It is estimated that every year in this State, there are 360 excess deaths as a result of accident and emergency department overcrowding. That is to say double the population of this Dáil die every year as a result of overcrowding in accident and emergency departments. However, new research in Britain has shown that this is likely to be an underestimate. The Emergency Medicine Journal found that there was a significant increase in the death rate for patients who had to spend more than five hours in an accident and emergency department. Senior clinicians have now also indicated a clear link between those who have to wait on trolleys and on chairs in accident and emergency departments and excess deaths.

Thus far this year, 100,000 people have had to wait on trolleys in hospitals, which is a record level. Thus far this year, we have also seen record waiting times for people who were seriously ill, with some people waiting 13 hours for admission in hospitals. Pets in this country are currently seen quicker by vets than patients are in accident and emergency departments throughout the State. Last year 75,000 people left accident and emergency departments in this country without being seen or treated. Accident and emergency departments are such a disaster zone in these places that seriously ill people and seriously injured people who went to accident and emergency departments waited for hours and then in their thousands left without being treated whatsoever.

In my area, sick people are being brought by ambulance from Navan to Drogheda to wait for hours, only to then be brought by ambulance back to Navan to be treated, such is the pressure in Drogheda at the moment. Long wait times in accident and emergency departments and the proliferation of trolleys are actually killing hundreds of people in this State. I will repeat that. Long wait times in accident and emergency departments and the proliferation of trolleys are killing hundreds of people in this State every single year. All we have seen from the Government on this is inaction. It is as if we have reached a tolerable level of death in terms of hospital overcrowding and accident and emergency department waiting times. Nobody is being held to account in HIQA. I have asked HIQA to investigate the effect that overcrowding has on excess mortality in this country but it said it was not even allowed to do that. HIQA cannot even investigate that particular issue.

Worse than this, when we have accident and emergency departments such as those in Navan and Drogheda literally out the door in terms of patients, when staff are leaving the health service in their droves because of the pressure and in the middle of the winter surge, the HSE has decided to close the accident and emergency department in County Meath. This is the same HSE which has now announced a two-step plan to close the accident and emergency department in Navan, which was to start on 12 December and will be completed in the new year. The HSE has given the figures to the Minister for Health a number of times over the last year. It looks like it is using the Cabinet reshuffle and the maternity leave of the Minister, Deputy McEntee, to force through its plan to close the accident and emergency department. Will the Government sit on its hands on this or will it represent the people that elected them in County Meath?

At a more general level in respect of the Irish healthcare service, the evidence is overwhelming. Certainly, in the last two decades and possibly the last three decades or longer, the Irish health service is actually increasing survival on all the main killers of people. With cardiac disease, cancer, stroke and chronic diseases generally such as chronic obstructive pulmonary disease, COPD, the outcomes are now much better than they would have been 20 years ago. The survival rates for cancer, based on the National Cancer Registry's latest report, are very impressive. We need to be careful and balanced in our description and analysis of the Irish healthcare service. There are challenges and problems, certainly in emergency departments. However, it is wrong to give the impression that the Irish healthcare service is actually killing people. It is not doing that.

Does the Taoiseach not think overcrowding affects it?

I have to stress the point that based on the figures, we are now living much longer as a nation for different reasons.

Medical technology and medical science.

I am sorry; the health service has improved dramatically. Cancer care has improved dramatically because, and I stress this point, of the concentration of services. I saw all the protests against the concentration of cancer services in regions all over this country. I saw the pickets and large meetings that people like the Deputy excel in. While people in the Deputy's position are entitled to their view, I am not sure that the position the Deputy was articulating at any given time was in the best interests of patients. I can remember petitions coming in looking to keep the cancer service in a particular local hospital and keep the heart treatment in another hospital. We now know that having concentrated cancer services through the national cancer control programme and having brought skill sets together through multidisciplinary teams, we are getting better outcomes for patients with cancer. We want to be more ambitious into the future. We are getting better outcomes for patients with heart disease. We are getting better outcomes for stroke patients with some dramatic improvements there. We need to do more on COPD and there is much more.

We need to analyse who is going into emergency care and who is not. The enhanced community care programme is the way to go. We need to prevent many people going into accident and emergency departments by getting in earlier and by preventing. In my view, there is no point in senior citizens going to an emergency department which is overcrowded and which does not benefit them when they could get a better faster service and the health service is working on that.

Regarding Navan and the ambulance bypass protocol, the Deputy knows that Our Lady's Hospital already has an ambulance bypass programme for patients who have suffered a stroke, heart attack and major trauma.

Nobody is arguing against it.

Is the Deputy for it?

Nobody has a problem with it.

I take it the Deputy is for that.

I am happy; I accept that-----

The Deputy needs to state he is for it because-----

-----but not the new one.

Please, Deputy.

There is a new one which stipulates that patients who are acutely ill will no longer be brought there. I ask the Deputy to think about that because clinicians are making these decisions and not him or me. Clinicians are telling us it is not safe to do what the Deputy is suggesting they should do.

It feels that we have a parallel Leaders' Questions here because we put a question forward and a parallel question is answered. The Taoiseach is hiding behind the issue of patient safety when it comes to Navan's accident and emergency department. However, this is the HSE that created a warzone in University Hospital Limerick by closing the accident and emergency departments in Nenagh and Ennis. This is the HSE that has presided over the increase in adverse incidents in this country from 79,000 in 2017 to 105,000 last year. This is the HSE that has paid over €1.4 billion in negligence claims in the past ten years. This is the HSE whose plan to close Navan accident and emergency department has been condemned by dozens of clinicians who are actually working at the coalface, not managers in the HSE itself. This is the HSE which has refused to carry out a feasibility study into what it would take to provide the consultants cover in Navan accident and emergency department to make it safe. This is the HSE which struggled during the Covid pandemic because of a lack of ICU beds and is now closing ICU beds in Navan. I am asking the Taoiseach to get a grip of the HSE and stop the closure of Navan accident and emergency department.

The Deputy is saying that the situation with the ambulance roster, and so on, constitutes closure. I put it to him that patients who are acutely ill should go to the hospital that guarantees them the best outcome. We need to be patient-focused. I put that to him very strongly.

They just wait in the other hospital.

My understanding is that Our Lady's Hospital in Navan has not been successful in securing fulltime consultant cover in the emergency department. My understanding is that there is currently a registrar with 9 am to 5 pm cover, a consultant provides out of hours cover and there are four emergency department registrar posts which have not been filled. This has resulted in the use of locum staff. These are important issues that need to be aired in my view and it-----

It is the result of the HSE trying to close it. Why would one try to get a job in a place that is going to close?

No, that is not the case. There is a whole range of reasons why certain hospitals, because of size, nature etc., will dictate to a large extent outside of the control of any authority where junior doctors will go into service. We need to have a more realistic debate about it. Fundamentally, if we can do it from the objective that the patient gets the best care and the best outcome, surely that is what we should all be agreed on in this House. I look forward to the debate on that.

The time is up.

It is not trolleys and it is not on waiting lists.