The need to build capacity in our hospitals has never been more urgent. Decades of bad Government policy meant that our health service was at breaking point before we ever heard of Covid-19. Now we face the most serious health emergency of a lifetime. However, despite what the past 18 months have taught us, there is a real absence of urgency and planning from the Government. We need more beds and staff. We must dramatically improve diagnostic and theatre capacity. Incredibly, however, the Government has waited until the middle of November to come forward with its winter plan for the health service.

As far back as July, Sinn Féin and others said there was no time to wait. We called for preparations for winter to start at that point and urgently. We drafted a plan, sent it to the Minister for Health, Deputy Stephen Donnelly, and we were ignored. The Government's plan does not go far enough. In fact, it is built on the failures of the recent budget. Like the budget, the plan does not provide for one additional acute bed beyond what was already committed, nor has it provided the increase in ICU beds needed to meet this emergency. Front-line staff have been left outside hospitals protesting over unsafe staffing levels, but the plan does nothing to improve recruitment for the health service, where it can take up to six months to recruit a nurse and a year and more to recruit a consultant. How can that be justified? My colleague, Deputy Cullinane, has met with hospital managers in Cork, Sligo, Galway and beyond, all of whom have capital requests lodged for months. They are left to wait. This means that badly-needed 50- to 100-bed expansions are delayed indefinitely. The capital approvals process does not work. It is simply too slow.

Even if we had not been hit by a pandemic, the Government's plan falls far short of what is needed to meet the challenge faced by hospitals even in a normal year. This should have been a plan for real progress and ambition. Instead, it is a plan for our creaking hospitals to stand still. The price for this lack of planning and urgency will be paid by patients left to wait on trolleys in hospital corridors. By the way, there are 409 such patients on trolleys today. It will be paid by children with scoliosis and other conditions crying out for procedures that would change their lives. It will also be paid by front-line healthcare workers, who are denied the resources to do their jobs and are left to work in stress cauldron conditions.

Ní théann plean an gheimhridh sách fada. Is é anois an t-am chun an cúram sláinte a fháil i gceart. Tá níos mó leapacha agus níos mó foirne ag teastáil sa tseirbhís sláinte uainn. Teastaíonn práinn agus seachadadh uainn. We need a big step forward from Government and we need a real change. Does the Taoiseach accept the urgent need to significantly ramp up the number of beds in the system? Will he immediately address the bottlenecks in the capital approvals process so that those hospitals can press ahead with their expansions? Will he act on the call made by the Irish Medical Organisation, IMO to cut the extraordinary time taken to recruit healthcare staff?

Ní aontaím leis an Teachta ó thaobh an plean atá foilsithe ag an Aire, an Teachta Donnelly, mar is léir gur plean cuimsitheach é. Caithfear é a chur i gcomhthéacs an plean a bhí againn anuraidh ina raibh an-chuid áiseanna agus airgid curtha ar fáil do na hospidéil ach go háirithe agus na seirbhísí sláinte go hiomlán. Diaidh ar ndiaidh, tá níos mó leapacha againn anois agus tá i bhfad níos mó daoine ag obair sa tseirbhís ná mar a bhí. Is léir go bhfuil dul chun cinn le feiceáil ach, dar ndóigh, tá dúshlán an-mhór amach romhainn, ní hamháin ó thaobh na paindéime de ach tá an daonra ag dul in airde agus tá brú faoi leith ar na daoine atá ag obair laistigh den tseirbhís.

I thank the Deputy for her question, but to be fair by comparison with previous winter initiative plans - €40 million in 2016, €40 million again in 2017, €10 million in 2018 and €10 million in 2019 - last year's winter initiative plan was €600 million. That went into the base and underpins the efforts we make this year. That €600 million along with additional funding has produced 800 non-ICU acute beds, which is the largest ever. By the end of the year, that will go up to approximately 950, which I would say is the largest increase in hospital beds in decades, and certainly in the history of the HSE. We want to do more on acute beds in 2022. A further 205 beds in 2022 are committed to and funded, and any additionality that can be brought on stream will be brought on stream.

