We should lead not follow.

I believe that in the years to come this Government will be known as the “coalition of crisis”. The cost-of-living crisis is hammering people’s ability to live and the housing crisis is threatening hundreds of thousands of families with homelessness and spiking rack rents. Despite all the Taoiseach said, the response of this Government has been stifling inertia in the face of these crises. Going by the rate of action of this Government, the only thing that will remain warm this winter is its own hands because it has been sitting on them all of this time. Such is the degree of the cluster of crises in our country that the massive health crisis we face is being eclipsed. However, it is still a life and death issue that is looming large in millions of people’s lives. Some 1.3 million people are on hospital waiting lists at this moment in time. According to the Irish Medical Organisation, IMO, mental health services are in crisis due to the lack of investment and soaring demand. The GP system, which was one of the few remaining functioning elements of the health service, is now broken. People are waiting up to two weeks to get an appointment. Hundreds of GPs are emigrating and moving to Australia every year. Accident and emergency departments are dealing with record waiting times. People are waiting 24 hours in Tallaght. University Hospital Limerick is like a warzone. Over the summer, every hospital in the Meath area at some stage advised patients not to come near them because of the pressure they were under. It is now stated that 360 people a year die in the State due to delays in accident and emergency departments. A figure equivalent to twice the number of elected Deputies in this State are dying every year due to dysfunction and waiting times in accident and emergency departments around the country. In the middle of all of this and just before we face a new wave of Covid and flu, the HSE has decided to close key capacity in the accident and emergency department in Meath. So removed is the HSE that 23 consultants in Drogheda hospital had to write a letter to the Minister for Health stating that if this action was to proceed, it would present a threat to people’s health.

The decision was paused by the Minister. We welcome that. The CEO of the HSE, Paul Reid, then resigned and a so-called review was started. However, the Minister for Health said the review of the closure of Navan accident and emergency department would have the closure built into it. The HSE would simply proceed with the original decision.

False.

I have seen letters the Minister has written, obtained through freedom of information requests, where he said the review was to be carried out under the understanding of reconfiguration. It is written in black and white. It is also in the terms of reference of the review. The Minister of State, Deputy English, said it will include a review of a functioning potential future for Navan to make it safe. Who is telling the truth? Both cannot be correct at the same time. Both cannot be in contradiction with each other and telling the truth to the people.

Are you telling the truth on Navan?

The Taoiseach is answering me with a question.

I am answering the Deputy rhetorically. Is he telling the truth? I have been through this over 30 years.

The Taoiseach set up the HSE - a monstrosity.

I will say this much: we need balance. This debate the Deputy is having now has been waged across many locations in this country over the last 30 years.

Limerick, Nenagh, and Ennis.

The Deputy can go through them all.

Monaghan.

Hospital action committees-----

That was a disaster.

Disasters, each one.

It was not.

An absolute disaster.

No, it was not.

The Taoiseach is defending the removal of services again.

This is Deputy Tóibín's question, please.

There was one gynaecologist, if the Deputy is talking about the maternity unit.

Accident and emergency services-----

I am talking about the Deputy's party's first stance, which elected its first Deputy.

Drogheda-----

Gabh mo leithscéal, a Cheann Chomhairle. An féidir leis an Taoiseach an cheist a fhreagairt?

Its modus operandi has been to exploit a crisis, get the marches going, get it simplified-----

The Taoiseach is still defending the removal of services.

It gets the issue to be "they are for it, we are agin it, and we will get elected". That is what is happening. It happened for a long time in health-----

The Taoiseach set up the HSE.

-----until we got sense as a country. The Minister has intervened. There is a review under way in respect of Navan involving James Connolly and Our Lady of Lourdes hospitals and the clinicians, in order to get an informed view.

There are more reviews than hot dinners.

