A report published by HIQA this morning is a damning indictment of Government health policy. It states emergency departments are now under "unprecedented strain", echoing the concerns of the INMO that our hospitals face a nightmare winter. Last month was the worst November on record for hospital overcrowding. Twelve thousand six hundred and twenty-four patients were on trolleys. The HIQA report cites that one patient in University Hospital Limerick was left waiting nearly five days for a bed. That is not a unique case. Every Deputy in the Dáil has stories of patients who were left on trolleys for days on end. Chronic overcrowding creates dangerous situations, and HIQA highlights how patients must often wait far too long to be triaged for care.

It is the incompetence and inaction of the Minister for Health, Deputy Donnelly, that are at the centre of this crisis. After two and a half years in office, he has failed to do what needs to be done. First, patients cannot get admitted because a quarter of the beds promised by the Government more than two years ago have not been delivered. Second, the Minister has not solved the delayed discharge problem. There are as many delayed discharges in the system as there are patients on trolleys. Patients cannot be discharged from hospital because of the lack of community recovery and step-down beds. Third, the Minister has failed to solve the crisis in home care. We now have more than 5,000 older people on home care waiting lists. This has been brewing for years, and it sees older people pushed into hospitals and nursing homes when they should be cared for in their own homes. There are no carers available to them because the Minister has failed to plan a sufficient workforce and address long-term pay and conditions issues that have harmed recruitment and retention. At the same time, people can hardly see a GP anymore. This exerts even more pressure on hospitals and emergency departments.

If progress is ever going to be made, the Government must get serious about delivering the right care in the right place and at the right time. This means urgently building bed capacity in our hospitals. It means rapidly increasing the number of community and step-down beds. We need a clear plan to address the lack of GPs and deficits in primary care. Crucially, the Government must invest in home care for our older people.

Taispeánann tuarascáil HIQA inniu gur tharla an róphlódú sna hospidéil go díreach de bharr teip an Aire, an Teachta Stephen Donnelly, sa phleanáil. Teip iomlán atá ann chun tuilleadh leapacha sa bhreis a chur ar fáil, agus tá an easpa infheistíochta i gcúram pobail agus baile ag cur brú ar an gcóras as a dtagann iarmhairtí tromchúiseacha. The Government's lack of planning and urgency in getting to grips with the bottlenecks in our hospitals must end.

I have some questions. The Minister for Health promised 51 additional consultants for our emergency departments. How many are now in place? For months, the Minister has promised an action plan to tackle hospital overcrowding. We have seen neither hide nor hair of it. Where is this plan? Can the Minister explain why one in four beds promised by the Government over two years ago has yet to materialise? When will we see these come on stream?

I thank the Deputy for raising what is a serious issue for many who are affected by overcrowding in accident and emergency departments around the country. The problem does not affect every accident and emergency department but the circumstances are quite serious in some. The Minister for Health has, of course, read the HIQA report and will respond to it formally in due course. In broad terms, he and the rest of the Government accept it and what HIQA is stating in it, particularly its points on workforce planning, management, bed capacity and diagnostics. The individual cases the Deputy highlighted and that her colleagues highlighted last night in the Dáil are not acceptable to the Government and HSE, so we need to do better.

We must recognise that the 136,000 professionals working in our health service are delivering good outcomes every day for patients across a range of specialties, including in cancer care, cardiac services, stroke services and maternity units. That is a given but it is important to put it on the record.

The context is important. Last night, the Deputy's party had a motion before the House on this issue and the challenges presenting in our hospitals. There was no mention of Covid-19, which was a global pandemic, a once-in-a-century event. We are still very much living with the effects because the virus is still here. We acknowledge that the demand for services has grown significantly because of Covid and respiratory syncytial virus, RSV, in addition to flu and streptococcus A. The difficulties evident in our hospitals and some of our emergency departments are not unique to Ireland. The Deputy will be quite familiar with the circumstances in Northern Ireland, in particular, and also in England, Scotland and Wales. The European Centre for Disease Control warned earlier this week of the impact of Covid, RSV and flu on health services right across Europe. That said, of course we have to do everything we possibly can to address the situation.

When engaging with Sinn Féin's health spokesperson last night, the Minister for Health, Deputy Stephen Donnelly, mentioned University Hospital Waterford and the fact that, come Saturday, it will have achieved 1,000 days without a patient on a trolley. The HSE needs to examine very carefully where best practice is occurring and how it can be replicated around the country. Some of it will come down to investment, bed capacity and staffing but also to effective management. When I consider this in the round, I note a healthcare budget whose core funding is now 24% higher than in 2020. The Minister for Health, Deputy Stephen Donnelly, has delivered more than 900 new acute hospital beds, 73 sub-acute beds and over 340 community beds. Critical care capacity, which we acknowledge was not where it needed to be, is now 25% higher than in 2020 and will continue to rise. We have had a 25% increase in the number of specialist palliative care beds across the system.

The action plan to which Deputy McDonald referred is the winter plan. It is fully funded-----

No, it is not.

-----with almost €170 million. The Minister for Health, his Department and the HSE are now working to implement that plan to recruit more staff. A further 608 people will be recruited as part of the winter plan. We have increased the workforce in health by more than 16,000 in the past two years. This is the largest-ever increase in the workforce in health because we recognise it as a priority. We have had to build up the permanent capacity, in respect of both beds and staff, to meet the demands of a growing population and the growing complexity of healthcare provision. We can and will do more.

The Minister for Public Expenditure and Reform, Deputy Michael McGrath, should not reach for the 136,000 good staff in the health service to try to hide behind them, nor should he reach to Tory austerity in Britain to try to spare the blushes the Government rightly experiences because of its absolute failure to resource the health service.

The Minister for Health, Deputy Stephen Donnelly, has a penchant for launching and announcing plans but very often does not deliver on them. The winter plan was announced quite separately from the plan to tackle overcrowding in hospitals. I asked where the latter plan is. Clearly, it does not exist. That is the only conclusion I can draw.

I also asked the Minister about bed capacity. The Minister is currently the Minister for Public Expenditure and Reform. Riddle me this. He made an announcement in 2020 promising 1,200 new beds. Two years on and one quarter of those beds have not been delivered. This is a crisis of capacity, of staffing and of investment, but above all else it is a political crisis and an abject failure of leadership by the Government and by the Minister for Health, Deputy Donnelly.

Far from hiding behind the staff, we are standing with the staff. We are investing in the Irish public health service. The Government has approved a new contract offer, which has been made to hospital consultants. It is well recognised we need far more consultants in our system. We need them to be present at weekends, and we need over time to remove private healthcare from our public hospital system. The Minister, Deputy Donnelly, and his team in the Department of Health and in the HSE have done an excellent job in delivering a package we believe has the potential to be a game changer in the provision of consultant-led care in the public hospital system. It is now a matter for the representative bodies to consider whether they are going to accept that. We very much hope they do.

Deputy McDonald referred to home care. Some 20.5 million hours of home care support was delivered in 2021. The constraint is not funding, the constraint is staffing.

What of the 1,200 beds?

That is up about 17%, which is a record increase in the delivery of bed capacity in acute, sub-acute, community and critical care capacity.

Is that why people are on trolleys?

We will continue to do more. We have increased the health budget by 24% over the past two years. We have recruited an extra 16,000 new healthcare professionals.

They are pen pushers.

There are growing demands but the Minister and the HSE do have a plan which they are focused on and implementing. We need a degree of balance and fairness in the presentation of these issues.