I echo the sentiments expressed about the report on "RTE Investigates" last night.

It is shocking to think 81,000 people are on waiting lists and that 34,000 are awaiting endoscopy procedures which are vital in the diagnosis of gastrointestinal cancers.

I call for an urgent debate on a separate issue, namely, the plans the Minister has in place to safeguard the 50,000 or more employees who work in the pharmaceutical industry in Ireland. They need safeguarding because of the policies of the President of the United States, Donald Trump. During his first press conference the then President-elect decided to target the pharmaceutical and medical technology sectors. In so doing stock prices for major US pharmaceuticals dropped by more than $25 billion in 20 minutes. It is the longer term impact which can be more profound and about which we must be concerned. At the time my party colleague, Deputy Niall Collins, expressed his unease at President Trump's comments and also questioned the failure of the Government to spell out any plan to respond to the emerging threats to jobs in US owned companies in Ireland. One month on, the Minister for Jobs, Enterprise and Innovation, Deputy Mary Mitchell O'Connor, has yet to adequately respond to these threats or illustrate any plan to deal with them. President Trump wants the US pharmaceutical companies to which Ireland is home to close up shop and return to the United States. He has spoken forcefully about getting US pharmaceutical companies to make a return and imposing sanctions on those which do not. It is worth remembering that Pfizer employs 3,200 people at six sites across the country. AbbVie's Irish operation employs more than 500 people at five locations across the country, while Boston Scientific which was founded in Galway in 1994 employs more than 4,000. These are just a few of the companies that are providing jobs and benefiting the economy. If we have learned anything from the first 18 days of the reign of President Trump, it is that he was not simply paying lip-service throughout his campaign and his plans for the pharmaceutical industry are no exception. He is a populist President and pharmaceutical companies are a popular villain. We cannot allow his comments which are very likely to become actions to rock a recovering country and one of our most fruitful industries.

I would also like to comment on the waiting lists issue covered on the television programme. It has been an ongoing problem for many years. We want waiting times for patients to be diminished, but it is not and never has been just about resources. I wish to correct the record for the leader of Sinn Féin. During my tenure as Minister for Health inpatient waiting times came down to eight months, despite €2.5 billion less being available. The number who had to endure long waiting times on trolleys, those most acutely ill and the seriously sick, was reduced by one third. There are still far too many waiting on trolleys and more work has to be done in that regard. The bottom line is that no part of the health service operates in isolation. If we want to cure what is happening in emergency departments and fix waiting lists, we must fix what is happening in primary care services. Unless there is a new GP contract and greater emphasis on prevention and early detection, people will continue to wait. As pointed out on the programme last night, if patients are left on waiting lists, they will go from being elective cases, that is, having their surgery planned, to emergency cases. All of the statistics show that the outcomes are not as good for them and that the expense on the State is greater. I commend the Minister for Health for starting negotiations on a new GP contract, but we also have to look at who is doing what within the health service. I have mentioned treating the patient at the lowest level of complexity that is safe, efficient, timely and as near to home as possible. Consultants are doing work GPs could be doing and GPs are doing work nurses could be doing. We are all doing work other paramedics could be doing. This must change.

I want to comment on management. It takes six years for a student to become a doctor and approximately four years to become a GP or 12 to become a specialist. What do we spend on managers? Many of them are excellent administrators who were promoted into management positions. They cannot take study leave and do not receive extra training. They are left in place.

During our time with the special delivery unit, SDU, we set up a programme to train 30 a year and provide postgraduate training. That programme needs to continue and be amplified. The point has been made that the funds go into the system and that we have the best doctors and nurses in the world. It is management that we need to address. There is no point in Senators giving out about management unless they are prepared to train and support managers during the course of their careers in order that they can do the job we all want to see done.

There is still a need for capital investment. Members have mentioned the emergency department in Galway. The same can be said of the emergency department in Beaumont Hospital. There is a need for more primary care units and day hospitals. All of these things will help to treat patients long before they get to the position where they will need to be in an acute hospital. That is what needs to be done.

As clearly outlined by my colleague, Senator Mark Daly, it is clear from Arlene Foster's disgraceful comments yesterday on the Irish language that it is coming under attack north of the Border. From speaking to European colleagues, it has come to my attention that the Irish language may also come under attack in the European Union as a result of Brexit. As the Government has decided that the Taoiseach is the Minister for Brexit, I request his presence in the Chamber in the coming days to discuss this worrying prospect. Currently, there are 24 official languages of the European Union, Irish being the official language of Ireland. The EU institutions currently use three languages, namely, English, French and German, in conducting its everyday business. English is by far the dominant language, with 80% of documents written in it. The next most popular language is French, at 7%. When the United Kingdom exits the European Union, no country will have English as its official language. The talk is that France and Germany will push to have their languages become more prominent in EU institutions and lessen the use of English. As a result of this push, pressure may come on Ireland from other member states eager to maintain the status of English to drop Irish as our official language. Danuta Hübner, the head of the European Parliament's committee on constitutional affairs, has recently warned us of this prospect. The Wall Street Journal has reported that French and German are being used increasingly since the referendum in June. Therefore, the prospect of Ireland coming under pressure to change our official language is worrying. The Government must guarantee that it will fight to maintain the status of the Irish language in order that it will not be diminished, notwithstanding the pressure that might be exerted on us to change it to facilitate other member countries. As an Irish speaker, I find this prospect worrying. We must protect the status of the Irish language in the European Union. If we do not, it will have a knock-on effect at home.

In view of the "RTE Investigates" programme broadcast last night, it is important to recognise that a great number of staff in the HSE - the vast majority - are working extremely hard and committed and dedicated to their jobs. My colleague referred to the average spend per head of population on health. We have the second highest spend in the OECD, but the question is whether we are spending the money wisely and, if not, how that situation has arisen. When one considers the HSE's 2015 annual report, it is worrying that the number of managers went from 4,700 to 5,000, an increase of 300. The number of clerical assistants increased by 700, whereas the number of public health nurses increased by 60. This is in an area in which we should be increasing the numbers of those on the ground to ensure people receive advice and care in their homes and localities rather than having to be admitted to hospital.

Some of the figures for the health service are being lost in the process. For instance, there are 3.2 million outpatient attendances every year, or 63,000 per week. There are 23,000 attendances in emergency departments per week, which gives a total of 86,000 attendances in these two areas alone per week. This is outside the numbers in hospitals.

The figure of 86,000 per week shows the volume of work being done. We do not give credit to those who are doing this work.

Three weeks ago I wrote an article for the Evening Echo in Cork about the increase in population. In the past 30 years the population of County Cork has increased from 410,000 to 542,000, an increase of 132,000 or approximately 30%. In the same period the number of hospital beds in the county has not increased. We had plenty of money in the period between 1998 and 2008, yet not one new major hospital facility was opened in the county during that time and no real long-term planning took place. One of the major problems in health care is that planning seems to be engaged in on an annual basis, rather than long term. Time and again I have referred to the need to provide more hospital beds in response to demographic changes. We can open all of the primary care centres we like, but they will not sort out the problems of emergency departments and waiting lists. The number of beds in major hospitals must be increased. While doctors have increased the number of day procedures which reduces the number of overnight admissions, this does not solve the problem. Planning is needed in this area.