It is unbelievable what Deputy McDonald-----

May we have respect for Deputy Shortall, please?

Along with the triple crisis of the cost of living, energy and housing, there is another crisis that demands urgent Government action, and that is the crisis in our health service, specifically in our emergency departments. Yesterday the president of the Irish Association for Emergency Medicine, Dr. Fergal Hickey, said that this winter was likely to be "hell on earth" for patients as well as staff and that we face what could be an Armageddon-type situation. We know there have been 40,000 breaches of waiting times this year. That is 40,000 patients waiting more than 24 hours. Last Wednesday there were 596 patients, including 20 children, without a bed. Dr. Hickey went on to say that emergency departments have become warehouses for admitted patients and that this is a 365-days-a-year problem. The Irish Nurses and Midwives Organisation, INMO, described the situation as an entirely predictable surge and called for a laser focus on recruitment and retention.

Staff vacancies arguably pose the greatest threat to our health service. There are almost 900 consultant vacancies and no sense of urgency from the Taoiseach's Government on agreeing a new consultant contract. Our non-consultant hospital doctors, NCHDs, are leaving Ireland in their droves due to the serious issue of excessive working hours, with doctors not even getting paid for that overtime and many reporting burnout, lack of career progression and bullying.

Nursing is equally under pressure to retain staff. Faced with the pressures on our health services, the cost of living and the prohibitive cost of housing, it is no wonder so many go away to work abroad in health services that actually function properly and provide care for patients who need it.

In addition, and importantly, our acute bed capacity is 2.8 per 1,000 population, while the OECD average is 4.3. Ireland has the lowest number of hospital beds in the EU. Over 300 of the beds which were to be delivered by the end of last year have yet to materialise.

Incredibly, yesterday's meeting of the emergency department task force was the first since January.

How will the Taoiseach prevent what is likely to be an Armageddon in our emergency departments when Covid and the flu put even more pressure on our emergency departments this winter? Will he announce a fully funded winter plan along with the budget next week? What will he do about the recruitment and retention crisis in our health service, which needs urgent attention? What action will he take to urgently increase the number of beds to a safe level?

I will first say that the health system went through very tough times during Covid-19, as we all realise. I have long articulated my admiration for all those who worked on the front line during the various stages of Covid. We saw on our television screens the enormous challenges and pressures that Covid put on our health system. Our health system proved itself resilient in the face of an unprecedented pandemic. Over the past number of years since the start of the pandemic, we have dramatically increased the level of funding to our public health service and increased capacity significantly. Approximately 900 acute beds and about 340 community beds have been provided. The number of ICU beds has gone up from approximately 255 to about 306, which is a significant increase.

It will be a very challenging winter. We have watched what has happened in the aftermath of Covid in places like Australia and New Zealand. We did not have the flu for the past two years, essentially, as Covid was dominant. There is now a real prospect of the widespread spreading of flu and Covid-19 during the winter period. Therefore, vaccination is the first line of defence in terms of people's lives and their health. I urge people to get vaccinated, particularly those who are recommended, with both the Covid booster dose and the flu vaccine. I think the flu vaccine campaign will commence in early October.

We have also increased home support hours with about 20.5 million hours delivered in 2021. That was 2.9 million more hours than in 2020, a 17% increase, and there is a higher target for this year. There are issues in terms of home care teams with them having expanded so quickly and in such a significant way. That created a strain and pressure on home care teams.

There will be a winter plan, for which funding will be announced in tandem with the budget. The HSE task force is meeting on a daily basis to prepare for winter. It will be a challenging winter.

I point out that overall staffing numbers have increased by 15,000 in the past two years. That is the largest increase on record since the HSE was established. That figure includes 4,500 nurses and midwives, 2,300 health and social care professionals, and 1,400 doctors and dentists. The health service is recruiting at a level it has never recruited at before. That does not mean that there still are not challenges in the recruitment of key professionals. There are but everything will be done to make sure we support the health service in the coming winter.

I am not sure what "everything will be done" means. I asked the Taoiseach for specifics.

I gave the Deputy specifics.

Does the Taoiseach not believe what the president of the Irish Association for Emergency Medicine is saying? He is saying that we are facing a potential "Armageddon" in our health service this winter, particularly in emergency departments. There are almost 900 consultant vacancies. What is the Taoiseach doing about that, to finalise the negotiations on the consultant contract? What is he doing about the significant loss of NCHDs - about which the Minister has been well warned - because of the dysfunction in the health services, because of burnout, because they are not being paid, and because there is no career progression? What is he doing to hold on to nurses and other key health professionals? This is all coming together. There is virtually no workforce planning going on within the health service at the moment. We have no idea how we will hold on to people and ensure an adequate number of training places.

There is a huge shortage of placements in the health service. The HSE stopped them a number of years ago. I am looking for specifics from the Taoiseach. What exactly will he do to avoid the hell on earth that is being predicted this winter?

I gave the Deputy specifics on beds-----

You did not.

I gave you specifics on ICU and home care hours-----

No, you said what had been done and not what you will do.

I gave you specifics on a whole range of issues in terms of preparing and upgrading the health service. The number of college places has been expanded for all of the professions over the past two years. The Deputy cannot just shake her head. They have been increased-----

There has been a huge problem with placements. People need placements for college places.

-----and in terms of career progression. The winter preparedness plan has adopted a bottom-up approach. It has gone to every hospital group and local plans have been sought. Sanction has being given to hire emergency consultants if the groups so wish. In the plans that have come from the various hospital groups, flexibility will be applied in sanctioning the teams they want to hire. As the Deputy knows, we are implementing measures to help with the flow by avoiding people gong to emergency departments and providing GPs greater access to diagnostic tests. This has been significant in a range of areas. We have developed community integration teams and integrated care teams for older people. Enhanced community care has been very effectively rolled out. All of this prevents people from going into emergency departments in the first place. The other key issue is the flow of patients through hospitals and subsequent discharge. This is key to keeping the emergency departments freer to take people.