Let us not undermine the motivations of other people who have different views, such as medics in Meath. There are different views between the medics in Meath. Some are genuinely concerned about safety issues, which have to be dealt with. I sometimes worry about the manner in which Deputies reduce things to just the electoral and political issue. That is why I have to say this. I have said this already on the record of the House. There are legitimate concerns with moving ahead in the absence of any proper provisions or additional capacity in terms of the needs of the people of the area. That has to happen. There has to be engagement and consultation with local stakeholders. I would have thought we had moved on. This decision was taken in 2013.

It is nine years out of date.

It was taken in 2013. I have been here since 2013. At this stage it is manifesting itself. Equally, I would say we need a more balanced approach in terms of health. Yes, there are huge challenges. Covid-19 has had a huge impact on our hospitals, negatively. There is no question about that with regard to waiting times. We have to focus very strongly on getting waiting times down because Covid negatively impacted them. There are other parts of health as well. I was at the support centre for stroke in Cork last Saturday morning. The two consultants said there has been a revolution in how we deal with stroke in this country. Mortality has gone from 18% to 8%. Is it too much, given the need for balance in this debate, to at least acknowledge that? Survival rates for cardiovascular disease have improved dramatically because of repeated and successive investment and interventions, and centralisation of cardiac care. The same has happened with cancer and oncology.

Cataracts.

Centres of excellence were opposed the length and breadth of the country at the time but have resulted in greater survival rates for the vast majority of cancers. We need balance in the debate. I appeal to the Deputy for that balance.

We do not have centres of excellence in this country; we have centres of trolleys. That is the case for anybody who has actually been in those hospitals. In the last ten months, 20,000 people have marched on the streets of Meath to protect the accident and emergency department, the most important piece of health infrastructure we have in the county. I delivered a petition to the Minister's office just two weeks ago, signed by 15,164 people. The vast majority of the 220,000 people who live in Meath at the moment are absolutely opposed to the HSE plan to close down the accident and emergency department. We will resist any efforts to make our region a University Hospital Limerick mark II. The Taoiseach should mark my words. On Friday at 1 p.m., the people of Meath will march again in Kells.

It is the constituency of the Minister, Deputy McEntee, and the Minister of State, Deputy Byrne. This march will be led by a number of funeral hearses to make sure that the Government knows that this is a life-or-death issue for the people of Meath. Thousands of people are alive in this county because of that emergency department. What we are asking is reasonable. We ask that the review include a feasibility study on what it would take to make Navan functional and safe for the people of Meath in the future. We want that to be fully included in the terms of reference-----

The Deputy's time is up.

-----in black and white, not just as a Minister's promise.

The Deputy brought it back to the march.

People power is the only thing that is saving it.

It is about having an honest, frank discussion and consultation between all involved about the right care for patients at the right time. Patients and their families want the best outcomes. What is the best location for that? The Minister has made clear that there will not be a change to the service provided at Our Lady's Hospital, Navan, until such time as the HSE can establish that Our Lady of Lourdes Hospital, Drogheda and Connolly Hospital have the extra capacity to deal with the inevitable increase in presenting patients.

Could the Taoiseach confirm that?

There have been significant improvements in Navan hospital. The State wants to invest in Navan. There has been an increase in employment in the hospital and of the day surgery capacity. As the Deputy knows, a second theatre has been completed, which will increase capacity from around 2,500 elective surgical procedures each year to 5,000 procedures. A day ward, an expanded recovery room, a new laboratory, a new rehabilitation unit and a new psychiatric day ward have all-----

Will the Taoiseach broaden the review?

-----been completed in Navan recently.

Will the Taoiseach broaden the review? Yes or no?

The future development plans include a new rheumatology day centre and a new endoscopy suite with four endoscopy rooms.

Yes or no?

There are also plans to spend €1.3 million on upgrades to the medical assessment unit and local injuries unit.

Will the Taoiseach answer the question?

That is important for the people of the region.

Will the Taoiseach broaden the review? That is the question I asked.

There is significant investment, which will continue.