I spoke at a recent Cabinet health subcommittee meeting. I fully understand the issue relating to capital approvals and I have asked for that to be accelerated. I have spoken to the HSE about that. We will work with the HSE in respect of capital approvals to get new elective facilities, in particular, delivered as fast as we can. In Ireland, large infrastructural projects, be they hospitals, road or rail, simply take too long. We have to go through all the planning processes, all the conditions and so on, but it is simply taking too long to get large projects done, and I am determined that major healthcare capital projects will get done much faster.

The winter plan is essentially focusing on a core objective of emergency department avoidance by treating people at home or in the community and by allowing them to return home quickly following hospitalisation. Those initiatives include GP liaison nurses to manage direct referrals from GPs to emergency departments; geriatric community support; enhancement and expansion of frailty intervention therapy teams models; community response teams, involving nursing and therapies in the community; community respiratory admission avoidance teams; expansion of the National Ambulance Service pathfinder initiative; additional home support hours; and COPD outreach teams. We want to get to people before they are admitted to hospital in the first place and then, within the hospital, to have far better flows than was historically the case. That was achieved last year through a record 5 million home care hours that were provided.

The challenge facing us this year is not funding or resources, but rather getting the workers in sufficient numbers in the country to take up posts as home carers. That is a challenge. We have recruited 4,462 whole-time equivalents in 2021.

Last year, it was 6,357 extra whole-time equivalents, so that means approximately 11,000 extra whole-time equivalents recruited in the guts of two years. Again, I have no issue with accelerating the recruitment processes. The funding is there. In fact, more funding was provided, meaning additional people could have been recruited if the people had been there.

The time is up.

As ever with the Taoiseach's Government, it is a case of too little and too late. The middle of November is not the time to produce the winter emergency plan, with the greatest of respect to all involved. That work should have been done in the summer. The facts are that the mistake made at budget time, where not one additional acute inpatient or community bed beyond what had been previously committed to was budgeted for, has been repeated in the winter plan. Resources and money are not everything but if he speaks to anybody working in any hospital across the State, they will give him chapter and verse as to how stretched they are and refer to the fact that resources are lacking. We need more beds, including more acute beds and ICU capacity.

We also need the capital approvals process to be streamlined. The resources held back include, for example, 96 beds for Limerick, 50 beds for Sligo, 50 beds for Cork and I could go on and on. Similarly, on the recruitment process, would the Taoiseach believe me if I told him the average recruitment time for a consultant is 562 days? It is six months for a nurse. Hospital managers across the State know this is ludicrous. This is a bureaucratic nightmare, Orwellian in its proportions.

Time is up.

Rather than the Taoiseach simply expressing interest or concern in this, it is his job to ensure this is sorted and these bottlenecks caused by excessive bureaucracy can be cut.

Time is up, Deputy.

There is a lack of capacity in hospitals.

The Deputy is way over her time. Please, Deputy.

I reiterate to the Taoiseach that the funds and resources must be made available. He has failed in that regard. It is astonishing stuff.

Since I became Taoiseach we have had record recruitment to the health service and record capital funding and beds provided. That is not enough and I am not resting on that. I want to do more. I want to accelerate capital programmes. In some cases, proposals have not come from certain hospital groups.

Is there an example?

I met Cork consultants, who were taken aback when we said funding was available if they wanted to increase bed capacity in the short term. We are there to respond as quickly as possible.

Sorry, who was-----

I made my point and instanced Cork. What tends to happen is working parties are set up and various consultants can have different views as to where particular elective facilities are to be located. They all have preferred options and there is too much analysis, which leads to a degree of paralysis. That is before it ever gets to the Department. That is something I want to cut through and we are going to cut through it to get badly needed facilities done. There will be 1,000 beds provided, more or less, by the end of this year. It is the largest number ever and the Deputy cannot ignore that. That is a fact. The money is there to recruit more than the numbers that have been recruited. I want to accelerate the recruitment process.

Time is up.

If we add this recruitment to what was recruited for the vaccination and testing programmes, the figure is enormous, to be fair to the HSE.

The Taoiseach should be clear. Which hospital was it?

We should give them credit.

Which hospital?

I call Deputy Catherine Murphy.