspapers are covering the tragic story of the late Mrs. Margaret Callaghan, who died in January 2018. Our thoughts this morning are with her family and friends. Mrs. Callaghan lived only 2 km from Letterkenny University Hospital, yet it took 71 minutes for an ambulance to reach her. She had been previously discharged after a test and rang for an ambulance the following day. Even after taking 71 minutes to travel 2 km, when the ambulance arrived at the emergency department in the hospital there were two ambulances ahead of her ambulance because of what are called offload delays. One of the ambulances had been there for six and a half hours and the other had been there for three and a half hours. Accordingly, Mrs. Callaghan's treatment was delayed. The urgency was not recognised. The medical director of the National Ambulance Service said that the issue with the offload times of ambulances throughout the country is endemic. It was one of the factors that led, regrettably, to Mrs. Callaghan's death. This case was covered in Letterkenny Coroner's Court yesterday.

Deputy Donnelly and other Members of the Houses have highlighted this issue previously. When one rings for an ambulance it is an emergency. One expects a quick turnaround. This country is lucky to have superb paramedics and ambulance personnel who are highly trained to do their jobs, but they are being prevented from doing them for all sorts of reasons, including a lack of investment in ambulance services and emergency departments. The Health Information and Quality Authority, HIQA, has said that all hospitals in Ireland should monitor the implementation of ambulance "patient handover time ... which requires 95% of patients being handed over from an ambulance crew to the emergency department staff in less than 20 minutes, and where this is not met, corrective action should be taken". The reply to Deputy Donnelly's parliamentary question shows that the target is only being met in just under 16% of cases nationwide, and the HSE 30 minute target is only achieved in 37.1% of cases. Those figures have rapidly decreased from those of September 2017, so the problem is getting worse.

What is the Government's reaction to what unfolded yesterday in Letterkenny Coroner's Court? This is not just an issue in rural areas. Ambulance turnaround and transfer times across the Ireland East hospital group, which includes some of the biggest hospitals in Dublin, and in the South/South West hospital group, which includes hospitals in Cork city, have also decreased substantially. What is the Government's response to this? What action will it take to ensure there are proper and efficient turnaround times in the ambulance service?

I thank Deputy Calleary for raising this tragedy. Before I respond on the occurrences in Letterkenny, I express my condolences to the family of Mrs. Margaret Callaghan. I cannot begin to understand or appreciate how difficult it will be for them to get over her death, given that it potentially should not have happened.

When the emergency care hospital system is under pressure there will be potential for delays in the transfer of care patients from an ambulance to emergency departments. However, the ambulance turnaround performance is currently below target. In the period from January to October 2019, 85.5% of ambulances achieved a turnaround time of 60 minutes or less, which is below the target of 95%. Effective management of timely ambulance turnaround times is a challenge, and probably more of a challenge in some parts of Ireland than in others. The ambulance turnaround framework has been developed to try to address the issues that exist. Ireland has seen a growing demand for unscheduled care, with increased pressure on emergency departments during peak times and particularly in the winter. The key drivers of the ongoing emergency department overcrowding are increasing attendances and admissions nationally, high occupancy rates and a significant increase in delays of transfers of care. In the first ten months of 2019, the number of patients attending hospital emergency departments increased by 2.7% on the number last year and the number of emergency department admissions increased by 1% compared with the same period last year. The numbers on trolleys at 8 a.m. in Letterkenny University Hospital have been persistently high this year.

In preparation for the anticipated increase in demand over the coming winter, the HSE winter plan was launched earlier this year than in any previous year, on 14 November. The plan is supported by an additional €26 million in winter funding nationally. The funding will support access to the fair deal scheme and provide additional home care supports and transitional care to facilities in a timely manner to ensure that discharge happens more quickly and to reduce congestion in emergency departments over the winter. Nine winter action teams, each aligned to the community healthcare organisation, CHO, and associated acute hospital groups, have prepared their integrated winter plans. As I said, there are issues that might affect some parts of the country but not necessarily all parts of the country. These plans will focus on demand management and staffing availability, timely access to the most appropriate care pathways for patients and appropriate and timely discharge from acute hospitals. I hope they will go a long way towards alleviating the situation that resulted in this lady's tragic death.

The Minister's answer indicates a complete disconnect between the Government and what is happening in hospitals. The difficulties in emergency departments have nothing to do with people getting sick and presenting there. They are to do with the fact that there were 300 fewer staff nurses employed in the health system in October compared with last December, 350 consultant vacancies where consultants are not available to attend and a further 350 consultant posts filled by non-consultants. Deputy McConalogue has consistently highlighted that in Letterkenny, despite a promise from the local Minister that 20 extra beds would be opened this year, only ten extra beds have been opened. That is where the difficulties lie.

Emergency departments are under-resourced and understaffed. The necessary nursing and consultant resources are not in place. The Minister cited the winter plan but no new beds will be opened and no new staff will be appointed under that plan. All of these issues affect the ambulance service and the good work it tries to do. While I know the Minister will be personally committed to this, I ask her to ensure that there is no repeat of this occurrence in the system. Unless the Government deals with the staffing and resource situation, I regret to say that there probably will be a recurrence.

I will outline the integrated winter plan for Letterkenny University Hospital that will be delivered by its action team. The membership of the team includes the CEO of Saolta University Health Care Group, the CEO of the RCSI hospital group, the chief officer of CHO 1 and the CEO of Letterkenny University Hospital. I believe the people involved in ensuring that the winter plan works for this region have a vested interest in the region. Specific funding has been allocated to the winter action teams to support the initiatives at local level. The initiatives for this area include the reablement programme to assist in reducing presentations and admissions and additional medical registrars, who are senior decision makers.

Therefore, the extra staff the Deputy says are needed will be put in place. There will be additional aids and appliances to facilitate the discharge of people when they need to be discharged, as opposed to keeping them in hospital when they should not be there, and additional rapid flu testing kits and local PCR flu testing to reduce the length of stays, facilitate diagnosis and treatment of flu patients to reduce isolation demand and reduce the impact of the outbreaks we know are going to come. We will also reduce patient experience times and trolley numbers through a speedier turnaround of the beds and management of infection control by providing additional cleaning hours.

All of that, while it does not directly impact what happened in this tragedy, has a knock-on effect as to when ambulances arrive. If there is nobody to take the people presenting in those ambulances into the hospitals, obviously, that is where the backlog arises. While I cannot give the Deputy a personal guarantee that it will not happen, I hope the initiatives we are putting in place can ensure that no other family has to go through what the Callaghan family are going through.