"It was crazy. People sitting on the floor. A long queue winding its way up to reception. People lying across chairs. This was Tuesday morning. Some had been there since Sunday. Staff under huge pressure, stressed with their workload. No time to think. It was just panic. At one point, I thought I'm going to die". Those are the words of Niamh, who presented at the accident and emergency in Galway University Hospital at 6 a.m. on Tuesday, 9 April after a night of intense stomach pain.

Despite being unable to walk or sit with the pain, Niamh was not triaged until after 7 a.m. She felt the nurse had no time to ask proper questions and she was rushed out. When her bloods were taken more than an hour later, Niamh was in a bad way and could barely move with the pain. Other patients looked on with worry but she had to ask for pain medication. It was then that a nurse finally asked whether she could be pregnant. Niamh never saw that nurse again. Niamh had an ectopic pregnancy that would not be spotted until much later.

Five hours after she presented at reception, Niamh finally saw a doctor. She had to walk to the other side of the emergency department in pain described as eight out of ten. She was not even offered a wheelchair. She felt the doctor was so rushed that he was not taking in what she was saying. Niamh was returned to the waiting area, which she described as being like a warzone. She provided a urine sample, which she was asked to leave on a cart for collection. Two hours later, she noticed that it was still lying there and she broke down crying. She asked a nurse why her sample was still sitting there and what was happening with her blood tests but her questions were met with confusion. One blood test result came back showing elevated levels of white cells and a suspected infection. She was prescribed an antibiotic and a pain drug, Keral. As the Keral was being administered, a nurse came rushing back in panic shouted: "You are pregnant. You can't be on this painkiller while pregnant." Panic then ensued as to how much she had been given.

Niamh was finally referred to a gynaecologist at 12.45 p.m. and it was only then that the possibility of an ectopic pregnancy was raised. It was determined that Niamh needed an emergency scan, which she did not get until 2.30 p.m., eight and a half hours after coming in. The scan showed nothing but blood in her uterus. Niamh's emergency surgery would not happen until 6.45 p.m., 12 hours after she first presented. Niamh's partner was told the operation would take 1.5 hours but it took more than three hours due to significant internal bleeding.

Sometimes Niamh cannot believe she survived. She kept thinking: "What's going to happen to my baby son if I don't survive?" It was deeply traumatising for her and her family. Niamh told me:

I don't blame anyone. There was too much pressure on them. They weren't even able to handle the amount of people at 6 a.m. I’m lucky I went in early in the morning, if I had gone later, I don’t know if I’d still be here.

The chaos Niamh experienced in UHG is not unique. In the past three years, the overcrowding alert was activated more times there than in any other hospital. The hospital was clearly understaffed and the workers were run off their feet. There clearly were not enough beds. Stories like Niamh's are why the Government's recruitment embargo is so dangerous. It should lift the embargo, fund the 1,500 beds our hospitals need, deliver an elective centre in the west and invest in our local health services. This is the only way to tackle overcrowding. I could ask the Tánaiste plenty of questions about the health service but I will leave that to Niamh, who wanted me to ask him a question:

People are dying needlessly in our emergency departments. I could have been one of them. We need change. What’s it going to take?

What is it going take for change to happen?

I dtús báire, déanaim comhbhrón le Niamh. Is olc an scéal atá luaite agus soiléirithe ag an Teachta inniu. Níl a fhios agam féin faoi chás pearsanta Niamh ach níl aon amhras ach gur scéal uafásach ar fad atá ann. The Deputy's description and presentation of Niamh's horrific and traumatic journey through the emergency department in Galway is shocking. I do not have details of the individual case but, clearly, Niamh went through an extraordinarily traumatic and horrific journey from arrival at the emergency department through subsequent developments and treatment.

On emergency departments more generally, I am not going to go through all of the statistics, although I have plenty of them. I will make two points. The organisation of trauma and emergency departments is fundamental to this issue. All-of-hospital buy-in with a multidisciplinary presence in emergency departments is key, as is the proper rostering of emergency departments to ensure consultant presence in our emergency departments over extended times. The public-only consultant contract we have supported and financed is making a difference in that respect.

People talk about the embargo. I have to say to the HSE and everybody else that I am mystified by the embargo because 28,000 extra people have been recruited into our health service since 2020. There comes a time when you have to look at other factors. What is happening on the ground? What is happening in the organisation of the hospital? Parallel to that is the need to enhance community-based interventions and care, which is happening. The enhanced community care programme has been expanded quite dramatically. It is quite significant. It is the same with the primary care sector. What I am saying is the emergency department issue is about more than just recruitment. A multifactorial approach has to be taken to dealing with the issues in emergency departments. The numbers of consultant and nursing and midwifery appointments and the numbers more generally in emergency departments have increased. The Health Information and Quality Authority, HIQA, is also involved because the quality of treatment is a key component of this as well.

I accept the story the Deputy has told in respect of Niamh but it raises more issues than just resources and the embargo because the numbers recruited have increased substantially. That is a fact. No one can dispute the fact that, in every individual hospital in this country, numbers have increased. There is no embargo on recruiting consultants and, within that employment control procedure, there is room for the recruitment of nurses and other clinicians. Of the 28,000 staff I mentioned, 9,614 are nurses and midwives, 4,240 are health and care professionals and 3,000 are doctors and dentists. These are all additional to what we had in 2020. It is about reducing the numbers on trolleys and the pressure on emergency departments and hospitals but it also has to be about reform of how we manage patients from the beginning of primary care, through to the community and the acute hospital setting.

Ní hé comhbhrón atá ag teastáil ó Niamh. Tá athruithe ag teastáil uaithi. Tá sé sin soiléir ón méid atá ráite aici liomsa. Is féidir leis an Tánaiste labhairt faoi athruithe atá déanta cheana ach teastaíonn athruithe láithreach. The hospital was clearly understaffed. Clinical professionals have been forced to take to the media to speak out against the embargo. The Tánaiste can say the reasons are multifactorial but the main factor is lack of staff. This happened to Niamh only a month ago. She was told by numerous medical staff that she was very lucky but she has been very clear that she should not have had to be lucky. Nobody should have to be lucky. Luck should not come into it. She has said that she is not asking for tea and sympathy; she is asking for change. She is saying very clearly that she does not want this to happen to anybody else. That is why she has come forward. The Government needs to lift the recruitment embargo, to invest in the 1,500 beds and to deliver the elective hospital in Galway.

I dtús báire, tá athrú ag tarlú.

Níl.

Tá bunathrú ag tarlú sna hionaid éigeandála.

Níl.

Tá níos mó daoine ag obair sna hionaid éigeandála anois ná mar a bhí bliain ó shin nó sa bhliain roimhe sin.

Níl sé ag oibriú.

Is é sin fírinne an scéil.

Níl sé ag oibriú.

Is é sin fírinne an scéil. Safe staffing in emergency departments has happened.

It has not.

Penpushers.

The Deputy knows that. It has been rolled out in every emergency department. There is also an obligation on everybody in this House. I have watched health budgets increase exponentially.

In the past three to four years, the health budget has increased dramatically. I think it is up to €8 billion additional or whatever. That is no comfort to Niamh or to other patients but it places an obligation on everybody focused on health policy in terms of the allocation and reforms. Are we really getting outcomes and productivity from that investment?

No.

That means in terms of hospital organisation-----

Mismanagement.

-----in terms of primary care, community care and acute setting, it needs a more rigorous analysis than simply saying more numbers will change things and resolve the issue; not necessarily is the point I am making.

We do not want this to happen again and it will happen again.

Absolutely I do not.

It will happen again-----